parenting styles, feeding styles, and their influence on child obesogenic behaviors and body weight....
TRANSCRIPT
Appetite 71 (2013) 232–241
Contents lists available at ScienceDirect
Appetite
journal homepage: www.elsevier .com/locate /appet
Research review
Parenting styles, feeding styles, and their influence on child obesogenicbehaviors and body weight. A review
0195-6663/$ - see front matter � 2013 Elsevier Ltd. All rights reserved.http://dx.doi.org/10.1016/j.appet.2013.08.015
⇑ Corresponding author.E-mail addresses: [email protected] (R.L. Vollmer), [email protected] (A.R. Mobley).
Rachel L. Vollmer, Amy R. Mobley ⇑University of Connecticut, Department of Nutritional Sciences, 3624 Horsebarn Road Extension, Unit 4017, Storrs, CT 06269, USA
a r t i c l e i n f o
Article history:Received 30 January 2013Received in revised form 21 May 2013Accepted 21 August 2013Available online 31 August 2013
Keywords:Feeding stylesParenting stylesChildhood obesityEating behaviorsPhysical activity
a b s t r a c t
With recommendations to include parents as targets for childhood obesity interventions, there is a needto review the relationship of general parenting influences on childhood obesity. Therefore, the aim of thisreview is to examine the existing literature regarding the influence of parenting style and/or feedingstyles on childhood obesogenic behaviors and body weight. Research articles related to parenting style(n = 40) and parental feeding style (n = 11) were identified and reviewed. An authoritative style appearsto be the most protective parenting and feeding style while the indulgent feeding style is consistentlyassociated with negative health outcomes. Overall, results for parenting style studies are inconsistentdue to differences in conceptualization and measurement, while the results for feeding styles are muchmore cohesive. The literature is lacking in the ability to describe the interplay between parenting andfeeding styles and child obesity risk. Recommendations for future research and interventions are dis-cussed in regards to feeding style and influences on childhood obesity.
� 2013 Elsevier Ltd. All rights reserved.
Contents
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Conceptualization and definition of parenting and feeding style typologies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233Parenting styles vs. feeding styles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Parenting style study characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234Parenting style measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234Results by outcome variable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235Food-specific outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Fruit and/or vegetable intake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236High fat and/or sugar intake. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Activity-specific outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Physical activity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236Sedentary behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236Weight-specific outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236General eating and/or meal behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237Feeding style study characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237Feeding style measures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237Results by outcome variable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237Food-specific outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Fruit and/or vegetable intake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237High fat and/or sugar intake. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237Dairy intake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
R.L. Vollmer, A.R. Mobley / Appetite 71 (2013) 232–241 233
Weight specific outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238Limitations in current literature. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239Recommendations and implications for future research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240
Introduction
Rates of childhood obesity have dramatically increased in theUS over the past two decades with approximately 17% of childrenaged 2–19 years old considered obese (Ogden, Carroll, Curtin,Lamb, & Flegal, 2010). It is important to prevent and/or treat child-hood obesity because obese children are more likely to show signsof chronic disease such as heart disease, type 2 diabetes, andbreathing problems that continue into adulthood (Freedman,Mei, Srinivasan, Berenson, & Dietz, 2007; Han, Lawlor, & Kimm,2010; Whitlock, Williams, Gold, Smith, & Shipman, 2005). Parentsremain one of the most significant influences on child weight(Faith et al., 2012). Parent weight is one of the most robust and sig-nificant predictors of a child’s weight, although some evidence sug-gests that there is a gender-specific influence (Agras, Hammer,McNicholas, & Kraemer, 2004; Perez-Pastor et al., 2009). Asidefrom genetic influence, parents also shape the food and meal envi-ronment at home through feeding behaviors such as food availabil-ity and accessibility, timing and frequency of meals. (Silventoinen,Rokholm, Kaprio, & Sorensen, 2010).
To develop effective childhood obesity prevention programs, itis important to consider and understand the parent–child relation-ship and the impact of parenting style and/or feeding style onchildhood obesogenic behaviors and body weight (Faith et al.,2012). Thus, the purpose of this review is to examine the literatureevaluating the relationship between parenting style and feedingstyle on child weight status and obesogenic behaviors such as die-tary intake (e.g. fruit and/or vegetable intake, sugar sweetenedbeverage intake, etc.), eating behaviors (e.g. disinhibited eating),family meal frequency, physical activity, and sedentary behaviors.For organizational purposes, parenting styles and feeding styleswill be presented separately in the following sections and thencomparisons between parenting and feeding styles as well as sug-gestions for future research will be presented in the discussionsection.
Table 1Four major parenting/feeding styles based on responsiveness and demandingness.
Parenting/feeding styledimensions
Responsiveness
Low High
Demandingness Low Neglectful/uninvolved
Permissive/indulgent
High Authoritarian Authoritative
Conceptualization and definition of parenting and feeding styletypologies
Specific parenting behaviors and practices influence childdevelopment and are part of a broader parenting environment,called parenting style, conceptualized by Diana Baumrind(Baumrind, 1966; Baumrind, 1967; Darling & Steinberg, 1993).Macoby and Martin (1983) provided a two-dimensional frame-work for parenting style by blending Baumrind’s typology withearlier definitions of parenting to develop linear responsivenessand demandingness dimensions (Darling & Steinberg, 1993).
