BACKGROUNG: The prevalence of overweight and obesity among children is on the rise. Similar to this rising tide of childhood obesity seen elsewhere, overweight and obesity among the children in Taiwan has increased considerably since the 1990s. In 1994, a survey of adolescents aged 12-15 in Taipei found that about 16.6% of boys and 11.1% of girls were obese, while an additional 11.6% of boys and 10.2% of girls were overweight. According to the 1997-2002 Nutrition and Health Survey in Taiwan (NAHSIT), about 27% of the children aged 7-12 were overweight or obese. Another survey conducted by the Ministry of Education in 2005-2006 found that about 15% of the elementary school students were overweight and 10% were considered as obese. These numbers clearly indicate that overweight and obesity among children and adolescents is an urgent public health problem in Taiwan. Parents, as food providers, enforcers, and role models, certainly have a strong influence in shaping child’s dietary behavior and weight status. However, studies have documented that parental control in children’s eating may have unintended consequences for children’s weight. There is evidence that parental control in child feeding could have adverse effects on child subsequent eating and weight status. That is, for children perceived as overweight, their parents may attempt to manage their weight status by restricting their dietary intakes and that, in fact, may make things worse. Restrictive feeding behaviors can have a differentiated effect on a child’s weight depending on the child’s overweight risk or current weight status, resulting in more harm among those who are genetically or biologically at risk and those who are already overweight. Other studies found that some parental control of child feeding would increase a standardized BMI score, after controlling for prior child weight status, among high-risk children, suggesting a reciprocal influence between child and parent. These findings underscore the need to assess the role of parents’ child-feeding practice with the family context to better understand the effectiveness and strategies in childhood obesity interventions.

METHODS: This was a longitudinal study, involving survey of parents’ feeding behavior and measurement of children’s weight and height status at the beginning of the 2008 fall semester (baseline) and again in the 2009 fall semester. After approved by the Institutional Review Board at Asia University, Taiwan, parents of all second and fourth graders in a nearby elementary school in Central Taiwan were contacted via an invitation letter brought home by their children. If the parents agreed to participate in this study, they were asked to sign a consent form and to complete a Parenting Style and Dimension questionnaire and a Child-feeding Behavior questionnaire, along with their demographic information. Children’s weights and heights were measured at the school’s student health center by a trained school nurse. Calibrated digital scales were used to measure weights and heights. Children were dressed in light clothing and without their shoes. We obtained both the 2008 and 2009 measures of weights and heights to compute BMI measurement for the same child over one year.

Parenting style and child-feeding behavior in predicting children’s weight status change in Taiwan Yao-Wen Chang 1, Ming-Chin Yeh 2, and Ho-Jui Tung1

Department of Healthcare Administration, Asia University, Taiwan1

Nutrition Program, School of Public Health at Hunter College, CUNY, New York 2

RESULTS: Among the 465 mother-child pairs included in this study, 76.8% of the mothers were between 30 to 40 years old, with a mean age of 37 years. The mean age of their children was 8.45 for boys and 8.35 for girls in 2009 (See Table 1). Using a gender- and age-adjusted Body Mass Index classification scheme issued by the Department of Health in Taiwan, 16.5% of the boys and 12.4% of the girls were considered obese (BMI≧ 95th percentile) in 2009. The obese percentages for the same boys and girls in 2008 were 14.3% and 13.2% respectively. Parenting styles were found to moderate the association patterns between several child-feeding practices, such as “concern about child weight” and “monitoring” and an overweight status in 2009 (See Table 2). First, after controlling for the weight status one year earlier, the two feeding practices “concern about child weight” and “monitoring” were significant predictors of child overweight status, but only among children with a more authoritative mother. For a more authoritative mother, if she expressed more concern about her child’s weight, the child would be more likely to be in an overweight status(O R=1.36) in 2009. At the same time, children with a more authoritative mother were less likely to be in an overweight status (OR=.77), if their mothers used more monitoring (keeping track of the sweets, snacks, and high fat foods that their children eat) toward their children’s dietary intake. The moderating effect of authoritarian parenting was contrastingly different from that of authoritative parenting. In the middle part of Table 2, we can see that concern about child weight was not a significant predictor of an overweight status in 2009 among the authoritarian mothers, but the opposite was true among the less authoritarian mothers (OR=1.35). More important, among mothers inclined to an authoritarian parenting style, more monitoring was associated with the chance of having an overweight child in 2009 (OR=1.35), which is an exact opposite a monitoring practice would do among the more authoritative mothers.

