Children's Eating Attitudes and Behaviour

Childrens eating attitudes and behaviour: a study of the modelling and control theories of parental influence
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Oxford Journals
Medicine
Health Education Research
Volume 19, Issue 3
Pp. 261-271.
Health Education Research

her.oxfordjournals.org Health Educ. Res. (2004) 19 (3): 261-271. doi: 10.1093/her/cyg040
Rachael Brown1 and Jane Ogden12
+
Author Affiliations
Received December 20, 2002. Accepted May 7, 2003.
Abstract The present study compared the modelling and control theories of parental influence on childrens eating attitudes and behaviour with a focus on snack foods. Matched questionnaires describing reported snack intake, eating motivations and body dissatisfaction were completed by 112 parent/child pairs. Parents completed additional items relating to control in terms of attempts to control their childs food intake and using food as a tool for controlling behaviour. The results showed significant correlations between parent and child for reported snack intake, eating motivations and body dissatisfaction, indicating an important role for modelling. Parents were then divided according to their control scores. Children whose parents indicated greater attempts to control their childs diets reported higher intakes of both healthy and unhealthy snack foods. In addition, those children whose parents indicated a greater use of food as a means to control their childs behaviour reported higher levels of body dissatisfaction. The results provide some support for both the modelling and control theories of parental influence. However, whereas modelling appears to have a consistent impact, parental control has a differential impact depending upon whether this control is focused on the childs diet or on other aspects of their behaviour. To conclude, a positive parental role model may be a better method for improving a childs diet than attempts at dietary control. Introduction Understanding childrens eating attitudes and behaviour is important in terms of childrens health. Evidence also indicates that dietary habits acquired in childhood persist through to adulthood (Kelder et al., 1994; Nicklas, 1995; Steptoe et al., 1995). In addition, research also indicates a role for childhood nutrition on adult health (Hales et al., 1991; Moller et al., 1994; Berenson et al., 1998). Much research also shows that many childrens diets in the Western world are unsatisfactory. For example, the Bogalsua Heart Study in the US showed that the majority of 10 year olds exceeded the American Heart Association dietary recommendations for total fat, saturated fat and dietary cholesterol (Nicklas, 1995). A survey in the UK showed a similar picture, with 75% of children aged 1011 exceeding the recommended target level for percentage of energy derived from fat (Butriss, 1995). Comparable results have also been reported by Wardle (Wardle, 1995) and Currie et al. (Currie et al., 1997). There has been a range of explanations offered to understand why children eat what they eat. Lack of knowledge has been implicated as causing poor diets, but is not explanation enough as health education campaigns have had limited success in changing eating habits (Gatherer et al., 1979). Other research has focused on social cognition models, but
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most studies using this approach have focused on adults rather than children and those which have explored childrens diets have left much of the variance in eating behaviour unexplained (Resnicow et al., 1997). An alternative approach to childrens diets has focused on developmental theories, and emphasizes the influence of significant others on a childs development of food preferences and eating habits. In line with Social Learning Theory [e.g. (Bandura, 1977)], some research has highlighted the role of observational learning and modelling. In one study, peer modelling was used to change childrens preference for vegetables (Birch, 1980). The target children were placed at lunch for 4 consecutive days next to other children who preferred a different vegetable to themselves (peas versus carrots). By the end of the study the children showed a shift in their vegetable preference which persisted at a follow-up assessment several weeks later. The impact of observational learning has also been shown in an intervention study designed to change childrens eating behaviour using video based peer modelling (Lowe et al., 1998). Research has also focused on the role of parents and Wardle (Wardle, 1995) contended that: Parental attitudes must certainly affect their children indirectly through the foods purchased for and served in the household influencing the childrens exposure andtheir habits and preferences. Some evidence supports an important role for parents. For example, Klesges et al. (Klesges et al., 1991) showed that children selected different foods when they were being watched by their parents compared to when they were not. Olivera et al. (Olivera et al., 1992) reported a correlation between mothers and childrens food intakes for most nutrients in preschool children, and suggested targeting parents to try to improve childrens diets. Likewise, Contento et al. (Contento et al., 1993) found a relationship between mothers health motivation and the quality of childrens diets. Food preferences therefore change through watching others eat. Research also indicates that children may not only model their parents food intake, but also their attitudes to food and their body dissatisfaction. For example, Hall and Brown (Hall and Brown, 1982) reported that mothers of girls with anorexia show greater body dissatisfaction than mothers of non-disordered girls. Likewise, Steiger et