RESEARCH ARTICLE
Parental Attitudes, Body Image Disturbance andDisordered Eating Amongst Adolescents andYoung Adults: A ReviewRachel Rodgers* & H. Chabrol
Centre d’Etudes et de Recherche en Psychopathologie, Universite Toulouse-II Le Mirail, France
Abstract
Objective: The purpose of this paper was to review the existing literature regarding the contribution of parental
influences to the sociocultural pressures on body image disturbance and disordered eating so as to highlight
principal findings so that parents can be given practical information and identify areas that require further research.
Methods: Relevant articles were located through Pubmed, Sciencedirect and PsychInfo, as well as the screening of
bibliographies.
Results: The available data suggest that parents are strong communicators of sociocultural pressures. Parental
influences via verbal messages and active encouragement have been shown to have more impact on offspring’s body
concerns and eating behaviours than modelling effects. Both mothers and fathers are important sources of influence
for their offspring.
Conclusion: Considering the role of parents could help improve public health management. Futher exploration of
the way adolescents and young adults interpret and perceive parental attitudes and of potential protective factors is
necessary. Copyright # 2009 John Wiley & Sons, Ltd and Eating Disorders Association.
Keywords
eating disorders; body image; parental influences
*Correspondence
Rachel Rodgers, CERPP, Maison de la Recherche, Universite de Toulouse-Le Mirail, 5 Allees Antonio Machado, 31058 Toulouse Cedex,
France.
Email: [email protected]
Published online 7 January 2009 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/erv.907
Introduction
In recent years, much effort has been devoted to
understanding factors contributing to the development
of body image disturbance and disordered eating (Stice,
2002). High levels of body dissatisfaction and weight
concerns, linked to disordered eating, are widespread in
western societies, occurring at particularly high
frequencies during adolescence and early adulthood
(Neumark-Sztainer, Paxton, Hanna, Stat, Haines, &
Story, 2006). Although most research has focused on
negative body image and disordered eating patterns in
girls, there is growing recognition that these concerns
Eur. Eat. Disorders Rev. 17 (2009) 137–151 � 2009 John Wiley & Sons, Ltd and
are not gender-bound (Paxton, Eisenberg, & Neumark-
Sztainer, 2006). Body dissatisfaction, disordered eating
and extreme methods of weight control are strong risk
factors for developing eating disorders (Thompson,
Heinberg, Altabe, & Tantleff-Dunn, 1999), and are
costly disturbances in psychological, personal, inter-
personal and financial terms (Crow & Peterson, 2003;
Hay & Mond, 2005; Paxton, Neumark-Sztainer,
Hannan, & Eisenberg, 2006).
Sociocultural pressures to conform to the ‘thin-ideal’
that pervades western societies are considered to exert a
strong influence on body image, especially among
adolescents who are particularly vulnerable to these
Eating Disorders Association. 137
Parental Influence on Eating Disorder R. Rodgers and H. Chabrol
messages (Cafri, Yamamiya, Brannick, & Thompson,
2005). By creating a discrepancy between reality and the
unrealistic body-deals portrayed, these pressures are
thought to play an important role in body dissatisfac-
tion (Cafri et al., 2005). Body dissatisfaction has, in
turn, been found to be an important predictor for
weight-loss strategies (McCabe & Ricciardelli, 2001;
Neumark-Stzainer, Paxton, Hanna, Stat, Haines, &
Story, 2006), and restrictive eating and bulimic
symptomatology (Dunkley, Wertheim, & Paxton,
2001; Keery, van den Berg, & Thompson, 2004; van
den Berg, Thompson, Obremski-Brandon, & Coovert,
2002, Wertheim, Koerner, & Paxton, 2001).
Sources of sociocultural pressures are numerous, and
involve explicit and implicit messages that appear to be
conveyed by the media and by important-others such as
peers, siblings or parents. (Thompson et al., 1999).
During adolescence and young adulthood parents can
be considered to be primary targets for identification,
and gender-role models, in particular regarding
attitudes towards body shape and eating. Exploring
the part played by parents is of particular importance as
they can be presumed to be trying to act in their
children’s best interests. In view of prevention,
identifying parental attitudes and behaviours is
necessary in order to develop and deliver appropriate
interventions. Therefore there is much to be gained
from a better understanding of the behaviours and
attitudes that foster body shape concerns and eating
problems amongst their offspring.
A developing body of research has investigated the
role of the family factors involved in the appearance of
body image disturbance and disordered eating. How-
ever, there is, to our knowledge, no existing review of
this evidence. The aim of the present paper is therefore
to provide a review of the literature concerning
adolescents and young adults by considering in turn:
methodological issues identified in the research
literature, parent influences in the light of other sources
of influence, mechanisms of action and mediating
variables that may account for their influence on body
shape concerns and disordered eating amongst their
offspring, and lastly gender considerations.
Method
The studies to be reviewed were located by a
combination of methods. We first conducted a search
on PsychINFO, Medline and ScienceDirect using the
138 Eur. Eat. Disorders Rev. 17 (2009)
search terms eating disorders or disordered eating or
body dissatisfaction, parents or family, and adolescents
over the period from 1985 to the present. This was then
completed by a manual search of the reference tables of
relevant articles. Criteria for inclusion were that articles
had been published in English in peer-reviewed
journals; reported research conducted with adolescent
or young adult samples; and separated influence from
parents from other sources of sociocultural pressures in
their analysis. We further excluded studies using clinical
samples as family attitudes concerning weight and
eating might have been influenced by diagnosis and
treatment interventions.
We located 56 relevant publications, of which 38 were
conducted in North America, 14 in Australia and New
Zealand, and 4 in European countries. The sample size
varied between 51 and 98 758. Of these studies,
22 included data from daughters only, 2 from sons
only, 17 from daughters and sons, 9 from daughters and
mothers, 2 daughters and both parents, 2 mothers and
their sons and daughters, 2 children of both gender and
both parents. Of these, 3 were longitudinal in design
and 53 were cross-sectional (Table 1).