The demands a parent makes on a child to become part of thefamily or society and the parent’s response to noncompliantchildren is called demandingness (Darling & Steinberg, 1993).Responsiveness refers to the parent’s awareness of his or herchild’s needs and how they foster a child’s autonomy. Responsive-ness also reflects how open a child is to a parent’s demand(Maccoby, 1992). Four parenting styles emerged from the linearbreak-up of responsiveness and demandingness (Macoby & Martin,1983). Authoritative (high demandingness, high responsiveness)
parents have reasonable expectations for their child, foster childautonomy, respect the child’s opinion, and provide warmth (Mac-coby, 1992). Authoritarian (high demandingness, low responsive-ness) parents are not sensitive to the child’s opinion and placestrict demands on their child without regard of the child’s abilityor maturity (Maccoby, 1992). Permissive or indulgent (lowdemandingness, high responsiveness) parents do not enforce de-mands on their child but show respect for their child and providewarmth (Maccoby, 1992). Neglectful or uninvolved (low demand-ingness, low responsiveness) parents do not place demands ontheir child and are unaware of their child’s needs or opinions (Mac-coby, 1992). It is important to note, however, that not all research-ers adhere to the above typology, thus clouding the literature.Because researchers have a variety of parenting style measures tochoose from, other parenting styles have been operationalized,measured, and implicated in the risk of child obesity such as withrejecting or nonauthoritative parenting styles. As parenting stylesare discussed in the results section, comparisons will be made tothe original four styles (authoritarian, authoritative, permissive/indulgent, neglectful/uninvolved) (Table 1).
Hughes, Power, Fisher, Mueller, and Nicklas (2005) differenti-ated between general parenting style and, parenting styles spe-cific to feeding or eating interactions, known as feeding styles,with responsiveness and demandingness dimensions. In feedingstyles, demandingness refers to the number of demands that aparent places on a child to get him/her to eat (Hughes et al.,2005). Responsiveness refers to the how demands are carriedout by the parent, which can be either parent-centered or child-centered (Hughes et al., 2005). Based on these two dimensions,authoritative (high demandingness, high responsiveness),authoritarian (high demandingness, low responsiveness), indul-gent (low demandingness, high responsiveness), and uninvolved(low demandingness, low responsiveness) feeding styles wereidentified (Table 1).
Due to confusion in the existing literature, it is important totake time to describe the differences between feeding styles andfeeding practices as this review is only focused on the feeding stylevariable. Practices, such as restriction or pressure to eat, are goaldirected behaviors and are defined by specific content such asrestriction of certain foods or modeling eating behaviors andchange in different contexts (Darling & Steinberg, 1993). Styles,on the other hand, provide the emotional climate and are not goaldirected and remain static in all contexts (Darling & Steinberg,1993). Practices help parents directly achieve child feeding andeating goals while the style alters the effectiveness of these prac-tices (Darling & Steinberg, 1993).
Table 2Literature search terms.
Parenting/feeding style terms Child weight related terms (MeSH terms) Behavior related terms (MeSH terms)
Parenting style Body mass index Dietary intakeFeeding style Body weight Fruit and/or vegetable intakeResponsiveness Weight status Sugar sweetened beverage intakeDemandingness Overweight Dairy intakeWarmth Obesity Whole grain intakeControl Snack choiceAuthoritarian Physical activityAuthoritative ExerciseIndulgent Screen timePermissive TV viewingUninvolved Computer usageNeglectful Sedentary activities
Family mealsFood choice
234 R.L. Vollmer, A.R. Mobley / Appetite 71 (2013) 232–241
Parenting styles vs. feeding styles
The feeding styles developed by Hughes et al. (2005) are basedon the typology of parenting styles and thus, have several similar-ities. When Hughes et al. (2005) developed the Caregiver FeedingStyle Questionnaire (CFSQ), they used the Parenting DimensionsInventory (PDI), which measures parenting style, to establish con-vergent validity and it showed significant main effects for feedingstyles across 5 of the PDI scales. For example, those who hadauthoritative feeding styles tended to be more nurturing on thePDI compared to authoritarian or uninvolved feeding styles, whichare low responsiveness styles (Hughes et al., 2005). Although thereare some similarities between feeding and parenting styles, theyare not interchangeable.
To illustrate this point, Hennessy, Hughes, Goldberg, Hyatt, andEconomos (2010) recruited 99 parent–child dyads and parentscompleted parenting style (PDI) and feeding style (CFSQ) measure-ments. The researchers found that parenting styles and feedingstyles agreed for approximately one third of the sample, whilestyles were in discord for the remaining sample (Hennessy et al.,2010). This indicates that many parents may apply a different stylespecific to the feeding environment compared to their general par-enting style (Mitchell, Farrow, Haycraft, & Meyer, 2013). Thus,there may be differing influences of parenting styles and feedingstyles on child weight and/or child dietary intake, eating behaviors,or activity behaviors (Hennessy et al., 2010).
It is important to consider the differing influences of parentingand feeding styles on child body weight and obesogenic behaviorsto inform future parent-focused interventions, thus, the aim of thispaper is to provide a comprehensive review of the existing literatureexamining the relationship between parenting styles and/or feedingstyles on child body weight and/or child obesogenic behaviors.
