Elsevier

Appetite

Volume 144, 1 January 2020, 104459
Appetite

Early mother-child dyadic pathways to childhood obesity risk: A conceptual model

https://doi.org/10.1016/j.appet.2019.104459Get rights and content

Abstract

Understanding the emotional quality of the mother-child dyadic relationship and parent-child feeding interactions may further clarify early developmental pathways to eating behaviours and obesity risk. The quality of parent-child relationships fosters all aspects of child development but has not yet been extensively examined in relation to childhood weight gain. The aim of this paper is to propose a conceptual model, which outlines early mother-child dyadic pathways linking parent-child feeding interactions to child body mass index, where parent-child relationships have a central role. It maps out individual and dyadic mother-child factors (i.e., attachment, child temperament and maternal mental health) that influence the nature and quality of parent-child feeding interactions from infancy to toddlerhood. Our model bridges the gap between research fields by bringing together key maternal and child factors implicated in child development. Understanding early parent-child feeding interactional patterns and their influence on child self-regulation and eating behaviours may be relevant to multidisciplinary approaches toward preventing childhood obesity. High quality quantitative and observational data capturing meaningful parent, child and dyadic level interactions around food contexts, attachment security, maternal mental health, child temperament and self-regulation will help to inform new, aetiologically important, targets for preventative intervention.

Introduction

Childhood obesity continues to be one of the most challenging public health issues of this century (World Health, 2016). Overweight prevalence amongst children under five years rose from 31 million in 1990 to 41 million in 2014 (World Health, 2016). It is predicted that by 2025, 70 million infants and preschool aged children (0–5 years) worldwide will be affected by overweight and obesity (World Health, 2016). Importantly, obesity-related behaviours are established in early childhood (Han, Lawlor, & Kimm, 2010) and track through to adulthood and early childhood overweight and obesity is associated with long-term above optimal weight status (Singh, Mulder, Twisk, Van Mechelen, & Chinapaw, 2008). A recent meta-analysis showed children with obesity have a fivefold increased risk of being affected by obesity in adulthood (Simmonds, Llewellyn, Owen, & Woolacott, 2016). Another study tracking children at two and again at five years of age showed children with obesity are more likely to be admitted to hospital and have a 60% higher health care costs compared to children with healthy weight status (Hayes et al., 2016). Implications of early childhood overweight and obesity extend beyond physical health during later stages of childhood and adulthood, negatively impacting self-esteem and mental health (e.g., Russell-Mayhew, McVey, Bardick, & Ireland, 2012), long-term education (e.g., Cohen, Rai, Rehkopf, & Abrams, 2013) and quality of life (e.g., Wille, Erhart, Petersen, & Ravens-Sieberer, 2008). Hence, understanding early risk factors for obesity, when biology and behaviour are more malleable, is crucial for informing prevention strategies.

The causes of childhood obesity are complex, extending from genetic to non-genetic influences (Han et al., 2010), including family and community/societal factors (Harrison et al., 2011; Mihrshahi & Baur, 2018). Over the past decades, obesity researchers have used Ecological Systems Theory to summarise the complex interplay between these multidimensional contributors to excess child weight development and inform childhood obesity research and prevention strategies (Birch & Fisher, 1998; Harrison et al., 2011). Ecological Systems Theory places parent and child factors as the most proximal influences on the development of overweight and obesity during early childhood. In relation to child eating, these factors include child self-regulation, parental feeding practices, and family meal climate (Harrison et al., 2011).

Ecological System Theory acknowledges that child development is influenced by individual and dyadic parent-child factors, whereby behaviours and responses from both the parent and child influence each other and contribute to the quality of parent-child interactions (Bronfenbrenner, 1977; Harrison et al., 2011). It has been well established that the quality of dyadic parent-child interactions fosters all aspects of development, including cognitive (e.g., Kochanska, Murray, & Harlan, 2000) and socio-emotional skills (e.g., Cooke, Stuart-Parrigon, Movahed-Abtahi, Koehn, & Kerns, 2016; Kochanska, Forman, Aksan, & Dunbar, 2005), although this has not yet been examined extensively in relation to physical weight gain development (Bergmeier et al., 2014a, Bergmeier et al., 2014b; Blewitt, Bergmeier, Macdonald, Olsson, & Skouteris, 2016).

