Persistently Obese Youth: Interactions Between Parenting Styles and Feeding Practices With Child Temperament

Authors: Richard E. Boles, PhD, Jennifer Reiter-Purtill, PhD, and Meg H. Zeller, PhD
Affiliations: University of Colorado Denver, Aurora, CO, USA; University of Cincinnati, OH, USA

Abstract

Objective: To assess the interaction between parental and child characteristics with feeding practices and mealtime functioning.
Design: Longitudinal predictive study comparing baseline characteristics with follow-up assessments.
Participants: Caregivers of 52 persistently obese youth and 32 nonoverweight comparison youth evaluated for child temperament, parental feeding practices, parenting styles, and mealtime interactions.
Results: Persistently obese adolescents were more likely to experience problematic feeding practices, particularly when their temperaments were reported as difficult. Those with difficult temperaments also showed lower levels of positive mealtime interactions.
Conclusion: Youth with persistent obesity are at increased risk for problematic parental feeding practices and poor mealtime functioning, especially with difficult temperaments. Further investigation into the mechanisms linking parent and child characteristics with health-related behaviors is warranted.

Keywords

parenting; temperament; obesity; adolescent; feeding

Introduction

The prevalence of childhood and adolescent obesity has remained high over the past decade. In the 2009–2010 study, obesity rates for adolescents aged 12 to 19 years were 18.4%, particularly evident in male adolescents. Interventions aimed at reducing adolescent obesity show limited success and suggest the necessity to explore contextual factors affecting health outcomes.

Parenting and Child Development

Parenting styles are linked to the social, behavioral, and emotional development of children. The development process is viewed as dialectical, influenced by both parental and child factors.

Parenting Styles

Baumrind's dimensions of parenting styles include:

  • Demandingness: Incorporates supervision and discipline.
  • Responsiveness: Focuses on developing child's individuality and self-regulation.

    Classification of Parenting Styles by Maccoby and Martin:
  1. Authoritative: High responsiveness and high demandingness
  2. Authoritarian: Low responsiveness and high demandingness
  3. Permissive: High responsiveness and low demandingness
  4. Neglectful: Low responsiveness and low demandingness
Studies Linking Parenting with Obesity
  • Rhee et al.: Found that authoritarian parenting increased the odds of a child being overweight.
  • Agras et al.: Reported no longitudinal association between parenting style and child weight.
  • Berge et al.: Found authoritative parenting predicted a lower BMI in adolescents five years later.

Inconsistent findings suggest that other child characteristics such as temperament may affect parenting's impact on obesity.

Child Temperament

Temperament is biologically based, consisting of reactivity and self-regulation:

  • Reactivity: Response levels to external and internal stimuli.
  • Self-regulation: The ability to orient and control attention and behavioral responses.

    A “difficult” temperament encompasses biological irregularity, intense withdrawal, and negative mood, increasing risk for adult psychosocial issues.
Previous Studies
  • The Boles study indicated that obese adolescents had more difficult temperaments and mothers reported less behavioral control.
  • Wu et al. found that children with difficult temperaments and insensitive mothers were at greater risk for obesity during grade school.
Parental Feeding Practices

Most research focuses on infant and young child feeding practices. Controlling feeding practices (restriction, pressure to eat) can interfere with a child's self-regulation of eating behaviors, leading to problematic outcomes.

Mealtime Functioning

Research ties the importance of mealtimes and positive interactions to lower rates of unhealthy weight control behaviors and depression among adolescents. Treatment-seeking mothers of obese adolescents report more mealtime challenges and less positive interactions than those with nonoverweight youth.

Study Aims

  • Aim 1: Investigate the longitudinal relationship between difficult temperament and parental feeding practices.
  • Aim 2: Explore the longitudinal relationship between difficult temperament and mealtime functioning.
Hypotheses

Aim 1: Higher youth difficult temperament at T1 predicts problematic feeding practices at T2, especially amongst persistently obese youth.
Aim 2: Higher youth difficult temperament at T1 predicts greater mealtime challenges and less positive interactions at T2, moderated by parental behaviors.

Method

Design and Procedures

A follow-up longitudinal study assessed psychosocial functioning in overweight youth seeking treatment versus nonoverweight peers. Initial data collection involved classroom and home assessments.

Measures
  1. Demographics: Family characteristics and socioeconomic status (SES) identified using the Revised Duncan method.
  2. Anthropometrics: Youth and mothers measured for height and weight, BMI calculated using CDC growth charts.
  3. Temperament: Revised Dimensions of Temperament Survey assesses child temperament through ten aspects, creating a Difficult Temperament Index (DTI).
  4. Feeding Practices: The Child Feeding Questionnaire (CFQ) and the About Your Child’s Eating–Revised (AYCE-R) measured parental beliefs about feeding and mealtime interactions.
  5. Parental Behavior: The PRPBI assessed parental warmth, psychological control, and behavioral control.
Participants

Obese youth must have a BMI at or above the 95th percentile age and gender-wise. Of 107 eligible families, 90 participated in initial studies; 52 obese and 32 nonoverweight youth remained for longitudinal assessment.

Statistical Analysis

Descriptive statistics and Pearson correlations of temperament with feeding practices and mealtime functioning were computed. Hierarchical linear regression analyses assessed the moderation of parenting behaviors on the association between difficult temperament and feeding practices.

Results

Descriptive statistics indicated significant differences in zBMI and BMI between groups. Within the obese group, higher DTI scores inversely related to positive mealtime interactions. In the comparison group, there was a positive correlation between DTI and pressure to eat.

Predicting Child Feeding Practices

Hierarchical regressions revealed:

  • Behavioral Control positively predicted pressure to eat.
  • DTI negatively predicted positive mealtime interactions.
  • Maternal warmth inversely predicted aversion to mealtimes.

Interactions showed:

  • DTI and psychological control inversely predicted pressure to eat.
  • DTI and parental warmth positively predicted monitoring.

Discussion

The study supports literature linking child temperament with parenting styles and mealtime functioning. Adolescents with persistent obesity experience problematic feeding practices, particularly when they demonstrate difficult temperaments, suggesting more research is needed to explore successful parenting in managing obesity.

Limitations

The sample may not represent all youth with persistent obesity, as participants were treatment-seeking. The lack of diverse ethnic backgrounds limits generalizability, and the research would benefit from child-reported data on parenting. Causal inferences are also limited by the study's longitudinal nature.

Future Directions

Further research needed to develop treatments considering key behaviors related to obesity and how child temperament can inform effective parenting strategies.