Maternal perception of child weight and concern about child overweight mediates the relationship between child weight and feeding practices

Abstract

Objective: To examine the mediating effects of maternal perception of child weight (weight perception) and concern about overweight (weight concern) on the paths between child weight and maternal feeding practices. Setting: Pudong District, Shanghai, China. Participants: A convenience sample of 1164 mothers who were primary caregivers of preschool children. Results: Sixty percent of the mothers perceived their overweight/obese children as normal weight or even underweight. The disagreement between actual child weight and maternal weight perception was statistically significant (Kappa = 0.212, P < 0.001). Structural equation modeling (SEM) indicated that weight perception fully mediated the relationship between child BMI Z-scores and pressure to eat. Weight concern fully mediated the relationships between child BMI Z-scores and the other three feeding practices. The serial mediating effects of weight perception and concern were statistically significant for the paths between child BMI Z-score and monitoring (β = 0.035, P < 0.001), restriction (β = 0.022, P < 0.001), and food as a reward (β = -0.017, P < 0.05). Conclusion: Child weight may influence maternal feeding practices through weight perception and concern. Thus, interventions are needed to increase the accuracy of weight perception, which may influence several maternal feeding practices and thereby contribute to child health.

The Relationships between Caregivers’ Concern about Child Weight and Their Non-Responsive Feeding Practices: A Systematic Review and Meta-Analysis

“…Characteristics of the included studies are shown in Table 1 . The studies were published between 2001 and 2022, conducted in the US ( n = 12) [ 21 , 24 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ], Australia ( n = 6) [ 26 , 27 , 75 , 76 , 77 , 78 ], Brazil ( n = 4) [ 28 , 30 , 50 , 79 ], Sweden ( n = 4) [ 22 , 80 , 81 , 82 ], China ( n = 2) [ 83 , 84 ], the Netherlands ( n = 1) [ 85 ], Ethiopia ( n = 1) [ 29 ], the UK ( n = 1) [ 86 ], Mexico ( n = 1) [ 87 ], South Korea ( n = 1) [ 88 ], Portugal ( n = 1) [ 23 ], India ( n = 1) [ 25 ], and France ( n = 1) [ 74 ]. The study designs were a cross-sectional study ( n = 32) and a cohort study ( n = 3) [ 23 , 26 , 85 ].…”

“…Thirty studies used the subscale of concern about child weight in CFQ to assess caregivers’ concern about children at risk of being overweight [ 19 ], and two studies [ 29 , 77 ] used the Preschooler Feeding Questionnaire (PFQ) [ 89 ] to assess caregivers’ concern about child underweight. CFQ ( n = 21) and the Chinese Child Feeding Questionnaire (C-CFQ) [ 90 ] ( n = 2) [ 83 , 84 ] was used to assess the domains of non-responsive feeding practices, including restriction, pressure to eat, and use of food as a reward. The Comprehensive Feeding Practices Questionnaire (CFPQ) [ 64 ] was also adopted in ten studies to assess caregivers’ restrictions for weight and health, pressure to eat, use of food as a reward, and emotional feeding.…”

“…In developing countries (e.g., China) or in low socioeconomic settings, caregivers tend to use food as a symbol of their love for their children, or as an educational and emotional tool for shaping their children’s eating and behaviors [ 62 ], because they may believe that higher weight indicates better health and nutrition status [ 100 , 101 ]. However, if they expressed concern about their child being overweight, they may not use food as a reward to encourage their children to eat more [ 84 ].…”

“… Effects of concern about child overweight on restrictive feeding (evaluated using β ) [ 21 , 22 , 23 , 26 , 27 , 29 , 74 , 76 , 83 , 84 , 85 ]. …”

“… Pooled β s of the associations between concern about child overweight and restrictive feeding in leave-one-out analysis [ 21 , 22 , 23 , 26 , 27 , 29 , 74 , 76 , 83 , 84 , 85 ]. …”