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Am J Clin Nutr 2003;78:215–20. Printed in USA. © 2003 American Society for Clinical Nutrition 215
Learning to overeat: maternal use of restrictive feeding practices
promotes girls’ eating in the absence of hunger
Leann L Birch, Jennifer Orlet Fisher, and Kirsten Krahnstoever Davison
Background: Experimental findings causally link restrictive
child-feeding practices to overeating in children. However, longi-
tudinal data are needed to determine the extent to which restrictive
feeding practices promote overeating.
Objectives: Our objectives were to determine whether restrictive
feeding practices foster girls’ eating in the absence of hunger
(EAH) and whether girls’ weight status moderates the effects of
restrictive feeding practices.
Design: Longitudinal data were used to create a study design fea-
turing 2 maternal restriction factors (low and high), 2 weight-
status factors (nonoverweight and overweight), and 3 time factors
(ages 5, 7, and 9 y).
Results: Mean EAH increased significantly (P < 0.0001) from 5
to 9 y of age. Higher levels of restriction at 5 y of age predicted
higher EAH at 7 y of age (P < 0.001) and at 9 y of age (P < 0.01).
Girls who were already overweight at 5 y of age and who received
higher levels of restriction had the highest EAH scores at 9 y of
age (P < 0.05) and the greatest increases in EAH from 5 to 9 y of
age (P < 0.01).
Conclusions: The developmental increase in EAH from 5 to 9 y
of age may be especially problematic in obesigenic environments.
These longitudinal data provide evidence that maternal restriction
can promote overeating. Girls who are already overweight at 5 y
of age may be genetically predisposed to be especially responsive
to environmental cues. These findings are not expected to be gen-
eralized to boys or to other racial and ethnic groups. Am J
Clin Nutr 2003;78:215–20.
KEY WORDS Eating in the absence of hunger, overeating,
restrictive feeding practices, girls
Parents use a variety of practices to achieve day-to-day goals
involving when, what, and how much children eat. Some practices,
although successful in their immediate effects on children’s eating,
may have unintended consequences for children’s food selection,
preferences, and the behavioral control of food intake. For exam-
ple, the current obesigenic food environment is characterized by
large amounts of inexpensive, readily available, palatable, energy-
dense foods (1). In response to this environment, parents may
attempt to limit children’s consumption of “junk” or “unhealthy”
foods by keeping foods out of reach or by placing constraints on
when and how much food may be consumed. Experimental stud-
ies have shown, however, that restrictive feeding practices increase
From the Department of Human Development and Family Studies, The
Pennsylvania State University, University Park (LLB and KKD), and the
Department of Pediatrics, US Department of Agriculture Children’s Nutrition
Research Center, Baylor College of Medicine, Houston (JOF).
Supported by NIH grants RO1 HD32973 and M01 RR10732 and by the
National Dairy Council.
Address reprint requests to LL Birch, 105N White Building, The Pennsyl-
vania State University, University Park, PA 16802. E-mail: firstname.lastname@example.org.
Received August 29, 2002.
Accepted for publication December 16, 2002.
children’s preferences for restricted foods (2), heighten respon-
siveness to the presence of palatable foods, and promote overeat-
ing when restricted foods are freely available (3).
Although children can self-regulate energy intake by respond-
ing to internal signals about the energy content of the foods that
they consume (4), they are also susceptible to environmental cues
such as portion size (5) and the presence of palatable foods (6).
Of particular concern, given our current obesigenic eating envi-
ronment, is whether restrictive feeding practices may inadver-
tently teach children to ignore their own hunger and fullness
when placed in eating environments where palatable, previously
restricted foods are readily available. To date, the association
between restrictive child-feeding practices and the behavioral
controls of eating has been largely limited to cross-sectional stud-
ies of middle-class white children; the findings are particularly
clear for young girls. Highly restrictive feeding practices are
associated with eating in the absence of hunger (EAH, 7), nega-
tive self-evaluations (8), restrained eating (9), and overweight
among young girls (7, 10). These eating behaviors are similar to
those that are overrepresented among overweight adults, which
include external and emotional overeating and symptoms of binge
eating disorder (11).
