Elsevier

Appetite

Volume 92, 1 September 2015, Pages 167-172
Appetite

Research report
Higher weight status of only and last-born children. Maternal feeding and child eating behaviors as underlying processes among 4–8 year olds

https://doi.org/10.1016/j.appet.2015.05.021Get rights and content

Highlights

  • Association of birth order with weight status mediated by mealtime behaviors.

  • Only child status associated with higher maternal discouragement and lower praise.

  • Youngest sibling status associated with lower praise and child food fussiness.

  • Only children and youngest siblings are more likely to be overweight/obese.

Abstract

Birth order has been associated with childhood obesity. The objective of this cross-sectional study was to examine maternal feeding and child eating behaviors as underlying processes for increased weight status of only children and youngest siblings. Participants included 274 low-income 4–8 year old children and their mothers. The dyads completed a videotaped laboratory mealtime observation. Mothers completed the Caregiver's Feeding Styles Questionnaire and the Children's Eating Behavior Questionnaire. Child weight and height were measured using standardized procedures. Path analysis was used to examine associations of birth order, maternal feeding behavior, child eating behavior, and child overweight/obese status. The association between only child status and greater likelihood of overweight/obesity was fully mediated by higher maternal Verbal Discouragement to eat and lower maternal Praise (all p values < 0.05). The association between youngest sibling status and greater likelihood of overweight/obesity was partially mediated by lower maternal Praise and lower child Food Fussiness (all p values < 0.05). Results provide support for our hypothesis that maternal control and support and child food acceptance are underlying pathways for the association between birth order and weight status. Future findings can help inform family-based programs by guiding family counseling and tailoring of recommendations for family mealtime interactions.

Introduction

Childhood obesity rates in the United States (US) continue to be excessively high (Ogden, Carroll, Kit, & Flegal, 2014). Although evidence for effective intervention strategies is scarce, family-based programs can be effective in achieving and maintaining weight loss among preschool and school-aged children (Epstein et al, 1994, Kaplan et al, 2013, Quattrin et al, 2012). Understanding how family structure is associated with child weight status can help inform family-based programs and allow efficient tailoring of recommendations that involve interactions between family members. Such interventions are especially needed for low-income children who may live in chaotic and unstable homes (Evans, 2004), and who are at higher risk for obesity (Ogden et al., 2014).

Birth order has been found to be associated with child overweight and obesity (Haugaard et al, 2013, Hesketh et al, 2007, Hunsberger et al, 2012, Mosli et al, 2015, Ochiai et al, 2012). Although findings are inconsistent, studies that examined only children, oldest siblings, and youngest siblings in separate birth order categories found that only children and youngest siblings have higher risk of obesity compared to oldest siblings (Haugaard et al, 2013, Hesketh et al, 2007, Hunsberger et al, 2012, Mosli et al, 2015, Ochiai et al, 2012). The underlying process for increased obesity risk of only children and youngest siblings is not well established (Chen, Escarce, 2010, Haugaard et al, 2013, Hunsberger et al, 2012). This is primarily due to the use of less comprehensive behavioral measures in previous studies and/or less discrete categorization of birth order (i.e., combining only children and oldest siblings in the same comparison group) (Chen, Escarce, 2010, Drucker et al, 1999, Duke et al, 2004, Haugaard et al, 2013, Hesketh et al, 2007, Hunsberger et al, 2012, Ochiai et al, 2012). Evidence from social science research suggests that children within the same family can experience a non-shared home environment and dissimilar parenting behavior (Dunn, Plomin, 1991, Hotz, Pantano, 2013, Kidwell, 1981). Such behavioral variations might explain the association between birth order and weight status.

Parents often use different disciplinary strategies with first-born compared to later born children (Hotz, Pantano, 2013, Kidwell, 1981), and siblings may interact differently among each other depending on their sex and birth order (Kidwell, 1981). Only children experience a unique home environment, which may be characterized by greater parental attention (Trent & Spitze, 2011). Greater parental attention may be manifested in well-established rules and boundaries. On the other hand, the home environment of a youngest sibling might be characterized by less parental involvement and less stringent parenting practices compared to first-born children (Hotz & Pantano, 2013). The home environment of a youngest sibling also includes the presence of older siblings who can act as potent role models and secondary caretakers (Abramovitch et al, 1979, Dunn, 1983). These distinctive behavioral interaction features of the home environment may also operate in the mealtime context and play a role in shaping child weight status.

