Understanding problematic eating in out-of-home care: The role of attachment and emotion regulation

doi:10.1016/j.appet.2018.12.027

Appetite

Volume 135, 1 April 2019, Pages 33-42

https://doi.org/10.1016/j.appet.2018.12.027 Get rights and content

Abstract

Children living in Out-of-Home Care (OoHC) are thought to be especially vulnerable to developing problematic eating behaviours due to their likelihood of having insecure attachment styles and emotion regulation deficits. Despite this increased risk, our understanding of problematic eating among children in OoHC is limited. Therefore, this study aimed to; (1) Explore the rate of problematic eating behaviours among children living in OoHC, specifically residential and foster care; (2) Investigate how carers manage problematic eating and (3) Understand carers' perceptions of the role of attachment and emotion regulation in relation to problematic eating in OoHC. Semi-structured interviews, focus groups, and surveys were conducted with residential care staff (n = 36) and foster carers (n = 8) in Victoria, Australia. Interviews were recorded, transcribed, and analysed for themes, and frequency data from the survey were generated. Residential and foster carers reported that approximately 38% of the children in their care displayed problematic eating behaviours at a clinical level. Both residential and foster carers commonly understood these behaviours as a function of the child's experiences of food deprivation and limited access to healthy foods prior to entering care which, they believe, has contributed to problems with regulating food intake and/or willingness to try new foods. Carers also commonly reported that the children in their care struggle to form attachments or regulate their emotions, which impacts carers ability to manage problematic eating. It is recommended that future interventions prioritise educating community service organisations (CSOs), responsible for delivering OoHC, to better recognise and address problematic eating behaviours. This will enable CSOs to train their residential and foster carers about how best to respond to and manage problematic eating behaviours.

Section snippets

Participants

This study was approved by the Deakin University Faculty of Health Human Ethics Advisory Group and the Deakin University Human Research Ethics Committee. Five major CSOs operating OoHC services across Victoria, Australia, were invited to participate in the current study. Organisational consent was obtained, and program managers distributed invitations to potential participants (i.e., residential carers currently employed at the organisation, or foster carers on their mailing list/database) via

Rate of problematic eating and food-related behaviours

Children's clinical profile scores from the food maintenance behaviour scale are presented in Table 2. According to carers responses to the food maintenance behaviour scale of the ACA, 37.7% of children were identified as having food maintenance behaviours in the clinical range (26% marked; 11.7% indicated). However, of the children in the sub-clinical range, 17% had scores in the elevated range, indicating that further psychological assessment or monitoring is required, due to the potential

Discussion

The first aim of this study was to explore the carer reported rates of problematic eating among children living in residential and foster care. The results revealed that approximately 38% of children living in OoHC in this study displayed food maintenance behaviours (including binge eating, hoarding food and overeating) at a clinical level (based on reports by their carers). This is substantially higher than the rate of 24% found by Tarren-Sweeney (2006). Tarren-Sweeney’s (2006) sample was

Conclusion and direction for future research

To our knowledge, this is the first study that has: (1) Explored carers’ lived experience of problematic eating behaviours among children in OoHC; and (2) Considered the role of both attachment and emotion regulation in the development and maintenance of problematic eating among children in OoHC. The findings demonstrated that carer reported rates of problematic eating behaviours are high among children in OoHC. However, children in OoHC face complex, inter-related physical and mental health

Conflicts of interest

There is no conflict of interest to be declared.

Acknowledgements

Jenna Miller, Rachel Byrne, Ghleanna Colgan.