Methodology
A literature review was conducted during October of 2012.Searches were conducted using PubMed, PsychINFO, and ERIC dat-abases as well as lateral reference tracking and author searches.Because the main objective of this review was to examine evidencefor parenting style and feeding style on child weight and/or obes-ogenic behaviors, only articles that included measures on parent-ing style or feeding style and child body weight or outcomes thathave been associated with childhood overweight or obesity risk,such as dietary intake (i.e. fruit and/or vegetable intake, low-nutri-ent dense food intake, sugar-sweetened beverage intake, etc.), eat-ing behaviors such as disinhibited eating, family meal frequency,sedentary behaviors, and physical activity behaviors. (Barlow,2007) were included. Inclusive studies did not need measures on
both child body weight and the identified behaviors. No guidelineswere placed on the year of publication to give the most compre-hensive review, and all studies published before September 2012were included. Specifically, literature searches were conductedusing at least one of the parenting/feeding style words, one ofthe weight-related words, or one of the behavior related words(Table 2). All papers were screened on title, abstract, parentingstyle or feeding style conceptualization and measurement, andoutcomes measured.
Exclusion criteria for articles included: not written in English,not published in a peer-reviewed journal, no measures of parentingstyle or feeding style and child weight and/or eating or activitybehaviors, use of nonhuman subjects, parent influence in a clinicalsetting, eating disorders, or disease management, and child or ado-lescent over the age of 18 at baseline. Studies that examined therelationship between single dimensions of parenting or feedingstyles were also excluded (i.e. the relationship between respon-siveness and child body weight) because these dimensions arenot mutually exclusive. For example, if a parent has high demand-ingness, there is limited evidence as to the emotional environmentthat the child is exposed to, and thus, limits interpretation. The fi-nal search resulted in 40 eligible studies examining the influence ofparenting styles and 11 eligible studies examining the influence offeeding styles on child weight and/or weight related outcomes,with only one study (Hennessy et al., 2010) examining the influ-ence of parenting style and feeding style on child body weight.
Results
Parenting style study characteristics
Sample sizes of the reviewed studies ranged from 44 (Taylor, Wil-son, Slater, & Mohr, 2011a) to 12,550 (Fuemmeler et al., 2012) par-ents or families. Mean ages of the parents in the studies rangedfrom 31 to 44.8 years old. Although studies were conducted in a vari-ety of countries, they were rarely ethnically or economically diverse,with most populations of middle to high socioeconomic status (SES).The age of the children in most studies were adolescents (n = 18) andschool-age child (n = 17) and a small number of studies used pre-school aged children (n = 5). All studies except one included bothmale and female children with the proportion split of male and fe-male children between 40% and 59%. Study characteristics such asparent measured, parent-reported vs. child-reported measures,and location of study are summarized in Table 3.
Parenting style measures
In total, the reviewed studies used 10 different standard, vali-dated measures to assess parenting style. The most common
Table 3Overview of parenting style study characteristics and outcome measures in chronological order (n = 40).
Study characteristics Outcome measured
Year Author/studycountry
Designa Parent measuredb Completedmeasurec
Food specific Activity specific Weightspecific
Generaleating/mealbehaviors
Mother Father Both PR CR Other F/V
High fat/sugarintake
Physicalactivity
Sedentaryactivity
2000 Gable US CS X X +
2002 Schmitz US CS X X X + �
2003 Kremers NL CS X X +Lytle US CS X X X +
2004 Agras US P X X X ØChen TW and US CS X X Ø
2005 Brann US CC X X X ØChen and Kennedy US CS X X � ØChen TW CS X X Ø
2006 Rhee US L X X +
2007 Van der Horst NL CS X X �Wake AU CS X X X +
2008 Blissett UK CS X X X ØChen TW CS X X +De Bourdeaudhuji BE,NL, PT, ES
CS X X Ø,+
Humenikova and GatesUS and CZ
CS X X X +
Kim US CS X X X �
2009 Lohaus DE L X X X +Pearson UK CS X X + �Topham US CS X X +Vereecken BE CS X X Ø Ø
2010 Berge (a) US CS X X X +Berge (b) US L X X X + +Berge US L X X X +Hennessy US CS X X ØOlvera US L X X +Vereecken BE CS X X Ø
2011 Franchini PT CS X X �Jago (a) UK CS X X +Jago UK CS X X +McIntosh US CS X X X �Rodenburg NL CS X X � +Taylor (a) AU CS X X X Ø ØTopham US CS X X �
2012 Fuemmeler US L X X +Johnson US CS X X + �Park and Walton-MossKR
CS X X +
Rodenburg(a) NL CS X X + +Rodenburg NL CS X X �
2013 Lane US L X X +
a CS = cross-sectional; P = prospective; L = longitudinal; CC = case control.b Mothers = only mothers parenting style was analyzed; Both = no separate analysis for mothers vs. fathers; Fathers = separate father’s parenting/feeding style.c CR = child-reported parenting style; PR = parent-reported parenting style.d + = association between parenting/feeding style and outcome was positive; � = association between parenting/feeding style and outcome was negative; Ø = association
between parenting/feeding style and outcome was null.
R.L. Vollmer, A.R. Mobley / Appetite 71 (2013) 232–241 235
instrument (n = 9) was the Parenting Style Instrument (Steinberg,Elmen, & Mounts, 1989). Other instruments included ParentingStyles and Dimensions (n = 4) (Robinson, Mandleco, Olsen, & Hart,1995), Authoritative Parenting Index (n = 2) (Jackson, Bee-Gates, &Henriksen, 1994), Child Rearing Practices Report (n = 4) (Block,1981), Parent Behavior Inventory (n = 3) (Schludermann & Schlud-ermann, 1970), Parenting Style Indicators (n = 2) (Devereux, Bron-fenbrenner, & Suci, 1962), Parenting Dimensions Inventory (n = 2)(Slater & Power, 1987), Parental Authority Questionnaire (n = 1)(Buri, 1991), Parental Acceptance–Rejection & Control Question-naire (Kim & Rohner, 2002) and the Attitudes Toward Child Rearing
Scale (n = 1) (Wang & Phinney, 1998). Nine studies developed theirown instruments relating to different dimensions of parenting orcombined questions from different measures (Berge, Wall, Bauer,& Neumark-Sztainer, 2010; Berge, Wall, Loth, & Neumark-Sztainer,2010; Berge, Wall, Neumark-Sztainer, Larson, & Story, 2010;Fuemmeler et al., 2012; Humenikova & Gates, 2008; Lohaus, Vier-haus, & Ball, 2009; Park & Walton-Moss, 2012; Wake, Nicholson,Hardy, & Smith, 2007). Two studies used direct observation ofchild–mother interactions using semi-structured activities (Lane,Bluestone, & Burke, 2013; Rhee, Lumeng, Appugliese, Kaciroti, &Bradley, 2006).
