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Q1 Research report

Child gender and weight status moderate the relation of maternal feeding practices to body esteem in 1st grade children ☆ Lenka H. Shriver a,*, Laura Hubbs-Tait b, Amanda W. Harrist b, Glade Topham b, Q2 Melanie Page c a

Department of Nutrition, University of North Carolina Greensboro, 311 Stone Building, Greensboro 27412, USA Department of Human Development and Family Sciences, 341 Human Sciences, Oklahoma State University, Stillwater, OK, USA c Assistant Vice President for Creative and Scholarly Activity, Psychology, PO Box 6216, 886 Chestnut Ridge Rd, Morgantown, WV 26505-6216, USA b

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A R T I C L E

I N F O

Article history: Received 14 March 2014 Received in revised form 14 December 2014 Accepted 21 January 2015 Available online Keywords: Controlling feeding practices Weight status Body esteem Gender School-age

A B S T R A C T

Prevention of body dissatisfaction development is critical for minimizing adverse effects of poor body esteem on eating behaviors, self-esteem, and overall health. Research has examined body esteem and its correlates largely in pre-adolescents and adolescents; however, important questions remain about factors influencing body esteem of younger children. The main purpose of this study was to test moderation by children’s gender and weight status of the relation of maternal controlling feeding practices to 1st graders’ body esteem. The Body Esteem Scale (BES) and anthropometric measurements were completed during one-on-one child interviews at school. Mothers completed the Child Feeding Questionnaire (restriction, monitoring, concern, self-assessed maternal weight). A total of 410 mother/child dyads (202 girls) participated. Percent of children classified as overweight (BMI-for-age ≥85th) was: girls – 29%; boys – 27%. Gender moderated the relation between restriction and body esteem (β = −.140, p = .05), with maternal restriction predicting body esteem in girls but not boys. The hypothesized three-way interaction among gender, child weight status, and monitoring was confirmed. Monitoring was significantly inversely related to body esteem only for overweight/obese girls (b = −1.630). The moderating influence of gender or gender and weight status on the link between maternal feeding practices and body esteem suggests the importance of body esteem interventions for girls as early as first grade. © 2015 Published by Elsevier Ltd.

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Introduction Body esteem has been strongly linked to overall self-esteem across different age groups, ranging from children to adolescents (Mendelson, Mendelson, & White, 1996; Mond, van den Berg, Boutelle, Hannan, & Neumark-Sztainer, 2011; Tiggemann, 2005; van den Berg, Mond, Eisenberg, Ackard, & Neumark-Sztainer, 2010). It is often referred to as the physical counterpart of self-esteem and consists of three dimensions, including self-evaluations related to

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☆ Acknowledgments: This research project was funded by the Oklahoma Center for Advancement of Science and Technology (Project #HR07-044) to Amanda W. Harrist, Melanie Page, Glade Topham, Lenka H. Shriver, and Laura Hubbs-Tait and by USDACSREES (Grant 05545) to Amanda W. Harrist, Tay S. Kennedy, Glade Topham, Laura Hubbs-Tait, and Melanie Page. We would like to thank Dr. Jeff Labban, a statistical analyst in the School of Health and Human Sciences at the University of North Carolina Greensboro, for his consulting services in terms of data analyses and interpretation of the findings for this paper. Conflict of interest: None of the authors are aware of any financial, personal or other conflicts of interest related to this study and this manuscript. * Corresponding author. E-mail address: [email protected] (L.H. Shriver).

one’s weight and appearance, and attributions to others of evaluations about one’s body (Mendelson & White, 1985). Body esteem tends to decline during adolescence when boys and girls experience significant emotional, psychosocial, and physiological changes and thus, the time prior to adolescence is important for developing a healthy body image and maximizing body satisfaction in children (Robins, Trzesniewski, Tracy, Gosling, & Potter, 2002; Tiggemann, 2005). Previous studies have linked low body esteem to a variety of negative psychological and emotional outcomes (Mond et al., 2011; Paxton, Neumark-Sztainer, Hannan, & Eisenberg, 2006). Findings from a large epidemiological study of adolescents, Project EAT, revealed that body dissatisfaction mediates the relationship between obesity and emotional well-being (i.e., self-esteem and depressive mood) in both younger and older adolescents (Mond et al., 2011). Adolescents with low body esteem are also more likely to engage in restrained and emotional eating, which makes them more vulnerable to the development of disordered eating compared to their peers (Flament et al., 2012). Because poor body esteem may have adverse effects on many aspects of teens’ well-being, it is crucial for individuals to develop a healthy body image prior to adolescence (Mendelson, Mendelson, & White, 2001; Wardle & Cooke, 2005).