Methodological issues identifiedin the research literature
Constructs and methods of assessment
In the literature to be reviewed, both body dissatisfac-
tion and disordered eating are most frequently assessed
by means of self-report measures. In addition to the
general biases that can result from self-report assess-
ment tools such as tendencies to under-report socially
undesirable behaviours, these scales may affect data in
other ways. In particular, measures of body dissatisfac-
tion may be more or less gender-appropriate, thus
partially accounting for differences in the literature.
Body dissatisfaction can be defined in terms of
affective, cognitive and behavioural components that
together form a person’s subjective evaluation of their
body image (Thompson et al., 1999). As such, there
have been various methods developed to assess it: a first
means of assessment involves self-report measures of
dissatisfaction on Likert-like scales, the most frequently
used of which is the Eating Disorders Inventory-Body
Dissatisfaction subscale (Garner & Olmsted, 1984).
However, many items on scales such as these appear to
be very much aimed at assessing women’s dissatisfac-
137–151 � 2009 John Wiley & Sons, Ltd and Eating Disorders Association.
Table 1 Summary of the characteristics of the reviewed article
Author Year Country Sample characteristics Body image and disordered
eating outcomes
Ata, R.N. 2007 USA 100 females, age¼ 15.8 BD, DE (EAT-26)
77 males, age¼ 15.8
Attie, I. 1989 USA 193 daughter, (t1)age¼13.93,
(t2)age¼ 15.93 and mother dyads
BD, DE (EAT-26, DEBQ-R)
Baker, C.W. 2000 USA 47 daughters, age¼18.6� 1.2 with
46 mothers, and 36 fathers
DE (EAT-26)
44 sons, age¼ 19.1� 1.2 with
41 mother, and 30 fathers
Benedikt, R. 1998 Australia 89 daughter, age¼ 15.9� 0.76,
mother dyads
BD, UWLB, DR
Byely, L. 2000 USA 77 daughter, (t1) age¼ 12.3,
(t2) age¼ 13.3 and mother dyads
BD, DE (EAT-26)
Davis, C. 2004 Canada 158 female, age¼ 21.04� 2.74 Weight preoccupation: BD
(EDI-BD/DT/BU)
Dixon, R. 1996 NZ 232 female, age¼ 13.97� 0.75 Dieting beliefs
Dunkley, T.L. 2001 Australia 577 female, age¼ 15.5�0.40 BD (FRS), DR (DEBQ-R)
Edmunds, H. 1999 UK 200 female, age¼ 12.08 DR (DEBQ-R)
202 male, age¼ 12.08
Elfhag, K. 2005 Sweden 279 daughter, age¼16,8� 0.4
and mother dyads
BD (EDI-BD); DE (EDI-DT/BU), DR;
emotional and uncontrolled eating
202 sons, age¼ 16,9� 0.4 and
mother dyads
Field, A.E. 2001 USA 6770 female, age¼ 9–14 Weight concerns, constant dieting
5287 male, age¼ 9–14
Fulkerson, J.A. 2002 USA 429 female, age¼ 14.6�1.7 Weight concern
381 male, age¼ 14.6�1.7
Less and more extreme
weight control behaviours
2006 USA 49,620 female, age¼ 6th–12th grade Binge/purge behaviours,
excessive weight loss
49,138 male, age¼ 6th–12th grade
Fulkerson, J.A. 2007 USA 684 female, age¼ 7th–12th grade,
BMI�85th percentile
BD, UWCB
667 male, age¼ 7th–12th grade,
BMI�85th percentile
Griffiths, J.A. 2000 Australia 111 female, age¼ 12.46 BD (EDI-BD), importance of
appearance, DE
Gross, R.M. 2000 USA 221 female, undergraduates
Hanna, A.C. 2006 Australia 315 female, age 14–28 BD (EDI-BD), DE (EDI-DT/BU)
Kanakis, D.M. 1995 USA 112 female undergraduates,
age¼ 18.9� 2.48
BD, DE: BU, DR, emotional and
uncontrolled eating
Keel, P.K. 1997 USA 51 daughter, age¼ 14.8� 1.8,
father mother triads
Weight satisfaction, DR,
DSM-IV criteria
Keery, H. 2004 USA 325 female, age¼ 12.6�0.90 BD (EDI-BD), DE (EDI-DT /BU)
Keery, H. 2005 USA 372 female, age¼ 12.6�0.90 BD (EDI-BD), DE (EDI-DT/BU)
Keery, H. 2006 USA 429 daughter, age¼7th–12th grade,
and mother dyads
BD, weight concerns, UWCB
381 son, age¼ 7th–2th grade, and
mother dyads
Kichler, J.C. 2001 USA 148 daughter, age¼19.3� 4.2 and
mother diads
BD, DE (EAT-40)
Laliberte, M. 1999 Canada 324 daughter, age¼17–22, and
121 mothers
DSM-IV criteria
Levine, M.P. 1994 USA 385 female, age¼ 13.20� 0.92 BD, investment in thinness,
DE (ChEAT)
(Continues)
Eur. Eat. Disorders Rev. 17 (2009) 137–151 � 2009 John Wiley & Sons, Ltd and Eating Disorders Association. 139
R. Rodgers and H. Chabrol Parental Influence on Eating Disorder
Table 1. (Continued)
Author Year Country Sample characteristics Body image and disordered
eating outcomes
Mccabe, M.P. 2001 Australia 644 female, age¼ 13.78� 1.09 BD, strategies to lose or increase
weight, binge eating
622 male, age¼ 13.94� 1.14
Mccabe, M.P. 2003 Australia 377 female, age¼ 13.69� 1.11 BD, body importance, strategies to
decrease/increase weight, increase
muscle-tone,
binge eating, food supplements
423 male, age¼ 13.92� 1.18
Mccabe, M.P. 2005 Australia 246 female, age¼ 14.22 BD, extreme weight-loss behaviours