236 R.L. Vollmer, A.R. Mobley / Appetite 71 (2013) 232–241
Results by outcome variable
Many of the studies included measurements on more than oneoutcome such as dietary intake, physical activity, weight status,meal and/or eating behaviors. To simplify the findings, the re-viewed studies have been organized by outcome variables: food-specific (n = 15), activity-specific (n = 5), weight-specific (n = 20),and general eating and/or meal behaviors (n = 5) (Table 3). Thosestudies that measured more than one of these variable categorieswere divided into the appropriate sections.
Food-specific outcomes
Fifteen studies examined the relationship between parentingstyle and food-specific outcomes. Two main categories of food-spe-cific outcomes emerged: fruit and/or vegetable intake (n = 12) andhigh fat and/or sugar food or beverage intake (n = 6).
Fruit and/or vegetable intakeIn four large cross-sectional studies no significant relationships
between parenting style and child intake of fruit and/or vegetableswere found (De Bourdeaudhuij, te Velde, Perez-Rodrigo, de Almei-da, & Brug, 2008; Taylor et al., 2011a; Vereecken, Legiest, De Bour-deaudhuij, & Maes, 2009; Vereecken, Rovner, & Maes, 2010). Therejecting style, which would be classified as the uninvolved stylewith high psychological control (Rodenburg, Oenema, Kremers, &van de Mheen, 2012), and the uninvolved style (Franchini, Poínhos,Klepp, & de Almeida, 2011) were found to be negatively associatedwith fruit and/or vegetable intake. Only one study found that thematernal permissive parenting style was positively related to childfruit and/or vegetable intake (Franchini et al., 2011).
More consistently, the authoritative parenting style was foundto have a significant, positive relationship with child or adolescentfruit and/or vegetable intake (Lytle et al., 2003; Park & Walton-Moss, 2012; Pearson, Atkin, Biddle, Gorely, & Edwardson, 2009;Rodenburg, Kremers, Oenema, & van de Mheen, 2012), and deter-minants of fruit and/or vegetable intake including parental supportand self-efficacy for fruit intake (Kremers, Brug, de Vries, & Engels,2003) and higher home availability of fruits and/or vegetables (DeBourdeaudhuij et al., 2008). This indicates that the authoritativeparenting style, particularly in mothers, may be the most beneficialfor child fruit and/or vegetable intake.
Interestingly, the association of paternal parenting style andchild fruit and/or vegetable intake appears to differ from maternalstyle. In a longitudinal study, paternal permissive style predictedmore fruit and vegetable intake in daughters (Berge, Wall, Loth,et al., 2010) and in a cross-sectional study, paternal nonauthorita-tive parenting styles were positively correlated with child fruitand/or vegetable intake (Lytle et al., 2003). Although there arefew studies separating the association of parenting styles of moth-ers and fathers, it seems that desired paternal parenting style maynot be authoritative as it relates to child fruit and vegetable intake.
High fat and/or sugar intakeOne study reported no significant relationship between parent-
ing styles and soft drink or sweets intake (Vereecken et al., 2009).In contrast, three other studies found that the authoritative parent-ing style was negatively associated with child high fat and/or sugarintake (Chen & Kennedy, 2005; Pearson et al., 2009; Van der Horstet al., 2007). Even though one study found that the authoritarianparenting style was negatively associated with child high fat and/or sugar intake, (Pearson et al., 2009) a study by Gable and Lutz(2000) found that the authoritarian style was positively associatedwith home availability of sweet drinks and candy. The authorita-tive parenting style may be associated with lower child high fatand/or sugar food and beverage intake although the authoritarian
style may also be beneficial due to high control of child intake,even if high fat and/or sugar foods are more available in the home.
Activity-specific outcomes
A total of six studies examined the relationship between par-enting styles and activity-specific outcomes. Two main categoriesof activity-specific outcomes emerged: physical activity (n = 4)and sedentary behaviors (n = 2).
Physical activityOne cross-sectional study found that children of parents with
the authoritative parenting style were more likely to have outdooractivity four or more days per week compared to other styles (Park& Walton-Moss, 2012). However, the effect of parenting style onphysical activity is inconclusive and appears to be gender depen-dent. While maternal authoritative style was positively associatedwith physical activity in daughters (Schmitz et al., 2002) and aero-bic capacity in sons (Chen, Unnithan, Kennedy, & Yeh, 2008), otherstyles were also shown to be positively correlated with physicalactivity. Maternal nonauthoritative and authoritarian styles werepositively correlated with physical activity for sons (Schmitzet al., 2002) and aerobic capacity in girls (Chen et al., 2008), respec-tively. Additionally, the permissive parenting style was positivelycorrelated with physical activity intensity for daughters and phys-ical activity volume for sons (Jago, Davison, Brockman, et al., 2011).From these studies, it seems that a certain parenting style is not animportant predictor of child physical activity, and thus parentsmay influence their child’s activity levels through other means.