Despite the acknowledged importance of investigating dyadic parent-child interactions with regards to feeding, the vast majority of research evaluating parental and child influences of childhood overweight and obesity has adopted a uni-directional perspective, mainly assessing the influence of the parent on the child (Bergmeier et al., 2014a, Bergmeier et al., 2014b; Skouteris et al., 2011). For example, extensive research efforts have focused on assessing the associations between parent child feeding practices and child eating and weight (Faith, Scanlon, Birch, Francis, & Sherry, 2004; Jansen, Daniels, & Nicholson, 2012; Shloim, Edelson, Martin, & Hetherington, 2015), largely overlooking the influence that the child contributes toward parent-child feeding interactions. Research into parent child feeding practices across different cultures (e.g., Geng et al., 2009; Liu, Mallan, Mihrshahi, & Daniels, 2014; Nowicka, Sorjonen, Pietrobelli, Flodmark, & Faith, 2014; Schmidt et al., 2017; Tovar et al., 2012), has generally indicated that parental excessive use of control to moderate child food intake is associated with child eating behaviour, such as eating in the absence of hunger (e.g., Birch, Fisher, & Davison, 2003), and weight status (e.g., Blissett & Bennett, 2013; Faith et al., 2004). Furthermore, it appears that parent child feeding practices may be a response to, rather than influence, child eating and weight status (e.g., Afonso et al., 2016; Rhee et al., 2009; Shloim et al., 2015). However, very few studies have attempted to include the dyadic influences between the child and the parent (Afonso et al., 2016; Anderson, Lemeshow, & Whitaker, 2014; Bergmeier et al., 2016; Bergmeier et al., 2014a, Bergmeier et al., 2014b). Furthermore, feeding practices, as measured by self-reports from parents and independent observations, are not always aligned (Bergmeier, Skouteris, Haycraft, Haines, & Hooley, 2015; Farrow, Blissett, & Haycraft, 2011; Lewis & Worobey, 2011); this may be because self-reports capture general feeding practices used to guide child eating (e.g., parental ideals and intentions relating to the use of practices to guide child eating), whereas observations are more likely to reveal variability in the execution of parent feeding practices when dyadic parent-child feeding interactional behaviours and responses are at play during the specific observed mealtimes (Bergmeier et al., 2017; Bergmeier et al., 2015).

Evaluations to date, either self-reported or independently observed, have not fully considered dyadic parent and child factors associated with child eating that are specific to the food-related context (e.g., Bergmeier et al., 2015; Farrow et al., 2011; Haycraft, Karasouli, & Meyer, 2017; Lewis & Worobey, 2011). To date, the few studies that have implemented dyadic parent-child measures reveal that parent-child dyadic behaviours during food-related interactions and the emotional quality of their relationship (i.e., trusting, sensitive and responsive to each other's needs) are both important to understanding developmental pathways to childhood eating behaviours and obesity risk (Bergmeier et al., 2014a, Bergmeier et al., 2014b; Blewitt et al., 2016). In order to advance our understanding of early pathways to obesity risk, we must address the paucity of research considering the role that dyadic parent-child factors play in the development of child eating and weight.

In this paper we aim to address this gap by proposing a conceptual model of Early Mother-Child Dyadic Pathways Influencing Childhood Obesity Risk (Fig. 1), which places parent-child relationships in a central role in understanding pathways that lead from parent-child feeding interactions to child body mass index (BMI). Contributors to childhood obesity development involve a complex interplay between multiple factors, including biology and society. The predominant focus of the model is on the interrelationships between the psychosocial factors that are modifiable from infancy and hence potentially responsive to intervention; the model incorporates principles stemming from Ecological Systems Theory (Bronfenbrenner, 1977; Harrison et al., 2011). Our model focuses on mother-child factors because mothers are typically the primary caregiver responsible for child feeding during preschool years (e.g., Haycraft et al., 2017); however, we ackowledge that fathers, co-parents and other caregivers also play a significant role in shaping child development.

In the following subsections we outline the theory and empirical findings that have informed the hypothesised pathways shown in the conceptual model. Each box presented in Fig. 1 is summarised as it appears sequentially in the model.

