Higher Maternal Protectiveness Is Associated with Higher Odds of Child Overweight and Obesity: A Longitudinal Australian Study

Geisel School of Medicine at Dartmouth College, United States of America
PLoS ONE (Impact Factor: 3.23). 06/2014; 9(6):e100686. DOI: 10.1371/journal.pone.0100686
Source: PubMed
ABSTRACT
In recent years there has been an increasing interest in overprotective parenting and the potential role it plays in child development. While some have argued that a trend towards increased parental fear and reduced opportunity for independent mobility may be linked to increasing rates of child overweight and obesity, there is limited empirical information available to support this claim. Using data from the Longitudinal Study of Australian Children, this study aimed to examine the longitudinal relationships between maternal protectiveness and child overweight and obesity. A cohort of 4-5 year old children was followed up at 6-7, 8-9 and 10-11 years of age (n = 2596). Measures included a protective parenting scale administered when children were 6-7 and 8-9 years of age, child body mass index (BMI), family characteristics including household income, neighbourhood disadvantage, child's position amongst siblings, and maternal BMI, education, employment, mental health and age at first birth. International Obesity Taskforce age- and sex-specific BMI cut points were used to determine if children were in the normal, overweight or obese BMI range. There was no association between maternal protectiveness and the odds of children being overweight or obese at age 4-5, 6-7 or 8-9 years. However at age 10-11 years, a 1 standard deviation increase in maternal protectiveness was associated with a 13% increase in the odds of children being overweight or obese. The results provide evidence of a relationship between maternal protectiveness and child overweight and obesity, however further research is required to understand the mechanism(s) that links the two concepts.

