Childhood obesity and parents’ influence

Child obesity is a major global health problem in both developed and developing countries. Tens of millions of children (perhaps as many as 15-20% of all children) are overweight or even obese by the age of 5 or younger. “Obese children are likely to become obese adults and are at higher risk of developing a range of chronic diseases such as cardiovascular disease (CVD), type 2 diabetes and cancer.”

Parents, of course, play a major role in their children’s lives, especially the younger the child. What influence do parents have on child obesity?

**Updated March 2021**

Quick bibliography: Articles–classic and recent–about the influence of parents on childhood obesity.

*Benton, D. (2004). Role of parents in the determination of the food preferences of children and the development of obesity. International Journal of Obesity and Related Disorders, 28(7), 858-869. [Cited by] **new**

“The role of parental behavior in the development of food preferences is considered. Food preferences develop from genetically determined predispositions to like sweet and salty flavors and to dislike bitter and sour tastes. Particularly towards the second year of life, there is a tendency to avoid novel foods (neophobia). Food aversions can be learnt in one trial if consumption is followed by discomfort. There is a predisposition to learn to like foods with high-energy density. However, from birth genetic predispositions are modified by experience and in this context during the early years parents play a particularly important role. Parental style is a critical factor in the development of food preferences. Children are more likely to eat in emotionally positive atmospheres. Siblings, peers and parents can act as role models to encourage the tasting of novel foods. Repeated exposure to initially disliked foods can breakdown resistance. The offering of low-energy-dense foods allows the child to balance energy intake. Restricting access to particular foods increases rather than decreases preference. Forcing a child to eat a food will decrease the liking for that food. Traditionally, educational strategies have typically involved attempts to impart basic nutritional information. Given the limited ability of information to induce changes in behavior, an alternative strategy would be to teach parents about child development in the hope that an understanding of the characteristic innate tendencies and developmental stages can be used to teach healthy food preferences.”

*Gohir, W., Ratcliffe, E. M., & Sloboda, D. M. (2015). Of the bugs that shape us: Maternal obesity, the gut microbiome, and long-term disease risk. Pediatric Research, 77(1-2), 196-204. [Cited by] **new**

Chronic disease risk is inextricably linked to our early-life environment, where maternal, fetal, and childhood factors predict disease risk later in life. Currently, maternal obesity is a key predictor of childhood obesity and metabolic complications in adulthood. Although the mechanisms are unclear, new and emerging evidence points to our microbiome, where the bacterial composition of the gut modulates the weight gain and altered metabolism that drives obesity. Over the course of pregnancy, maternal bacterial load increases, and gut bacterial diversity changes and is influenced by pre-pregnancy- and pregnancy-related obesity. Alterations in the bacterial composition of the mother have been shown to affect the development and function of the gastrointestinal tract of her offspring. How these microbial shifts influence the maternal-fetal-infant relationship is a topic of hot debate. This paper will review the evidence linking nutrition, maternal obesity, the maternal gut microbiome, and fetal gut development, bringing together clinical observations in humans and experimental data from targeted animal models.”

*Hughes, S. O., & Papaioannou, M. A. (2018). Maternal predictors of child dietary behaviors and weight status. Current Nutrition Reports, 7(4), 268-273. [Cited by]

“Current research shows that authoritative styles in both feeding and general parenting contexts has been consistently associated with better child health outcomes. Authoritative feeding styles have been associated with better child dietary quality and weight. Indulgent feeding styles have been associated with problematic child eating behaviors and higher weight. Authoritative general parenting styles have predicted healthier child weight status over time.”

“Authoritative parenting is characterized by reasonable demands and high responsiveness. While authoritative parents might have high expectations for their children, they also give their kids the resources and support they need to succeed. Parents who exhibit this style listen to their kids and provide love and warmth in addition to limits and fair discipline.”

Highly controlling feeding behaviors in the form of parental styles or practices hinder development of healthy eating in children. It is more productive to study styles of feeding as opposed to practices as feeding styles show less variability in predicting child health outcomes.”

*Kiefner-Burmeister, A., & Hinman, N. (2020). The role of general parenting style in child diet and obesity risk. Current Nutrition Reports, 9(1), 14-30. [Cited by]

“The childhood obesity epidemic is widely considered to have reached pandemic proportions. Across the world, children with obesity are facing numerous psychological and physiological issues that follow them into adulthood, frequently leading to chronic illness and early death. In an effort to combat the compounding effects of childhood overweight, researchers are attempting to identify biological and environmental contributors to child weight. Parenting styles are one recognized influence on child diet and body mass index (BMI). This review is a comprehensive examination of the literature on the influence of parenting style on childhood diet and BMI over the past 5 years.