http://dx.doi.org/10.1016/j.appet.2015.01.017 0195-6663/© 2015 Published by Elsevier Ltd.

Please cite this article in press as: Lenka H. Shriver, Laura Hubbs-Tait, Amanda W. Harrist, Glade Topham, Melanie Page, Child gender and weight status moderate the relation of maternal feeding practices to body esteem in 1st grade children , Appetite (2015), doi: 10.1016/j.appet.2015.01.017

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Correlates of body dissatisfaction in adolescents range from intrapersonal characteristics and peer influences to broader family and societal contexts (Helfert & Warschburger, 2011; Murray, Rieger, & Byrne, 2013; van den Berg et al., 2010). Body weight/size appears to be one of the main correlates of body esteem in this age group, with a strong positive relation between weight and body dissatisfaction (Neumark-Sztainer, Story, Hannan, & Croll, 2002; Xanthopoulos et al., 2011). However, much less is known about correlates of body esteem in younger children. While previous studies found that weight status may be a significant correlate of body esteem even among elementary school age children (Davison, Markey, & Birch, 2003; Shriver et al., 2013), additional research on factors that influence younger children’s body esteem prior to adolescence is currently needed (Davison & Birch, 2002). Some studies point to the moderating effect of gender on the relation between body weight and body esteem (Ricciardelli & McCabe, 2001; Shriver et al., 2013; Wood, Becker, & Thompson, 1996). The period between ages 8 and 10 has been suggested as the time when gender differences in body esteem might begin to appear (Ricciardelli & McCabe, 2001; Wood et al., 1996). However, at least two previous studies with samples of 7- to 12-year-old children found no significant differences in body satisfaction between boys and girls (Hill, Draper, & Stack, 1994; Ricciardelli, McCabe, Holt, & Finemore, 2003). In contrast, Danielsen et al. (2012) found that among children between the ages of 10 and 13, lower satisfaction with physical appearance was associated with higher BMI, being female, and being evaluated by parents as overweight. Thus, there are inconsistencies in the literature on relations between body esteem and gender. Such inconsistencies are viewed as indicative of effect modification (i.e., one specific moderator) or complex interactions among variables (Baron & Kenny, 1986; Ventura & Birch, 2008). In the case of child body esteem, high parental control over food has been linked to a variety of disinhibited eating behaviors and weight issues or concerns (Birch & Fisher, 2000; Faith et al., 2003; Joyce & Zimmer-Gembeck, 2009; Kröller & Warschburger, 2009), which have been linked to children’s body esteem or body dissatisfaction in other studies (Helfert & Warschburger, 2011, 2013; Xanthopoulos et al., 2011). A handful of studies have also linked early childhood eating and controlling feeding practices to increased risk of later disordered eating (Jacobi, Hayward, De Zwaan, Kraemer, & Agras, 2004; Lev-Ari & Zohar, 2013). Taken together, these studies suggest that advancing the understanding of children’s body esteem requires conceptual and statistical models of the relation of interactions among children’s gender, child weight status, and parental controlling feeding practices and attitudes to children’s body esteem. Thus, the purpose of the current study was to test hypotheses about interactions among parental controlling feeding practices and children’s gender and weight status in predicting children’s body esteem. Controlling feeding practices typically include pressure to eat, restriction, and monitoring. Pressure to eat has very different correlates and consequences from the other two practices and is best viewed as a parental response to concern about their child’s low weight (Spruijt-Metz, Lindquist, Birch, Fisher, & Goran, 2002; Webber, Cooke, Hill, & Wardle, 2010; Webber, Hill, Cooke, Carnell, & Wardle, 2010). In contrast, restriction and monitoring are moderately positively correlated but restriction is consistently found to be an authoritarian and direct strategy (Hubbs-Tait, Kennedy, Page, Topham, Q5 & Harrist, 2008; Kröller & Warshburger, 2008), whereas monitoring has been identified as a feeding practice that may be authoritative Q6 (Hubbs-Tait et al., 2008), indirect (Kröller & Warschburger, 2009), authoritarian and overtly restrictive (Birch & Fisher, 2000), or covertly restrictive (Webber, Cooke, et al., 2010). In the case of the parental feeding practice of restriction, several different programs of research suggest that restriction should have a much more negative influence on girls’ body esteem than on boys’ body esteem. Fisher and Birch (1999) measured mothers’ restric-