344 male, age¼ 14.49
McKinley, N.M. 1999 USA 151 daughter, age¼ 18.41�0.73
and mother dyads
BD, Objectified Body Consciousness,
DR, dieting
Meesters, C. 2005 Netherlands 224 female, age¼ 12.5� 1.5 DE (ChEAT)
181 male, age¼ 12.5� 1.5
Nathanson, A.I. 2003 USA 160 students, age¼ 21, 220 parents,
149 siblings, age¼ 12–17
BD (EDI-BD), DE (EDI-DT/BU)
Neumark-Sztainer, D. 2004 USA 2363 female, 14.9�1.7 UWCB, Binge eating, Chronic Dieting
2383 male, 14.9�1.7
Ogden, J. 2000 UK 30 daughter, age¼17.13�0.78
and mother dyads
DR (DEBQ-R)
Paxton, S.J. 2006 USA 440 female, age¼ ,12.7� 0.74,
946 female age¼15.8� 0.81
BD
366 male age¼ 12.8� 0.76,
764 male age¼ 15.9� 0.78
Peterson, K.A. 2007 USA 191 female, age¼ 16.53 BD (EDI-BD), DE (EAT, EDI-DT)
142 male, age¼ 16.53
Pike, K.M. 1991 USA 77 mothers of daughters with
high levels of DE, age¼ 16
BD (EDI-BD), DE (EDI-DT, BU)
Pike, K.M. 1995 USA 410 female, age¼ 16� 1.2 BU (BULIT-R), dieting
Presnell, K. 2004 USA 293 female, age¼ 17 BD
238 male, age¼ 17
Ricciardelli, L.A. 2000 Australia 40 male, age¼ 12–15 BD, body change methods
Schwartz, D.J. 1999 USA 139 female, age¼ 20.26� 2.09 BD
114 male, age¼ 20.26� 2.09
Shisslak, C.M. 1998 USA 523 females, age¼9–15 BD (FRS), DE
Shroff, H. 2006 USA 391 female, age¼ 12.61� 0.85 BD (EDI-BD), DE (EDI-DT/ BU)
Smolak, L. 2006 USA 287 male, age¼ 12.9� 0.72 Drive for muscularity
Stice, E. 1996 USA 320 female high-school students BU (BULIT-R), DR (DEBQ-R)
117 female college students
Stice, E. 1998 USA 114 female students, age¼ 17–29 BD, BU (BULIT-R), DR (DEBQ-R)
218 female high-school students,
age¼16–18
Strong, K.G. 1998 Australia 141 female, age¼ 14.6 BD (EDI-BD), dieting
The McKnight Investigators 2003 USA 1103 female age¼6th–9th grade BD,DE
Twamley, E.W. 1999 USA 249 female age¼20� 2.4 BD, DE (EAT-26)
Usmiani, S. 1997 Canada 82 menstrual daughter, age¼13.42
and mother diads
BD
31 premenstrual daughter,
age¼12.5 and mother diads
Van den Berg, P. 2002 USA 196 female, age¼ 19.5 BD (EDI-BD), DE (EDI-BU/DT,
EAT-FP/ D), DR
(Continues)
140 Eur. Eat. Disorders Rev. 17 (2009) 137–151 � 2009 John Wiley & Sons, Ltd and Eating Disorders Association.
Parental Influence on Eating Disorder R. Rodgers and H. Chabrol
Table 1. (Continued)
Author Year Country Sample characteristics Body image and disordered
eating outcomes
Vincent, M.A. 2000 Australia 306 female, age¼ 13.66� 1.12 DE (EDI-DT, DEBQ-R, BULIT-R)
297 male, age¼ 13.89� 1.13
Wade, T.D. 2002 USA 323 female, age¼ 14�0.7 BD, DE
Wertheim, E.H. 1997 Australia 30 female, age¼ 14–16 BD, dieting
Wertheim, E.H. 1999 Australia 369 daughter, age¼15.8,
mother, father triads
BD, DR (DEBQ-R)
Wertheim, E.H. 2002 Australia 619 female, age¼ 12.81� 0.23 BD (EDI-BD, FRS), DE (EDI-DT, BU)
587 male, age¼ 12.08� 0.2
Young, E.A. 2004 USA 193 female undergraduates, under30 BD, BU (BULIT-R)
BD, body dissatisfaction; BU, bulimic symptoms; ChEAT, Children’s Eating Attitudes Test (Maloney, McGuire, & Daniels, 1988); DE,disordered eating, DR, dietary restriction; EAT-26, Eating Attitudes test (Garner, Olmstead, Bohr, & Garfinkel, 1982); EAT-FP/ D, EatingAttitudes Test Bulimia and Food Preoccupation subscale/Dieting subscale (Garner & Garfinkel, 1979); FRS, Figure Rating Scales (Stunkard,Sorensen, & Schlusinger, 1983); EDI, Eating Disorders Inventory (Garner & Olmsted, 1984); EDI-BD, Eating disorders Inventory BodyDissatisfaction subscale; EDI-DT/BU, Eating Disorders Inventory Drive for Thinness subscale/Bulimia subscale (Garner et al., 1984); DEBQ-R,Dutch Eating Behaviours Questionnaire Restriction subscale (Van Strien, Frijters, Bergers, & Defares, 1986); Bulit-R, Bulimia Test-Revised(Thelen, Farmer, Wonderlich, & Smith, 1991).
R. Rodgers and H. Chabrol Parental Influence on Eating Disorder
tion with their figure, with items often phrased in terms
of body areas being ‘too big’, and an emphasis on lower-
body parts such as stomach and thighs. These measures
may therefore not be as relevant to young men who are
more concerned with a muscular figure, and perturb
investigations of gender differences. Other measures of
body dissatisfaction involve the use of silhouette figure
drawings, representing weights ranging from very thin
to obese. Participants are invited to indicate which
figure they regard themselves to be most close to, and
which figure they would most like to resemble. Body
dissatisfaction is then taken as the gap between both
body sizes. Frequently used figure-rating measures
include the Figure Rating Scale (Stunkard, Sorensen, &
Schlusinger, 1983). These figures can be gender and age
specific so as to control for population differences.