Sedentary behaviorsSimilar to physical activity, the association of parenting style
and sedentary behavior may differ according to gender of parentand child. Maternal authoritative parenting style was negativelyassociated with sedentary leisure habits for daughters, but notfor sons, while the paternal parenting style did not have a signifi-cant relationship with daughters or sons sedentary behaviors (Sch-mitz et al., 2002). One other cross-sectional study found thatadolescents of permissive mothers were more likely to watch morethan 4 h of TV per day compared to adolescents of authoritative orauthoritarian mothers (Jago, Davison, Thompson, et al., 2011).Although only two studies have examined the association of par-enting style and sedentary habits, it may be that any level ofdemandingness or control by at least one parent can decreaseexcessive sedentary habits of children.
Weight-specific outcomes
Six studies did not find any significant relationship betweenparenting style and child or adolescent weight status (Agraset al., 2004; Blisset & Haycraft, 2008; Brann & Skinner, 2005; Chen,Kennedy, Yeh, & Kools, 2005; Hennessy et al., 2010; Taylor et al.,2011a). Seven studies, including three longitudinal studies, foundthat the permissive or indulgent parenting style had a positiverelationship with child BMI (Humenikova & Gates, 2008; Johnson,Welk, Saint-Maurice, & Ihmels, 2012; Lane et al., 2013; Olvera &Power, 2010; Rhee et al., 2006; Topham et al., 2009; Wake et al.,2007). Five studies, including three longitudinal studies, found thatthe authoritarian style was associated with higher child bodyweight (Berge, Wall, Bauer, et al., 2010; Berge, Wall, Loth, et al.,2010; Fuemmeler et al., 2012; Lane et al., 2013; Rhee et al.,2006). Two additional longitudinal studies also found that theneglectful parenting style predicted higher child weight status(Fuemmeler et al., 2012; Rhee et al., 2006) and a cross-sectionalstudy found that the neglectful parenting style was associated withhigher child weight (Rodenburg, Kremers, et al., 2012). Rodenburg,
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Oenema, et al. (2012) found that by adding psychological control tothe parental dimensions resulting in a fifth style, the rejectingstyle, characterized by high psychological control and low supportand behavioral control, was positively associated with child weightstatus. An interesting finding from a study by Berge, Wall, Bauer,et al. (2010), found that having an authoritarian mother and aneglectful father was associated with higher body weight in sonsonly, indicating that it may be a combination of parenting stylesthat is associated with child weight, not the parenting style of justone parent.
In one study, the authoritative parenting style was negativelyassociated with child weight status (Kim et al., 2008). Conversely,the authoritative parenting style was found to be positively corre-lated with child weight status, however, this was found among asample of Chinese American adolescents only (Chen & Kennedy,2004, 2005). This relationship may not be generalizable to otherpopulations because traditionally, the parent–child relationshipin the Chinese culture is characterized by high parental controland child obedience, thus the authoritative style may not be bene-ficial for this subpopulation (Chen & Kennedy, 2004, 2005).
Given this evidence and considering that many of the abovestudies, including two longitudinal studies, used the authoritativestyle as the reference, it appears that the authoritative parentingstyle may lower the risk of a child becoming overweight or obese(Olvera & Power, 2010; Rhee et al., 2006; Wake et al., 2007).
General eating and/or meal behaviors
Five studies examined the relationship between parentingstyles and general eating and/or meal behaviors such as familymeal frequency, obesogenic home environments, fast food usage,emotional eating, and general positive or negative health behav-iors, such as poor nutrition. The authoritative style was positivelyassociated with family meals in a longitudinal study (Berge, Wall,Neumark-Sztainer, et al., 2010) and negatively correlated with fastfood establishment use (McIntosh et al., 2011), emotional eating(Topham et al., 2011), and obseogenic home environments incross-sectional studies (Johnson et al., 2012). Furthermore, a longi-tudinal study found that the authoritarian and neglectful parentingstyles were positively associated with adolescent negative healthbehaviors such as nicotine and/or alcohol consumption, sedentaryleisure time activities, risk behaviors, and poor nutrition comparedto adolescents of authoritative parents (Lohaus et al., 2009). Thesestudies provide some insight as to why children of authoritativeparents are at less risk for becoming overweight or obese.
Feeding style study characteristics
Sample sizes ranged from 50 (Moens, Braet, & Soetens, 2007) to718 parents or caregivers (Hughes, Shewchuk, Baskin, Nicklas, &Qu, 2008). When reported, mean ages of the parents ranged from31 to 37 years. The ages of children in the studies were equallydivided among preschool aged children (n = 6) and school agedchildren (n = 5). The studies conducted in the US included ethni-cally diverse samples and mostly low SES parents and children.All studies included both male and female children. Study charac-teristics such as parent measured, parent-reported vs. child-reported measures, and location of study are summarized inTable 4.
Feeding style measures
In total, the reviewed studies used 2 different measures. Themost common instrument used (n = 9) was the CFSQ (Hugheset al., 2005). Direct observations of meal times and coding ofbehavioral control was used for one study (Moens et al., 2007).
Except for the use of the direct observation, all studies used par-ent-reported feeding styles (n = 10).
Results by outcome variable
Many of the studies included measurements on more than oneoutcome including weight status and dietary intake. To simplifythe findings, the reviewed studies have been organized by outcomevariables: food-specific (n = 4), and weight-specific (n = 7)(Table 4).