tion of 3- to 6-year-old children’s access to foods and children’s perceptions of restricted access at home. While there were no differences in mothers’ reports of restricting foods as a function of the gender of the child, there were marked gender differences in the link between maternal restriction and children’s perceptions of restricted access to foods. The correlation between girls’ recognition of being restricted and mothers’ reports of restriction was positive, significant, and of large magnitude (.58), whereas the correlation for boys’ recognition of being restricted and mothers’ reports was .02. Similarly, mothers’ reports of restriction interacted with gender to predict children’s consumption of restricted snacks when allowed access in a laboratory procedure. Girls did; boys did not. In a subsequent study of 197 girls between the ages of 4.6 and 6.4 years, Fisher and Birch (2000) found that girls’ negative emotions about eating “too much” snack foods were linked significantly to parental restricting practices. Taken together, these two studies of child obesity and overeating suggest that restriction may have a significant negative influence on body esteem for first grade girls but not boys. In a study of eating disorder risk, Lev-Ari and Zohar (2013) reported a similar gender difference in adults’ recollections of maternal feeding practices during childhood. Restriction and concern predicted body dissatisfaction in women but not in men. Furthermore, maternal restriction was positively correlated with disordered eating among women. Thus, previous research suggests the hypothesis that maternal restriction will be negatively related to body esteem in girls but not boys. Because no study to date has tested this hypothesis, we proposed to test it. In contrast to the studies on restriction, results of research on monitoring suggest that its relation with child body dissatisfaction may be moderated by child weight status as well as child gender. Researchers have pointed out that parental concerns about child weight may be communicated indirectly by using excessive monitoring (Webber, Cooke, et al., 2010). While parental practices related to weight control are often intended to be positive and encouraging, such messages can be harmful to body image (Helfert & Warschburger, 2011). Excessive monitoring appears to be intrusive or authoritarian to the child who is the object of monitoring behaviors and comments and is linked to increased child energy intake and weight (Birch & Fisher, 2000) and, like authoritarian parenting in general, may be linked to lower esteem (Heaven & Ciarrochi, 2008), including body esteem. In adolescence, parental statements encouraging or urging teens to pay attention to body shape are inversely associated with body esteem (Helfert & Warschburger, 2011) and are more commonly directed to teens who are overweight (Helfert & Warschburger, 2013). The measurement of encouraging attention to body shape is similar to the measurement of monitoring of foods, in that statements are not negative. Statements of weight-related teasing, in contrast, are explicitly negative, predict higher body dissatisfaction (see Menzel et al., 2010 for meta-analysis), and interact with gender to predict greater body dissatisfaction in females than males (Menzel et al., 2010; Schaefer & Blodgett Salafia, 2014). Recent research underscores that it is not the positive or negative nature of comments but the focus on weight and shape that matters. Even positive weight and shape comments were significantly correlated with body dissatisfaction in adolescent and young adult women (Herbozo, Menzel, & Thompson, 2013). Weight status also moderated the relation between positive comments and body dissatisfaction because only for obese females were such comments associated with their weight and shape concerns. We conjectured that maternal monitoring, when directed to overweight and obese children, would focus attention on child weight. Thus, we hypothesized that parental monitoring of foods would be particularly intrusive to obese and overweight children and, consistent with the findings reported above for adolescents and adults, would be more likely to influence body esteem in girls than boys,

