Arya M. Sharma, MD

Regular readers are well aware of the accumulating evidence that early childhood influences may play a major role in the development of childhood and adult obesity.

Many of these influences may result from parental response to infant temperament and parental perception of infant growth and appetite.

These issues were further explored by Sarah Redsell and colleagues from the University of Nottingham, UK, in a paper just published in BMC Public Health.

The researchers conducted six focus groups in 38 parents (36 female, 2 male), age range 19-45 years, of infants less than one year of age. Parents were selected from different demographic groups. Twelve parents were overweight and eight were obese.

Five main themes were identified:

a) parental concern about breast milk, infant contentment and growth;

b) the belief that the main cause of infant distress is hunger is widespread and drives inappropriate feeding;

c) rationalisation for infants’ larger size;

d) parental uncertainty about identifying and managing infants at risk of obesity;

e) intentions and behaviour in relation to a healthy lifestyle.

A common problem was that parents panicked or felt inadequate when the growth curves of their infants fell below the growth charts, even though the kids appeared otherwise healthy and content.

On the other hand, other parents expressed a sense of fulfillment when their infants gained large amounts of weight according to the centile charts. In particular, parents of premature infants had a strong desire for them to catch up to perceived norms, which was endorsed by others in the group.

Overweight or obese parents appeared biased towards larger babies and believed that having a bigger infant was healthier.

Mothers were quite defensive about any suggestion that their infant might be overweight or growing too quickly and found it easy to justify their infant’s size amongst themselves but feared criticism from others, such as health professionals, family or peers. Parents were not keen on the idea of restricting diet during infancy even for very large infants but thought that that dietary content and quality could be explored by health professionals.

Interestingly, several parents commented on the negative influence of grandparents (a topic I have previously blogged about). Although parents admitted it was grandparents’ prerogative to indulge their grandchild but when this extended to family mealtimes they reported feeling they had lost control of their infant’s diet. Overall, there was a stronger preference for larger infants amongst older family members.

This study clearly shows that there are a number of barriers to early intervention with parents of infants at risk of developing obesity but also that parents appear receptive to prevention prior to weaning.

Specifically, parents would likely benefit from better understanding the physiology of breast feeding, how to differentiate between infant distress caused by hunger and other causes, and the timing of weaning.

In addition some parents appear to need guidance to recognize and prepare healthy foods and facilitate physical activity for their infants.

Clearly, parenting support that focusses on raising healthy infants could play a major role in the prevention of subsequent childhood and adult obesity.

AMS
Edmonton, Alberta

Redsell SA, Atkinson P, Nathan D, Siriwardena AN, Swift JA, & Glazebrook C (2010). Parents’ beliefs about appropriate infant size, growth and feeding behaviour: implications for the prevention of childhood obesity. BMC public health, 10 (1) PMID: 21087482

One of the most common assertions is that home environments including parenting styles are a major determinant of obesity risk in kids.

This issue was now examined by Jerica Berge and colleagues from the University of Minnesota in a paper published in the latest issue of OBESITY.

As described in the paper, the four classic parenting styles (known to be a characteric of the parent and to generally be stable over time) are:

Authoritative: high level of demandingness (on the child) with high level of responsiveness (to the child)

Authoritarian: high level of demandingness with low level of responsiveness

Permissive: low level of demandingness with high level of responsiveness

Neglectful: low level of demandingness with low low level of responsiveness

Furthermore, parenting practices can be divided into direct (e.g. encouraging) and indirect (e.g. modeling) patterns.

Data from Project EAT, a population-based study with over 2,500 adolescents from 31 Minnesota school with diverse ethnic and socioeconomic backgrounds, were used.

Maternal authoritative parenting style predicted lower BMI in adolescent sons and daughters, whereas maternal authoritarian style predicted higher BMI in sons (especially when combined with neglectful dads) but had no effect on daughters’ BMI.

In contrast fathers’ parenting styles alone, appeared to have no effect on sons or daughters’ BMI.

Sons of parents who encouraged but did not model healthy lifestyles had a higher BMI, but the effect of encouraging vs. modeling on daughters’ BMI was less clear.

Oddly, paternal permissive parenting style predicted more fruits and vegetables intake in daughters

Most surprisingly, no significant associations were found between parenting style and adolescent physical activity levels.

While there were no interactions between ethnicity and parenting styles, lower SES parents tended to be more authoritarian, while higher SES parents tended to be more authoritative.

The authors interpret their findings to suggest that authoritative parenting style may play a protective role related to adolescent overweight and that warmth and/or caring in the parent-adolescent relationship may be important in relation to female adolescent healthy dietary intake.

The biggest surprise however was the apparent importance of opposite sex parents’ influence on their offspring.

Based on their findings, the authors had two clinical tips:

1) Clinicians should perhaps promote authoritative parenting styles as high parental expectations and structure along with caring and emotional responsiveness, rather than rigidness, less structure and emotional unresponsiveness, may protect against overweight in sons.

2) Clinicians should promote congruency between parenting practices (in both words and actions), as this may be protective in both sons and daughters.

However, given the fact that parenting styles and behaviours have previously been shown to be stable over time, it may be doubtful as to how much influence clinicians can truly have on parenting.

Furthermore, although clearly an authoritarian parenting style appears worst, I am rather surprised that the influence of different parenting styles was not far greater or clearer than what was found in this study.

This may either be a reflection of how little influence parents actually have on adolescent behaviours and/or how little parenting actually has to do with kids’ risk for overweight or obesity in the first place.

AMS
Edmonton, Alberta

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Berge JM, Wall M, Bauer KW, & Neumark-Sztainer D (2010). Parenting characteristics in the home environment and adolescent overweight: a latent class analysis. Obesity (Silver Spring, Md.), 18 (4), 818-25 PMID: 19816417

While I am taking a brief break from clinics and other obligations (including daily blog posts), I will be reposting past articles, which I still believe to be relevant but may have escaped the attention of the 100s of new readers who have signed up in the past months.

The following was first posted on 11/12/07

Those of you following my blog may have noticed my concern about how maternal obesity and lifestyles seem to impact future risk of childhood obesity.

Well, apparently it’s not just Mom’s “fault” - Dads matter too!

Melissa Wake and colleagues from the Royal Victoria Hospital in Victoria (AUS) studied the relationships between BMI status at ages 4 to 5 years and mothers’ and fathers’ parenting dimensions and parenting styles.

Participants were composed of all 4983 of the 4- to 5-year-old children in wave 1 of the nationally representative Longitudinal Study of Australian Children with complete BMI and maternal parenting data.

Mothers and fathers self-reported their parenting behaviors on 3 multi-item continuous scales (warmth, control, and irritability) and were each categorized as having 1 of 4 parenting styles (authoritative, authoritarian, permissive, and disengaged) using internal warmth and control tertile cut points.

They found that while mothers’ parenting behaviors and styles were not associated in any model with higher odds of children being in a heavier BMI category, higher father control scores were associated with lower odds of the child being in a higher BMI category.

Thus, compared with the reference authoritative style, children of fathers with permissive and disengaged parenting styles had higher odds of being in a higher BMI category (~30-50% greater risk depending on the statistical model).

Apparently these findings are consistent with a previous intervention study by Stein et al., which showed that fathers’ but not mothers’ parenting (warmth and support) predicted better maintenance of weight loss after a behavioral parenting intervention for pediatric obesity.

These authors suggest that fathers’ parenting may well be an important determinant of the extent to which the family environment as a whole is supportive of children’s attempts to lose weight.

Message to Dads: “Get involved - you count!”

AMS