al. (Steiger et al., 1994) found a direct correspondence between mothers and daughters levels of weight concern, and Hill et al. (Hill et al., 1990) reported a link between mothers and daughters degree of dietary restraint. Research therefore emphasizes the role of observational learning with a particular role for parental attitudes and behaviour. Other studies have highlighted a role for parental control. Some research has explored the impact of controlling food intake by rewarding the consumption of healthy food as in if you eat your vegetables I will be pleased with you. For example, Birch et al. (Birch et al., 1980) gave children food in association with positive adult attention compared with more neutral situations. This was shown to increase food preference. Similarly an intervention study using videos to change eating behaviour reported that rewarding vegetable consumption increased that behaviour (Lowe et al., 1998). The relationship between food and rewards, however, appears to be more complicated than this. In one study, children were offered their preferred fruit juice as a means to be allowed to play in an attractive play area (Birch et al., 1982). The results showed that using the juice as a means to get the reward reduced the preference for the juice and have been supported by similar studies (Lepper et al., 1982; Birch et al., 1984; Newman and Taylor, 1992). These examples are analogous to saying if you eat your vegetables, you can eat your pudding. Although
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parents use this approach to encourage their children to eat vegetables the evidence indicates that this may be increasing their childrens preference for pudding even further as pairing two foods results in the reward food being seen as more positive than the access food. As concluded by Birch: although these practices can induce children to eat more vegetables in the short run, evidence from our research suggests that in the long run parental control attempts may have negative effects on the quality of childrens diets by reducing their preferences for those foods. [(Birch, 1999), p. 10] Birch also reviewed the evidence for the impact of imposing any form of parental control over food intake and concluded that: child feeding strategies that restrict childrens access to snack foods actually make the restricted foods more attractive. [(Birch, 1999), p. 11] For example, when food is made freely available children will choose more of the restricted than the unrestricted foods particularly when the mother is not present (Fisher and Birch, 1999). In summary, childrens diets are often poor and research has addressed reasons for this. Some studies have focused on modelling, and indicate that children may model both their parents eating behaviour and also their eating related attitudes and body dissatisfaction. Other studies have highlighted a role for control, and have indicated that whilst many parents impose control over their childs intake and use food to control their childs behaviour, this may not always have the desired positive effect. However, these two theories have been mainly addressed independent of each other. In line with this, the present study aimed to explore the relationship between parents and childrens eating attitudes and behaviour, and to assess and compare the modelling and control theories of parental influence. Much previous research has explored childrens diets in terms of major food groups with an emphasis on staple foods such as bread, pasta and vegetables. These foods make up the content of a childs main meals throughout the day and are part of a childs daily routine. In contrast, snack foods such as sweets, chocolate, grapes and toast are often eaten in between meals, and can be sources of either conflict or pleasure. Further, such snack foods often play an important role as the currency central to the interaction between parent and child. Therefore, the present study aimed to explore the relative role of modelling and control with a focus on the intake of snack foods. Method
Participants
Children aged between 9 and 13 were recruited from two junior schools and one secondary school in southern England. Children were approached by either the researcher or a teacher at the school and asked to give a consent form to their parents. It is estimated that about 260 children were asked for their consent and that 50% of children agreed to take part. Questionnaires were then given to 137 parents and children and 112 pairs of completed questionnaires were returned (response rate = 81.7%).
Design
The study used a dyadic design looking at pairs of parents and children.
Procedure
A letter was sent to the head teachers of the schools, explaining the nature of the project and requesting participation from one of their year
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groups. Information was then sent to parents requesting consent for their children to participate and asking if they would take part. On receiving consent from parents, questionnaires were administered in the schools. Administration varied according to the requests of the Head Teacher. The questionnaires were administered in small groups in one junior school, whole-class administration in the other junior school, with items being read out verbally to both. In the secondary school the questionnaires were sent home. The childrens weight and height data was collected from the schools either by the class teachers or the researcher (R. B.).
Measures
Children and parents received matched questionnaires consisting of the following items. The internal reliability of the items was explored where appropriate using Cronbachs .
Profile characteristics
Participants were asked to state their age and gender.