Please cite this article in press as: Lenka H. Shriver, Laura Hubbs-Tait, Amanda W. Harrist, Glade Topham, Melanie Page, Child gender and weight status moderate the relation of maternal feeding practices to body esteem in 1st grade children , Appetite (2015), doi: 10.1016/j.appet.2015.01.017

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a three-way interaction among monitoring, child weight status, and gender. Parental concern about child weight is a feeding attitude linked to parental restriction across multiple investigations (Gray, Janicke, Wistedt, & Dumont-Driscoll, 2010; Payne, Galloway, & Webb, 2011; Seburg et al., 2014; Webber, Hill, et al., 2010). Because of this well replicated finding and results on differences in maternal weight concern as a function of child gender (Campbell, Williams, Hampton, & Wake, 2006), we entertained the hypothesis that parental concern would interact with child gender. We hypothesized that gender would moderate the relation of parental concern to child body esteem analogous to the moderating effect of gender we proposed for the relation of parental restriction to child body esteem. Until recently, very few studies have examined associations between the parental practice of monitoring and the parental attitude of weight concern. Seburg et al. (2014) did examine this association in children at risk for obesity and found a significant association between concern and parental monitoring for children with the propensity to become obese, suggesting that, as with monitoring, we should expect both gender and obese/overweight child weight status to moderate the association between parental weight concern and child body esteem. Thus, we tested both two-way (gender × concern) and three-way (gender × child weight status × concern) models for parental concern and child body esteem. In sum, to realize our goal of advancing the understanding of young children’s body esteem, we proposed three models about the moderating effects of child gender and weight status on the relation between child body esteem and two parental feeding practices, restriction and monitoring, and one feeding attitude, concern. For restriction, the model was a two-way interaction; for monitoring the model was a three-way interaction. Because the research on parental concern suggests that concern may be congruent with both restriction and monitoring we proposed to examine models of both two- and three-way interactions. Material and methods Study design Data for this correlational study were collected as part of a large randomized intervention study called the Families and School for Health (FiSH) project in a Midwestern state of the U.S. Children and their mothers were recruited through their respective elementary schools in the falls of 2005 and 2006 with children/parent dyads from a total of 29 rural schools participating in the overall study (total of 1171 children). Data for the current study were collected when children were attending the first grade (before the intervention was delivered). The initial written informed consents were obtained from each school’s principal and parental consent forms were obtained after familiarizing parents of 1st graders at backto-school nights and other school events (letters about the study’s goal and its benefits and risks were also sent home with the children). Parents signed an informed consent form and gave permission for their child to participate in the study prior to any data collection. Children were asked for assent before any data were collected from them. Further details about the larger study’s design and methodology are described elsewhere (Shriver et al., 2013; Topham et al., 2011). The study protocol was reviewed and approved by the University Institutional Review Board prior to data collection.

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turned completed questionnaires (42% response rate of n = 1171), with majority being biological mothers of the children in the sample (96%) (Topham et al., 2011). Of the 87% mothers who completed demographic questions, 79.4% were married, 77.6% were of European American descent, 93.3% had completed secondary education, and 35.4% had a college degree. After matching maternal data with all the child variables of interest, a total of 410 mother/child dyads (73.7% European American, 20.2% Native American, 2.7% Hispanic, 2.0% African American, and 1.5% multiracial/ethnic descent) were used in the final analyses for the current study, including 208 boys and 202 girls. The final maternal response rate was 35%, which is higher than reported in similar previous studies (Blissett & Haycraft, 2008; Corsini, Danthiir, Kettler, & Wilson, 2008). Individual child interviews and assessments were utilized to collect data from children at the participating schools, including psychosocial information and anthropometrics. The interviews took place during regular school days and regular class time/recess, depending on teachers’ schedules. The procedures used for the oneon-one child interviews are described elsewhere (Topham et al., 2011). Maternal data included in this study were self-reported and were collected through a questionnaire packet that was mailed directly to mothers as part of the larger project. Mothers were asked to complete the packet, which included a series of questionnaires related to their own and their child’s behaviors and characteristics, and return it to the researchers. Child measures: weight status and body esteem During the child interviews, standard anthropometric assessment procedures were followed to obtain children’s height and weight (Center for Disease Control and Prevention (CDC, 2007). Height measurements to the nearest 0.2 centimeters were taken twice using a portable height board. The measurement was repeated for the 3rd time if the value was not within ±.3 centimeters and the mean of the three measurements was used in the analyses. Weight was determined to the nearest ±.2 pounds using a portable digital scale (Tanita Electronic Scale, BWB-800). Children’s Body Mass Index-for-age (BMI-for-age percentile) was calculated utilizing the Epi Info software program for Windows (Dean et al., 2007). For the final analyses, children’s BMI-for-age percentile was used to categorize children in a dichotomous variable as (1) nonoverweight (i.e., ≤85th percentile) and (2) overweight/obese (i.e., >85th percentile), with underweight children (85th percentile) (CDC, 2000). b Score range of 1–5. c Score range of 1–4. d Score range of 1–5.

