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This article helps pediatricians understand how mother/child feeding interactions factor into the complex issue of childhood obesity.
On a daily basis, the busy pediatric provider is faced with the task of helping parents keep their children healthy in an environment where TV promotes the consumption of high-calorie food, and overweight is so common it looks normal.
The individual pediatrician's ability to alter this obesity-inducing environment is limited. But they can and do have influence on the way parents and their children behave. While fathers play an important part in this framework, this review focuses exclusively on the mother/child dyad, for the simple reason that very few studies of fathers' role in feeding have been published.
A central theme in the study of the dyadic interaction is its reciprocal nature: maternal feeding style is altered by child behavior, and child behavior is altered by maternal feeding style. Neither is independent of the other. Therefore, one cannot assume that a child's weight status is due entirely to the mother's feeding practices.1-3 The pediatrician's role is to find the point in the relationship where effective intervention is possible. Don't expect this task to be easy. According to a recent survey, most pediatricians (81%) find the lack of parental involvement one of the greatest barriers to treating childhood obesity.4 But when the effort succeeds, the rewards are considerable.
Many of the behaviors discussed in this article are innate behavioral dispositions or culturally mediated attitudes about food, which have not changed in generations. These relatively stable genetically or culturally mediated behaviors may have been highly functional at one time. But as the environment in which they are expressed changes, these same characteristics can contribute to increasing rates of obesity.
For example, during the Depression, or in war-torn Europe and Asia, or at any time in history when food supplies were uncertain, mothers who urged their children to "clean their plates" were engaging in a highly adaptive behavior. But in the US today, where food in large portions is available to almost everyone, a belief system built on an imperative that food must not be wasted can contribute to childhood obesity.
Fifty years ago, when television ads for high-calorie foods were not ubiquitous, a child's genetic predisposition to respond to external rather than internal cues to eat may not have been problematic. Today, children are barraged by ads designed to increase their consumption of junk food-children 8 to 12 years of age see more than 7,600 food ads a year (more than 50 hours) on TV alone.5 Therefore a genetic predisposition to be more responsive to external food cues may be much more dangerous today than it was decades ago, when children had less media exposure. It's a factor worth considering when examining how kids today respond to food.
What junior brings to the table
As we noted earlier, children may exhibit a variety of behaviors and attitudes about food, some of which may be genetically or culturally mediated. Eating in the absence of hunger (EAH) is an example of a behavioral phenotype that is relatively stable in individual children, and is also believed to be genetically mediated.6,7
Imagine two school-age children who have just finished lunch on a Saturday afternoon. Both children are presumably satiated. An hour later, one child asks her mother for a snack, even though she couldn't possibly be hungry. The other child, offered popcorn by a teenage brother watching a football game, turns it down and runs off to play. The first child is displaying a behavioral phenotype of high EAH. The second child has low EAH.
Children with high EAH seem to eat in response to social cues in the environment; they don't have to be hungry (see "How can you be hungry? You just ate!"). Children with low EAH, once they are satiated, are relatively impervious to prompts to eat from the environment. Children with high EAH have a higher body mass index (BMI), and are more likely to be overweight.7 These children presumably elicit responses from their parents that are different from responses to low EAH children, and require different types of parenting where food is concerned.