Associations between food-related parenting practices and adolescent weight status and disordered eating behaviors: findings from a population-based study

Abstract

Objectives and Aims: The objective of this dissertation is to explore the types of food-related parenting practices utilized by a racially/ethnically and socioeconomically diverse population of parent-adolescent pairs and to assess the relationship between food-related parenting practices and adolescent weight status and disordered eating behaviors. Background: There is a growing body of evidence that the family environment plays an integral role in contributing to child weight status and disordered eating behaviors, including dieting, unhealthy and extreme weight control behaviors, and binge eating. Specifically, food-related parenting practices have been identified as a potentially significant correlate of weight status and weight-related behaviors among young children. However, unaddressed questions and inconsistencies in the literature both limit the generalizability of preliminary research findings and call into question exactly what food-related parenting practices parents should employ to best support a healthy weight and healthful weight-related behaviors in their adolescent children who are in the process of becoming more independent in making choices related to food and eating. This dissertation fills an important gap in the current literature by broadening the fields understanding of the association between food-related parenting practices and child weight-related outcomes to include an understanding of the nature of this relationship within an adolescent population and among racially/ethnically and socioeconomically diverse parent-adolescent dyads of different genders. The types of feeding strategies utilized within certain population-level subgroups were also examined. Methods: Data for this dissertation were drawn from two coordinated, population-based studies. EAT 2010 (Eating and Activity in Teens) was a population-based study of 2,793 [14.4 years old (SD= 2.0)] adolescents from 20 urban public schools in Minnesota designed to examine dietary intake, weight status and associated factors. Surveys and anthropometric measures were completed by adolescents during 2009-2010. Project F-EAT (Families and Eating and Activity Among Teens) was designed to examine factors within the family environment of potential relevance to adolescent weight-related behaviors. Survey data were collected via mail or phone from up to two parents (n=3,709) of the adolescents in EAT 2010; all parents in Project EAT 2010 were invited to participate in Project F-EAT and a response rate of 77.6% was achieved. Separate linear regression models were fit to estimate the associations between parental report of pressure-to-eat and food restriction and 1) parental demographic characteristics; and 2) adolescent weight status. Adjusted means, difference in means, and 95% confidence intervals were calculated. Poisson regression models were fit to estimate the association between parental pressure-to-eat and food restriction and adolescent disordered eating behaviors (e.g., dieting, unhealthy and extreme weight control behaviors, and binge eating). Prevalence ratios (PRs) and 95% confidence intervals were calculated. To assess potential effect measure modification of the relationship between food-related parenting practices and adolescent weight and disordered eating behaviors by race/ethnicity or income, interaction terms were included in the models. Further, because of our interest in examining the role of gender in the association between food-related parenting practices and adolescent disordered eating behaviors, all analyses were stratified by parent and adolescent gender; potential effect modification by parent and adolescent gender was also examined. In order to account for potential clustering of parent responses when two parents of the same child responded to the survey, a robust variance estimator was used to correct for within cluster variance in all models. Results: Associations with demographic characteristics. The mean level of overall parental food restriction was 2.51 [(scale range: 1 (low control) to 4 (high control)] indicating that, on average, parents within the sample reported engaging in a moderate level of overall food restriction with their adolescent children. Level of restrictive feeding was found to differ significantly by both race/ethnicity and household income, after adjustment for other sociodemographic characteristics, with parents in racial/ethnic minority subgroups and parents with a low household income utilizing the highest levels of food restriction. No significant differences were seen in parent self-report of restrictive feeding practices by parent gender, education level or employment status. The mean level of overall pressure-to-eat reported by parents was 2.21 indicating that on average, parents within the sample reported using a low-to-moderate level of pressure-to-eat with their adolescent child. Parental report of pressure-to-eat feeding strategies varied significantly by parent gender, race/ethnicity, education level and employment status and household income. Fathers reported significantly higher levels of pressure-to-eat than mothers. Non-white parents utilized significantly higher levels of pressure-to-eat compared to white parents. A significant decreasing trend was found between level of parental education and use of pressure-to-eat strategies with parents reporting at least some college education reporting the lowest use of this strategy. No significant differences were seen in parent self-report of pressure-to-eat feeding practices by employment status. Associations with adolescent weight status. Mean food restriction levels were significantly higher among parents of overweight and obese adolescents as compared to non-overweight adolescents. On the other hand, levels of pressure-to-eat were significantly higher among parents of non-overweight adolescents. Fathers were more likely than mothers to engage in pressure-to-eat behaviors and boys were more likely than girls to be on the receiving end of parental pressure-to-eat. Parental report of restriction did not differ significantly by parent or adolescent gender. No significant interactions by race/ethnicity or socioeconomic status were seen in the relationship between restriction or pressure-to-eat and adolescent weight status. This finding suggests that while the extent to which parents adopt a controlling approach to child feeding is known to differ across families,1–4 specifically with regard to race/ethnicity or SES, the associations between food-related parenting practices and child weight status in the current population did not differ based on the race/ethnicity or SES of the parent. Associations with adolescent disordered eating behaviors. Adolescent boys exposed to higher levels of pressure-to-eat or food restriction were significantly more likely to report engaging in dieting and disordered eating behaviors compared to boys exposed to lower levels of pressure-to-eat or food restriction. For example, for every one unit increase in food restriction reported by mothers, boys were two times more likely to engage in extreme weight control behaviors. Examination of the association between food-related parenting practices and dieting and disordered eating behaviors among girls yielded primarily null findings. However, analyses did reveal that for every one unit increase in food restriction reported by mothers, girls were at 1.34 times more likely to engage in extreme weight control behaviors. No significant interactions by race/ethnicity or socioeconomic status were seen in the relationship between food restriction and pressure-to-eat and adolescent disordered eating behaviors. Conclusions: This dissertation added depth to a growing body of scientific literature by being the first research study to explore the specific types of food-related parenting practices utilized by parents of adolescents, as well as the first study to explore associations between food-related parenting practices and adolescent weight status and endorsement of disordered eating behaviors. Findings indicate that use of controlling food-related parenting practices, such as pressuring children to eat and restricting children‟s intake, is common among parents of adolescents, particularly among parents in racial/ethnic minority subgroups, parents with less than a high school education, and parents with a low household income. Further, findings suggest that use of controlling practices is associated with higher weight status among adolescent girls and boys and greater risk of disordered eating behaviors among adolescent boys. Replication studies are needed to confirm these in other adolescent populations. Nonetheless, dietitians, physicians and other health care providers should take time to explore the types of food-related parenting practices utilized within the home and should educate parents on the role that their feeding practices may have in their adolescent‟s weight status and attitude toward food and eating. Clinicians should empower parents to promote a healthy weight and a healthy relationship with food for their teen by making nutritious food items readily available within their home, modeling healthy food choices, and encouraging adolescent‟s autonomy in self-regulation of food intake. Additional qualitative and pilot studies are needed to better understand how to best conduct public health interventions aimed at changing food-related parenting practices. More research is also required to understand parental motivation for use of particular food-related parenting practices and to establish temporality of the observed associations.