Parental eating attitudes and the development of obesity in children. The Framingham Children's Study

OBJECTIVE: To investigate the extent to which parents' degree of dietary self-control, as measured by self-reported dietary restraint, disinhibition, and perceived hunger, affects the development of excess body fat in the child. DESIGN: Prospective observational study. SUBJECTS: Ninety-two 3-5 y old children and their parents, enrolled in 1987 in the Framingham Children's Study. MEASUREMENTS: Self-reported levels of parental dietary restraint, disinhibition and perceived hunger were estimated using Stunkard and Messick's Three-Factor-Eating Ouestionnaire. Anthropometric measurements (height, weight and skinfold measurements at five sites) were obtained yearly for children and parents. The child's activity level was measured on multiple days each year using Caltrac accelerometers. Energy intake and percentage of calories from total fat were estimated from multiple sets of food diaries, collected each year. All analyses were adjusted for the following potential confounders: child's sex and baseline values for age, height, mean physical activity level, total calories and percentage of calories from fat as well as the educational levels of the parents at baseline. RESULTS: Over 6 y, children's body fat increased linearly with increasing levels of self-reported parental disinhibition (eg 6 y increase in the child's sum of five skinfolds was 34.4, 45.8 and 59.2 mm across increasing tertiles of parental disinhibition, P = 0.012). Overall, children whose parents had higher dietary restraint scores had greater increases in body fatness than children whose parents had the lowest levels of restraint. When both parents had above average scores on dietary disinhibition or restraint, the children had greater increases in body fat (on all anthropometry measures) than when only one parent or when neither parent had high scores on those factors. Parental scores on the perceived hunger scale had no clear effect on body fat change of children. Since disinhibition and dietary restraint frequently co-exist, we then examined the joint effect of these two factors. The children with the greatest increases in body fat were those whose parents scored high on both factors. In the final analysis, we found that dietary restraint adversely affected the child's body fat only when associated with high parental disinhibition. CONCLUSION: This study suggests that parents who display high levels of disinhibited eating, especially when coupled with high dietary restraint, may foster the development of excess body fat in their children. This association may be mediated by direct parental role modeling of unhealthy eating behaviors, or through other indirect, and probably subconscious, behavioral consequences such as the suppression of the child's innate regulation of dietary intake.