How can mindful parenting be related to emotional eating and overeating in childhood and adolescence? The mediating role of parenting stress and parental child-feeding practices
Introduction
Parents play a determinant role in shaping children's eating environment and are the most important vehicles for the implementation of eating habits (Birch & Fisher, 1998). More than providing food, parents' specific feeding strategies, concerns and beliefs regarding child feeding contribute to children's eating behavior and ultimately affect children's weight (Couch, Glanz, Zhou, Sallis, & Saelens, 2014). Moreover, the specific parental feeding practices employed may be affected by parenting stress. For instance, parents who experience higher levels of parenting stress use more controlling child-feeding practices and serve less healthy foods to their children (Berge et al., 2017). Recently, studies on mindful parenting and mindful feeding have found positive associations between these parenting approaches and healthier eating habits in children (Dalen, Brody, Staples, & Sedillo, 2015; Emley, Taylor, & Musher-Eizenman, 2017). Therefore, a new avenue of research has emerged to better explore the promising contributions of developing a mindful approach when feeding a child. Understanding how the association between parental practices and children's eating behavior occurs will allow more tailored interventions with families and children/adolescents with problematic eating behaviors. Since disordered eating behaviors are highly prevalent among youth (Neumark-Sztainer, Wall, Larson, Eisenberg, & Loth, 2011) and are considered serious public health issues that may lead to pediatric and future obesity (O'Reilly & Black, 2015), in this study, we focus on how mindful parenting may be associated with disordered eating behaviors (i.e., emotional eating and overeating) in children/adolescents. Specifically, we explore whether this association may be mediated by parenting stress and parental child-feeding practices.
In recent years, a growing number of studies have attempted to understand how parental child-feeding practices are associated with children's eating and weight outcomes (Ventura & Birch, 2008). Parental child-feeding practices encompass all behavioral strategies employed by parents to control what, how much, or when their children eat (Faith, Scanlon, Birch, Francis, & Sherry, 2004; Ventura & Birch, 2008; Wardle & Carnell, 2007). For instance, parents may employ controlling feeding strategies, such as restricting children's access to selected foods or groups of foods, using preferred food as a reward for a valued behavior, pressuring children to eat certain types or quantities of food, and monitoring what children eat (Ventura & Birch, 2008). Furthermore, parental beliefs such as concerns about child weight and perceived responsibility for feeding the child may influence parental control over child-feeding (Birch et al., 2001; Moore, Tapper, & Murphy, 2010). These feeding strategies and beliefs can influence children's food preferences and habits (Birch & Fisher, 1998) as well as children's self-regulation of food intake (i.e., satiety responsiveness; Birch, McPhee, Shoba, Steinberg, & Krehbiel, 1987) and their weight status (Birch & Fisher, 1998, 2000; Wardle & Carnell, 2007). For instance, the use of restrictive strategies has been associated with unhealthy eating behaviors such as increased eating of palatable and high energy-dense food, and with disordered eating behaviors such as emotional eating and overeating (Boots, Tiggemann, Corsini, & Mattiske, 2015; Faith et al., 2004; Ventura & Birch, 2008). Similarly, pressuring children to eat has been associated with greater intake of unhealthy foods and lower intake of healthy foods and greater pickiness and food dislikes (Fisher, Mitchell, Smiciklas-Wright, & Birch, 2002; Sleddens et al., 2014; Ventura & Birch, 2008). In contrast, monitoring the child's eating behavior has been associated with a healthier diet, greater enjoyment of food and less emotional eating (Jansen et al., 2012). Considering the significant role that parental child-feeding practices have in children's eating behavior, it is important to identify which variables may influence the implementation of a specific child-feeding practice and may promote the use of more adaptive practices.