References (40)

E.E. Burns et al.
Deficits in emotion regulation mediate the relationship between childhood abuse and later eating disorder symptoms
Child Abuse & Neglect
(2012)
L. Goossens et al.
Loss of control over eating in pre-adolescent youth: The role of attachment and self-esteem
Eating Behaviors
(2011)
C.A. Hardman et al.
Using food to soothe: Maternal attachment anxiety is associated with child emotional eating
Appetite
(2016)
S.M. Mason et al.
Child maltreatment's heavy toll: The need for trauma- informed obesity prevention
American Journal of Preventative Medicine
(2016)
G.A. Tasca et al.
Adult attachment, depression, and eating disorder symptoms: The mediating role of affect regulation strategies
Personality and Individual Differences
(2009)
AIHW
Child protection Australia 2015-2016
(2017)
L.J. Berlin et al.
Mothers' self-reported control of their preschool children's emotional expressiveness: A longitudinal study of associations with infant– mother attachment and children's emotion regulation
Social Development
(2003)
L. Birch et al.
Influences on the development of children's eating behaviours: From infancy to adolescence
Canadian Journal of Dietetic Practice and Research
(2007)
J. Bowlby
Attachment and loss
(1969)
V. Braun et al.
Using thematic analysis in psychology
Qualitative Research in Psychology
(2006)

J. Cassidy et al.

Contributions of attachment theory and research: A framework for future research, translation, and policy

Development and Psychopathology

(2013)

Commonwealth of Australia

Consultation paper: Institutional responses to child sexual abuse in out-of-home care

T. Corrales

Understanding differences in the outcomes of children and young people across care types

(2015)

A. Dakanalis et al.

Attachment insecurities, maladaptive perfectionism, and eating disorder symptoms: A latent mediated and moderated structural equation modeling analysis across diagnostic groups

Psychiatry Research

(2013)

Eating Disorders Victoria

What is an eating disorder: Risk factors

(2017)

K. van Durme et al.

Insecure attachment and eating pathology in adolescence: Role of emotion regulation

Journal of Early Adolescents

(2015)

A. Faber et al.

Parental attachment insecurity predicts child and adult high- caloric food consumption

Journal of Health Psychology

(2015)

B. Fisher et al.

Early intervention foster care: A model for preventing risk in young children who have been maltreated

Children's Services: Social Policy, Research, and Practice

(1999)

C. Hazan et al.

Romantic love conceptualized as an attachment, process

Journal of Personality and Social Psychology

(1987)

A.R. Kelly et al.

The effects of perceived early childhood attachment and care status on young people's eating behaviour

Adoption and Fostering

(2016)

Cited by (13)