Reported snack food intake
Much previous research has focused on a wide range of foods consumed including staple foods such as pasta and bread, and snack foods such as sweets and fruit. The present study aimed to focus solely on the intake of snack foods as these play a central role in the interaction between parent and child, and are often the place where many of the problems with food intake occur. In line with this, participants circled the number of times that a snack food item was eaten both yesterday and in general using fivepoint Likert scales. For yesterday the scale ranged from 0 (0) to 4+ times (4) and for in general the scale ranged from never (0) to every day (4). The foods were presented in a random order. They were analysed both in terms of the individual food items and in terms of total scores which were summated to reflect unhealthy and healthy foods (range 04). These foods were selected to provide some preliminary insights into the kinds of snacks that children and their parents eat. The measure was not designed to comprehensively assess all foods eaten. Unhealthy snack foods: chocolate, crisps, pastries, ice cream, sweets, cakes and biscuits (childrens = 0.71, adults = 0.63). Healthy snack foods: grapes, oranges, peaches, yoghurt, toast and apples (childrens = 0.69, adults = 0.48).
Motivations to eat
Participants rated eight items using a five-point Likert scale, following the statement How often do you feel like eating when... [never (1), not very often (2), sometimes (3), very often (4), always (5)]. These were derived from the Dutch Eating Behaviour Questionnaire (Van Strien et al., 1986) and summated to create total scores (range 15).
Internal motivation. Four items measured internal motivation: you have nothing to do, are frightened, are feeling upset, are feeling cross. A higher score reflected greater levels of internal motivation (childrens = 0.59; parents = 0.69). External motivation. Four items measured external motivation: If you walk past a bakery sweet shop or caf how often do you really want to eat something?, If food looks, smells or tastes good, how often do you eat more of it than usual?, If you have got something delicious how often do you want to eat it straight away?, If you see other people eating, how often do you eat more of it than usual. A higher score reflected greater levels of external motivation (childrens = 0.77, parents = 0.69).
Body dissatisfaction
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This was measured using a shortened Body Satisfaction Questionnaire (Cooper et al., 1987). Ten items were rated using a five-point Likert scale (never, not very often, sometimes, very often, always), e.g. Have you ever felt unhappy about your body?, How often do you refuse food because you are worried about your weight?, Has eating sweets or cakes ever made you feel fat, Have you been afraid of becoming fat (or fatter)? A higher score reflected greater body dissatisfaction (range 15) (childrens = 0.81, parents = 0.87).
Body difference
Using body silhouettes of adult and children (Stunkard et al., 1986) participants were asked to circle one of the nine figures they felt closest to their own size and then rate the figure they would most like to look like. The discrepancy between the two figures was scored. A more positive score reflected a desire to be fatter and a more negative score reflected a desire to be thinner.
Additional parental items
Control
This assessed two aspects of control and food. Items were rated on a fivepoint Likert scale and summated to create a total score (range 15).
Control over their childs diet.
Examples of items include: How often are you firm about what your child should eat?, How often do you allow your child a free choice of what to eat?, How often are you firm about when your child should eat?, How often do you allow your child to eat between meals?. A higher score reflected a greater degree of control placed on the childs food intake by the parent (eight items, = 0.67).
Control over their childs behaviour using food
Examples of items include: How often do you treat your child with food for good behaviour?, If your child is unhappy how often do you use food to cheer them up?, Is a snack between meals considered a treat for good behaviour?, Do you use food as a way of distracting your child (e.g. if they are preventing you from doing your chores)?. A higher score reflected a higher use of food to control the childs behaviour (eight items, = 0.81).
Profile characteristics:
Parents were also asked to record their: Subjective class (working class, lower middle class, upper middle class, upper class), ethnicity (black, white, Asian, other), weight and height.
Data analysis
The results were analysed to (1) describe the participants profile characteristics and their reported snack food intake using descriptive statistics, and (2) to assess the modelling theory of parental influence, parents and childrens reported snack food intake, motivations for eating and their body dissatisfaction were compared using Spearmans correlation coefficients. Finally, the pairs were then divided into groups based upon median splits on the parents ratings of control. The childrens reported snack food intake, eating motivations and body dissatisfaction were then assessed as to whether their parents showed high or low control over their childs diet and high or low use of diet to control their childs behaviour as a means to test the control theory of parental influence. Analysis used independent t-tests and Levenes test for homogeneity of variance.
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Results
Participants profile characteristics are shown in Table I. There were 112 pairs of parents and children. Childrens ages ranged from 9 to 13; adults from 23 to 53. The majority of the parents were female, but there was almost an equal split of boys and girls. The majority of parents were white and described themselves as lower middle class. Childrens and adults BMI were within the healthy range.
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Table I.
Parents and childrens reported snack food intake
Table II describes the reported snack food intake of parents and children. Childrens most common snack foods for yesterday were sweets, chocolate, biscuits, toast and crisps, and for in general were crisps, toast, chocolate, apples and biscuits. Many of the foods being eaten by the children could be considered unhealthy. Adults ate more healthily, with three out of their five most common foods being categorized as healthy. The foods most often eaten for both yesterday and in general were toast, chocolate, biscuits, apples and yoghurt, although ranked in a different order for these different time points.
Table II.
Parents (n = 112) and childrens (n = 112) food
intake (yesterday and in general)

