Parenting Styles and their Impact on Child Adiposity

The study conducted by Hurley and colleagues (Hurley, Pallen, Lancashire, Adab & Investigators, 2018) aimed to investigate the relationship between parents or caretakers feeding practices to children at the age 7-8 years old and their adiposity measurements one year later at age 8-9 years old. The study took into account a secondary analysis to collect feedback from parents and children qualitative data on feeding practices in subscale categories. Adiposity was measured with the three factors of waist-to-height ratio, body fat percentage, and weight status to develop baseline data and compare results in the secondary analysis.

The study of Hurley et al. (2018) hypothesized that parent feeding practices have a significant effect on a child's BMI, waist-to-height ratio, and body fat percentage, which in turn impacts adiposity. Second, the study suggests parental food patterns are the dominant family system determinants of the child's eating behavior. The parent's food patterns will in return determine their child's weight status as the parent's practices are the dominant influence. Third, Hurley and colleagues suggest parents develop their own feeding practices early on in their childhood, which translates to their child's eating behaviors.

The participants in the Hurley et al. (2018) study visited 54 primary schools in the West Midlands with the WAVE cohort (West Midlands Active Lifestyle and Healthy Eating in Schoolchildren). Consent was collected from parents and children gave verbal consent before the three proxy measurements were given. Adiposity was collected based on weight status, body fat percentage, and waist-to-height ratio. The children were measured by WAVE-trained researchers using age and sex-specific 85th percentile cut-off from the UK 1990 growth reference charts. Children were separated by overweight, which included obese children and not overweight. Waist circumference and height were calculated to create children at high and low risk. Body fat percentage was used according to age and sex-specific threshold for a high body fat percentage of each child.

Hurley et al. (2018) continued gathering qualitative data through The Comprehensive Feeding Practices Questionnaire, which assessed the diversity of the feeding practices through subscales. These were kept to a minimum for easy accessibility to parents, including child control, emotion regulation, environment, food as a reward, modeling, monitoring, pressure to eat, and restriction for weight control. Adaptations were made to the questionnaire to correlate to the UK population. The questions could be answered on a scale of 1 to 5, with five standing for always. Item scores were added and divided by the number of items on the subscale. Socioeconomic status was collected from home postcodes and the English Index of Multiple Deprivation. Data from baseline measurements of adiposity from children ages 7-8 were taken and repeated one year later for further results. Qualitative data was done in the secondary analysis as well with children of ages 8-9 and adiposity measurements.

Conclusions from the Hurley et al. (2018) study can be extracted from the data on the correlation between parent feeding practices and their child adiposity. Without baseline values, associations were found with parents who implement restrictions for weight control and pressure to eat. Parents who had an overweight child were more likely to practice restriction. This philosophy was compared to a parent with a child that is not overweight, they are more likely to practice pressuring others to eat.

It could be said that the influence of parental feeding practices is more significant at a younger age. The preadolescent range used in the study may identify the point at which children desire greater freedom in their eating behaviors. When the baseline measurements are used in the study, the associations between parents' feeding practices become less apparent. The Hurley et al. (2018) study suggests this may be because the results support the theory of reverse causation. This theory shows that a child's level of adiposity leads to the parent's choice of feeding practices rather than being the consequence. The study is not able to identify whether parents use the same feeding practices they developed in their childhood. It was not possible to determine from the qualitative data.

In reviewing the study by Haines and colleagues (Haines, Downing, Tang, Campbell & Hesketh, 2018), parenting behaviors were evaluated in relation to the parent's concern about their child's weight, dietary intake, physical activity, and media use. The child's practices and parent's practices were compared in search of a correlation that could identify child weight-related behaviors, as it is often seen that parenting practices are one of the main components of obesity prevention. The article states that there has been limited research addressing the reasons for the parent's behaviors even though it is so critical to obesity prevention practices. The study hypothesizes whether a large level of concern for their child's weight leads to better food, physical activity, or media practices.

However, the researchers understand that results may support the theory that higher levels of concern for their child's weight may not be the only component needed in obesity prevention.

The Haines et al. (2018) research was conducted on 62 first-time parent groups in Australia on mothers with preschool children. A two-stage random sampling was designed to select participants. These parent groups were picked from fourteen local government areas within a 60km radius of the place where the research took place. Participants were told to provide written consent and were randomized into two groups, one being the intervention and another the control. 528 mother and child pairs were randomized into these two groups. The Melbourne Infant Feeding Activity and Nutrition Trial program was 15 months in length, with intervention involving six interaction sessions. These were showcased through the meetings with the parents and their children. These interventions included modes of delivery and educational strategies on dietary intake, promoting physical activity, and role modeling. The intervention group was juxta opposed to the control group, who read newsletters on topics that did not involve weight or nutrition strategies. However, both groups received attention from a Maternal and Child Health nurse.

