The Moderating Effect of Parental Feeding Style in Relation to Familial Psychosocial Risk Factors and Childhood Obesity

Azam Davodi; PhD*¹ & Anis Ahadi; MSc¹

¹ Department of Physiology, Shiraz branch, Islamic Azad University, Shiraz, Iran.

Introduction

The global prevalence of obesity among children is rising rapidly. According to the available data, more than 10% of Iranian children of school age are overweight and 4.8% of them are obese (Vagheri et al., 2009). As a result, the children of the present generation are expected to die before their parents (Vagheri et al., 2009). The growing trend of obesity among children has led researchers to explore factors associated with obesity in children. Gene-environment interaction leads to obesity, indicating the significant role of parents in the development or prevention of childhood obesity. Although parents provide genes, they also create a healthy or unhealthy lifestyle which may lead to obesity, and the home environment may have lasting effects on children's weight gain (Birch and Davison, 2001). According to Per Birch's theory (2001), the mother's feeding pattern and her role in meeting the feeding needs and eating of the infant in early childhood are important in formulating the basic pattern of feeding in upcoming years (Birch and Davison, 2001). As the child gets older, the family eating styles and parent-children interactions during meal time, would affect children's eating habits and behavior (Blissett, 2011). Parental dietary habits can determine the amount of vegetables, sugar, and dairy consumed by children, and these factors have shown to directly correlate with the child's weight (Hennessy et al., 2012, Hughes et al., 2005, Patrick et al., 2005) .

In order to investigate the moderating role of the parental feeding style in the study population, simultaneous multiple regression analysis was used to identify the familial and psychosocial risk factors affecting childhood obesity. Parental anxiety level, education level, and income of the mothers were identified as the familial and psychosocial risk factors affecting childhood obesity.

Furthermore, the z-score of anxiety level of the mother, education level, and income were used as psychosocial and familial risk factors affecting childhood obesity in order to classify the sample individuals in cluster analysis. To determine the number of interpretable clusters, first, 2 clusters, then, 3 clusters, and finally, 4 clusters were analyzed for classification. The results showed that clusters could only be interpreted when three clusters were extracted. Table 4 reveals the results of cluster analysis using three clusters with mean variables in each cluster.

The results showed that being in an anxious family with a controlling and emotional feeding style increases the child's risk of obesity at the highest possible level. In contrast, being in a wealthy-educated family which has emotional and instrumental style minimizes the risk of childhood obesity (increases the risk of malnutrition). Instrumental feeding style only reduces or controls the child's weight when the family is average or rich and educated; if this style is used by anxious families, it will make the child obese. Controlling feeding style is associated with childhood obesity; and if the anxious family uses this style, it will lead to obesity in the child. However, if a wealthy-educated family uses this style, the child's weight will be normal.

In general, anxious families are more likely to have overweight/obese children compared to other families; but if these families use an emotional feeding style, their children's weight will decrease. In general, rich-educated families have thinner children compared to other families; but if these families use a controlling and encouraging style, their children's weight may increase. Encouraging feeding style is the best feeding style to prevent child’s obesity/overweight or underweight; therefore, it suggests that families regardless of socio-economic or psychological status may benefit from the feeding style leading to a lower BMI of the child and normal weight.

Discussion

The effect of parental feeding style as a new variable on child obesity in children aged 6-11 years was considered in this study and Wardle’s PFSQ were validated and used for the first time in Iran. The results show that parental eating styles can moderate the association between psychosocial and familial risk factors and childhood obesity in a positive way.

Anxious families have more overweight children compared to other families; however, if these families use an emotional feeding style, their children's weight will decrease. This might be due to the natural-biological reaction in which children respond to emotional distress by refraining from eating. If these types of families use a controlling feeding style, the children's weight may be higher compared to other feeding style groups. Rich-educated families have more underweight children than other families; however, if these families use a controlling and encouraging feeding style, their children's weight will increase and become normal. Emotional feeding style is more frequent in families with higher income; since they have easier access to a variety of food sources and are able to provide more attractive and tasty food dishes (Musher‐Eizenman et al., 2007). The control style leads to obesity. Rich- educated families who use controlling styles emphasize on the type, amount, time, and type of feeding which leads to obesity. Similarly, if an anxious family uses this style, it can lead to childhood obesity.

Encouraging feeding style is the best feeding style to prevent overweight or underweight in children. Studies have shown that regardless of economic, social or psychological conditions, this style of feeding will promote a normal BMI in children. Hubbs et al. reported that parental eating styles can be used to predict the parenting style (Hubbs-Tait et al., 2008). Encouraging feeding style is associated with authoritative parenting style (Blissett, 2011, Hubbs-Tait et al., 2008). Authoritative styles are associated with a child's normal weight (Horodynski et al., 2018, Hubbs-Tait et al., 2008). The authoritative style is associated with children's easy access to healthy fruits, vegetables, and foods with encouragement and motivation. It has been reported that children of authoritative parents who use the encouraging style consume high values of fruits, vegetables, and healthy foods (Patrick et al., 2005). Gerards and Kremers reported that the encouraging feeding style, along with the parents' subtle control (hidden control) over the child's healthy eating is evident in a family with an authoritative parenting style which ultimately improves the child's weight (Gerards and Kremers, 2015).