Food-specific outcomes
Four studies examined the relationship between feeding styleand food-specific outcomes. Three main categories of food-specificoutcomes emerged: fruit and/or vegetable intake (n = 3), high fatand/or sugar intake (n = 2), and dairy intake (n = 4).
Fruit and/or vegetable intakeAuthoritarian (Hughes et al., 2007), indulgent, and uninvolved
(Hoerr et al., 2009) feeding styles were negatively associated withchild fruit and/or vegetable intake. Furthermore, the authoritarianstyle was negatively associated with home availability of fruitsand/or vegetables (Patrick, Nicklas, Hughes, & Morales, 2005).Interestingly, when child care workers had the indulgent feedingstyle, children had higher intakes of vegetables, indicating theremay be differential effects between parental and child care work-ers feeding styles (Hughes et al., 2007). Although the authoritativefeeding style was not associated with child intake of fruit and veg-etables, the authoritative feeding style was positively related tohome availability and child feeding attempts of fruits and/or vege-tables, which may lead to higher intake of fruits and/or vegetablesas the children age (Patrick et al., 2005). Thus, from these cross-sectional studies the authoritative feeding style shows the mostpromise for higher child intake of fruits and/or vegetables com-pared to other feeding styles.
High fat and/or sugar intakeThe indulgent feeding style was positively associated with child
intake of high energy dense food, low nutrient dense food, sugar-sweetened beverage (SSB), and fats and oils (Hennessy, Hughes,Goldberg, Hyatt, & Economos, 2012; Hoerr et al., 2009). This is notsurprising considering that parents with the indulgent feeding stylecater to child food preferences and do not place boundaries on theirchild’s food intake (Hughes et al., 2005). Conversely, children ofparents with the authoritative feeding style had lower intakes oflow nutrient dense foods in a cross-sectional study (Hennessyet al., 2012). Hoerr et al. (2009) found that children of parents withuninvolved feeding styles consumed higher amounts of energydense foods in a cross-sectional study, which conflicts with findingsfrom Hennessy et al. (2012) which found that the uninvolved feed-ing style was associated with less child intake of energy and sweet-ened beverages. The reason for these contradictory findings isunclear, however, the indulgent feeding style has been consistentlyassociated with poor diet quality among children.
Dairy intakeThe authoritative feeding style was positively associated with
dairy home availability (Patrick et al., 2005) and child intake ofdairy (Hughes et al., 2007; Patrick et al., 2005). The indulgent feed-ing style was associated with higher child intake of dairy in twostudies (Hennessy et al., 2012; Hughes et al., 2007), but in anotherstudy this style was negatively associated with child intake of dairy(Hoerr et al., 2009). These conflicting findings may be due to childpreferences for dairy, considering that parents with indulgentfeeding styles characteristically fulfill child requests for preferred
Table 4Overview of feeding style study characteristics and outcome measures in chronological order (n = 11).
Study characteristics Outcome measured
Year Author/studycountry
Designa Parent measuredb Completed measurec Food specific Weightspecific
General eating/mealbehaviors
Mother Father Both PR CR Other F/V High fat/sugar Dairy
2005 Hughes US CS X X +
2005 Patrick US CS X X �, Ø +
2007 Hughes US CS X �, + +Moens BE CC X X Ø
2008 Hughes US CS X X +
2009 Hoerr US CS X X � + �
2010 Hennessy US CS X X +
2011 Hughes US CS X +, Ø
2012 Hennessy US CS X X �, + +Moroshko AU CS X X ØTovar US CS X X +
a CS = cross-sectional; P = prospective; L = longitudinal; CC = case control.b Mothers = only mothers parenting style was analyzed; Both = no separate analysis for mothers vs. fathers; Fathers = separate father’s parenting/feeding style.c CR = child-reported parenting style; PR = parent-reported parenting style.d + = association between parenting/feeding style and outcome was positive; � = association between parenting/feeding style and outcome was negative; Ø = association
between parenting/feeding style and outcome was null.
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foods. The uninvolved feeding style was negatively associated withchild evening intake of dairy (Hoerr et al., 2009). Overall, theauthoritative feeding style was associated with higher intake ofdairy among children, and potentially, the indulgent feeding stylemay also be associated with higher child dairy intake if the childprefers dairy foods.
Weight specific outcomes
Two studies did not find any significant relationships betweenfeeding styles and child weight (Moens et al., 2007; Moroshko &Brennan, 2012). Four of the six studies that examined the relation-ship between feeding style and child weight status found a signif-icant, positive relationship between the indulgent feeding styleand child weight status (Hennessy et al., 2010; Hughes et al.,2005, 2008; Tovar et al., 2012), One additional study also con-firmed this relationship only among Hispanic boys (Hughes et al.,2011). The indulgent feeding style alone explained as much as26% of the variance in child BMI z-score, and thus seems to be astrong predictor of child weight status (Tovar et al., 2012).
Discussion
The objective of this review was to examine the literature eval-uating the relationship between parenting style and/or feedingstyle on childhood obesogenic behaviors and body weight. Only se-ven studies examining the relationship between parenting styleand child weight and obesogenic behaviors are longitudinal, whileall feeding style studies reviewed are of cross-sectional design. Inthe broad scope of parenting style and feeding style, it appears thatthe authoritative parenting and feeding style is associated withdesirable behaviors such as increased fruit and/or vegetable intake,physical activity, and lower risk of child overweight. This is sup-ported by the results of four longitudinal studies. The authoritativeparenting style lowered the risk of childhood overweight or obesity(Berge, Wall, Loth, et al., 2010; Olvera & Power, 2010; Rhee et al.,2006) and, development of negative health risk behaviors, suchas low-grade nutrition, sedentary leisure time activities, nicotineand/or alcohol consumption, and risk behavior (Lohaus et al.,2009).