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make Type II errors in identifying moderation effects. This .10 criterion is more conservative than significance levels of .15 that have been implemented in previous research testing moderation models (e.g., Durand, Dunton, Spruijt-Metz, & Pentz, 2012). All other levels of statistical significance were set at p < .05.

The anthropometrics, body esteem, and feeding characteristics of the children and their mothers in the sample are presented in Table 1. Nearly one third of the children were overweight or obese within each gender. The mothers in the sample rated their weight status as follows: 17% noticeably overweight, 39% overweight, 42% normal weight, and 2% underweight. As expected, exploratory analyses revealed several significant inverse correlates of body esteem and the results differed by gender (Table 2). In girls, child weight status, maternal weight status rating, restriction, and maternal concern were inversely associated with body esteem, while only maternal concern about child weight was related to body esteem in boys (Table 2).

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Hypothesis 1: Gender moderates relation of restriction to body esteem.

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The results of the analysis for hypothesis 1 are depicted in Table 3. In the hierarchical regression testing the interaction between gender and restriction in the prediction of global body esteem, there was one significant main effect: child weight status. The interaction between gender and maternal restriction was also significant. For

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Results

117 Table 2 Pearson’s correlations between Body Esteem Scale (BES) scores and maternal feeding practices, concern about child weight, maternal weight status rating, and child BMI. BESa

BMI-for-age percentile (child) Maternal weight status rating Monitoring Restriction Maternal concern about child weight

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Sample

122

r

r

123

−0.244** −0.173* −0.084 −0.161* −0.190**

−0.153** −0.128** −0.040 −0.086 −0.170**

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Boys

Girls

r −0.060 −0.080 −0.003 −0.001 −0.155*

a Pearson’s correlation coefficients. * p < 0.05. ** p < 0.01.

Please cite this article in press as: Lenka H. Shriver, Laura Hubbs-Tait, Amanda W. Harrist, Glade Topham, Melanie Page, Child gender and weight status moderate the relation of maternal feeding practices to body esteem in 1st grade children , Appetite (2015), doi: 10.1016/j.appet.2015.01.017

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Model

Global body esteem

4

Restriction × gender

B

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Block 1 Maternal weight status rating Child weight status Child gender Weight concern Monitoring Restriction Block 2 Child gender × restriction Girls Block 1 Maternal weight status rating Child weight status Block 2 Restriction Boys Block 1 Maternal weight status rating Child weight status Block 2 Restriction

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Table 4 Hierarchical regression analysis of monitoring × gender × weight status.

Table 3 Hierarchical regression analysis of restriction × gender.

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5

SE

Β

t

p

−.418 −.914 .288 −.390 −.154 −.109

.226 .423 .342 .236 .219 .236

−.092 −.118 .042 −.095 −.036 −.024

−1.851 −2.161 .844 −1.656 −.706 −.462

.065 .031 .399 .099 .481 .645

−.861 B

.438 SE

−.140 Β

−1.965 t

.050 p

−.650 −1.676

.319 .546

−.141 −.212

−2.035 −3.071

.043 .002

−.606 B

.304 SE

−.136 Β

−1.993 t

.048 p

−.293 −.826

.313 .526

−.065 −.110

−.935 −1.572

.351 .118

.125

.315

.028

.395

.693

Notes: Child gender (0 = boys) and weight status (0 = normal weight) are dummy coded. All other variables are centered.