Comparison of parents and childrens snack food intake, eating motivations and their body dissatisfaction
Parents and children were analysed to explore the correlation between their snack food intake, eating motivations and body dissatisfaction. The results are shown in Table III. For snack food intake the results showed a significant correlation between parents and childs snack food intake in general, and between parents and childs unhealthy snack food eaten yesterday, indicating that a more healthy or unhealthy diet shown by the parents was associated with a similar diet by their child. There was no association for healthy snack food eaten yesterday. In terms of motivations, the results showed a significant correlation between parent and child for internal motivations, but not for external motivations, indicating that a child was more likely to state that they ate for reasons such as feeling upset or cross if their parent also stated likewise. The results also showed a significant correlation between parent and child for both measures of body dissatisfaction, indicating that a higher dissatisfaction by the parent was reflected in a higher level in the child.
Table III.
Comparisons between parents and their childrens
food intake
Role of parents level of control over their childs diet
Parents who exercised high control over their childrens diets were compared with parents who exercised lower control to see if control levels influenced their childs snack intake, motivations for eating and body dissatisfaction. The results are shown in Table IV. The results showed no effect of parental control over diet on snack food intake in general, eating
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motivations or body dissatisfaction. However, those children whose parents reported higher levels of control over their childrens diet reported eating more of both the unhealthy and healthy snack foods yesterday, indicating that attempts to restrict a childs food intake may be paradoxically associated with its increase.
Table IV.
Impact of parents control over diet on childrens food intake, eating motivations and body dissatisfaction
Role of parents level of control over their childs behaviour using food
Parents who exercised high control over their childs behaviour using food were compared with parents who exercised lower control to see if control levels influenced their childrens snack food intake, motivations for eating and body dissatisfaction. The results are shown in Table V. No differences were found between the two groups for snack food intake, eating motivations or body difference. However, those children whose parents reported a greater use of food to control their childs behaviour showed higher levels of body dissatisfaction.
Table V.
The impact of parents use of diet to control the childs behaviour on childrens food intake, eating motivations and body dissatisfaction
Discussion The present study aimed to explore the ways in which parents effect their childs eating attitudes and eating behaviour, and to test both the modelling and control and control theories of parental influence. There are some problems with the study, however, which need to be addressed. First, many children did not consent to take part in the study. Because consent was needed to opt into the study rather than to opt out, it is possible that some parents did not receive the consent form and were not told about the study. Non-consent may therefore reflect the childs forgetfulness rather than an objection to a study on eating behaviour. However, it is also possible that those who did not consent were different to those who did in terms of eating attitudes and food intake. It is not possible to estimate the impact of this on the results as eating control and consent could be related in either direction. Therefore, care must be taken in generalizing from the results of this study to all children in general. Second, the measure of food intake focused only on snack foods rather than providing a comprehensive description of all aspects of the childrens diets. In addition, the measure relied upon self-report which was not supported by any objective assessment. However, all measures of food intake are problematic. Researcher observation can change food intake, laboratory assessments offer an unnatural environment, and diary measures cause self-monitoring and either increase or decrease eating. Further, fully comprehensive food checklists can yield data which is unmanageable and unsynthesized. The measure used in the present study was designed to be simple and short so that it could be understood by both parents and children. It was also designed to be focused on a childs consumption of snack foods which are often at the centre of eatingrelated negotiations between the parent and child. The limitations of the measure are acknowledged, but it is believed that it provides some insights into the impact of modelling and control. The results indicated that both parents and childrens diets consisted of