In the Haines et al. (2018) study, the control and intervention group mothers were required to complete a survey for baseline results. The survey was to be completed through the child's age timeline at nine months and 20 months and follow-ups at three and half years old and five years old. Three hundred fifty-six mothers completed the survey up until the five-year mark. Forty-six mothers did not complete the survey and were not included in the survey. The instrumentation of the study included seven of the twelve subscales of the Comprehensive Feeding Practices Questionnaire. The seven subscales included were pressure in feeding, use of foods as rewards, restriction, modeling, monitoring, encouraging balance and variety, and use of food for emotion regulation. Each question had a scale ranging from 0 to 4 as possible answers. The scores were calculated by taking the mean of the subscales.

Covert control of their child's eating was also included in the questionnaire and answered on the same scale. This question was described as behaviors to control their child's food practices without the child being aware. Co-participation was evaluated by asking how often in the past month the mother played with their child. Encouragement was evaluated by asking how often the mother encouraged their child to become physically active or to go outside and play. Mothers were also evaluated on whether they provided opportunities to their child by asking how often in the past month did they take their child for a ride on a bike/scooter, buy an item for their child to be active, and take their child for a walk. These questions were responded to on a scale of 1 to 6.

The restriction was calculated by asking the mothers how much they disagreed or agreed with the statements like "I often tell my child to sit still when he/she is being active inside." These questions were rated on a scale of 1 to 4. Co-participation and providing opportunities were also evaluated in relation to often the mother let their child watch TV and how often they bought a video for the child to watch. Once again, ranking on a scale of 1 to 6. Mothers were asked to include their level of concern about their child's weight in a single question through a scale of little concern about the child eating too much, not concerned about the child's eating, a little concerned about a child not eating enough, and very concerned about a child not eating enough. The same scale was used to evaluate maternal concern about child physical activity and child media.

The Haines et al. study showed the mean age of mothers being 37.5 years old with English as the main language. 60% of mothers attended university. 40% of mothers were overweight or obese. 60% of mothers reported some concern for their child's weight, with a majority only having one concern. 2% of mothers were concerned about their child's weight and the three weight-related behaviors. 15% of mothers had a concern that their children were not active enough, and more were concerned that their child weight too little than too much. Mothers who said they were concerned their child did not eat enough had higher levels of pressuring their child to eat, restriction, and use of food for rewards. In mothers who were concerned with their child weighing too much, there were higher reports of restriction. Mothers concerned about their child weighing too much had lower levels of co-participation in physical activity with their child. Mothers concerned with their child weighing too little were evaluated with higher levels of their child using media.

The Haines et al. (2018) study found that 60% of mothers had at least one concern related to their child's weight but did not increase the mother's feeding behaviors to prevent weight gain. The results showed lower health-promoting practices and co-participation in physical activity with high rates of restriction and use of media in mothers who had at least one concern. The data of mothers who had a concern reporting higher controlling feeding practices supports the idea that mothers concerned about their child's weight see more restrictive feeding practices and pressure to eat. It was seen that when mothers believed their children ate very little, they were pressured to eat more. It may be concluded that mothers' concern about their child's weight does not mean the mother will implement health-promoting practices to impact their child's weight.

Although parents may have wanted to increase physical play with their children, the barriers of everyday life prevented active play. It can be determined that active parent play can be increased with practical strategies that work in the daily stressors. It can also be seen that there is not a deeper concern about the child's weight, even if the mother has a concern that their child is overweight. Mothers' who were concerned about their child's media use provided more opportunities for the child to have screen time. This could be related to the mother's low confidence or little self-efficacy to change their child's behavior.

Norman and colleagues (Norman, Elinder & Berline, 2018) study was executed to explore how parents with low socioeconomic status have an impact on their child's dietary behaviors. The study will be explored through a recorded session using motivational interviewing. The background information presents the complication being there is little research done on the association between feeding styles of parents in different socioeconomic statuses. The study suggests from the background that lower socioeconomic status parents use less restriction in feeding practices when compared to higher educated parents. Lower socioeconomic parents are seen to pressuring to eat and restrict unhealthy food servings. Background also suggests parenting practices also depend on how the parents see their child's ability of self-efficacy compared to parents who see their child with high self-efficacy are less restrictive.