However they only provide information regarding
overall appearance, and may not be as sensitive.
Reported versus perceived measures
There has been much debate over the use of measures of
attitudes towards body shape and eating reported by
parents versus those perceived by their offspring, and
the role of perception in the transmission of concerns in
these areas. A number of studies have discovered
daughters’ reports of encouragement to be thin, and
criticism to be more predictive of body dissatisfaction
and disordered eating outcomes than parents’ (Baker,
Whisman, & Brownell, 2000; Kanakis & Thelen, 1995;
Eur. Eat. Disorders Rev. 17 (2009) 137–151 � 2009 John Wiley & Sons, Ltd and
Keel, Heatherton, Harden, & Hornig, 1997; Wertheim,
Mee, & Paxton, 1999). Perception of maternal dieting
has been more strongly associated with their offspring’s
weight concerns and weight control behaviours
than maternal self-reports of dieting (Keery, Eisen-
berg, Boutelle, Neumark-Sztainer, & Story, 2006).
Interestingly, the frequencies perceived by sons and
daughters were higher than those reported by the
mothers.
However, focussing on perceived criticisms and
encouragments could bias the assessment of inter-
generational transmission of body shape and eating
concerns (Baker et al., 2000). It may be the case that
participants with higher levels of concern are more
sensitive to parental encouragement to diet or body
criticism, and tend to exagerate reports of these
behaviours. Similarly parents may be uncomfortable
reporting overt criticism of their offspring (Baker et al.,
2000). Thus, both parents’ and their offpring’s
perception and reports of the levels of family criticism
may be inaccurate, and measures of parental influences
unreliable. However, accurate measures of these
behaviours appear extremely difficult to obtain.These
results highlight the role of perception and interpret-
ation of parental attitudes and behaviours in the
shaping of their offspring’s own attitudes. Future
research should concentrate on perception when
investigating associations with disordered eating and
body shape disturbances, but could also benefit from
exploring the origin of the discrepancy between
perceived and self-reported data.
Eating Disorders Association. 141
Parental Influence on Eating Disorder R. Rodgers and H. Chabrol
Study design
As mentioned above, only 3 of the 56 articles to be
reviewed are of longitudinal design. This somewhat
limits the possibility of concluding as to the prospective
effects of parent influences on body image disturbance
and disordered eating. The majority of studies are
cross-sectional with relatively small sample-size, there-
fore the significance of their results might be considered
with a degree of caution when interpreting predictive
relationships.
Furthermore, only two of the studies to be reviewed
includes a mixed-gender sample and both parents. This
is particularly relevant when considering the relative
influence of each parent, or attempting to explore
gender differences.
Parent influences in the contextof multiple independentsociocultural agents
Three main sources of pressure have typically been
identified, namely parents, peers and the media. It has
been proposed that these sources of influence,
combined, are stronger predictors of body shape and
weight concerns than any single one (Dunkley,
Wertheim, & Paxton, 2001; Levine, Smolak, & Hayden,
1994; Peterson, Paulson, & Williams, 2007). This
conception has led to the suggestion of the existence of a
‘Subculture of dieting’ (Levine et al., 1994), in which
media, parents and peers combine to convey the
importance of slenderness. Attempts to determine the
relative importance of different sources of influence
have not led to conclusive findings.
In order to gain a better understanding of the
relationships between parent, peer and media influ-
ences and body shape and eating concerns, a number of
studies have chosen to consider sociocultural factors as
independent agents. In one of the first studies to explore
sources of influence seperately (Levine et al., 1994),
parental teasing and criticism was found to be
associated with body shape and eating concerns,
although media influences emerged as the strongest
predictor. Prospective studies have also supported the
theory that sociocultural sources of influence act as
seperate agents. One such study involving a large
sample of adolescent girls and boys (Field, Camargo,
Barr, Berkey, Roberts, & Colditz, 2001), indicated that
parental influences were an important source of
142 Eur. Eat. Disorders Rev. 17 (2009)
pressure, independently of media or peer influence,
in the prediction of the appearance of weight concerns
or constant dieting. These findings reveal that the
patterns of sociocultural influences on body shape and
eating disturbances are intricate, with no single agent
emerging as a principal source of influence. However,
an important limitation of these studies resides in their
failure to assess pressure from the three sources of
influence using comparable measures.
In order to address this issue, parallel measures of
parent, media and peer influence have been developed.
These self-report scales are designed to examine the
three sources of social influence concurrently and better
assess their relative contribution.
The ‘Family, Peers and Media Influence Scale’,
expanded from a scale first used by Levine et al. (1994),
contains three parallel scales assessing the participant’s
recollections of family, friends and the medias’ attitudes
towards dieting behaviours, weight and general
appearance. As such, it does not directly assess percep-
tion of influence, but can be used to explore the
association between the attitudes and values of others
and the participants’ own responses. Research using
this measure, in conjunction with other scales to obtain
a global view of family influences as part of the tripartite
model, have shown an association with body dis-
satisfaction and measures of disordered eating (Keery
et al., 2004; van den Berg et al., 2002). A replication of
this model has suggested that influences from peers and
the media may be better predictors than those from
parents (Shroff & Thompson, 2006).
Other questionnaires focus more specifically on a
particular outcome. The Perceived Sociocultural Pres-
sure Scale (Stice, Ziemba, Margolis, & Flick, 1996) is a
6-item scale assessing pressure to be thin from parents,
peers and media. The Bulimic Modelling Scale (Stice,
1998) assesses awareness of bulimic behaviours in
family members, friends or the media. Using these
measures, family and peer influences were shown to
prospectively predict bulimic symptomatology,
whereas media influence was not found to be significant
(Stice, 1998).