A parental factor that may influence the adequate implementation of child-feeding strategies is parenting stress. Parenting stress is the stress that arises when parents perceive that the actual demands of parenting exceed their personal and social resources (e.g., knowledge, parenting skills, and social support) to cope with those demands (Abidin, 1995). In fact, it is very common for parents to experience some degree of parenting stress at some stage of their lives (Crnic & Greenberg, 1990). Nevertheless, the experience of high levels of parenting stress should not be neglected since it may compromise not only the caretaking of the child (e.g., more authoritarian parenting styles and less nurturing behavior; Anthony et al., 2005; Crnic & Low, 2002), but also the child's development (e.g., negative psychological outcomes; Deater-Deckard, 1998; Neece, 2014). In addition, the experience of higher levels of general stress by the parents was also found to diminish the quality of the parent-child relationship (e.g., more problematic parent-child relationships; Bögels, Lehtonen, & Restifo, 2010; Webster-Stratton, 1990). For instance, under high levels of stress, parents may react automatically and exhibit negative patterns of interaction with their child, becoming more rejecting and controlling and less warm toward them (Webster-Stratton, 1990). These interaction patterns may also be present in the child-feeding context since increased levels of stress (whether general or parenting stress) may diminish parents' ability to interpret cues of satiety from their children and lead to an increased use of controlling child-feeding practices, such as pressure to eat, restriction and monitoring, and offering more unhealthy foods to their children (e.g., Berge et al., 2017; Gemmill, Worotniuk, Holt, Skouteris, & Milgrom, 2013; Mitchell, Brennan, Hayes, & Miles, 2009).
A myriad of factors have been identified that increase levels of parenting stress, from children's characteristics (e.g., behavioral problems, emotion dysregulation, younger age of children; Williford, Calkins, & Keane, 2007) to parents' characteristics (e.g., psychopathology, attachment insecurity, self-criticism, lower levels of self-compassion and mindfulness; Casalin, Luyten, Besser, Wouters, & Vliegen, 2014; Moreira, Gouveia, & Canavarro, 2018; Moreira, Gouveia, Carona, Silva, & Canavarro, 2015; Williford et al., 2007) and contextual factors (e.g., single parenthood, low social support, having more than one child, child caretaking difficulties, negative life events; Ostberg & Hagekull, 2000; Williford et al., 2007). Recently, a parental approach that has been identified as a useful way to decrease levels of parenting stress is mindful parenting (Bögels, Hellemans, van Deursen, Römer, & van der Meulen, 2013; Bögels & Restifo, 2015). Mindful parenting is a parenting style that intentionally brings mindful awareness to everyday parent-child interactions (Bögels & Restifo, 2015; Kabat-Zinn & Kabat-Zinn, 1997) and is characterized by five parenting qualities: listening with full attention to the child, adopting an attitude of non-judgmental acceptance toward the self and the child, developing emotional awareness of the self and the child, exerting self-regulation in the parenting relationship, and directing compassion toward the self as a parent and toward the child (Duncan, Coatsworth, & Greenberg, 2009).
Developing greater mindful awareness in parent-child interactions has been demonstrated to foster positive parenting practices (e.g., more positive parent-child interactions, more positive communication with children, more involvement in childcare, less harsh and more consistent discipline; Gouveia, Carona, Canavarro, & Moreira, 2016; Lippold, Duncan, Coatsworth, Nix, & Greenberg, 2015; Parent, McKee, Mahon, & Foreh, 2016), more adaptive parenting styles (e.g., more authoritative and autonomy-encouraging; less authoritarian, overprotective and rejecting; Bögels et al., 2013; Gouveia et al., 2016), positive psychological functioning in the child (e.g., lower levels of depressive, anxiety, internalizing and externalizing symptoms, and increased well-being; Bögels et al., 2013; Moreira et al., 2018; Parent et al., 2016), and positive parental psychological adjustment (e.g., decreased levels of parenting stress, better emotional regulation; Bögels et al., 2013; Bögels & Restifo, 2015). For instance, mindful parenting-based interventions have been proven effective in reducing levels of parenting stress in parents referred to secondary mental healthcare (Bögels & Restifo, 2015) and in mothers of infants with higher levels of stress (Potharst, Aktar, Rexwinkel, Rigterink, & Bögels, 2017).