Section snippets

Individual and dyadic parent-child factors associated with parent-child feeding interactions

Ecological Systems Theory highlights that there are particular child, parent and dyadic factors that influence child development (Bronfenbrenner, 1977), and potentially parent-child feeding interactions (Harrison et al., 2011). They include attachment security, child temperament and maternal mental health:

Attachment security. The foundations of early parent-child relationship quality are built on the child's early attachment to their parent (Ainsworth, Blehar, Waters, & Wall, 1978; Bowlby &

Establishment of early parent-child feeding interactions

As children transition to solids and are being socialized to become independent eaters, parent-child feeding interaction patterns emerge, revealing the Mutually Responsive Orientation in the dyadic feeding relationship. The Mutually Responsive Orientation of parent-child dyads is characterised by two main components: mutual parent-child responsiveness and shared positive affect (Kochanska, 2002). The degree of mutual reciprocity and responsiveness within the dyad appears to be an important

Child self-regulation and eating behaviours

Self-regulation is defined as a multidimensional construct that encompasses the conscious and unconscious neurocognitive processes by which individuals manage and regulate their attention and arousal in order to engage in goal-directed behavior (Calkins, 2007). Decades of child development research shows that positive parent-child relationships support the development of child self-regulation (e.g., Anderson & Keim, 2016; Caleza, Yañez-Vico, Mendoza, & Iglesias-Linares, 2016). As discussed

Further directions and implications for obesity prevention

Given the theoretical and empirical advances highlighting the important role of the parent-child relationship in fostering optimal child eating behaviours and weight gain, understanding modifiable early dyadic mother-child pathways to childhood obesity risk is crucial. Despite recent progress, it is clear that knowledge of the various pathways linking parent-child interactions with child eating- and weight-related outcomes remains rudimentary. This could be partly due to the disconnect between

References (100)

  • L.A. Francis et al.

    Predictors of maternal child-feeding style: Maternal and child characteristics

    Appetite

    (2001)
  • G. Geng et al.

    Confirmatory factor analysis of the Child Feeding Questionnaire (CFQ) in Japanese elementary school children

    Appetite

    (2009)
  • J.C. Han et al.

    Childhood obesity

    The lancet

    (2010)
  • E. Haycraft et al.

    Controlling feeding practices and psychopathology in a non-clinical sample of mothers and fathers

    Eating Behaviors

    (2008)
  • E. Haycraft et al.

    Maternal feeding practices and children's eating behaviours: A comparison of mothers with healthy weight versus overweight/obesity

    Appetite

    (2017)
  • S.K. Kumanyika

    Environmental influences on childhood obesity: Ethnic and cultural influences in context

    Physiology & Behavior

    (2008)
  • C.Y.Y. Leung et al.

    Surgency and negative affectivity, but not effortful control, are uniquely associated with obesogenic eating behaviors among low-income preschoolers

    Appetite

    (2014)
  • M. Lewis et al.

    Mothers and toddlers lunch together. The relation between observed and reported behavior

    Appetite

    (2011)
  • W.-H. Liu et al.

    Feeding beliefs and practices of Chinese immigrant mothers. Validation of a modified version of the Child Feeding Questionnaire

    Appetite

    (2014)
  • S. McMeekin et al.

    Associations between infant temperament and early feeding practices. A cross-sectional study of Australian mother-infant dyads from the NOURISH randomised controlled trial

    Appetite

    (2013)
  • A.L. Miller et al.

    Observed self-regulation is associated with weight in low-income toddlers

    Appetite

    (2016)
  • S. Mitchell et al.

    Maternal psychosocial predictors of controlling parental feeding styles and practices

    Appetite

    (2009)
  • G.L. Mitchell et al.

    Parental influences on children's eating behaviour and characteristics of successful parent-focussed interventions

    Appetite

    (2013)
  • P. Nowicka et al.

    Parental feeding practices and associations with child weight status. Swedish validation of the Child Feeding Questionnaire finds parents of 4-year-olds less restrictive

    Appetite

    (2014)
  • J.K. Orrell-Valente et al.

    “Just three more bites”: An observational analysis of parents' socialization of children's eating at mealtime

    Appetite

    (2007)
  • R. Schmidt et al.

    Parental feeding practices in families with children aged 2–13 years: Psychometric properties and child age-specific norms of the German version of the Child Feeding Questionnaire (CFQ)

    Appetite

    (2017)
  • C. Schwartz et al.

    Development of healthy eating habits early in life. Review of recent evidence and selected guidelines

    Appetite

    (2011)
  • J.L. Temple et al.