Food practices among adolescents in German residential care. Findings from a quantitative survey
2023, Appetite
Citation Excerpt :
Regarding residential care settings, such research has mainly examined eating disorders or if enough food is provided for proper physical development. Food also played a connotative role to social foci in many studies as well (Ali, Gamereldawlla, & Almaola, 2019; Cox et al., 2017; Erikstad Vogt, Rukooko, Iversen, & Barth Eide, 2016; Norrish et al., 2019; Pysz, Leszczyńska, & Kopeć, 2015). For example, it was found that adolescents in residential care often engage in problematic eating behaviours, such as overeating or secretly storing food.
Food is of great importance for socialization. So far, there are few quantitative studies analysing food practices in residential care. The aim of this paper was to describe individual food practices in these homes. Associations with sociodemographic and home-related characteristics as well as attitudes towards food were examined to identify differences between adolescents following different food practices. 400 young people aged between 12 and 21 years living in 67 residential care homes in Germany completed a standardized questionnaire. Food practices were operationalized by questions on the regularity of meals, company at meals and the eating location. Cluster analysis for types of food practices were conducted. Differences by home-related and sociodemographic characteristics as well as attitudes towards food were tested by logistic regression analyses. Two types of food practices were identified which differed regarding to age, duration of stay, and the importance as well as impact of eating on well-being: the independents (29%) and the embedded (71%). In comparison to the embedded, the independents ate fewer regular meals and eat in the homes less often, but more often alone. Furthermore, the independents were older, give less meaning to food and have more money available for food. Age was found to be an important variable that indicated increasing independence of adolescents. Food practices should therefore be discussed and reflected pedagogically in the care homes.
Food practices and nutrition of children and adolescents in residential care: A scoping review
2021, Appetite
Food practices of children and adolescents have thus far been researched mainly regarding families and schools. However, there are children and adolescents who live outside of their families of origin in various forms of residential accommodation together with other young people and staff. It can be assumed that food practices and eating habits are central and challenging topics in everyday life in these institutions. Therefore, this paper aimed to provide an overview of the empirical research on food practices in residential care for children and adolescents. We identified 11 studies presented in 19 publications. These studies examined data from 479 children and adolescents, as well as 187 staff members, from 48 residential care units in 8 countries. Due to the interdisciplinary research field, the included studies showed great heterogeneity in the examination of food. In summary, the main foci have been the meaning of food practices in residential care, food practices and forced migration, biopolicy, and nutrition and health. A major topic is the social dimension of food, especially the symbolic meaning in terms of providing care and “making a family”. Nutritional or health aspects have been mainly analyzed in terms of eating disorders or providing enough food. Future research on food practices in residential care homes should also pay attention to quantitative designs that include a broader understanding of food, including its social and emotional facets.
Barriers to nutrition and physical activity participation for Australian children in foster and kinship care
2021, Children and Youth Services Review
Citation Excerpt :
Children in home-based care are also more likely to engage in higher rates of problematic eating (Casey, Cook-Cottone, & Beck-Joslyn, 2012; Cox, Skouteris, Hemmingsson, Fuller-Tyszkiewicz, & Hardy, 2015b; Helton, Schrieber, & Fiese, 2017; Kelly & Ogden, 2016; Norrish et al., 2019). For example, Norrish et al. (2019)’s study found that 38 per cent of children living in residential and foster care displayed problematic eating behaviours including binge eating, overeating and hoarding food. As a result, when compared to their peers not in care, children in home-based care experience disproportionately higher rates of childhood obesity and associated chronic physical illnesses, such as diabetes (Skouteris et al., 2011; Szilagyi et al., 2015; Turney & Wildeman, 2016).
Foster and kinship carers face unique and complex challenges in caring for Australia’s most vulnerable children. It is therefore necessary to ensure that home-based carers are adequately upskilled and supported to promote the health of children in their care. The aim of this paper was to better understand the barriers to developing healthy lifestyle behaviours (relevant to nutrition and physical activity) among children in home-based care, from the perspective of foster and kinship carers. Focus group sessions were conducted with 21 carers: eight foster carers and 13 kinship carers. Four key themes were identified: (1) Childhood experience and children’s healthy lifestyle behaviours; (2) There are personal costs of being a carer; (3) Carers require support to develop healthy lifestyle behaviours in children; and (4) Broader systemic factors impact healthy lifestyle development. Carers in the current study described their experience of key emotional, financial, and systemic barriers to facilitating healthy lifestyle behaviours among the children in their care. To address such challenges, carers recommended the development of trauma-informed support, education, and resources to prioritise and facilitate healthy lifestyle development among children in home-based care.
Are the voices of young people living in out-of-home care represented in research examining their health?: A systematic review of the literature
2020, Children and Youth Services Review
Citation Excerpt :
Eight studies conducted a clinical mental health assessment, using a structured diagnostic interview. Six studies used qualitative methods, with three studies interviewing carers about their perceptions of the health of the YP in their care (Fleming et al., 2005; Muirhead et al., 2017; Norrish et al., 2019), one study interviewing social care professionals (Roberts et al., 2018), and three studies interviewing YP themselves about their perspectives of their health status and experiences of accessing or receiving health care (Anderson et al., 2004; Blower et al., 2004; Fleming et al., 2005). This review aimed to synthesise and review the academic literature to examine if and how the voices of YP living in OoHC are represented in research examining their health status and health care needs or concerns.
There are strong imperatives for young people living in out-of-home care (OoHC) to exercise their right to participate in health-related decision making and health care practices to foster better health outcomes. This systematic review aimed to explore if and how the voices of young people in OoHC are represented in research examining their health. Studies published in the prior 15 years that examined the health needs and/or health status of young people living in OoHC were included. A total of 39 studies met the inclusion criteria. Of these, only three studies involved directly interviewing young people about their perspectives on what health means to them. The remaining studies relied on carers’ reports or self-report questionnaires that primarily examined prevalence of specific mental illnesses or other health conditions. This review showed that the voices of young people in OoHC have been underrepresented in research examining their health and health care needs. The adoption of new research designs to better incorporate young people’s perspectives of health matters appears warranted to better explore the unique health needs of this population.
Do aftercare services take young people's health behaviour into consideration? A retrospective document analysis from Finland
2020, Journal of Pediatric Nursing
Citation Excerpt :
In addition to overeating, the young people have engaged in binge eating, secret eating, food hiding and food stealing. These problems have been estimated to have been caused by difficulties related to obtaining food in childhood, unhealthy dietary habits, and attachment disorder (Norrish et al., 2019). Of the young people placed in out-of-home care, 40% engage in substance use (Beal et al., 2018).
Health disparities among children and young people predict health disparities in adulthood and cause a long-term detrimental impact on a person's quality of life as well as increased costs to society.
The purpose of the study was to describe the health behaviour of Finnish young people (n = 600) who had left aftercare services by the end of April 2015 based on their electronic patient records.
A retrospective document analysis. Data were collected from the register by a structured worksheet designed for this study and analysed using descriptive statistical methods.
The entries made in the aftercare participants' records concerning their weight, sleep and rest, smoking and sexual health were insufficient. The documents contained clearly more detailed reports of their substance use. Women were affected more than men by lifestyles other than substance abuse endangering their health. An increase in the number of out-of-home care placements produces a spike in risky behaviour.
The young people in aftercare are in an unequal position compared to the mainstream population in the area of health promotion. Their risky behaviour is not identified or taken into consideration.
Aftercare and the related multiprofessional collaboration must be developed to prevent risks related to the young persons` health and to take these comprehensively into account.
Love addiction and sexual satisfaction within the attachment perspective: an empirical contribution
2024, Psychology and Sexuality