The Norman et al. (2018) study participants had to meet the criteria of parents focused on their child's eating behaviors and who had a low education with a maximum of 12 years of schooling. Fifty-seven sessions were able to be conducted on parents. MI sessions were then selected based on a variation of the way parents controlled their child's dietary intake with characteristics of sex of the parent, sex of the child, school class, birth country, and child's weight status. Summaries of the dietary behaviors and a table of characteristics were made from the sessions. With input from colleagues, 29 MI sessions were chosen to use in the study, which lasted 12-61 minutes. Most of the parents were mothers living in an apartment born in the Nordic region with Sweden as their primary language. 30% of the children selected were overweight or obese. The study was designed as a qualitative approach.

This approach was used to explore parents' influence on their children's feeding practices. Variations of the phenomena are to be analyzed and identified in a certain group. In this specific study, the variations in experience are seen as experiencing different phenomena related to each other within a relationship. The approach is used on the recorded and transcribed MI sessions collected within the Healthy School Start intervention. The MI counseling method is used to incite answers that participants arrive at on their own with no judgment and to promote behavior change.

The Norman et al. (2018) study began with MI sessions expressed in Swedish with two motivational interviewing counselors. MI was used as a client-centered style of interviewing to support behavior change. The session was flexible and changed depending on the answers from the participants. Topics of dietary and behavior changes were targeted in the 29 sessions, including increased interest in vegetables, interest in specific types of foods, decreased child food aggravation, reduced amounts of sweets, or eating dinner as a family. The goal of the MI counselors was to get parents' own thoughts, feelings, and values about the behavior change.

The parents would describe the behavior of the child and move toward the changes the parent believed were necessary for the benefit of the child. Specific situations and examples would be used to provide evidence of the behaviors. The sessions were then listened to several times and transcribed 10 out of the 29. The 19 sessions left were transcription by a transcriptions device. A preliminary analysis was conducted on 14 sessions with Norman and colleagues. The transcripts were then noted and marked for important context. Second order perspective was used with the phenomenography approach by searching for information taken for granted by the parent.

With analysis of the Norman et al. (2018) study, the MI sessions were placed in five categories describing parents' influence on a child's dietary behaviors through different parenting styles of invisible guidance to force the child. Three structural relationships were formed from the parenting styles, including the positive-negative impact of parental responsibility for the child's eating, parental trust in the child's satiety response, and advice from professionals regarding the child's health and parental emotional distress around the food situation. These three categories were then looked at in relation to the parenting styles or guidance given by the parents to the child relating to their eating behaviors. These rankings started with silent guidance and open guidance being defined with a positive impact, high trust, and low distress. Conscious lack of guidance and subconscious lack of guidance fell under parental responsibility for the child's healthy dietary habits. Enforcement correlated on the scale to negative impact, low trust, and high distress.

Norman et al. (2018) results researched parents feeding behaviors in low socioeconomic status through motivational interviewing sessions. From the 29 sessions used, five categories were able to define how parents defined their feeding practices over their children and the impact this had on the child. The type of parenting practices was influenced by the parental perceptions of responsibility for the child's health, the self-efficacy of the child's ability in food intake, and the child's emotional distress. Parents in the silent and open guidance believed their child had high self-efficacy and had a positive interaction with their child's dietary behaviors. Parents in the remaining three categories needed additional support. The parents with silent and open guidance have clear structures for healthy eating through the trust of the child, which symbolizes the authoritative parenting style. However, these parents do have different parenting styles as the silent parent does not want the child to notice, whereas the open parent does want the child to notice.

Parents in categories of subconscious lack of guidance and enforcement need the most support as they have not developed structure or responsibility with their child's eating behavior. Parents that have a subconscious lack of guidance don't recognize their own responsibility compared to parents who use enforcement parents have a strong responsibility but lack the knowledge to make the behavior change. Both of these parents do not believe in their child's self-efficacy to regulate their food intake and act on their emotional distress. The questions of whether socioeconomic status affects the strategies and guidance of the parent's feeding behaviors are different from those in a high socioeconomic status. Norman et al. (2018) state that this cannot be answered but instead would require a larger sample. The study shows that all parents have an interest in the feeding practices that impact their children. Yet, parents may not have the knowledge or resources to support their children in certain feeding practices.

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