An important point which must be considered at all influential stages is an important variable called culture. Different countries have different attitudes and opinions towards eating and feeding children. These beliefs affect the way parents choose to feed their children. Concerns about children’s weight are not consistent among ethnicities, races, and cultures. In many Asian countries, including Iran, childhood obesity used to be considered a sign of health and wealth. It is recommended to consider the effect of culture on parental feeding style in future studies and opportunity to educate parents during planning parenthood.

Conclusion

In summary, it was shown that parental eating styles can moderate the association between psychosocial and familial risk factors and childhood obesity in a positive way. Encouraging feeding style is the best feeding style to prevent children becoming overweight or underweight; since it seems to promote a healthy BMI regardless of families’ socioeconomic or psychological conditions.

Acknowledgment

Authors are thankful to Education (and Training) administration of Shiraz for their assistance in issuing permit to submit questioners in primary schools.

Authors' contributions

Davodi A and Ahadi A designed and conducted the research and also, analyzed the data, wrote the manuscript and both had primary responsibility for final content. All authors read and approved the final manuscript.

Conflict of interest

There is not any conflict of interest.

References

Ahadi A & Davoodi A 2019. Psychometric Properties of Wardle's Parents' Nutritional Style Questionnaire. Quarterly journal of psychological methods and models. 10 (37): 45-64 [in Percian].

Asghari-Moghadam M, Mehrabian N, Pak Nejad M & Saed F 2010. Psychometric characteristics of the depression anxiety stress scales (DASS) in patients with chronic pain. Journal of educational psychology. 40 (1): 13-42.

Birch L & Davison K 2001. Childhood and adolescent obesity: Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight. Pediatric clinics of North America. 48 (4): 893-907.

Blissett J 2011. Relationships between parenting style, feeding style and feeding practices and fruit and vegetable consumption in early childhood. Appetite. 57 (3): 826-831.

Blissett J, Haycraft E & Farrow C 2010. Inducing preschool children’s emotional eating: relations with parental feeding practices. American journal of clinical nutrition. 92 (2): 359-365.

Brink PJ, Ferguson K & Sharma A 1999. Childhood memories about food: the Successful Dieters Project. Journal of child and adolescent psychiatric nursing. 12 (1): 17-25.

Bruch H 1981. Developmental considerations of anorexia nervosa and obesity. Canadian journal of psychiatry. 26 (4): 212-217.

Didarloo A, Azizzadeh T, Alizade M, Khorami A & Pourali R 2013. Survey of obesity, underweight, physical activity level and dietary consumption among male students in guidance schools of Makoo. Journal of Urmia nursing and midwifery faculty. 11 (4): 275-283 [in Percian].

Gerards S & Kremers S 2015. The role of food parenting skills and the home food environment in children’s weight gain and obesity. Current obesity reports. 4 (1): 30-36.

Hennessy E, Hughes SO, Goldberg JP, Hyatt RR & Economos CD 2012. Permissive parental feeding behavior is associated with an increase in intake of low-nutrient-dense foods among American children living in rural communities. Journal of the academy of nutrition and dietetics. 112 (1): 142-148.

Horodynski MA, et al. 2018. Familial psychosocial risk classes and preschooler body mass index: the moderating effect of caregiver feeding style. Appetite. 123: 216-224.

Hubbs-Tait L, Kennedy TS, Page MC, Topham GL & Harrist AW 2008. Parental feeding practices predict authoritative, authoritarian, and permissive parenting styles. Journal of the American dietetic association. 108 (7): 1154-1161.

Hughes SO, Power TG, Fisher JO, Mueller S & Nicklas TA 2005. Revisiting a neglected construct: parenting styles in a child-feeding context. Appetite. 44 (1): 83-92.

Hughes SO, Power TG, Liu Y, Sharp C & Nicklas TA 2015. Parent emotional distress and feeding styles in low-income families. The role of parent depression and parenting stress. Appetite. 92: 337-342.

Hurley KM, Cross MB & Hughes SO 2011. A systematic review of responsive feeding and child obesity in high-income countries. Journal of nutrition. 141 (3): 495-501.

Lovibond PF & Lovibond SH 1995. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy. 33 (3): 335-343.

Musher‐Eizenman DR, Holub SC, Hauser JC & Young KM 2007. The relationship between parents’ anti‐fat attitudes and restrictive feeding. Obesity. 15 (8): 2095-2102.

Patrick H, Nicklas TA, Hughes SO & Morales M 2005. The benefits of authoritative feeding style: caregiver feeding styles and children's food consumption patterns. Appetite. 44 (2): 243-249.

Rand CS & Stunkard AJ 1977. Psychoanalysis and obesity. Journal of the American academy of psychoanalysis. 5 (4): 459-497.

Vagheri G, et al. 2009. The comparison of children physical growth status between Turkman and non-Turkman in rural area in Gorgan, north of Iran. Journal of Gorgan University of medical sciences. 11 (3): 47-52 [in Percian].

Wardle J, Sanderson S, Guthrie CA, Rapoport L & Plomin R 2002. Parental feeding style and the inter‐generational transmission of obesity risk. Obesity research. 10 (6): 453-462.

World Health Organization 2014. Global status report on noncommunicable diseases 2014. World Health Organization.