The Perceived Sociocultural Influences on Body
Image and Body Change Questionnaire (McCabe &
Ricciardelli, 2003) uses parallel measures to investigate
pressures in relation to weight change, and muscle-tone
increase strategies. It consists of five scales assessing
feedback from father, mother, best male friend, best
female friend and media influences. The four feedback
137–151 � 2009 John Wiley & Sons, Ltd and Eating Disorders Association.
R. Rodgers and H. Chabrol Parental Influence on Eating Disorder
scales each assess general feedback and encouragement,
teasing and behavioural example to gain weight and
increase muscle tone, or lose weight and increase
muscle tone. One of the strong points of this scale lies in
its relevance to both girls and boys, as a result of its
focus not only on weight loss and slenderness but also
muscle tone. Consistent with previous findings, the
authors reported effects of parental pressure on body
dissatisfaction. Although the complexity of the study
design, which involved a large number of sources of
influence and of outcome variables, made it difficult to
draw general conclusions, they reported that
parents were the most important source of social
influence.
Dunkley et al. (2001) assessed pressures to be thin
using other parallel measures. Social sources of
influence were further subdivided with family listed
as mother, father and siblings, peers as friends, other
girls, popular girls and boys, and media as fashion,
advertising, magazines and TV. With the sociocultural
agents thus decomposed, pressure from the media was
reported to be stronger than that from peers, itself
stronger than that from parents. The overall authors’
findings again confirmed parental pressures to be a
predictor of body image disturbance and disordered
eating.
Attempts to evaluate the relative importance of
different sources of sociocultural pressures on body
image disturbance and disordered eating have therefore
met with moderate success. Adolescent and young adult
reports show that parents do have an influence on body
shape and weight concerns, but their relative import-
ance with respect to other agents remains unclear.
Mechanisms of influence
Two main modes of influence have been proposed to
account for the association between parents and their
offspring regarding body shape and eating attitudes and
behaviours. The first theory suggests that children’s
body image and eating behaviours are modelled by
those of their parents. The second theory places
emphasis on parental attitudes towards their offspring’s
shape, weight and eating behaviours, conveyed by
verbal messages in the form of teasing, criticism, and
encouragement to lose or control weight (Thompson
et al., 1999). Both of these theories have received
support from the literature and led to the exploration of
possible mediating variables.
Eur. Eat. Disorders Rev. 17 (2009) 137–151 � 2009 John Wiley & Sons, Ltd and
The modelling theory
Several studies have lent support to the modelling
theory. Amongst daughters there has been evidence of a
relation between levels of body dissatisfaction and levels
of maternal body dissatisfaction (Elfhag & Linne, 2005;
Fulkerson, McGuire, Neumark-Sztainer, Story, French,
& Peery, 2002; Keery et al., 2006; Kichler & Crowther,
2001, McKinley, 1999; Usmiani & Daniluk, 1993), and
paternal body dissatisfaction (Keel et al., 1997).
Regarding the modelling effects of dieting amongst
daughters, there has been little support. Keery et al.
(2006) and Dixon, Adair, & O’Connor (1996) reported
no evidence of an association between mother and
daughter reports of dieting. Only Fulkerson et al. (2002)
described a positive correlation regrading these
behaviours, which was no longer significant after
controlling for BMI. One study, however, reported a
positive relationship between fathers’ and daughters’
dieting (Dixon et al., 1996).
None of the studies exploring the link between
mothers’ and sons’ self-reported body dissatisfaction,
have provided any evidence of a relationship (Elfhag &
Linne, 2005; Fulkerson et al., 2002; Keery et al., 2006;
Wertheim, Martin, Prior, Sanson, & Smart, 2002), nor
was there any evidence of an association between
maternal body dissatisfaction and dieting amongst sons
(Fulkerson et al., 2002; Keery et al., 2006). However,
Keery et al. (2006) explored the relationship between
perception of maternal dieting and offsprings’ eating
behaviours and reported an association with dieting
and weight concerns in sons, and extreme weight-loss
methods in both sons and daughters.
Restriction and abstention behaviours amongst
daughters have been reported to be associated with
the dieting, abstention and restrictive behaviours of
their mothers (Vincent & Mccabe, 2000) and fathers
(Wertheim et al., 1999). Drive for thinness has shown a
positive correlation with maternal dieting amongst
daughters (Strong & Huon, 1998; Wertheim et al.,
2002) and sons (Wertheim et al., 2002). A similar
relationship has been reported regarding extreme
weight-loss amongst mothers and daughters (Benedikt,
Wertheim, & Love, 1998). These findings provide
further support for the theory that daughters’ restictive
behaviours appear shaped by those of their mothers.
There has been evidence of a modelling effect
regarding maternal disordered eating amongst sons
(Keery et al., 2006; Vincent & McCabe, 2000), and
Eating Disorders Association. 143
Parental Influence on Eating Disorder R. Rodgers and H. Chabrol
daughters (Attie & Brooks-Gunn, 1989, Elfhag & Linne,
2005; Pike & Rodin, 1991). Regarding bulimic
symptoms in particular, there is evidence to support
the modelling effect amongst girls (Pike, 1995; Stice
et al., 1996; Wertheim et al., 1999).
Similarly, the offspring of parents who place high-
importance on the regularity of family meals appear to
display less disordered eating (Fulkerson, Story, Mellin,
Leffert, Neumark-Sztainer, & French, 2006), even after
controlling for parental weight pressures such as
encouragement to diet (Neumark-Sztainer, Wall, Story,
& Fulkerson, 2004) suggesting a modelling effect might
also exist for positive eating behaviours.
Several studies have reported findings that do not, or
only partially lend support the modelling theory (Byely,
Archibald, Graber, & Brooks-Gunn, 2000; Kanakis &
Thelen, 1995; Keel et al., 1997; McKinley, 1999; Ogden
& Steward, 2000; Usmiani & Daniluk, 1993, Wertheim
et al., 2002). These failures to replicate the relationship
between attitudes towards weight and eating behaviours
in parents and offspring could be in part due to sample
size, and age: the studies conducted by Byely et al.
