Parental feeding behavior and children's fat mass

The number of overweight children and adolescents increased dramatically from 1980 to 1994 (1), and the latest data indicate that the number is even higher today (2). The increasing number of overweight children and adolescents is often attributed to modern lifestyles that tend to foster an imbalance between energy intake and energy expenditure (3), resulting in positive energy balance and, hence, fat deposition. Because overweight children and, particularly, overweight adolescents become overweight adults, reversing the trend of increasing adiposity in children and adolescents is an important strategy for reducing the number of overweight adults. This, in turn, should reduce the many complications associated with being overweight, including type 2 diabetes, the prevalence of which is also increasing dramatically in children, adolescents, and adults (4). Thus, efforts are underway both to reduce energy intake, particularly fat intake, and to increase physical activity. Although some progress has been made toward reducing fat intake and perhaps increasing physical activity, reducing total energy intake remains a challenge. The study by Spruijt-Metz et al (5) in this issue of the Journal suggests that changing parental feeding behaviors may help to modify children’s intakes. In this study, maternal scores on 2 subscales of a previously validated Child Feeding Questionnaire (6), pressure to eat and concern for child’s weight, accounted for 15% of the variance in the children’s fat mass. Others have shown effects of parental feeding strategies not only on children’s body mass index (BMI) and weight-forlength percentile but also on food intake (7, 8). These new data expand this general area of research to include the effects of parental feeding strategies on fat mass as measured by dualenergy X-ray absorptiometry, rather than only on BMI, the use of which is problematic in children and early adolescents (9). The study also expands previous findings conducted primarily in white girls to both boys and girls as well as to both white and African American children and adolescents. Logically, influences of parental feeding strategies on body fat mass should be mediated by differences in either total energy intake or fat intake. However, in this study, nonfat energy intake explained only 5% of the variance in body fat mass and neither energy intake from fat nor, presumably, total energy intake explained any of the variance. This raises the question of whether parental feeding behaviors affect fat mass directly or rather simply reflect the parents’ responses to their children’s inappropriate body fat mass, regardless of how or when it became inappropriate. Such questions are likely to be disturbing to those of us involved in what we consider more traditional or more mainstream nutritional research. As discussed by Spruijt-Metz et al, the cross-sectional nature of their study does not permit conclusions concerning cause and effect. On the other hand, considerable evidence from other studies suggests that the eating behaviors of children and adolescents are affected by parental feeding behaviors. Specifically, restrictive feeding practices, which in the study by Spruijt-Metz et al were highly correlated with concern for the child’s weight, are associated with higher energy intake and higher BMI whereas parental pressure to eat secondary to concerns that the child is too thin is associated with lower energy intake and lower BMI. Studies also have shown that parents who think their children are overweight or at risk of becoming overweight are more likely to practice restrictive feeding behaviors and those who think their children are too thin are more likely to attempt to increase intake (10). To further illustrate the complexity of eating behavior, parental eating behavior and weight status also appear to influence children’s eating behaviors (11).