CONCLUSIONS:

1.Parenting style has a moderating effect on the relationship between specific child-feeding practices and child’s weight status. What a non-authoritative mother does in the way she feeds her child may be identical to that of an authoritative mother, but their outcomes can be quite different.

2.As suggested by the ecological framework, interventions targeting at only one-context are unlikely to have powerful or sustained effects. Interventions integrating both school and family environments may hold the key to success in childhood obesity prevention.

3.Parenting styles and parent’s feeding practices could be an important focus for future public health interventions to reduce childhood obesity.

Correspondent: htung@asia.edu.tw

Table 1. Table 1. Distribution of sample Characteristics By children’s gender

Boys (N=231) Girls (N=234)Mother mean age (SD) 37.05(4.19) 37.03(4.95)Mother’s Education (%) Junior High or less 9.9 12.8 Senior high 53.7 55.1 Some college and above 36.4 32.1Child Mean Age in 2009 8.45 (1.03) 8.35(1.02)Grade Second grader in 2008 119(51.5) 136(58.1) Fourth grader in 2008 112(48.5) 98(41.9)BMI status in 2008(%) Obese 33(14.3) 31(13.2) Overweight 48(20.8) 28(12.0) Normal weight 123(53.2) 133(56.8) Under weight 27(11.7) 42(17.9)BMI status in 2009(%) Obese 38(16.5) 29(12.4) Overweight 43(18.6) 26(11.1) Normal weight 119(51.5) 125(53.4) Under weight 31(13.4) 54(23.1)Means of CFQ Subscales (SD) Perceived responsibility 12.5(2.6) 12.6(2.2) Perceived Child weight 12.0(1.8) 11.7(1.9) Concern about child weight 7.4(3.1) 7.7(3.1) Restriction 30.4(5.0) 30.0(5.4) Pressure to eat 16.1(3.0) 16.1(2.9) Monitoring 11.3(2.6) 10.9(2.7) Perceive parent weight 12.1(1.4) 11.9(1.6)

Parenting styles Mean Authoritative parenting score (SD) 106.3(15.1) 104.7(16.9)

Mean Authoritarian parenting score(SD) 43.1(8.6) 44.1(8.9)

Mean Permissive parenting score(SD) 30.1(5.3) 30.5(6.4)

Note: BMI = Body Mass Index. CFQ = Child-Feeding Questionnaire. SD=Standard Deviation

Authoritative parenting Authoritarian parenting Permissive Parenting

Less authoritative

mother (N=219)

More authoritative

mother (N=246)

Less authoritarian

mother (N=259)

More authoritarian

mother (N=206)

Less permissive

mother (N=256)

More permissive

mother (N=209)

Overweight in 2008 63.9 *** 80.0 *** 53.8 *** 90.3*** 41.3*** 128.7***

CFQ subscales

Responsibility .85 1.24 .99 .93 1.17 .82

Perceived child weight 1.93* 1.64* 1.39 1.70** 1.77** 1.67

Concern 1.06 1.36** 1.35*** 1.04 1.14 1.35*

Restrict .99 .95 .94 .99 1.03 .94

Pressure to eat 1.07 .88 1.01 .99 .89 1.12

Monitoring 1.22 .77* .86 1.35* .96 1.06

Perceived parent weight .91 1.21 1.15 .98 .83 1.57

-2 Log Likelihood 152.53 206.92 207.65 146.85 168.51 184.58

Degree of Freedom 8 8 8 8 8 8

Table 2. Odds Ratios from logistic regression models predicting children’s overweight status in 2009 under different parenting styles