(2000), Kanakis and Thelen (1995), Keel et al. (1997),
Ogden and Stward (2000) all involving fewer than 115
participants, and mean age in the samples used by
Usmiani and Daniluk (1993) and Wertheim et al.
(2002), being of 12.5 and 12.81 years old, respectively.
As the modelling of behaviours is a gradual process, it
might be that these relations are visible only in slighlty
older samples, who have been more exposed to these
behaviours from their parents. Similarly, these relations
may not be visible among smaller samples, lacking in
statistical power.
Although the findings in this area are not unanimous,
parents’ attitudes towards eating and body shape have
been shown to have a modelling effect on attitudes
amongst adolescents and young adults.
Active influences
The impact of perceived parental pressures on body
image and disordered eating has been repeatedly
demonstrated. Amongst girls, parental teasing and
encouragement to diet has been associated with body
dissatisfaction (Ata, Ludden, & Lally, 2007; Fulkerson,
Strauss, Neumark-Sztainer, Story, & Boutelle, 2007;
Hanna & Bond, 2006; Keel et al., 1997; Keery, Boutelle,
Berg, & Thompson, 2005; Schwartz, Phares, Tantleff-
Dunn, & Thompson, 1999), dieting (Dixon et al., 1996;
144 Eur. Eat. Disorders Rev. 17 (2009)
Keel et al., 1997; Ricciardelli, McCabe, & Banfield, 2000;
Wertheim et al., 2002), restriction and weight-loss
attempts (Benedikt et al., 1998; Dunkley et al., 2001,
Keel et al., 1997), disordered and high-risk eating
behaviours (Ata et al., 2007; Dixon et al., 1996; Hanna &
Bond, 2006; Kanakis & Thelen, 1995; Young, Clopton,
& Bleckley, 2004), and eating disorders (Keery et al.,
2005; The McKnight Investigators, 2003).
Although fewer studies have included male partici-
pants, similar patterns have been suggested in boys.
Amongst boys, parental encouragement to lose weight
has been reported to be associated with body
dissatisfaction (Wertheim et al., 2002), strategies to
lose weight (McCabe & Ricciardelli, 2005, Ricciardelli
et al., 2000), extreme weight-loss (Vincent & McCabe,
2000), drive for muscularity (Smolak & Stein, 2006),
drive for thinness (Vincent & McCabe, 2000; Wertheim
et al., 2002), dieting and eating and weight concerns
(Fulkerson et al., 2002; Meesters, Muris, Hoefnagels, &
van Gemert, 2007), and binging (Fulkerson et al., 2002).
However parental teasing has not been found to be
associated with body dissatisfaction in boys (Schwartz
et al., 1999).
Prospectively, amongst both adolescent boys and
girls, family pressures to be thin have not been shown to
predict any increase in body dissatisfaction over time
(Presnell, Bearman, & Stice, 2004), and although
correlated with body dissatisfaction, parental dieting
and encouragement to diet were not significant
longitudinal predictors when considered amongst other
influences, in particular from peers (Paxton et al., 2006).
Regarding critisim of present body shape and weight
rather than encouragement to lose weight, negative
comments from parents about body shape have been
found to be linked to body dissatisfaction (Vincent &
McCabe, 2000). Disordered eating has been reported to
be associated with criticism regarding shape and weight
from both parents among girls, and from fathers among
boys (Baker et al., 2000). Furthermore, it has been
proposed that perceived parental criticism, was more
predictive of offspring’s disordered eating than parent’s
own levels of disordered eating behaviours (Baker et al.,
2000; Benedikt et al., 1998; Wertheim et al., 1999).
However, Griffiths and McCabe (2000) found no
association between adolescent girl’s perception of their
parents’ view of their body and disordered eating,
suggesting that perhaps the association is to be found
only when parents directly communicate their opinion
regarding their offspring’s shape and weight.
137–151 � 2009 John Wiley & Sons, Ltd and Eating Disorders Association.
R. Rodgers and H. Chabrol Parental Influence on Eating Disorder
In order to explore the exact nature of parental verbal
messages, Gross and Nelson (2000) designed a
questionnaire exploring the perceived frequency of
15 messages regarding weight and shape. The results
showed that young women with low body dissatisfac-
tion perceived negative parental messages. This finding
was replicated and extended to reveal that the
perception of negative messages predicted disordered
eating (Hanna & Bond, 2006). Gross and Nelson (2000)
also reported that participants with higher body
satisfaction perceived higher frequencies of positive
messages. It has been proposed that among boys,
positive messages were also associated with body
satisfaction, suggesting that positive messages might
act as a protective factor for body shape concerns.
(Ricciardelli et al., 2000).
It would appear that the relationship between body
image disturbance and disordered eating and active
influences such as parental criticism, verbal encourage-
ment to lose weight and teasing is stronger than the
modelling effect. However, these studies take into
account only a limited spectrum of parental messages,
mainly direct and explicit references their own off-
spings’ weight and eating behaviours. Although useful,
these do not explore more indirect messages, or
comments directed at other individuals as part of an
increased appearance orientated context. Furthermore,
few studies have explored the potential protective effect
of positive comments concerning weight and body
shape.
Mediating variables
Parental influences on body image disturbance and
disordered eating have been reported to be mediated by
a number of psychological variables that illustrate the
close-knit nature of the various factors involved in
appearance and eating concerns and the necessity of
considering parent-child interections in their light.
