Associations between Parental Concerns about Preschoolers’ Weight and Eating and Parental Feeding Practices: Results from Analyses of the Child Eating Behavior Questionnaire, the Child Feeding Questionnaire, and the Lifestyle Behavior Checklist

Abstract

IntroductionInsight into parents’ perceptions of their children’s eating behaviors is crucial for the development of successful childhood obesity programs. However, links between children’s eating behaviors and parental feeding practices and concerns have yet to be established. This study aims to examine associations between parental perceptions of preschoolers’ eating behaviors and parental feeding practices. First, it tests the original 8-factor structure of the Child Eating Behavior Questionnaire (CEBQ). Second, it examines the associations with parental feeding practices, measured with the Child Feeding Questionnaire (CFQ).Materials and MethodsQuestionnaires were sent to parents from 25 schools/preschools in Stockholm, Sweden and to parents starting a childhood obesity intervention. The CEBQ factor structure was tested with confirmatory factor analysis (CFA). Associations between CEBQ subscales Food approach and Food avoidance and CFQ factors Restriction, Pressure to eat and Monitoring were examined with structural equation modelling (SEM), adjusting for child and parental characteristics, and parental confidence, measured with the Lifestyle Behavior Checklist (LBC). CFQ Concern for child weight and Perceived responsibility for child eating were used as mediators.Results478 parents completed the questionnaires (children: 52% girls, mean age 5.5 years, 20% overweight/obese). A modified 8-factor structure showed an acceptable fit (TLI = 0.91, CFI = 0.92, RMSEA = 0.05 and SRMR = 0.06) after dropping one item and allowing three pairs of error terms to correlate. The SEM model demonstrated that Food approach had a weak direct effect on Restriction, but a moderate (β = 0.30) indirect effect via Concern, resulting in a substantial total effect (β = 0.37). Food avoidance had a strong positive effect on Pressure to eat (β = 0.71).DiscussionThe CEBQ is a valid instrument for assessing parental perceptions of preschoolers’ eating behaviors. Parental pressure to eat was strongly associated with children’s food avoidance. Parental restriction, however, was more strongly associated with parents’ concerns about their children’s weights than with children’s food approach. This suggests that childhood obesity interventions should address parents’ perceptions of healthy weight alongside perceptions of healthy eating.

Feeding and Mealtime Correlates of Maternal Concern About Children's Weight

“…Evidence is mixed as to whether parental concern about children’s weight is associated with healthy changes in child weight 10, 14 or parents’ participation in behaviors that promote children’s healthy weight. 5, 8, 15–18 Some studies have found that parents concerned about their child’s weight are more likely to limit screen time, encourage physical activity, and change the family diet, as compared to parents who are not concerned. 8, 15 These are evidence-based actions that have been recommended to address childhood obesity.…”

Directive and non-directive food-related parenting practices: Associations between an expanded conceptualization of food-related parenting practices and child dietary intake and weight outcomes

“…2–8 Food-related parenting practices, including encouraging children to eat healthful foods and restricting intake of palatable snack foods, have also been identified as potentially significant determinants of children’s dietary intake and weight status. 9–12 …”

“…Research has shown that parents often adopt controlling food-related parenting practices (e.g., food restriction and pressure-to-eat) in response to concern about their child’s weight status or dietary intake patterns; 9,11,12 for example, parents who are worried about their child gaining weight might place restrictions on the amount of sweets consumed by that child, and parents concerned about children’s picky eating patterns might respond by requiring them to eat all of the food on their plate at mealtime. Unfortunately, while parents likely engage in these controlling behaviors in an effort to improve their children’s dietary intake or weight status, the results associated with the impact of these behaviors on child outcomes are mixed.…”

Reducing childhood obesity: opportunities to influence transitional infant feeding

“…160 However, unlike restriction and pressure-to-eat, monitoring does not appear to be influenced by child weight or eating behaviours. 164,165 Much of the evidence on the association between feeding practices with poor dietary and weight outcomes in children is based on cross-sectional studies limiting the understanding of the causative factors. 23 While there is evidence that feeding practices are driven by poor or large appetites in the child, 165,166 with paradoxical child eating and weight outcomes as outlined above, there is some support that these practices are also mediated by concern for child weight [167][168][169] as well as child weight.…”

“…164,165 Much of the evidence on the association between feeding practices with poor dietary and weight outcomes in children is based on cross-sectional studies limiting the understanding of the causative factors. 23 While there is evidence that feeding practices are driven by poor or large appetites in the child, 165,166 with paradoxical child eating and weight outcomes as outlined above, there is some support that these practices are also mediated by concern for child weight [167][168][169] as well as child weight. 23,166,170,171 Current longitudinal evidence now supports the bidirectional relationship between these feeding practices and child weight, with a few large studies suggesting that feeding practice adaption in response to child's weight as the dominant direction.…”