    Overweight children find food more reinforcing and consume more energy than do nonoverweight children

    American Journal of Clinical Nutrition

    (2008)
  • M.S. Ainsworth

    Infant–mother attachment

    American Psychologist

    (1979)
  • M.D.S. Ainsworth et al.

    Patterns of attachment

    (1978)
  • M.D.S. Ainsworth et al.

    Infant feeding and attachment

    (1972)
  • N. Aksan et al.

    Mutually responsive orientation between parents and their young children: Toward methodological advances in the science of relationships

    Developmental Psychology

    (2006)
  • S.E. Anderson et al.

    Quality of early maternal–child relationship and risk of adolescent obesity

    Pediatrics

    (2012)
  • S.E. Anderson et al.

    Parent–child interaction, self-regulation, and obesity prevention in early childhood

    Current obesity reports

    (2016)
  • S.E. Anderson et al.

    Maternal-infant relationship quality and risk of obesity at age 5.5 years in a national US cohort

    BMC Pediatrics

    (2014)
  • S.E. Anderson et al.

    Attachment security and obesity in US preschool-aged children

    Archives of Pediatrics & Adolescent Medicine

    (2011)
  • S. Anzman-Frasca et al.

    Infants' transitions out of a fussing/crying state are modifiable and are related to weight status

    Infancy

    (2013)
  • B. Beebe et al.

    The contribution of mother-infant mutual influence to the origins of self-and object representations

    Psychoanalytic Psychology

    (1988)
  • H. Bergmeier et al.

    Systematic research review of observational approaches used to evaluate mother-child mealtime interactions during preschool years–

    American Journal of Clinical Nutrition

    (2014)
  • H.J. Bergmeier et al.

    Do maternal perceptions of child eating and feeding help to explain the disconnect between reported and observed feeding practices?: A follow‐up study

    Maternal and Child Nutrition

    (2017)
  • H. Bergmeier et al.

    Associations between child temperament, maternal feeding practices and child body mass index during the preschool years: A systematic review of the literature

    Obesity Reviews

    (2014)
  • L.L. Birch et al.

    Development of eating behaviors among children and adolescents

    Pediatrics

    (1998)
  • C. Blewitt et al.

    Associations between parent–child relationship quality and obesogenic risk in adolescence: A systematic review of recent literature

    Obesity Reviews

    (2016)
  • J. Blissett et al.

    Cultural differences in parental feeding practices and children's eating behaviours and their relationships with child BMI: A comparison of black Afro-Caribbean, white British and white German samples

    European Journal of Clinical Nutrition

    (2013)
  • J. Bowlby et al.

    Parent-child attachment and healthy human development

    (1988)
  • U. Bronfenbrenner

    Toward an experimental ecology of human development

    American Psychologist

    (1977)
  • M.R. Broth et al.

    Depressed and well mothers' emotion interpretation accuracy and the quality of mother—infant interaction

    Infancy

    (2004)
  • C. Caleza et al.

    Childhood obesity and delayed gratification behavior: A systematic review of experimental studies

    The Journal of Pediatrics

    (2016)
  • S.D. Calkins

    The emergence of self-regulation: Biological and behavioral control mechanisms supporting toddler competencies

    Socioemotional development in the toddler years: Transitions and Transformations

    (2007)
  • J. Cassidy et al.

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

    Development and Psychopathology

    (2013)
  • Cited by (33)

    • Intergenerational transmission of appetite self-regulation

      2021, Journal of Applied Developmental Psychology
      Citation Excerpt :

      Appetite SR is strongly related to measures of non-appetite SR (e.g., Anderson & Keim, 2016; Russell & Russell, 2020), but the two domains are also believed to be distinct (see Liew, Zhou, Perez, Yoon, & Kim, 2020). Like with non-appetite SR (which, like Russell & Russell, 2020, we refer to here as “general SR”), parents play a large role in the development of appetite SR through their attachment relationships, interactions with their children, and feeding practices (Bergmeier et al., 2020; Russell, Londhe, & Britner, 2013; Saltzman et al., 2018). Although this focus has generated important interventions designed to improve parental responsiveness and associated child outcomes (e.g., Daniels et al., 2014), children's appetite SR may be directly related to how well their parents are able to engage self-regulation with regard to food.

    View all citing articles on Scopus
    View full text