View all citing articles on Scopus

View full text

Understanding problematic eating in out-of-home care: The role of attachment and emotion regulation

Abstract

Section snippets

Participants

Rate of problematic eating and food-related behaviours

Discussion

Conclusion and direction for future research

Conflicts of interest

Acknowledgements

Child Abuse & Neglect

Eating Behaviors

Appetite

American Journal of Preventative Medicine

Personality and Individual Differences

Child protection Australia 2015-2016

Mothers' self-reported control of their preschool children's emotional expressiveness: A longitudinal study of associations with infant– mother attachment and children's emotion regulation

Social Development

Influences on the development of children's eating behaviours: From infancy to adolescence

Canadian Journal of Dietetic Practice and Research

Attachment and loss

Using thematic analysis in psychology

Qualitative Research in Psychology

Contributions of attachment theory and research: A framework for future research, translation, and policy

Development and Psychopathology

Consultation paper: Institutional responses to child sexual abuse in out-of-home care

Understanding differences in the outcomes of children and young people across care types

Attachment insecurities, maladaptive perfectionism, and eating disorder symptoms: A latent mediated and moderated structural equation modeling analysis across diagnostic groups

Psychiatry Research

What is an eating disorder: Risk factors

Insecure attachment and eating pathology in adolescence: Role of emotion regulation

Journal of Early Adolescents

Parental attachment insecurity predicts child and adult high- caloric food consumption

Journal of Health Psychology

Early intervention foster care: A model for preventing risk in young children who have been maltreated

Children's Services: Social Policy, Research, and Practice

Romantic love conceptualized as an attachment, process

Journal of Personality and Social Psychology

The effects of perceived early childhood attachment and care status on young people's eating behaviour

Adoption and Fostering