Early mother-child dyadic pathways to childhood obesity risk: A conceptual model
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)
- et al.
Bidirectional association between parental child-feeding practices and body mass index at 4 and 7 y of age
American Journal of Clinical Nutrition
(2016) - et al.
Risk factors for childhood overweight: A prospective study from birth to 9.5 years
The Journal of Pediatrics
(2004) - et al.
Mutually responsive orientation: A novel observational assessment of mother-child mealtime interactions
Appetite
(2016) - et al.
Reported and observed controlling feeding practices predict child eating behavior after 12 months
Journal of Nutrition
(2015) - et al.
Learning to overeat: Maternal use of restrictive feeding practices promotes girls' eating in the absence of hunger
American Journal of Clinical Nutrition
(2003) - et al.
Parental eating disorder symptoms and observations of mealtime interactions with children
Journal of Psychosomatic Research
(2011) - et al.
Associations between child emotional eating and general parenting style, feeding practices, and parent psychopathology
Appetite
(2014) - et al.
Parental use of restrictive feeding practices and child BMI z-score. A 3-year prospective cohort study
Appetite
(2010) - et al.
Parental feeding practices and socioeconomic status are associated with child adiposity in a multi-ethnic sample of children
Appetite
(2012) Postpartum depression effects on early interactions, parenting, and safety practices: A review
Infant Behavior and Development
(2010)
Predictors of maternal child-feeding style: Maternal and child characteristics
Appetite
Confirmatory factor analysis of the Child Feeding Questionnaire (CFQ) in Japanese elementary school children
Appetite
Childhood obesity
The lancet
Controlling feeding practices and psychopathology in a non-clinical sample of mothers and fathers
Eating Behaviors
Maternal feeding practices and children's eating behaviours: A comparison of mothers with healthy weight versus overweight/obesity
Appetite
Environmental influences on childhood obesity: Ethnic and cultural influences in context
Physiology & Behavior
Surgency and negative affectivity, but not effortful control, are uniquely associated with obesogenic eating behaviors among low-income preschoolers
Appetite
Mothers and toddlers lunch together. The relation between observed and reported behavior
Appetite
Feeding beliefs and practices of Chinese immigrant mothers. Validation of a modified version of the Child Feeding Questionnaire
Appetite
Associations between infant temperament and early feeding practices. A cross-sectional study of Australian mother-infant dyads from the NOURISH randomised controlled trial
Appetite
Observed self-regulation is associated with weight in low-income toddlers
Appetite
Maternal psychosocial predictors of controlling parental feeding styles and practices
Appetite
Parental influences on children's eating behaviour and characteristics of successful parent-focussed interventions
Appetite
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
“Just three more bites”: An observational analysis of parents' socialization of children's eating at mealtime
Appetite
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
Development of healthy eating habits early in life. Review of recent evidence and selected guidelines
Appetite
Overweight children find food more reinforcing and consume more energy than do nonoverweight children
American Journal of Clinical Nutrition
Infant–mother attachment
American Psychologist
Patterns of attachment
Infant feeding and attachment
Mutually responsive orientation between parents and their young children: Toward methodological advances in the science of relationships
Developmental Psychology
Quality of early maternal–child relationship and risk of adolescent obesity
Pediatrics
Parent–child interaction, self-regulation, and obesity prevention in early childhood
Current obesity reports
Maternal-infant relationship quality and risk of obesity at age 5.5 years in a national US cohort
BMC Pediatrics
Attachment security and obesity in US preschool-aged children
Archives of Pediatrics & Adolescent Medicine
Infants' transitions out of a fussing/crying state are modifiable and are related to weight status
Infancy
The contribution of mother-infant mutual influence to the origins of self-and object representations
Psychoanalytic Psychology
Systematic research review of observational approaches used to evaluate mother-child mealtime interactions during preschool years–
American Journal of Clinical Nutrition
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
Associations between child temperament, maternal feeding practices and child body mass index during the preschool years: A systematic review of the literature
Obesity Reviews
Development of eating behaviors among children and adolescents
Pediatrics
Associations between parent–child relationship quality and obesogenic risk in adolescence: A systematic review of recent literature
Obesity Reviews
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
Parent-child attachment and healthy human development
Toward an experimental ecology of human development
American Psychologist
Depressed and well mothers' emotion interpretation accuracy and the quality of mother—infant interaction
Infancy
Childhood obesity and delayed gratification behavior: A systematic review of experimental studies
The Journal of Pediatrics
The emergence of self-regulation: Biological and behavioral control mechanisms supporting toddler competencies
Socioemotional development in the toddler years: Transitions and Transformations
Contributions of attachment theory and research: A framework for future research, translation, and policy
Development and Psychopathology
Cited by (33)
Health-related behaviors and weight-related outcomes within sibling pairs: A systematic review
2023, Journal of Pediatric NursingIntergenerational transmission of appetite self-regulation
2021, Journal of Applied Developmental PsychologyCitation 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.
Research progress in the correlation between maternal depression and childhood obesity
2024, Zhongguo Ertong Baojian Zazhi