In the context of child feeding, the role of mindful parenting has rarely been investigated. The few existing studies suggest that parents with higher levels of mindful parenting tend to be more mindful feeders and to demonstrate a profile of feeding behaviors that promotes a more balanced and healthier diet in the child (Emley et al., 2017; Meers, 2013). For instance, mindful food parenting (i.e., mindfulness in parents' food-related parenting) has been associated with a lower use of food as reward and as an emotional regulation strategy, with higher availability, encouragement and consumption of healthier (i.e., fruits and vegetables) and varied food in the child (Emley et al., 2017; Meers, 2013). Given the knowledge from research in mindful parenting, mindful food parenting, and parenting practices and styles, it may be hypothesized that by developing a mindful, aware, non-judgmental and compassionate approach when interacting with children, parents will be better able to adequately recognize children's satiety cues and effectively respond to their real nutritional (as well as emotional) needs. However, the extent to which such a posture in parenting helps children/adolescents to decrease disordered eating behaviors remains unknown.
Disordered eating behaviors are significant public health concerns worldwide among youth since they contribute to poor dietary and unhealthful habits that, when present since an early age, can lead to future serious health consequences, such as obesity (O'Reilly & Black, 2015). Some of the most common disordered eating behaviors among youth are emotional eating and overeating. Emotional eating is eating in response to generally negative emotional states rather than hunger (Braet & van Strien, 1997). In contrast, overeating is engaging in episodes of uncontrollably eating large amounts of food, which are usually accompanied by negative feelings associated with eating (Eichen, Chen, Boutelle, & McCloskey, 2017; Garner, 1991). These disordered eating behaviors are generally associated with the ingestion of high-energy dense foods, leading to the development of obesity and being more common among overweight/obese youths (Gorlach, Kohlmann, Shedden-Mora, Rief, & Westermann, 2016; Tanofsky-Kraff et al., 2007). Not surprisingly, these disordered eating behaviors have been associated with dysregulated ways of dealing with private emotions and thoughts, which trigger a behavioral response of eating certain kinds or amounts of foods as an emotional relief (Evers, Stok, & Ridder, 2010; Graziano, Calkins, & Keane, 2010). Therefore, it is of utmost importance to identify factors that may contribute to such disordered eating behaviors in children/adolescents so that more tailored interventions aimed at decreasing these unhealthful behaviors among youth can be proposed.
Although little research has focused on identifying such mechanisms, some clues have been proposed. Recently, a literature review suggested that mindfulness-based interventions can be an effective way of promoting healthier eating behaviors and diminishing disordered eating behaviors among youth (O'Reilly & Black, 2015). In fact, by developing mindfulness skills, children and adolescents may interrupt the engagement in habitual behaviors, such as disordered eating behaviors, by being more aware of how their emotions and thoughts influence their behavior, allowing them to step back and make healthful decisions about food choices (O'Reilly & Black, 2015). Family-based interventions have been considered preferable ways to improve child eating habits and dietary intake because these interventions take into consideration eating habits in the family environment rather than only in the individual context of the child/adolescent (Young, Northern, Lister, Drummond, & O'Brien, 2007). Therefore, by applying the principles of mindfulness in the parenting context, parents may transmit to children, directly and indirectly, ways to adequately respond to their needs (whether emotional or nutritional).
Although the influence of parents on children's eating behavior is undeniable, the exact mechanisms by which parents exert their influence and how these mechanisms relate to each other are not well known. The current study explores an innovative model linking mindful parenting to disordered eating behaviors in children and adolescents of different weights. Specifically, it explores the mediating role of parental stress and parental child-feeding practices in the association between mindful parenting and children/adolescents' disordered eating behaviors (i.e., emotional eating and overeating). We hypothesize that when parents adopt a mindful approach to parenting, they may be more able to cope with the stress of parenting and, in turn, more capable of adopting healthier feeding practices, which may be associated with decreased engagement in unhealthier and disordered eating behaviors by the child/adolescent.