Current research continues to support the use of traditional parenting style categories (i.e., authoritative, authoritarian, permissive, uninvolved/neglectful): however, newer subcategories of Baumrind’s styles and the inclusion of previously underrepresented groups (e.g., fathers, cross cultural comparison studies) are shedding more light on the nuance of parenting’s relationship with child weight.

Parenting styles that focus on the balance of warmth and control (e.g., authoritative) in contrast to the styles dedicated to only one of these constructs (e.g., permissive, authoritarian) seem to promote the healthiest dietary habits and may be protective of child BMI.

*Mihrshahi, S., & Baur, L. A. (2018). What exposures in early life are risk factors for childhood obesity? Journal of Paediatrics and Child Health, 54(12), 1294-1298. [Cited by]

“Globally, estimates show that 41 million children younger than 5 years of age are affected by overweight and obesity. In many regions of the world, these prevalence rates have increased dramatically, especially in low‐ and middle‐income countries, making childhood obesity a global policy issue. Recent data show that many children are already affected by overweight or obesity by the time they start school; hence, the examination of early exposures, with interventions around these exposures, is warranted. In this review, we outline the main modifiable exposures in early life that can lead to an increased risk of obesity. These exposures can be broadly categorised into parental factors such as obesity and gestational diabetes; dietary exposures in early life, including breastfeeding and complementary feeding and feeding behaviours; physical activity, sedentary behaviours and sleep; and environmental exposures such as maternal exposure to tobacco.”

*Morrison, H., Power, T. G., Nicklas, T., & Hughes, S. O. (2013). Exploring the effects of maternal eating patterns on maternal feeding and child eating. Appetite, 63, 77-83. [Cited by]

“Recent research has demonstrated the importance of maternal feeding practices and children’s eating behavior in the development of childhood obesity. The purpose of this study was to examine the relations between maternal and child eating patterns, and to examine the degree to which these relationships were mediated through maternal feeding practices. Two hundred and twenty-two low-income mothers and their preschool children participated. About half of the families were African American and half were Latino. Mothers completed questionnaires assessing maternal eating patterns, maternal feeding practices, and children’s eating patterns. Maternal external eating (eating in response to outside stimuli, not internal hunger/thirst cues) was positively correlated with two child eating scores: picky eating and desire to eat. Mediational analyses showed that external eating in mothers was related to picky eating in children through high maternal control in feeding; the relationship between mothers’ external eating and desire to eat in children was not mediated through maternal control. Picky eating and desire to eat in children were related to emotional eating in mothers as well.”

*Shloim, N., Edelson, L. R., Martin, N., & Hetherington, M. M. (2015). Parenting styles, feeding styles, feeding practices, and weight status in 4–12 year-old children: A systematic review of the literature. Frontiers in Psychology, 6, 20. [PDF] [Cited by]

Childhood is a critical period in the development of obesity. Eating patterns established early in life track into later life. Therefore, parental approaches to feeding in their general parenting style, feeding styles, and specific feeding practices will have a profound impact on how children eat and grow. A systematic research review following PRISMA guidelines was conducted to identify, discuss and integrate recent research investigating the relationship between parenting styles, feeding styles, feeding practices, and body mass index (BMI) in children. Medline (Ovid), PsycINFO, Web of Science, and Food Science and Technology Abstracts were systematically searched using sensitive search strategies. Studies were limited to papers published in English between 2010 and February 2015 with participants aged 4–12 years old with outcomes including obesity, change in weight, or BMI. The search yielded 31 relevant quantitative peer-reviewed papers meeting all inclusion criteria: seven longitudinal, 23 cross-sectional, one randomized control trial. Associations between parenting style and child BMI were strongest and most consistent within the longitudinal studies. Uninvolved, indulgent or highly protective parenting was associated with higher child BMI, whereas authoritative parenting was associated with a healthy BMI. Similarly for feeding styles, indulgent feeding was consistently associated with risk of obesity within cross-sectional studies. Specific feeding practices such as restriction and pressure to eat were linked to BMI, especially within cross-sectional studies. Where child traits were measured, the feeding practice appeared to be responsive to the child, therefore restriction was applied to children with a high BMI and pressure to eat applied to children with a lower BMI. Behaviors and styles that are specific to the feeding context are consistently associated with child BMI. However, since obesity emerges over time, it is through longitudinal, carefully measured (through questionnaire and observation) studies which take account of child appetite and temperament that the association between parenting style, feeding style, specific feeding practices, and child obesity will be understood.”

For additional research about childhood obesity, please see the Science Primary Literature Database.

Questions?  Please let me know (engelk@grinnell.edu).

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