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girls, b = −0.494 and for boys, b = 0.367; thus for each unit increase in maternal restriction, girls’ body esteem diminished 0.494, whereas boys’ body esteem increased 0.367 (see Fig. 1). Tests of the simple effect of maternal restriction within gender (controlling for maternal self-reported weight status) revealed that only for girls did maternal restriction significantly predict body esteem with higher restriction associated with lower body esteem and vice versa (see bottom of Table 3).

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Hypothesis 2: Gender and weight status moderate relation of monitoring to body esteem.

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The results of the analysis for hypothesis 2 are depicted in Table 4. The coefficients for predictors and covariates are identical in the first block for hypotheses 1 and 2 and thus will not be discussed again (see Tables 3 and 4). The monitoring × gender × weight status interaction was significant. Tests for 2-way interactions were conducted for girls’ data as well as for boys’ data. None of the main effects or the interaction effect was significant for boys. For girls, in contrast, the relation of child weight status to body esteem was significant as was the expected monitoring × weight status interaction. For overweight and obese girls, b = −1.630 and for normal

Model

Global body esteem

Monitoring × gender × weight status

B

Block 1 Maternal weight status rating Child weight status Child gender Weight concern Restriction Monitoring Block 2 Monitoring × child gender Monitoring × weight status Child gender × child weight status Block 3 Monitoring × gender × weight status Girls Maternal weight status rating Child weight status Weight concern Restriction Monitoring Block 2 Monitoring × weight status Boys Maternal weight status rating Child weight status Weight concern Restriction Monitoring Block 2 Monitoring × weight status

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SE

β

t

p

−.418 −.914 .288 −.390 −.109 −.154

.226 .423 .342 .236 .236 .219

−.092 −.118 .042 −.095 −.024 −.036

−1.851 −2.161 .844 −1.656 −.462 −.706

.065 .031 .399 .099 .645 .481

−.603 −.580 −1.031

.425 .494 .750

−.093 −.066 −.104

−1.417 −1.175 −1.376

.157 .241 .170

−1.653 B −.587 −1.430 −.280 −.466 −.416

.990 SE .322 .583 .314 .322 .329

−.121 β −.127 −.181 −.070 −.104 −.088

−1.671 t −1.821 −2.453 −.892 −1.448 −1.261

.096 p .070 .015 .374 .149 .209

−1.575 B −.272 −.347 −.583 .251 −.027

.763 SE .317 .624 .366 .352 .301

.159 β −.061 −.046 −.136 .056 −.007

−2.064 t −.859 −.557 −1.594 .714 −.090

.040 p .391 .578 .112 .476 .928

.298

.649

.038

.459

.647

Notes: Child gender (0 = boys) and weight status (0 = normal weight) are dummy coded. All other variables are centered.

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weight girls, b = −0.054. Thus, for each unit increase in maternal monitoring, overweight and obese girls’ body esteem declined 1.630 whereas normal weight girls’ body esteem declined 0.054 (see Fig. 2). A regression evaluating the simple effect of monitoring on body esteem (controlling for maternal self-reported weight status) within each child weight status group revealed that, unlike normal weight girls (β = −.035, t = −0.419, p = .68), for overweight/obese girls, maternal monitoring predicted body esteem (β = −.267, t = −2.195, p = .03).

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Hypothesis 3: Gender or gender and weight status moderate relation of weight concern to body esteem.

98 99

16.5 16

16.5

49

Body Esteem

16 15.5 Boys Girls

15

Body Esteem

15.5 Normal Weight Girls

15 14.5

100

Overweight Girls

14 13.5

14.5

13

14

12.5 Low Monitoring

13.5 Low Restriction

50 51 52

High Monitoring

High Restriction

Fig. 1. Association of maternal restriction and child gender on body esteem score in the sample of 1st grade children. Note: Body Esteem Score range: 0–20.

Fig. 2. Interaction between maternal monitoring and child weight status on body esteem score among 1st grade girls. Note: Body Esteem Score range: 0–20; Normal weight: ≤85th BMI percentile; Overweight/obese: >85th BMI percentile.

