Qualitative Themes and Associations Between Parental Feeding Behaviors and Youth Body Image Among Black and Latino Caregivers

Abstract

Background: Emphasis on parenting for healthy eating habits has increased with increased attention to rising rates of childhood obesity globally. Prior research has primarily focused on the impact of food parenting behaviors on child and adolescent eating behaviors, it has yet to be explored the impact food parenting may have on psychological outcomes such as body image, which also impact eating behaviors in youth. Further, adolescents, racial and ethnic minorities, and individuals in larger bodies are at higher risk of experiencing body dissatisfaction, engaging in disordered eating and weight control behaviors, and less likely to be diagnosed or receive timely care. This work focuses on the experiences of diverse understudied populations. Objectives: Utilizing a multigenerational life-course framework, this thesis investigates the relationship between body image and food parenting. The aims of the thesis were: (i) Understanding how parenting strategies for diet, physical activity, and coping behaviors are influenced by personal and social experiences of body image and body ideal internalization among Black women caregivers, (ii) Explore associations between parent feeding styles and adolescent body esteem in Costa Rican families, (iii) Identify associations between parent feeding behaviors and youth body dissatisfaction and disordered eating outcomes, and identify if acculturative stress modifies these relationships. Methods: The first chapter qualitatively explores the role that body image plays in parenting decisions using a thematic framework analysis in a cohort of Black women caregivers enrolled in a weight management randomized control trial. The second chapter cross-sectionally investigates associations between parent feeding style using the Parent Feeding Questionnaire (PFQ) and body esteem outcomes using the Body Esteem Scale for Adolescents and Adults (BESAA) in dyads of Costa Rican parents and their adolescents 13-19 years using. The third chapter investigates cross-sectional associations between parent feeding behaviors measured using the Parenting for Eating and Activity Scale (PEAS-Diet) and youth desire for thinness measured using scores from the Body Contour Test and youth history of dieting in a US-based cohort of Hispanic/Latino parents and children 8-16 years. Results: (i) Black women caregivers expressed multiple modalities for sources of body image, emphasizing the role of family members. Their personal experiences with body image influenced their motivations and strategies for parenting their children for healthy body esteem and healthy habits. (ii) No associations were found between appearance and weight-specific body esteem scores and any parent feeding behavior, however an inverse association was found between attribution body esteem and instrumental feeding behavior. (iii) No significant associations were found between parent feeding behavior and youth desire for thinness, however a strong positive association was found between youth history of dieting and monitoring food parenting behavior. Youth acculturative stress was positively associated with youth history of dieting, however there was not evidence for effect measure modification. Conclusions: Caregivers described multiple ways their personal and social experiences with body image inform their parenting strategies for youth body esteem and health behaviors. Food parenting behaviors did not show strong empirical evidence for an association between most body esteem outcomes, however there is evidence that suggests there may be an association between perception of external body validation and parent feeding behavior. The evidence also suggests that parent feeding behavior may be mimicked in youth eating behaviors, including dieting behaviors. Further investigation is recommended to understand unintended consequences of recommended food parenting behaviors.