Although there were no longitudinal studies conducted examin-ing the relationship between feeding styles and childhood obesityrisk factors, in cross-sectional studies, it appears that the authori-tative feeding style is also desirable, and has been associated withhigher vegetable and dairy intake (Hughes et al., 2007; Patricket al., 2005), lower intake of low-nutrient dense foods and fatsand oils (Hennessy et al., 2012) and, lower risk of child overweightor obesity (Hughes et al., 2005; Tovar et al., 2012).
Additionally, the relationship between the indulgent feedingstyle and/or permissive parenting style and childhood obesity re-lated outcomes appears to put children at higher risk for develop-ing overweight or obesity with 12 studies showing a positiverelationship between the indulgent feeding style or permissiveparenting style and child BMI. In fact, three longitudinal studiesfound that the permissive parenting style was found to have aninfluence on higher child weight. Although no longitudinal studieshave examined the relationship of parental feeding style and childweight, the predictive effects of the indulgent feeding style aloneare very robust, explaining approximately 26% of the variance inchild weight even after controlling for parent BMI in a cross-sec-tional study (Tovar et al., 2012). As children are introduced to solidfoods, they are predisposed to like sweet and salty, calorically-dense foods, and reject any new foods (Birch & Anzman, 2010). Ifa parent does not continue to expose the child to new foods andattempt to add variety to the child’s diet, then it may be difficultfor the child to learn to like new foods such as vegetables (Birch& Anzman, 2010). Characteristically, the indulgent parent willnot place many demands on his/her children in terms of whatfoods to eat or how much food to eat, instead, these parents willcater to his/her child’s preferences (Hughes et al., 2008). Thus,the child’s predispositions for neophobia, especially during thepreschool years, and the preference for sweet, salty, calorically-dense foods may carry on and possibly result in poor diet quality,thus increasing the risk of high BMI (Birch & Anzman, 2010).
Interestingly, three longitudinal studies provided evidence thatthe authoritarian parenting style influences a child to gain exces-sive weight and one cross-sectional study found that theauthoritarian parenting style was positively associated with childweight status, while the authoritarian feeding style was not linkedto child weight status by any study (Berge, Wall, Loth, et al., 2010;Fuemmeler et al., 2012; Lane et al., 2013; Rhee et al., 2006). The
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reason for these differences in the findings between feeding stylesand parenting styles may be due to the age of the children beingstudied or the variables that are measured. While the parentingstyle literature focuses mostly on adolescent and school age chil-dren, most of the feeding style literature evaluates the preschoolchild. Children in preschool may benefit more from an authoritar-ian feeding style because high demands for a child to eat healthfulfoods such as fruits and/or vegetables and restriction of high en-ergy dense foods, such as chips or cookies, may act to keep childweight low when the child is young (Fuemmeler et al., 2012). How-ever, as the child ages, this feeding style may no longer be benefi-cial because the child may not be able to gauge their hunger orfullness cues and may rely on environmental cues such as a ‘‘cleanplate’’ (Fuemmeler et al., 2012).
Limitations in current literature
The parenting style studies reviewed used ten different vali-dated measures while other studies used unvalidated measuresdeveloped by specific authors, which resulted in different concep-tualizations of parenting style and dimensions. The dimension de-fined as demandingness by Maccoby and Martin wasconceptualized as several different things including psychologicalcontrol, behavioral control, strictness, or lax to firm control (Dar-ling & Steinberg, 1993). Further, the responsiveness dimensionwas conceptualized differently as well; for example, this dimen-sion was also called warmth, involvement, or support. With thesedifferent combinations of dimensions, not all measurements re-sulted in the same typologies of parenting style. For instance, theAuthoritative Parenting Index assigned parents into either author-itative or nonauthoritative parenting styles while the ParentingDimensions Inventory assigned parents into authoritarian, author-itative, permissive, or neglectful styles. With these variations inmeasurements and conceptualization of style dimensions it makesit very difficult to understand the relationship between parentingstyle and childhood obesity related risk factors outcomes, and thuscomparisons are limited. In addition, because feeding style andparenting style are not synonymous, it is difficult to understandthe relationship between parenting style and childhood obesityrisk factors, and it has been suggested that parenting style is toobroad to impact child eating behavior, dietary intake, physicalactivity, and/or body weight (Mitchell et al., 2013). However, someresearchers argue that when median splits are used, multi-dimen-sional aspects of parenting may be lost (Riesch et al., 2013; Van derHorst et al., 2007).
Additionally, studies often relied on different individuals, usu-ally parents or adolescents, to report on parenting style. Whileboth are subjective reports, adolescents and parents may reportdifferently on parenting style. To illustrate this, Taylor, Wilson, Sla-ter, and Mohr (2011) discovered differences for child reported andparent reported parenting dimensions. Child reported parentdemandingness was positively related to child liking of fruits andvegetables, while child reported responsiveness was positively re-lated to child liking of fruit and negatively related to child liking ofnon-core food items. The same relationship did not exist for theparent reported dimensions. Only parent-reported responsivenesswas shown to have significant, negative relationship with child in-take of non-core food items (Taylor et al., 2011a). Thus, one shoulduse caution when comparing results of these parenting style stud-ies due to inconsistencies in measurements and, conceptualizationof parenting styles and parenting dimensions.