Although experimental research documents that restriction pro-
motes children’s intake in a laboratory setting (3, 12), whether
parental restriction is observed as a cause or as the effect of girls’
overeating and overweight within a family context has not been
established. Current research on child development indicates that
parenting both influences children and is elicited in response to
children’s characteristics (3, 12). The present study used a proto-
col designed to provide an index of individual differences in
responsiveness to food cues in the environment by measuring chil-
dren’s EAH. The main objective of the analyses was to determine
whether restrictions that mothers place on their daugthers’ eating
at 5 y of age promotes the daughters’ overeating in the absence of
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216 BIRCH ET AL
hunger from 5 to 9 y of age and to assess whether girls’ weight
status moderates the effects of restriction.
SUBJECTS AND METHODS
Participants were from central Pennsylvania and were part
of a longitudinal study of the health and development of young
girls. At entry into the study, the participants consisted of 197
girls with a mean (± SD) age of 5.4 ± 0.4 y and their parents.
Of those participants, 192 girls and their parents were
reassessed 2 y later when the girls had a mean age of 7.3 ± 0.3 y.
A third assessment, which consisted of 182 families, was per-
formed 2 y later, ie, 4 y after the initial assessment, when the
girls had a mean age of 9.34 ± 0.3 y. The eligibility criteria for
girls’ participation at the time of recruitment were as follows:
living with both biological parents, the absence of severe food
allergies or chronic medical problems affecting food intake,
and the absence of dietary restrictions involving animal prod-
ucts. Families were not recruited on the basis of weight status
or concern about weight. This study was conducted in accord
with the Helsinki Declaration of 1975, as revised in 1983. All
procedures were approved by The Pennsylvania State Univer-
sity Institutional Review Board, and the mothers provided writ-
ten informed consent for their own and their daughters’ partic-
ipation before data collection.
Families were recruited for participation in the study with
the use of flyers and newspaper advertisements. In addition,
families with age-eligible female children within a 5-county
radius received mailings and follow-up phone calls (Metromail
Inc, Chicago). On average, the parents were in their mid-30s
at the time of recruitment (mothers’ mean age: 35 ± 5 y;
fathers’ mean age: 37 ± 5 y). Ninety-seven percent of the
fathers and 63% of the mothers were employed when the girls
were 5 y old; the employment percentages increased to 99%
and 76%, respectively, when the girls were 7 y old and
remained at 99% for the fathers and increased to 78% for the
mothers when the girls were 9 y old. When the girls were 5 y
old, approximately equal numbers of families reported incomes
in the following ranges: $20 000–35 000, $35 000–50 000, and
> $50 000. The percentage of families reporting incomes
> $50 000 increased to 47% when the girls were 7 y old and
then to 57% when the girls were 9 y old. The parents were well
educated; the mothers’ mean amount of education was 15 ± 2 y
(range: 12–20 y), and the fathers’ mean amount of education
was 15 ± 3 y (range: 12–20 y). Parents were, on average,
slightly overweight at the first measurement, with a mean body
mass index (BMI; in kg/m
) of 25.6 ± 5.3 for the mothers and
28.1 ± 4.5 for the fathers. Weight status increased slightly
from time 1 to time 2, with mean BMI values at time 2 of
26.9 ± 6.2 for the mothers and 28.4 ± 4.3 for the fathers. There
was also a slight increase from time 2 to time 3, with mean
BMI values increasing to 27.5 ± 6.3 and 28.9 ± 4.4 for the
mothers and the fathers, respectively.
Eating in the absence of hunger: free-access protocol
To minimize the influence of hunger on intake in the free-
access session, each girl participated in a standard ad libitum
lunch before the free-access session with 3–6 other girls of the
same age. Each girl was provided with generous portions of food
at lunch, and portion sizes were increased for some items as the
girls increased in age. The portion sizes, including changes with
age where applicable, were as follows: bread (56 g), sandwich
meat (4 slices at 5 y of age and 6 slices at 7 and 9 y of age),
carrots (20 g), applesauce [120 mL (4 oz)], cheese (1 slice at 5 y
of age and 2 slices at 7 and 9 y of age; 21 g/slice), cookies
(2 medium, 16 g each), and milk [300 mL (10 oz)]. In addition,
a subjective measure of hunger was obtained from each girl
immediately after lunch with the use of 3 figures depicting “hun-
gry,” “half-full,” and “full.” Girls who ate little before the free-
access snack session or who indicated that they were “hungry”
after lunch were not included in the analyses.