The effect of sociocultural influences on body shape
concerns and disordered eating has been explored in
relation to the internalisation of social norms, as well as
individual tendencies to engage in social comparison,
which have been described as mediators (Halliwell &
Harvey, 2006). The tripartite model (Thompson et al.,
1999) proposes a pathway for the influence of family,
peer and media pressure on body image disturbance
and disordered eating, including both internalisation of
social norms and social comparison tendencies as
Eur. Eat. Disorders Rev. 17 (2009) 137–151 � 2009 John Wiley & Sons, Ltd and
mediational variables. The exploration of the role of
social comparison provided support for its role as a
mediator of the effects of parental pressures on body
dissatisfaction and disordered eating (van den Berg
et al., 2002). A re-appraisal of this model (Keery et al.,
2004) brought further evidence to suggest that parental
influence was fully mediated by internalisation and
social comparison. Another replication, however, did
not support the full-mediation hypothesis and
described a direct pathway leading to restrictive
behaviours in addition to the previous findings (Shroff
et al., 2006). It is important to note that all of these
studies were conducted amongst adolescent girls, and
therefore did not explore potential differences amongst
adolescent boys.
Comments about shape and weight have been
proposed to lead to the overvaluation of the personal
implications of physical appearance, leading in turn to
disordered eating (Wade & Lowes, 2002). Kichler and
Crowther (2001) suggested that negative comments
from family members moderated the effects of maternal
modelling of their daughters’ body satisfaction and
eating attitudes. In their sample, they reported high
levels of modelling effects only in conjunction with high
levels of negative communications. Parental pressures
to control weight have also been suggested to moderate
the relationship between the awareness of sociocultural
norms and their internalization (Twamley & Davis,
1999). These authors proposed family pressures to be a
risk factor for high levels of internalisation only when
initial levels of awareness were low. Again, these studies
included all-female samples. These findings suggest that
negative comments are associated with increased
disordered eating not only through their content but
also by facilitating other phenomenon.
A study investigating the mediating effect of parents
on media pressures (Nathanson & Botta, 2003)
reported that parental mediation of media messages
concerning sociocultural ideals led to body image and
eating disturbance. Nathanson and Botta (2003) found
that the extent to which parents commented on the
physical appearance of TV characters was associated
with disordered eating, with social comparison acting as
a mediating variable. Interestingly, this association was
similar in strength regardless of the complimentary or
critical nature of the comments, suggesting that the
effect was due to the focus on appearance, rather
than the appreciation or criticism of media beauty-
standards.
Eating Disorders Association. 145
Parental Influence on Eating Disorder R. Rodgers and H. Chabrol
Finally, Davis, Shuster, Blackmore, and Fox (2005),
investigated ‘proneness to anxiety’ as a moderating
variable of family orientation towards appearance and
disordered eating. Their results revealed that partici-
pants who claimed to be easily made anxious, showed
more vulnerability to family influences.
The existing literature describes complex relation-
ships between sociocultural pressures and body image
disturbance and disordered eating, involving several
mediating variables. Findings suggest that parental
influences are, entirely or partially, mediated by
personal factors such as internalisation of social ideals,
comparison tendencies or anxiety. The results of the
previous studies are interesting to consider together as
they suggest that parents play a role by intentionally
encouraging their offspring to strive for the socially
valued body shape, but may also perhaps unintention-
ally increase their offspring’s’ body shape and weight
concerns with potentially well-meant comments.
Regardless of the specific pathway or mode of action,
it would appear that some families provide a climate
more conducive to the appearance of disorder eating,
displaying high levels of family body shape dissatisfac-
tion and placing importance on appearance (Laliberte,
Boland, & Leichner, 1999).
Gender considerations
Gender differences in outcomes
There are significant gender differences in frequency of
body dissatisfaction and disordered eating. Some research
has suggested that body image and weight concerns are
less frequent among boys (Ericksen, Markey, & Tinsley,
2003; Field et al., 2001; Phares, Steinberg, & Thompson,
2004; Thelen & Cormier, 1995). However, a detailed
review of the literature argued that this finding could be
explained by the frequent use of wish for weight-loss as
and indicator of body dissatisfaction. This is problematic
as body dissatisfaction amongst boys is expressed in equal
proportions as a wish for weight-loss and weight-gain
(McCabe & Ricciardelli, 2004). Studies have revealed that
girls diet more frequently than boys, and exhibit more
dietary restraint and disordered eating (Edmunds & Hill,
1997; Halliwell & Harvey, 2006). Consistent with their
respective gender body-ideals, although girls appear
more likely to adopt strategies to lose weight, boys
appear more likely to adopt strategies to increase
muscle (McCabe & Ricciardelli, 2005). Furthermore, in
boys, perceived pressure has been reported to be the
146 Eur. Eat. Disorders Rev. 17 (2009)
strongest predictor of body dissatisfaction whilst in girls
the strongest predictor was internalisation (Knauss,
Paxton, & Alsaker, 2007). These initial differences
render the investigation of the differences in impact and
action of sociocultural pressures in function of gender
all the more challenging.
There has been some evidence of gender differences
regarding the amount of pressure perceived from
parents. Girls have tended to report higher levels of
weight-related teasing (Ata et al., 2007), maternal
criticism (Baker et al., 2000), weight-loss discussions
with mothers (Vincent & McCabe, 2000), and general
feedback concerning appearance from their fathers
(Schwartz et al., 1999) than their male counterparts.
These differences could stem from a gender-linked
cultural context that tends to place more emphasis on
appearance and body shape in female than in males.
Interestingly however, gender comparisons of active
pressure to be thin and to lose weight have shown
conflicting findings. Some authors have reported girls
to receive more pressure (Ata et al., 2007; Peterson et al.,
2007; Presnell et al., 2004), whereas others have
reported no gender differences in encouragement to
diet and lose weight (Meesters et al., 2007; Vincent &
McCabe, 2000; Wertheim et al., 2002). These seemingly
contradictory findings could be the reflection of several
phenomena. It would appear that gender differences
become apparent in the more recent studies, suggesting
they may firstly be attributable to a general trend over
time for parents to engage more actively in encouraging
their daughters to achieve social standards of thinness,
but other gender-appropriate stereotypes for their sons.