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The results of the analysis for hypothesis 3 revealed that neither the 2-way nor the 3-way interaction was significant. For the 2-way interaction between gender and weight concern, β = −.040, t = −0.538, p = .591. The 3-way interaction between child gender, child weight status, and concern also did not reach significance, β = −.164, t = −1.399, p = .163.

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Discussion The main purpose of the current study was to test the hypothesized moderating effects of gender and weight status on the relation between children’s body esteem and maternal controlling feeding practices of restriction and monitoring as well as a maternal attitude of concern about child weight. Our regression analyses revealed a differential influence of restriction and monitoring, but not maternal attitude of concern about child weight, on young girls’ versus boys’ body esteem. Furthermore, these effects were moderated by girls’ weight status in the case of maternal monitoring. Our study adds new important insights to the existing body of research on the relations among children’s body esteem, maternal feeding practices/ attitudes, and weight status in young school-aged girls and boys. Our findings need to be discussed in light of existing research on feeding practices, obesity risks, and self-esteem in young children (Davison et al., 2003; Joyce & Zimmer-Gembeck, 2009; Shriver et al., 2013). Based on findings from previous studies, we proposed that the negative association of maternal restriction to body esteem would be greater for girls than boys (Fisher & Birch, 2000; Lev-Ari & Zohar, 2013). Our results confirmed this interaction, and, in fact, girls’ body esteem diminished as mothers’ restriction intensified whereas boys’ body esteem had the reverse association with maternal restriction. It is possible that the greater negative association of maternal restriction to daughter’s than sons’ body image is related to emotional issues linked to both feeding and similarity in gender (Blissett, Meyer, & Haycraft, 2006). Alternatively, as pointed out by Fisher and Birch (2000), the greater influence of maternal practices on daughters may be due to gender differences in shame or in the desire to attain external standards that are focused on thinness and slim physique for girls and perpetuated by the media in Western societies (Ricciardelli & McCabe, 2001). The significant interaction effect of gender, weight status, and maternal monitoring on body esteem found in our sample of 1st graders fills an important gap in current literature related to the influence of feeding practices on children’s well-being. Although monitoring can be viewed as an authoritative and positive feeding practice in relation to children’s intake of high-energy dense foods and excessive weight gain (Brown & Ogden, 2004; Faith, Scanlon, Birch, Francis, & Sherry, 2004; Haszard, Skidmore, Williams, & Taylor, 2014), our findings suggest that monitoring may negatively influence children’s body esteem, especially among girls. In our sample, greater maternal monitoring was not only associated with lower body esteem in girls compared to boys, but its influence was substantially greater among overweight and obese girls. Similarly to positive weight-related comments being linked to higher body dissatisfaction in teen and young adult women (Herbozo et al., 2013), our study is consistent with findings suggesting that overweight girls may internalize monitoring behaviors of their mothers to a greater degree than normal-weight girls (Davison, Schmalz, Young, & Birch, 2008). As a result, the well-intended practice of monitoring may, in fact, negatively influence girls’ feelings about their bodies at a very young age. Because the early elementary school years represent a critical time period for development of healthy body image (Robins et al., 2002; Tiggemann, 2005), our findings related to both restriction and monitoring predicting lower body esteem among 1st grade girls are troubling and warrant more attention in future research.