Immediately after lunch, during the free-access session, the
girls’ preferences for the snack foods (data not shown) were
assessed. Each girl was asked to rate small (2-bite) samples of the
following 10 sweet and savory snack foods varying in fat, energy
content, and sensory properties: popcorn (15 g), potato chips
(58 g), pretzels (39 g), nuts (44 g), fig bars (51 g), chocolate chip
cookies (66 g), fruit-chew candy (66 g), chocolate bars (66 g), ice
cream (168 g), and frozen yogurt (168 g). Next, the girl was shown
various toys and containers holding generous, preweighed por-
tions of the same 10 snack foods. The girl was instructed that she
could play with the toys or eat any of the foods while the experi-
menter did some work in the adjacent room. The experimenter
then left the room for 10 min. When the experimenter returned,
the girl was interviewed about whether her parents let her have
the foods provided and how she felt about her eating during the
session. To determine energy intake for each child, each of the
food items that were served was weighed before and after the ses-
sion. Manufacturers’ data were used in conjunction with gram-
consumption data to calculate each child’s total energy intake dur-
ing the 10-min EAH period.
The girls’ height and weight were measured in triplicate at each
age by a trained research assistant, and the girls’ BMI was calcu-
lated from the height and weight measures. Because BMI during
childhood is age and sex specific, BMI percentiles were calculated
by using recent growth charts from the Centers for Disease Con-
trol and Prevention (13).
Mothers’ child-feeding practices
The mothers’ child-feeding practices and their perception of
their daughter’s risk for overweight were assessed at each age by
using the Child Feeding Questionnaire (14). The questionnaire’s
restriction subscale, which assesses the extent to which mothers
control how much, when, and what girls eat, was the primary
child-feeding measure used in these analyses. Two other aspects
of control in feeding were assessed to evaluate the extent to which
girls who received high levels of restriction differed in other
aspects of control in child feeding. These 2 aspects were moni-
toring, which assesses the extent to which mothers keep track of
what their daughters eat, and pressure to eat, or mothers’ tendency
to pressure girls to eat more food, particularly at meal times. In
addition, the following 2 aspects of maternal perceptions of the
child were assessed: perceived child’s weight, or mothers’ per-
ceptions of their daughter’s weight history, and concern about
child’s weight, which assesses mothers’ concern about their
daughter’s risk of becoming overweight. Previous analyses of this
sample provided evidence of acceptable internal consistency and
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EATING IN THE ABSENCE OF HUNGER 217
criterion validity for the Child Feeding Questionnaire subscales
included in this analysis (14).
Several background characteristics were examined in this study
as potential confounding variables for the associations between
weight status, maternal restriction, and girls’ EAH. These charac-
teristics were family income (< $20 000, $20 000–35 000,
$35 000–50 000, > $50 000), mothers’ years of education, and
mothers’ BMI, which was based on 3 measures of the mothers’
height and weight when the girls were 5 y old.
Data for 140 girls were used in the analyses outlined below.
Only girls with complete data were considered for the analyses
(n = 182). Of the 182 girls who participated from 5 to 9 y of age,
data for 29 girls at 5 y of age were excluded, data for 6 girls at 7 y
of age were excluded, and data for 7 girls at 9 y of age were
excluded. These data were excluded for the following reasons:
interviewer ratings indicated general behavioral difficulties
throughout the interview day; interviewer ratings indicated that
the girl did not seem comfortable or understand instructions dur-
ing the 10-min period in which she was told she could play or eat;
the girl ate less than a total of 1680 kJ (400 kcal) at breakfast, a
midmorning snack, and the lunch preceding the free-access ses-
sion; or the girl indicated that she was hungry before the free-
access session. Thus, excluding all subjects with either missing
data at a given age or excluded data, 140 subjects with complete
EAH data were retained. The 140 girls who were included in the
analyses did not differ significantly from the excluded girls in
terms of family income (F = 0.82, P = 0.37), mean maternal
restriction (F = 0.16, P = 0.70), or mean BMI across the 5-y period
(F = 0.92, P = 0.34).