Another possibility, however, regarding conflicting
reports of the presence of gender differences, might
pertain to the phrasing of the items assessing parental
influence. Participants could interpret differently items
exploring parental ‘encouragement’ to diet and lose
weight and parental ‘pressure’ to do so. If this were the
case, participants might understand items phrased in
terms of ‘encouragement’ to be exploring positive,
supportive and helpful attitudes in relation to their own
weight-loss attempts, whilst items phrased in terms of
‘pressure’ might assume more coercive and manip-
ulative connotations. In this light, female adolescents
and young adults might report perceiving more
pressure, and messages pushing them to lose weight
than their male counterparts, but reports of perceived
support and encouragement regarding weight-loss
would produce no gender differences.
137–151 � 2009 John Wiley & Sons, Ltd and Eating Disorders Association.
R. Rodgers and H. Chabrol Parental Influence on Eating Disorder
Further gender differences have been investigated
regarding the strength of the association between
parental influences and body shape concerns and
disordered eating amongst adolescents and young
adults. Although Schwartz et al. (1999) reported
stronger associations between perceived teasing and
feedback and body shape satisfaction amongst female
participants, there has been little evidence for this
regarding eating outcomes. No gender interaction was
found in the extent to which family criticism contributed
to disordered eating by Baker et al. (2000), and Fulkerson
et al. (2002) reported stronger associations between
maternal encouragement to diet and body shape and
eating outcomes amongst boys. Encouragement to lose
weight and develop muscle were also reported to be more
strongly associated with disordered eating in boys by
Meester et al. (2007). Vincent &McCabe (2000) suggested
that in boys, encouragement to lose weight was an
important predictor of disordered eating, whereas other
forms of influences such as weight-discussions, criticism
and modelling were not. The authors proposed that boys
could be less exposed to weight-loss discussions, an
important predictor amongst girls, and therefore
attribute significance to active encouragement.
In summary, although findings are unclear as to
whether there are gender differences regarding amounts
of messages perceived regarding shape and weight, it
would appear that these messages are more strongly
associated with behavioural outcomes in girls. This
may, in part, be a reflection of the differences in body
shape ideals.
Gender of parent
While both mothers and fathers have been alternately
highlighted as primary souces of influence, there would
appear to be emerging evidence of the importance of
both parents. Mothers have been described as exerting
greater influence over boys’ body image than any other
source of sociocultural pressure (Ricciardelli et al.,
2000). However, in both girls and boys, constant dieting
was predicted by the perception of the importance of
thinness to their fathers but not their mothers (Field
et al., 2001), and pressures to be thin from fathers but
not mothers prospectively predited weight control
behaviours in middle school girls, although only when
parents were separated/divorced (Shisslak et al., 1998).
Other research has tended to disagree with this
theory, and proposed that both mothers and fathers
Eur. Eat. Disorders Rev. 17 (2009) 137–151 � 2009 John Wiley & Sons, Ltd and
exert an influence on body and eating concerns
(McCabe & Ricciardelli, 2003, Vincent & McCabe, 2000).
A gender-linked transmission model of parent influ-
ences would suggest that mothers are more influential
for daughters, and fathers for sons. This model has been
supported by the findings of several studies (Wertheim,
Paxton, Schutz, & Muir, 1997; Wertheim et al., 1999).
However, it has been pointed out that findings that
could be attributable to this gender-link may be due to
the higher rates of body and eating concerns amongst
girls, as well as their increased vulnerability to parent
influences (Elfhag & Linne, 2005).
A cumulative sociocultual model would propose that
the combination of messages from both parents
regarding body shape and eating would be more
strongly associated with those factors in their offspring
than values transmitted by either parent alone.
However, studies that have explicitly examined this
model have found little support for it (Wertheim et al.,
1999, 2002).In order to continue to explore the
respective roles of both parents in the transmission
of body shape and eating attitudes further research on
mixed-gender samples, seperating influences from both
parents is necessary to provide evidence of their
respective roles.
Conclusion
The aim of this paper was to review the literature
concerning parental influences on body image disturb-
ance and disordered eating. The studies included clearly
point to parents as important sociocultural influences
in the development of these concerns. This review
demonstrates the importance of family attitudes, and in
particular of direct verbal messages concerning body
shape and eating habits. It also however, highlights the
small number of studies that consider these effects
amongst male adolescents and young adults, despite
increasing evidence of the relevance of these issues to
young men.
From a practical point of view, there is evidence that
focussing on appearance and weight in a number of
ways is conducive to increasing body shape and weight
concerns amongst offspring. This effect would appear
to be particularly strong regarding active encouragment
and criticism, but also present in relation to parental
behaviour. Parents could be made aware of the impact
of the importance they attribute to appearance in
general.
Eating Disorders Association. 147
Parental Influence on Eating Disorder R. Rodgers and H. Chabrol
Future research might contribute to current under-
standing in several ways. The large majority of the
research reviewed here involves cross-sectional designs.
More longitudinal work is necessary to better determine
prospective effects of parental influences. Secondly,
further investigation of the exact nature of parents’
messages and comments concerning body shape, weight
and eating behaviours, and the way in which they are
perceived and interpreted by their offspring, also appear
necessary. Given both the discrepancy reported between
parental self-report data and their perceived attitudes,
and the stronger association between perceived attitudes
and behaviours and body shape and eating outcomes, it
would appear important to explore the meaning
attributed to parental pressures and encouragements.
Furthermore, research should increasingly aim to
incorporate a wide variety of attitudes and behaviours
in their measures so as assess the entire spectrum of
parent influences. This is particularly important in view
of the suggestion that negative comments might interact
with modelling effects. Finally, gender differences require
more thorough examination, through the design and
implementation of gender-appropriate instruments.
Understanding the extent of family influences and
their contributions to the development of body shape
concerns and disordered eating is particularly import-
ant as, unlike the media, parents are able to deliberately
adapt their communication with their children. Greater
knowledge of the manner in which family attitudes can
act as protective or risk factors will enable future
prevention programs to better target their action and be
increasingly effective.
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