Highly demanding and controlling parental feeding practices, such as restriction and pressure to eat, have been associated with maladaptive eating behaviors and higher weight status among children (Drucker et al, 1999, Fisher, Birch, 1999, Fisher, Birch, 2002, Johnson, Birch, 1994). It has been suggested that such parenting practices may alter the child's ability to self-regulate and respond to internal satiety cues, leading to overeating and weight gain (Drucker et al, 1999, Faith et al, 2004, Fisher, Birch, 1999, Fisher, Birch, 2002, Johnson, Birch, 1994). However, appropriate control that is exerted in a warm and supportive manner has been associated with a healthy weight status, such that adaptive parental involvement and praise may encourage internalized control and healthy eating behaviors (Patrick et al, 2005, Rhee et al, 2006, Stanek et al, 1990, Vereecken et al, 2004).

In the context of general parenting, only children compared to youngest siblings experience different degrees of parent control and involvement (Conley, Glauber, 2006, Hotz, Pantano, 2013, Kidwell, 1981). Therefore, we hypothesized that feeding-specific parenting might show the same pattern. That is, excessive control and/or inadequate involvement during mealtimes may act as potential mediators in the association between only child or youngest sibling status and child overweight or obesity.

Another potential pathway involving mealtimes through which birth order might predict child weight status is the child's own eating behavior. The way a child behaves towards food (e.g., his/her response to satiety cues) can influence the quantity and quality of food consumed (Birch, Fisher, 1998, Wardle et al, 2001), and child eating behavior is associated with weight status and obesity risk (Birch, Fisher, 1998, Johnson, Birch, 1994, Wardle et al, 2001). Children are known to alter their eating behavior in response to the presence of other children (Birch, 1980, Lumeng, Hillman, 2007, Salvy et al, 2008). Since older siblings are known to exert powerful role-modeling influences on younger siblings (Abramovitch et al, 1979, Birch, 1980), and older children typically consume larger quantities of food than younger children (Piernas & Popkin, 2011), youngest siblings may be imitating the behavior of older siblings and eat larger quantities of food in the presence of their older siblings. Therefore, the eating behavior of youngest siblings might be characterized by high acceptance of food and increased food intake. Only children may also exhibit unique eating behaviors due to the absence of other children during home meals. For example, only children may be more likely to eat alone, and among school-aged children, eating alone has been associated with lower satiety responsiveness and increased food intake in the absence of hunger (Tanofsky-Kraff et al., 2007) (i.e., decreased use of internal signals of hunger and satiety as a basis for adjusting energy intake and responding with a desire to eat when a palatable food becomes freely available, even when not feeling physically hungry (Birch, Fisher, 1998, Fisher, Birch, 1999)). We therefore hypothesized that child eating behavior is a potential mediator in the association between birth order and child weight status.

In summary, the present study examined maternal feeding and child eating behaviors as underlying processes that may contribute to increased weight status of only children and youngest siblings.

Section snippets

Participants and procedures

The study sample included 301 child–mother dyads recruited through Head Start programs in South-Central Michigan. Head Start is a federally funded preschool program for low-income, high-risk families in the US. Children were between the ages of 4 and 8 years old at the time of data collection. Inclusion criteria were: caregiver is fluent in English and has less than a college degree; and child is not in foster care, was born at ≥35 weeks gestation without significant perinatal or neonatal

Results

The final sample size was 274. Mean child age was 5.4 years, and the prevalence of OWOB was 42.3%. Table 1 shows the distribution of demographic characteristics, birth weight z-score, birth order, maternal feeding and child eating behaviors for the total sample, as well as by OWOB status. In bivariate analyses, birth order, maternal feeding and child eating behaviors were associated with OWOB status (Table 1), and maternal feeding and child eating behaviors were associated with birth order (

Discussion

Results provided support for our hypothesis that the mealtime interaction features play a role in the association between birth order and child overweight/obesity. Specifically, we found that birth order was associated with maternal feeding behavior and child eating behavior, which in turn were associated with child OWOB.

For only children, we found that maternal control and involvement were involved in the pathway of association between only child status and greater likelihood of OWOB. Mothers

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    Acknowledgements: RM designed the study, analyzed the data, and drafted the initial manuscript. JL, AM, and KR designed the data collection instruments, coordinated and supervised data collection, and critically reviewed the manuscript. NK, KP, and AB provided input on the analysis plan and critically reviewed the manuscript. All authors have approved the final manuscript as submitted. This study was supported by NIH grant 5R01HD061356. Conflicts of interest: No conflict of interest was declared.

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