In this study, we were primarily interested in how maternal
restriction at 5 y of age affected girls’ subsequent intake regula-
tion, or EAH, from 5 to 9 y of age. We were also interested in
whether the effects of restriction differed significantly between
girls who were overweight and those who were not overweight at
entry into the study. Therefore, we used a 2 2 factorial design
based on maternal reports of restriction and girls’ weight status at
5 y of age, which resulted in the following 4 groups: girls who
were overweight and exposed to high restriction, girls who were
overweight and exposed to low restriction, girls who were not
overweight and were exposed to high restriction, and girls who
were not overweight and were exposed to low restriction.
Median splits were used to categorize girls as receiving either
low or high levels of maternal restriction in feeding at 5 y of age.
The girls’ BMI percentile scores were used to categorize the girls
as being nonoverweight or overweight. At 5 y of age, only 28 of
the 140 girls were at or above the overweight cutoffs from the
Centers for Disease Control and Prevention (ie, ≥ 85th BMI per-
centile), and only 8 of those girls fell into the overweight, low
restriction group. Therefore, a less restrictive cutoff of the 75th
BMI percentile was used to ensure that the numbers of girls in the
4 groups were more equal (ie, approximately the same number of
girls in each of the 4 groups).
To identify potential covariates for the relation between mater-
nal restriction and girls’ EAH, differences between the 4 groups in
background characteristics (family income, mothers’ years of edu-
cation, and mothers’ BMI) were examined by using analysis of
variance. In addition, the association between each background
characteristic and the dependent variable of interest (ie, EAH) was
examined by using correlation analysis. In instances in which
significant differences in the background characteristic were iden-
tified for the independent variable (ie, the restriction–weight-status
groups) and the dependent variable (ie, EAH), the background vari-
able was entered as a covariate in the analyses outlined below.
Initial analyses examined differences in maternal child-feed-
ing practices at 5 y of age, including monitoring and pressure,
and in reaction to overweight in children by using analysis of
variance featuring 2 restriction categories (low and high) and
2 weight-status categories (nonoverweight and overweight). A
2 (weight status) 2 (restriction) 3 (time) repeated-measures
analysis of variance was then used to examine the following:
1) changes in the girls’ mean EAH scores from 5 to 9 y of age;
2) differences in the girls’ EAH at each age as a function of mater-
nal restriction, girls’ weight status, and the interaction between
restriction and weight status; and 3) changes in the girls’ EAH from
5 to 9 y of age as a function of restriction, weight status, and the
interaction between restriction and weight status. All analyses were
performed with the use of SAS (version 8.2; SAS Institute Inc,
Cary, NC), and P < 0.05 was used to indicate significant effects.
Of the 140 girls who had complete data at 5, 7, and 9 y of age,
41 were categorized as nonoverweight with low levels of maternal
restriction at 5 y of age, 45 were nonoverweight with high restric-
tion at 5 y of age, 25 were overweight with low restriction at 5 y
of age, and 29 were overweight with high restriction at 5 y of age.
With the use of reference data from 2000 from the Centers for Dis-
ease Control and Prevention, mean (± SD) BMI percentile scores
for the nonoverweight and overweight groups were 46 ± 2 and
86 ± 1, respectively. On a scale of 1 to 5, mean maternal restric-
tion scores at 5 y of age in the low-restriction and high-restriction
groups were 2.2 ± 0.1 and 3.7 ± 0.0, respectively.
Maternal perceptions of child’s weight status and maternal
aspects of control in child feeding at 5 y of age according to
child’s weight status and level of maternal restriction in feeding at
5 y of age are shown in Tabl e 1 . For perception of child’s weight,
there were significant main effects of weight status (P < 0.0001)
and restriction (P < 0.05). The mothers with overweight daugh-
ters and the mothers reporting high levels of restriction perceived
their daughters as being more overweight than did the mothers
with nonoverweight daughters or the mothers reporting low lev-
els of restriction. For concern about child’s overweight, there
were main effects of weight status (P < 0.001) and restriction
(P < 0.05), but these effects were modified by a significant inter-
action (P < 0.01). Post hoc follow-up analyses indicated that the
mothers who had overweight daughters and reported high levels of
restriction reported significantly higher concern about child’s
overweight than did the other 3 groups. For monitoring of child’s
eating, there was a significant main effect of restriction (P < 0.01).