A few studies suggest that gender differences in body satisfaction might begin to develop between the ages of 8 and 10 (Ricciardelli & McCabe, 2001; Wood et al., 1996). Our study of more than 400 children demonstrates that some maternal feeding practices and child weight status are associated with body esteem among girls even earlier than that. Although mean body esteem was similar for boys and girls, our further analyses revealed gender differences in the factors that influence body esteem, with girls’ body esteem influenced by their weight status as well as by maternal restriction and monitoring of their food intake. In contrast, neither the specific feeding practices nor other maternal variables, such as maternal weight status rating, predicted body esteem of 1st grade boys. The moderating effect of gender on the link between feeding practices and body esteem extends previous research on the differential association of maternal feeding practices with young girls’ eating behavior and with adult women’s body dissatisfaction (Fisher & Birch, 2000; Lev-Ari & Zohar, 2013). In our sample, perceived maternal weight status was inversely correlated with girls’ but not boys’ body esteem. This is consistent with findings of a study by Elfhag and Linné (2009) who found significant positive links between body weight, dysregulated eating behaviors, and disordered eating risks, including body dissatisfaction in mother–daughter but not in mother–son dyads. Our study provides the bridge that links the findings on young girls’ eating behavior with adult women’s body dissatisfaction that represents an important risk factor for disordered eating (Flament et al., 2012; Jacobi et al., 2004). Recent research suggests that maternal restriction during adolescence may result in disordered eating in both males and females (Loth, MacLehose, Fulkerson, Crow, & Neumark-Sztainer, 2014) so further research is needed to clarify whether adolescence is a period of increased vulnerability for males to maternal restriction. While maternal concern about child weight was the only maternal variable inversely related to body esteem across both boys and girls, this association disappeared in subsequent regression analyses where we found no common predictors of body esteem for boys and girls. Therefore, our results suggest that different mechanisms of body esteem development may be in place for young elementary school-age boys and these pathways should be explored in order to identify potential predictors of their body esteem over time. Alternatively, construct-related issues may exist within the research instruments currently utilized for examination of body/weight concerns among boys versus girls. For instance, social influences related to appearance among boys are focused on muscularity rather than thinness that is emphasized for girls (Helfert & Warschburger, 2011). While the internal consistency reliability of the body esteem scale in boys was acceptable and our diagnostic assessment did not reveal potentially problematic items, future conceptual and methodological assessment of these instruments may advance research in this area. Our study has several major strengths, including a large sample size of more than 400 1st grade children and a high maternal response rate (35%) compared to other similar studies (e.g., Blissett & Haycraft, 2008). The study has, however, several limitations that need to be noted. First, the sample comes from 29 schools from rural areas of a Midwestern U.S. state. Thus, our findings need to be replicated with representative samples of children and parents before findings can be generalized more broadly. Second, maternal data were self-reported, including the maternal weight status rating and feeding practices. Direct observations of feeding practices and anthropometric measurements of parents were not possible due to the large scale of the overall study, thus maternal findings are based on self-report. Similarly, BES was a self-reported measure of children’s body esteem and the mode of delivery was modified to verbal administration by a trained interviewer to minimize potential impact of the children’s reading and writing levels on BES completion during the study. Although validated in previous research, the BES subscales

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(i.e., BE-Weight, BE-Appearance, BE-Attribution) were not used in this study due to the young age of the children in the sample and the relatively low reliabilities of the BE-Weight and BE-Attribution subscales. Fourth, a certain degree of response bias cannot be ruled out, as the mothers who returned the completed questionnaires may have differed from those who chose not to participate in the study. Moreover, no assumptions about the direction of effects from parents to children may be made due to the correlational nature of the research design of the current study. While it is unlikely that parents would respond to lower body esteem with restriction, research suggests that parents do respond to higher child weight with restriction (Webber, Cooke, et al., 2010). Thus, longitudinal research is needed to identify the degree to which child body esteem is influenced by changes in child weight and changes in maternal restriction. Finally, as is the case for many other studies (Campbell et al., 2010; Corsini Q7 et al., 2008; Webber, Hill, et al., 2010), all parental data in the current study were provided by mothers and research on fathers is a crucial need.

19 Conclusions

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To our knowledge, this is the first study that examined the moderating influences of gender and weight status on the relation between body esteem and maternal controlling feeding practices/ attitudes. As our findings suggest, maternal restriction and monitoring, but not concern about child weight, represent important predictors of body esteem in 1st grade girls, with monitoring influencing body esteem even more negatively in overweight or obese girls than in normal weight girls. Thus, these constructs should be further examined in future studies with young school age girls, using large and diverse samples. The findings of this study, combined with the current knowledge related to adolescents’ body esteem, suggest the importance of future interventions focusing on the development of a healthy body image, parent education about positive feeding and weight-related behaviors, and promotion of healthy dietary habits within the family to optimize body esteem of girls as early as first grade.

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