Household structure within existing parent feeding literature: An umbrella review
Creators: name: Cocks, Genevieve
name: York, Andrea
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Dietetics and Clinical Nutrition
subject: Medicine and Health Sciences
subject: child weight outcomes
subject: feeding practices
subject: parental feeding practices

description: With the prevalence of childhood overweight and obesity being at an all-time high, one of the greatest public health priorities is the prevention and treatment of the chronic disease (Brown et al., 2017; Faith et al., 2004; Kiefner-Burmeister et al., 2014; Rodgers et al., 2013). In Australia, statistics from 2017-2018 show that one in four children aged 2-17 years (25%) are considered either overweight or obese which is a figure that has gradually increased since the early 1990s (Australian Institute of Health and Welfare, 2020). Obesogenic traits including dietary habits and psychological and socio-cultural associations with food developed in earlier childhood are expected to continue into adulthood (Boswell et al., 2019; Brown et al., 2017; Clark et al., 2007). As such, the establishment of overweight and obesity in early childhood has been linked to increased risk of adverse health outcomes alongside greater healthcare costs in adult life (Brown et al., 2017; Faith et al., 2004; Rodgers et al., 2013; Ruggiero et al., 2021). During childhood development, parents contribute to the formation of eating behaviours and relationships with food as well as the provision, content, timing and structure of meals (Boswell et al., 2019; Rodgers et al., 2013). As such, the feeding practices used by parents within the food environment play a significant role in the development of childhood overweight and obesity (Boswell et al., 2019; Rodgers et al., 2013). These parental feeding practices influence the development of obesogenic traits as they are directly related to dietary intake and how the child perceives mealtimes (Boswell et al., 2019; Rodgers et al., 2013; Russell et al., 2016). Due to the modifiable nature of such practices, the identification of those associated with childhood overweight and obesity risk is an important step to preventing initial onset of the disease (Russell et al., 2016). Definitive parental feeding practices have been developed from broader parenting styles to standardise, compare and explore the effects of parenting attitudes, beliefs and behaviours. Over time, a collaborative effort by researchers Baumrind, Maccoby and Martin (1983) operationalised four parenting styles known as ‘authoritative parenting,’ ‘authoritarian parenting,’ permissive/indulgent parenting,’ and ‘uninvolved parenting’. Such parenting styles were conceptualised across a continuum of two parenting dimensions; demandingness - the amount of control a parent exerts, and responsiveness - the acceptance and warmth a parent shows in response to the needs of the child (Maccoby &amp; Martin, 1966). This same continuum provides the foundation of parent feeding styles, where the dimensions of demandingness and responsiveness are applied to the feeding context, and are mealtime specific (Shloim et al., 2015). Furthermore, the particular goal-orientated behaviours that are used by parents to influence child eating are referred to as parental feeding practices (Shloim et al.,2015). Due to the large body of research available on feeding practices, as well as the direct (and modifiable) impact that parental feeding practices can have on child outcomes, parental feeding practices will be the focus of this umbrella review. However, given the evolving area of research and the multitude of feeding practices that exist, inconsistencies in feeding practice terminology have created challenges in understanding the impact of specific practices (Vaughn et al, 2016). To navigate this, a conceptualised content map developed by Vaughn and colleagues (2016), outlines three overarching feeding practice constructs; coercive control, structure and autonomy support; along with specific sub-constructs which will be used within the umbrella review to guide cross-study comparisons of feeding practice terminology. Through the literature, parental feeding practices falling under the ‘coercive control’ construct (food restriction, pressure to eat, food based threats and bribery), have been shown to lead to negative child weight outcomes with findings of both overweight and underweight (Brown et al., 2016; Kiefner-Burmeister et al., 2014; Powell et al., 2017; Rollins et al., 2014; Haszard et al., 2019). It has been suggested that a possible cause is due to the bidirectional influence that child eating behaviours can have on particular parental feeding practices (Vaughn et al, 2016). In contrast, parental feeding practices falling under both ‘structure’ and ‘autonomy support’ constructs (modeling of healthy eating, provision of healthy foods, child involvement and encouragement of healthy food behaviours), has shown positive child weight outcomes (Boswell et al., 2019; Haszard et al., 2019; Murashima et al., 2012; Rollins et al., 2014). When looking specifically at parent feeding practices in relation to child behavioural and weight outcomes, the vast majority of findings have primarily focused on mother-child dyads or nuclear family structures. Traditional gender roles supported such literature in which the husband/father took on the role as primary breadwinner while the wife/mother acted as the primary caregiver, taking on majority of child care responsibilities (Kramer &amp; Kramer, 2016; Ledin et al., 2007; Morin, 2012). Gender ideologies have since evolved towards a more egalitarian division of paid and unpaid work, resulting in fathers having a greater role in child care (Kramer &amp; Karmer, 2016). In the past decade, fathers' roles in child feeding have received greater attention in the literature, likely due their increasing involvement. Limited research, however, can be found on children in non-traditional household structures such as co-parenting arrangements. Such arrangements have increased in Australia from 6.2% to 11.6% between 2002 and 2015 and are increasingly popular in many Western countries (Smyth, 2017; Smyth &amp; Chisholm, 2017). These arrangements involve children spending 25-50% of their time with each parent (Smyth, 2017). This umbrella review aims to identify how household structures are currently represented in the literature in regard to parental feeding practices and child outcomes. Given the evolution of gender roles and different household structures, this research is an important step to be able to provide recommendations as to how future research on the topic can effectively integrate data from families with co-parenting arrangements.