The mothers who reported high levels of restriction also reported
high levels of monitoring. Finally, for pressure to eat in feeding,
there was a significant main effect of weight status (P < 0.01). The
mothers of nonoverweight daughters pressured their daughters to
eat more than did the mothers of overweight daughters.
The EAH scores of the girls in the 4 groups at 5, 7, and 9 y of
age are shown in Figure 1. A time-related increase in the girls’
EAH over the 5-y period was observed (P < 0.0001). The mean
energy intakes from snack foods consumed during the free-access
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218 BIRCH ET AL
Maternal perceptions of child’s weight status and maternal aspects of control in child feeding at 5 y of age according to child’s weight status and level of
maternal restriction in feeding at 5 y of age
Low restriction (n = 41) High restriction (n = 45) Low restriction (n = 25) High restriction (n = 29)
Perception of child’s weight
2.6 ± 0.1 2.8 ± 0.1 3.0 ± 0.1 3.1 ± 0.1
Concern about child’s overweight
2.0 ± 0.2 1.9 ± 0.2 2.2 ± 0.2 3.1 ± 0.1
Monitoring of child’s eating
3.4 ± 0.1 3.9 ± 0.1 3.5 ± 0.2 4.1 ± 0.2
Pressure to eat in feeding
2.2 ± 0.1 2.6 ± 0.1 1.9 ± 0.1 1.9 ± 0.1
Values are the mean (± SD) item response on the Child Feeding Questionnaire: higher scores indicate higher values of the construct. The high and low
restriction groups were classiﬁed on the basis of a median split. Nonoverweight and overweight were classiﬁed on the basis of the 75th BMI percentile.
Signiﬁcant main effect of weight status, P < 0.05 (2 2 ANOVA).
Signiﬁcant main effect of restriction, P < 0.05 (2 2 ANOVA).
Signiﬁcant interaction between weight status and restriction, P < 0.05 (2 2 ANOVA).
FIGURE 1. Mean (± SEM) energy consumed during periods of eat-
ing in the absence of hunger (EAH) by girls at 5, 7, and 9 y of age
according to membership in 1 of the 4 following groups categorized by
child’s weight status and maternal restriction in child feeding: normal
weight and low restriction (; n = 41), normal weight and high restric-
tion (; n = 45), overweight and low restriction (; n = 25), and over-
weight and high restriction (; n = 29). Changes over time in energy
consumed (ie, EAH score) and differences in EAH scores between the
groups were assessed by using 2 2 3 repeated-measures ANOVA.
There were no significant effects at 5 y of age. At 7 y of age, there was
a significant main effect of restriction (P < 0.0002). At 9 y of age, there
was a significant main effect of restriction (P < 0.0018), which was mod-
ified by a significant interaction between weight status and restriction
(P < 0.053). There was also a significant time effect (P < 0.00001) and
a significant time weight status restriction interaction (P < 0.007).
periods at 5, 7, and 9 y of age were 523 ± 32 kJ (125 ± 8 kcal),
728 ± 39 kJ (174 ± 9 kcal), and 944 ± 48 kJ (225 ± 11 kcal),
respectively, which constituted 6.9%, 8.7%, and 11.2%, respec-
tively, of the age- and sex-specific recommended daily energy
intakes. At 5 y of age, there were no significant effects of weight
status or restriction on the girls’ EAH. At 7 y of age, there was a
significant main effect of restriction (P < 0.01). The girls who
were exposed to high levels of maternal restriction had higher
EAH scores than did the girls who were exposed to low levels of
restriction. At 9 y of age, there was also a main effect of restric-
tion (P < 0.01), but it was modified by an interaction between
weight status and restriction (P < 0.05). Overweight girls exposed
to higher levels of restriction had the highest EAH scores. For the
girls’ EAH scores from 5 to 9 y of age, there was a significant
time restriction interaction (P < 0.05). This effect, however,
was modified by a time weight status restriction interaction
(P < 0.01). Post hoc follow-up analyses indicated that girls who
were overweight and who were exposed to high levels of mater-
nal restriction showed the greatest increases in EAH across time.
