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Feeding practices and child weight: is the association bidirectional in preschool children?
Pauline W Jansen1, Anne Tharner1, Jan van der Ende1
1From the Departments of Child and Adolescent Psychiatry/Psychology (PWJ, JvdE, FCV, and HT) and Pediatrics (VWVJ), Erasmus University Medical Center (Erasmus MC)-Sophia, Rotterdam, Netherlands; The Generation R Study Group (PWJ, AT, and VWVJ) and Departments of Epidemiology (AT, AH, VWVJ, and HT), Public Health (HR), and Psychiatry (HT), Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands; the Institute of Psychology (PWJ) and School of Pedagogical and Educational Sciences (MHvI), Erasmus University Rotterdam, Rotterdam, Netherlands; the Murdoch Childrens Research Institute, Melbourne, Australia (MW); the Department of Pediatrics, University of Melbourne, Melbourne, Australia (MW); and the Centre for Community Child Health, Royal Children's Hospital, Melbourne, Australia (MW).
Insights
Parents adjust feeding practices based on a child's body mass index (BMI), not the other way around. This bidirectional relationship suggests interventions should consider parental responses to child weight.
Area of Science:
- Pediatric Nutrition
- Child Psychology
- Public Health
Background:
- Parental feeding practices are linked to children's body mass index (BMI).
- The causal direction between feeding practices and child BMI is debated.
- Parental feeding may be a response to a child's weight status.
Purpose of the Study:
- To examine the directionality of the relationship between controlling feeding practices and child BMI in early childhood.
- To longitudinally assess how parental restriction, monitoring, and pressure to eat influence child BMI.
Main Methods:
- Longitudinal study of 4166 children from the Generation R Study.
- Body mass index (BMI) measured at ages 2 and 6 years.
- Parental feeding practices (restriction, monitoring, pressure to eat) assessed at age 4 years using the Child Feeding Questionnaire.
Main Results:
- Higher child BMI at age 2 predicted increased parental restriction and decreased pressure to eat at age 4.
- Parental restriction at age 4 predicted higher child BMI at age 6, but this effect was weak.
- Parental pressure to eat predicted lower child BMI at age 6, independent of prior BMI.
- The influence of child BMI on parental feeding practices was stronger than the reverse.
Conclusions:
- The relationship between parental feeding practices and child BMI is bidirectional.
- Parents appear to adapt their feeding behaviors in response to their child's BMI.
- Intervention programs targeting parental feeding practices should consider this parental response to child weight.
Background:
Parental feeding practices are associated with children's body mass index (BMI). It has been generally assumed that parental feeding determines children's eating behaviors and weight gain, but feeding practices could equally be a parent's response to child weight.
Objective:
In longitudinal analyses, we assessed the directionality in the relation between selected controlling feeding practices and BMI in early childhood.
Design:
Participants were 4166 children from the population-based Generation R Study. BMI was measured at ages 2 and 6 y. With the use of the Child Feeding Questionnaire, parents reported on restriction, monitoring, and pressure to eat (child age: 4 y). BMI and feeding-behavior scales were transformed to SD scores.
Results:
With the use of linear regression analyses, there was an indication that a higher BMI at age 2 y predicted higher levels of parental restriction (adjusted β = 0.07; 95% CI: 0.04, 0.10) and lower levels of pressure to eat (adjusted β = -0.20; 95% CI: -0.23, -0.17) 2 y later. Restriction at age 4 y positively predicted child BMI at 6 y of age, although this association attenuated to statistical nonsignificance after accounting for BMI at age 4 y (β = 0.01; 95% CI: -0.01, 0.03). Pressure to eat predicted lower BMI independently of BMI at age 4 y (β = -0.02; 95% CI: -0.04, -0.01). For both restriction and pressure to eat, the relation from BMI to parenting was stronger than the reverse (Wald's test for comparison: P = 0.03 and < 0.001, respectively). Monitoring predicted a lower child BMI, but this relation was explained by confounding factors.
Conclusions:
Although the feeding-BMI relation is bidirectional, the main direction of observed effects suggests that parents tend to adapt their controlling feeding practices in response to their child's BMI rather than the reverse. Therefore, some components of current programs aimed at preventing or treating unhealthy child weight may need to be carefully scrutinized, especially those targeting parental food-related restriction and pressure to eat.
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