Although parental feeding styles are now recognized as animportant factor in the development of child eating behaviors, die-tary intake, and body weight (Hughes et al., 2008), many research-ers fail to include other parameters that may impact thisrelationship. Conceptually, parent feeding styles moderate the
relationship between parent feeding practices and child eatingbehaviors or diet intake but, they do not have a direct relationshipon childhood obesogenic behaviors. For example, restriction andmonitoring a child’s dietary intake is detrimental when a parentalso has an indulgent feeding style, but is more successful for thoseparents who do not have an indulgent feeding style (Hennessyet al., 2012). These results highlight the complexity of the influenceparents have on their children’s dietary behaviors and thus, weightstatus (Rhee, 2008). Additionally, some studies fail to control forcovariates that have been linked to the relationship maternal par-enting style and child weight, such as depression (Topham et al.,2009).
Recommendations and implications for future research
Because parental feeding style is more specific to the feedingenvironment, it may be more informative to measure feeding styleinstead of parenting style when studying the relationship withchildhood obesity risk factors. Furthermore, parenting style doesnot directly predict feeding style (Hennessy et al., 2010; Mitchellet al., 2013). It is not clear how feeding style develops and how par-enting style may influence feeding style (Mitchell et al., 2013). Fur-thermore, because researchers are using a variety of instruments tomeasure parenting styles, some of which are not validated, the par-enting style literature may benefit from additional observationalresearch approaches, such as videotaping in the home, to validatesome of these measures. While the results of the studies examiningthe relationship between feeding style and childhood obesity re-lated outcomes are relatively consistent, all of the reviewed studiesare cross-sectional. These cross-sectional studies assume a unidi-rectional relationship and do not give any information about thedirection of the relationship between the feeding style and thechildhood obesity related risk factor. These studies are assumingthat parental feeding style influences a child’s weight and/or eatingbehavior, however, it is most likely a reciprocal relationship (Ven-tura & Birch, 2008). More specifically, the way a parent perceiveshis or her child’s weight or eating behavior may influence theirfeeding style (Ventura & Birch, 2008). Thus, there is a need for lon-gitudinal or experimental studies to examine the direction of influ-ence between parent feeding style on childhood obesogenicbehaviors and body weight.
Further, some studies only obtained measures on weight and ig-nored child behaviors, including food intake, or other parentbehaviors, such as feeding practices. Not only is there a need forlongitudinal studies, but there is a need for these studies to collectinformation with at least three points of influence: parent relatedvariables, child related behaviors, and child weight (Ventura &Birch, 2008). Parent related behaviors should not only includefeeding style, but also parent feeding practices and parent charac-teristics such as BMI. Originally, Macoby and Martin (1983) sug-gested that the high responsiveness characteristic of theauthoritative parenting style can influence the child to be moreopen to the parent’s practices or demands. From this prospective,parental feeding style could serve as a moderator between feedingpractices and childhood obesity related outcomes. It may not bethe authoritative feeding style itself that is protective, but thatthe practices that are employed by these parents are more influen-tial on the children because children are more receptive to them.Hennessy et al. (2012) provided evidence for this hypothesis byshowing that parents with the indulgent feeding style and highmonitoring practice reported higher child intake of low-nutrientdense foods. Conversely, when parents had a non-indulgent feed-ing style and practice high monitoring, it was associated with low-er child intakes of low nutrient dense food (Hennessy et al., 2012).Because it is hypothesized that the authoritarian feeding style mayteach the child to ignore hunger and fullness cues, child eating
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behaviors, such as breakfast skipping, or appetitive traits, such assatiety responsiveness, should also be included in future studies.In addition, more studies are needed to examine the relationshipbetween feeding styles and child intake of certain food groups,while also controlling for total caloric intake. Thus, researchersshould collect information related to parent feeding style, parentfeeding practices, child eating behavior, child dietary intake andchild weight over time to better understand these complexrelationships.
When measuring parental feeding styles, the CFSQ categorizesparents into one of four feeding styles based on median splits ofdemandingness and responsiveness. As stated above, and as evi-denced by Van der Horst et al. (2007), information could be lostby only examining the high and low dimensions of responsivenessand demandingness. It is unknown if there is a difference betweenparents who are closer to the median split vs. those that are at theextreme high or low ends of the dimensions and thus, more infor-mation could be gained if these dimensions are split into quartiles(Hughes et al., 2012).
Another component missing from the current feeding style lit-erature is the influence of the paternal feeding style. Oppositesex relationships among dyads in parenting style research indicatethat fathers may offer a unique influence, but the relationship hasyet to be studied in feeding styles. All of the studies focused on thematernal feeding style and it is not known how the father’s feedingstyle influences the child’s eating behavior and/or weight.
This review provides evidence that researchers interested inchildhood obesity interventions should consider parental feedinginfluences on child eating behaviors and weight and, utilize themas agents of change (Faith et al., 2012). While general parentinghas been targeted in interventions, feeding styles have yet to bea target for childhood obesity interventions and thus could proveto be an effective target considering the fact that interventions thatemploy parent involvement are generally more successful com-pared to interventions that target children only (Golan & Weizman,2001). Because parenting and feeding styles are not synonymous,future researchers should focus on feeding style because parentingstyle may be too broad to influence child dietary intake or bodyweight (Mitchell et al., 2013). Based on the current literature, chil-dren of parents with an indulgent feeding style may be at a higherrisk of becoming overweight or obese compared to children of par-ents with the authoritative feeding style. However, further re-search is needed to fully understand the parent–child feedingrelationship.
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