Research has shown links between parents’ feeding practices
and children’s eating and weight status, but causality has remained
at issue; experimental research indicates that restriction can cause
overeating and is associated with overweight among children (3,
12), but other findings indicate that overweight girls tend to elicit
more restrictive feeding practices by mothers. The findings of this
study provide new longitudinal evidence that restrictive feeding
practices can promote overeating in response to the presence of
palatable foods among young girls during middle childhood, per-
haps increasing their risk for subsequent problems with eating and
energy balance. Regardless of the level of maternal restriction, the
girls’ EAH increased from 5 to 9 y of age in both absolute and rel-
ative terms and constituted an increasing percentage of the age-
and sex-specific recommended energy intake. This developmental
trend, which is consistent with a heightened responsiveness to the
presence of food, is consistent with other findings indicating that
as children develop, eating becomes increasingly responsive to
environmental cues, including portion size (5). This trend may be
especially problematic in our current environment, which is char-
acterized by the ready accessibility and availability of inexpen-
sive, palatable foods. The girls whose mothers reported using
higher levels of restriction when their daughters were 5 y old ate
more in the absence of hunger at 7 and 9 y of age than did those
whose mothers used lower levels of restriction. Furthermore, the
girls’ overweight was not a necessary precondition for the impo-
sition of maternal restriction, and restriction increased the girls’
EAH over time for both overweight and nonoverweight girls.
Five-year-old girls who were already overweight and who were
subject to higher levels of restriction showed the greatest overeat-
ing at 9 y of age. This group also showed the largest increases in
overeating from 5 to 9 y of age. These findings, which show that
the effects of early restrictive feeding practices were greatest
among the girls who were already overweight by 5 y of age, may
reflect a gene-by-environment interaction, with the child’s
genetic predisposition for overweight status moderating the effect
of maternal restriction. It is possible that girls who are already
overweight by 5 y of age may also be genetically predisposed to
be highly responsive to environmental factors, including both
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EATING IN THE ABSENCE OF HUNGER 219
maternal restrictive feeding practices and the presence of palat-
able food. This pattern is consistent with recent epidemiologic
data charting population increases in weight status, which show
that the most overweight persons may be the most susceptible to
obesigenic environments (1, 15). During a time period in which
the eating environment has been characterized as increasingly
obesigenic, the greatest increases in weight status are at the upper
end of the weight-status distribution.
The results of the present study corroborate previous experi-
mental findings (3, 7, 8, 10) showing that feeding practices can
foster individual differences in children’s eating within the family
context, which indicates that parenting influences child outcomes.
In particular, these findings provide the first longitudinal evidence
indicating that maternal use of restrictive feeding practices pro-
motes daughters’ EAH. With respect to possible effects of the
child on parenting, the mothers of overweight girls in the present
study were more concerned about their daughters’ weight and eat-
ing and were less likely to pressure their daughters to eat. Paths of
influence in parent-child interactions flow in both directions, and
these bidirectional paths of influence create feedback cycles in
which both maternal feeding styles and the child’s overeating and
weight status persist across time, leading to higher levels of
restriction and greater degrees of overweight (10).
Among adults, dietary disinhibition and binge eating are char-
acterized by consuming relatively large amounts of food in the
absence of hunger, and both can be elicited by self-restrictions on
eating. Although we know little about the causes of these eating
problems, the present research indicates that EAH, a critical fea-
ture of both disinhibited eating and binge eating, is apparent
among girls during middle childhood (9, 16) and is fostered by
maternal restriction. In a retrospective study of overweight female
binge eaters (17), some women reported that dieting preceded the
onset of binge eating, but others indicated that binging preceded
the initiation of dieting. The present findings, which show that
girls’ overeating in the absence of hunger is promoted by higher
levels of maternal restriction, raise the possibility that maternal
restriction of girls’ intake might serve as one trigger for initial
overeating or binge eating episodes, which in turn, may initiate
self-imposed restrictive dieting attempts.
