Parent-child feeding dynamics and childhood obesity : The importance of foreign background and effects of early obesity treatment

Abstract

Childhood obesity is often characterised as a global epidemic. Yet, little progress has been made in addressing its increasing levels, especially among certain populations. The present thesis includes five studies and offers an examination of parenting practices and child behaviours, in relation to foreign background in Sweden and in the context of obesity treatment among pre-schoolers. In Studies I and II, parental feeding practices and perceived child eating behaviours, respectively, were compared between Swedish-born mothers and mothers of foreign background. Data were merged from a population-based sample in Malmö and two samples (school and clinical) in Stockholm. Studies III through V offer an evaluation of secondary outcomes (parenting practices and child behaviours) of the More and Less study (ML study), a randomised controlled trial for obesity treatment in Sweden. The ML study includes two treatment approaches, namely a parent support programme (enhancing evidence-based parenting practices)–with and without boosters–and standard treatment (focusing on lifestyle modifications). Compared to Swedish-born mothers, mothers with a foreign background exerted higher levels of unfavourable and controlling feeding practices by restricting access to and intake of energy-dense foods and pressuring their children to eat. Accordingly, mothers with a foreign background perceived their children to overeat in response to external cues (whether food or emotion related), but also to eat according to their internal cues for satiety and hunger to a larger degree than Swedish-born mothers. Maternal concerns about child weight status influenced the observed associations. In the context of early obesity treatment, controlling feeding practices of both mothers and fathers overall remained stable, while the parent support programme particularly affected fathers’ evidence-based parenting practices when compared to standard treatment. While child food intake did not change during treatment, children showed a trend for decreasing certain behaviours, which relate to excess eating. In conclusion, the thesis highlights the importance of foreign background in obesity-related parenting practices and child behaviours, and also provides insights into some of the mechanisms that may be at play to facilitate reductions in child weight status