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many unhealthy snack foods such as crisps, chocolate and biscuits, confirming previous findings from larger-scale surveys [e.g. (Butriss, 1995; Nicklas, 1995; Wardle, 1995)]. The results also indicated a strong association between a parents and their childs snack food intake for all snacks in general and unhealthy snacks eaten yesterday. This provides support for the modelling theory of parental influence and indicates that childrens diets are effected by the types of food eaten by their parents [e.g. (Klesges et al., 1991; Olivera et al., 1992; Wardle, 1995)]. Modelling also appeared to have a role in the transmission of eating-related attitudes, with the results showing associations between parents and their childrens internal motivations and body dissatisfaction. This reflects previous research which has reported a correspondence between mothers and daughters degree of weight concern (Hall and Brown, 1982; Hill et al., 1990; Steiger et al., 1994). The results from the present study therefore support a modelling theory of parental influence, and indicate that parents eating behaviours and attitudes closely correspond to those of their children. The present study also explored the role of control. This was first assessed in terms of parental attempts to control their childs diet, and the results showed that children whose parents reported greater attempts to restrict their childs food intake indicated eating more of both the healthy and unhealthy foods. These parents may have been imposing such control because their child had a pre-existing tendency to overeat. However, in line with previous studies of parental control (Birch, 1999; Fisher and Birch, 1999), it is also possible that parentally enforced food restriction has the paradoxical effect of triggering overeating in children. Such an impact is in accordance with experimental studies of childrens diets (Fisher and Birch, 1999), and also finds reflection in studies of dietary restraint and the impact of self-imposed food restriction on eating behaviour [e.g. (Herman and Mack, 1975; Ogden, 2003)]. The role of control was also explored in terms of the use of food to modify behaviour. The results showed that such parental control had no impact upon the childs diet, which is in contrast to previous research [e.g. (Birch et al., 1980, 1982; Newman and Taylor, 1992)]. However, those children whose parents reported a greater use of food as a tool for behavioural modification reported higher levels of body dissatisfaction. Food is embedded with a complex set of meanings removed from hunger and satiety (Ogden, 2003). It is possible that using food to change behaviour detaches food further from its role in satiating hunger and promotes a more problematic relationship with eating. The body dissatisfaction reported in the present study may be a reflection of such a relationship. In summary, previous research has described theories concerned with both modelling and control. The results from the present study offer support for both these theories in pairs of parents and children. In particular, modelling was found to have a clear influence on how children both think and behave around food, with consistent associations found between parents and childrens eating behaviours and attitudes. Parental control was also found to exert an impact. Whilst control over diet, however, influenced the childs food intake and not their attitudes, using food to control behaviour was found to have the reverse effect. Accordingly, whilst modelling may have a consistent impact upon a childs diet and attitudes, the impact of parental control depends upon whether this control is focused directly at the childs diet or indirectly uses diet as a means to modify other aspects of the childs behaviour. To date, the theories of modelling and control have been developed as independent perspectives using different populations and different methodologies. The results from the present study provide some insights into the relative impact of these different forms of parental influence and indicate that a
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positive parental role model may be a more effective means to facilitate change than parental attempts to impose control over their childs food intake. Such results have direct implications for the development of health education interventions. Recent recommendations for the development of intervention programs have called for the provision of information to parents concerning meal content, size and timing, and details about the potentially damaging influence of coercive feeding practices (Birch and Davison, 2001). The results from the present study indicate that in addition to simply educating parents what to feed their children, the parents diet itself should also be the focus on change. If parents can be encouraged to recognize that their own eating behaviour is the most important source of information for their children then maybe parents can be encouraged to adopt a do as I do not what I say approach to their childrens food intake.
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Children's Eating Attitudes and Behaviour

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Children's Eating Attitudes and Behaviour

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Childrens eating attitudes and behaviour: a study of the modelling and control theories of parental influence

Health Education Research

Volume 19, Issue 3

Health Education Research

Participants were asked to state their age and gender.

Parents and childrens reported snack food intake

Parents (n = 112) and childrens (n = 112) food

intake (yesterday and in general)

Comparisons between parents and their childrens

Role of parents level of control over their childs diet

Medical Journal, 303, 10191022.

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Online ISSN 1465-3648 - Print ISSN 0268-1153

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