A limitation of the present study is that our sample was exclu-
sively non-Hispanic white and included girls only. We selected
this sample because, by adolescence, a high prevalence of over-
weight; high rates of maladaptive eating behaviors, including
binge eating; weight concerns; body dissatisfaction; and high rates
of chronic use of unhealthy weight-control practices are endemic
among non-Hispanic white girls. However, because our findings
were obtained in a sample of exclusively non-Hispanic white fam-
ilies with girls, we cannot generalize these findings to other racial,
ethnic, or income groups or to boys. In this instance, because par-
enting is so culturally specific, there is good reason to predict that
our findings would not generalize to other groups. Parenting prac-
tices reflect, in part, parents’ responses to perceived environmen-
tal threats to goals for their children (18), and although a few
parental goals for children are universal (eg, child health), other
goals differ by ethnicity, race, income, education, and child sex.
Furthermore, parents may differ in their beliefs about the envi-
ronmental conditions that either threaten or promote the attain-
ment of particular parenting goals.
For parents of non-Hispanic white girls, physical attractiveness
is an important goal for daughters (19, 20). Especially among this
group, overweight is stigmatized, and thinness, as a dimension of
physical attractiveness, is especially highly valued (21). Restric-
tive feeding strategies are used to protect daughters from the obe-
sigenic environment’s threat to their thinness and attractiveness. In
contrast, among Hispanics and African Americans, both of whom
have a particularly high prevalence of overweight and obesity dur-
ing childhood, thinness is not a goal, and childhood overweight is
not typically viewed as a problem or a threat to parental goals but
as a sign of success in meeting parental goals. The accelerated
growth and higher weight status of overweight children is viewed
positively, as evidence that the child is eating well, growing well,
and attaining the goal of good health (22, 23). We would not
expect restrictive feeding practices to be used by parents who are
interpreting children’s overweight status positively. These con-
trasting parental evaluations of childhood overweight among
racial, ethnic, and income groups highlight the need for qualitative
and quantitative research in these groups to address links between
cultural beliefs and parental goals and beliefs regarding children’s
eating and weight status and to determine how parenting practices
influence or are influenced by children’s weight status.
An increasingly obesigenic environment has been implicated in
the dramatic increases in the prevalence of overweight and obe-
sity among both children and adults of all racial and ethnic groups
(1, 24). For young children, parents play a central role in deter-
mining the extent to which the child’s eating environment is obe-
sigenic and may play a central role in determining the child’s sus-
ceptibility to environmental factors. In the present study, increases
in EAH were noted for all the groups across middle childhood, and
these increases in overeating were greater among the girls who
received high levels of restriction at 5 y of age than among those
who received low levels of restriction. The girls who were already
overweight by5yofageappeared to be especially susceptible to
the effects of maternal restriction, perhaps reflecting a genetic pre-
disposition for a heightened responsiveness to various environ-
mental factors as controls of food intake.
Although the present research shows that mothers’ attempts to
restrict daughters’ eating can have negative effects on the girls’
development of food-intake controls, this is only one avenue of
parental influence over what, when, and how much children eat.
Parents also select the foods and the size of food portions that are
offered to children; structure the timing, frequency, and social
contexts of eating (ie, determining whether family members eat
in front of the TV or together at the table); set an example through
their own eating behavior; and directly guide children’s eating via
feeding practices. Effective prevention programs must address
these multiple avenues of parental influence while being sensitive
to differences among racial, ethnic, and socioeconomic groups.
The findings of the present study provide additional support for
the view that prevention of childhood overweight must begin in
early childhood and include anticipatory guidance on parent-child
interactions in feeding. Our findings, which indicate that restric-
tion is counterproductive and not an effective approach to limiting
girls’ food intake, emphasize the importance of providing guid-
ance to parents on alternative methods of setting limits for chil-
dren in the feeding context that allow the development of adequate
self-control mechanisms. Primary prevention programs should
promote parenting skills that help children learn to like healthy
food choices, to consume appropriate portion sizes, and to be
responsive to hunger and satiety cues as determinants of when and
how much they eat. Because our findings indicate that restrictive
feeding practices tend to make girls more vulnerable to obesigenic
environments, programs to promote healthy eating and weight status
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220 BIRCH ET AL
among this group should provide parents with alternatives to
restrictive approaches to feeding.
The services provided by the General Clinical Research Center of the The
Pennsylvania State University are appreciated.
LLB contributed to the study design and the writing of the manuscript, and
JOF and KKD contributed to data collection and analysis and the writing of the
manuscript. None of the authors had any financial or personal interest in the
organizations sponsoring this research.
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