Because our sample is composed of children (aged between 7 and 11 years old) and adolescents (aged between 12 and 18 years old), girls and boys, and youths with normal weight and overweight/obesity, we also analyze whether the proposed path model is invariant across children/adolescents' age, gender and weight status. Since disordered eating behaviors seem to be more prevalent among adolescents (e.g., Klump, 2013), girls (e.g., Neumark-Sztainer & Hannan, 2000) and youths with overweight/obesity (e.g., Gorlach et al., 2016), we hypothesize that the proposed associations are stronger among these groups of children/adolescents compared to children, boys and youths with normal weight. Moreover, some studies have shown that parental child-feeding practices and parenting stress vary according to children's characteristics such as age and weight (e.g., Deater-Deckard, 1998; Jansen et al., 2012; Russell et al., 2018) and, less studied and with mixed results, children's gender (e.g., Ek et al., 2016; Mais, Warkentin, Latorre, Carnell, & Taddei, 2017; Williford et al., 2007). Therefore, we hypothesize higher levels of parenting stress and concerns about child weight and greater use of controlling feeding strategies, such as restriction and monitoring, in parents of younger children and children with overweight/obesity.
In addition, we analyze whether the proposed associations in the path model vary according to the parent's gender and weight status because mindful parenting skills, parenting stress and parental child-feeding practices may vary according to parents' gender (e.g., Deater-Deckard, 1998; Medeiros, Gouveia, Canavarro, & Moreira, 2016; Wei et al., 2018) and because parental weight status may influence the parental child-feeding practices employed and children/adolescents' outcomes (e.g., Bahreynian et al., 2017; Birch & Fisher, 2000). Therefore, we expect mothers to present higher levels of mindful parenting skills and parenting stress and to use more controlling feeding strategies compared to fathers, and we expect parents with overweight/obesity to present more dysfunctional child-feeding practices that are associated with more disordered eating behaviors in the children/adolescents.
Section snippets
Participants
The sample comprised 726 parent-child dyads. Of these, 579 (79.8%) included mothers and 147 (20.2%) included fathers. The majority of the children/adolescents were girls (n = 303, 55.5%), and the total sample of children/adolescents had a mean age of 12.76 years. From the total sample, 232 (32%) of the participants were children (7–11 years old) and 494 (68%) were adolescents (12–18 years old). Most adolescents were in the early stage of adolescence (ages 12 to 14; n = 311, 42.8%), 17.9% were
Preliminary analyses and correlations among sociodemographic, clinical and study variables
Differences between weight groups (i.e., children/adolescents with normal weight vs. children/adolescents with overweight/obesity not undergoing nutritional treatment vs. children/adolescents with overweight/obesity undergoing nutritional treatment) in the sociodemographic and clinical characteristics of parents and children/adolescents are presented in Table 1.
As presented in Table 2, with regard to the study variables, controlling for the sociodemographic and clinical variables that varied
Discussion
This study explored an integrative model suggesting that higher levels of mindful parenting skills were associated with lower engagement of children and adolescents in disordered eating behaviors through lower levels of parenting stress and, in turn, more adaptive parental child-feeding practices. Specifically, mindful parenting was negatively associated with children/adolescents' emotional eating through lower levels of parenting stress followed by less frequent use of food as a reward as well
Conclusions
Considering the great variability and availability of high-energy dense foods and the role of advertisements that stimulate disordered eating behaviors in consumption behavior in contemporary society, eating behavior is becoming more complex and a behavioral response to diverse stimuli. This complexity urges the need to integrate knowledge from different disciplines to provide more efficient interventions tailored to disordered eating behaviors. The importance of the parental role and the
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Conflict of interest
The authors of this manuscript declare no conflict of interest.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Acknowledgements
Funding: This study was funded by the Portuguese Foundation for Science and Technology (grant number SFRH/BD/102722/2014).
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