Full-text

Available from: Kirsten J Hancock, Jun 25, 2014
Higher Maternal Protectiveness Is Associated with
Higher Odds of Child Overweight and Obesity: A
Longitudinal Australian Study
Kirsten J. Hancock*, David Lawrence, Stephen R. Zubrick
Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
Abstract
In recent years there has been an increasing interest in overprotective parenting and the potential role it plays in child
development. While some have argued that a trend towards increased parental fear and reduced opportunity for
independent mobility may be linked to increasing rates of child overweight and obesity, there is limited empirical
information available to support this claim. Using data from the Longitudinal Study of Australian Children, this study aimed to
examine the longitudinal relationships between maternal protectiveness and child overweight and obesity. A cohort of 4–5
year old children was followed up at 6–7, 8–9 and 10–11 years of age (n = 2596). Measures included a protective parenting
scale administered when children were 6–7 and 8–9 years of age, child body mass index (BMI), family characteristics
including household income, neighbourhood disadvantage, child’s position amongst siblings, and maternal BMI, education,
employment, mental health and age at first birth. International Obesity Taskforce age- and sex-specific BMI cut points were
used to determine if children were in the normal, overweight or obese BMI range. There was no association between
maternal protectiveness and the odds of children being overweight or obese at age 4–5, 6–7 or 8–9 years. However at age
10–11 years, a 1 standard deviation increase in maternal protectiveness was associated with a 13% increase in the odds of
children being overweight or obese. The results provide evidence of a relationship between maternal protectiveness and
child overweight and obesity, however further research is required to understand the mechanism(s) that links the two
concepts.
Citation: Hancock KJ, Lawrence D, Zubrick SR (2014) Higher Maternal Protectiveness Is Associated with Higher Odds of Child Overweight and Obesity: A
Longitudinal Australian Study. PLoS ONE 9(6): e100686. doi:10.1371/journal.pone.0100686
Editor: Olga Y. Gorlova, Geisel School of Medicine at Dartmouth College, United States of America
Received October 29, 2013; Accepted May 29, 2014; Published June 23, 2014
Copyright: ß 2014 Hancock et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This study was supported by a National Health and Medical Research Council program grant (#572742) (http://www.nhmrc.gov.au). The funders had
no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
* Email: kirsten.hancock@telethonkids.org.au
Introduction
Overprotective parents are defined as parents who are highly
supervising, have difficulties with separation from the child,
discourage independent behaviour and are highly controlling [1].
In recent years, the concept of overprotective parenting has
received increasing public attention, inspiring a number of
colloquial labels including ‘helicopter parenting’, ‘bulldozer
parenting’ and more recently, ‘chauffeur parenting’. The interest
appears to be motivated by uncertainty about perceived changes
in modern parenting practices and concerns about the potential
impacts that overprotective parenting might have for children.
Some suggested impacts of overprotective parenting include
mental health problems, lack of independence and resilience,
and increased obesity [2,3], however these suggested associations
remain largely untested.
Though the literature is limited, studies examining the impacts
of overprotective parenting on child development have begun to
emerge in recent years. The focus of these studies has been on
social and emotional outcomes, either for very young children
[4,5] or those entering early adulthood [6,7]. For example,
Cooklin et al. [5] found that higher levels of maternal protective-
ness were associated with poorer socio-emotional functioning in
2–3 year old children. At the other end of the developmental
spectrum, surveys of college students have found that students who
reported having controlling or overprotective parents also reported
higher levels of depression and less satisfaction with life [7], as well
as reduced self-efficacy [6]. While these studies suggest that
overprotective parenting may be associated with poorer social and
emotional outcomes for children and young adults, there are still
substantial gaps in the literature regarding other stages of child
development or developmental outcomes.
The particular parenting behaviours that comprise parental
overprotection may vary according to the developmental needs of
the child. As such, the implications of overprotective behaviours
are also likely to vary for children of different ages. For example,
an overprotective parent of a young child might discourage
independent activities, which may stifle opportunities for unstruc-
tured play and creativity. An overprotective parent of a young
adolescent may not allow them to walk or ride to school, impacting
on their ability to be independently mobile or active. News stories
have also documented overprotective ‘‘helicopter’’ parents of
college students attending classes with their children for the first
week of college, or intervening with professors if their child
receives an unexpectedly low grade [8]. These intrusive behav-
iours could limit opportunities for young people to learn about risk
and taking personal responsibility.
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The extent to which parental protectiveness becomes overprotec-
tive largely depends on the appropriateness of the parenting
behaviours given the risks to which children may be exposed [3].
In popular media, overprotective parenting is often positioned as a
problem that mainly exists among middle- and upper-class families
[9], and while some evidence supports this view [10], other studies
show that overprotective parenting is characterised by markers of
disadvantage. For example, high maternal separation anxiety has
been associated with financial hardship, poor neighbourhood
quality and inadequate levels of social support [11]. Maternal
overprotection is also more prevalent in families with younger
mothers, lower maternal education and fewer children [1,12].
Concerns about child safety, though common to most families, are
also more prevalent in disadvantaged families [13]. These patterns
may reflect the different challenges faced by families from lower or
higher socio-economic backgrounds, and context is therefore
important. Younger children, and children living in high-risk
environments such as in neighbourhoods with high levels of crime
and violence for example, may be well served by parents who are
concerned by their child’s young age or the safety of the
environment and who act accordingly to protect their child. The
extent to which protective parenting is a problem for children can
therefore vary from family to family.
There are suggestions that the prevalence of overprotective
parenting has increased over time [3] and particularly in the last
two decades [10]. One possible reason for this shift is that
overprotection increasingly represents normative parenting be-
haviour because more parents perceive the world as a dangerous
place for children. Therefore, heightened vigilance is ‘normal’ and
parents who do not conform to the new standards may be
considered as ‘bad parents’ [10]. As parental fear becomes
normalised, any potential consequences of this parenting style also
become normalised, including limitations on the amount of
outdoor or free play that children are permitted to engage in. A
review of the relevant literature pointing to a decline in levels of
outdoor and free play in recent decades supports this view [14]. A
study of mothers in the United States, for example, suggested that
while 70% of mothers reported they had played outdoors daily as a
child, only 31% said their child did the same. The majority of
mothers (82%) also reported they restricted outdoor play because
of safety concerns [15].
Parental fear is easily understood as a motivator for overpro-
tective parenting, however the events that give rise to the worst
parental fears generally have a very low risk of occurring. The
likelihood of a child being abducted, murdered or harmed by a
stranger is very low [16], and in cases that are reported, an
estimated 85% of child sexual assaults are committed by people
known to the child, rather than the stereotypical stranger [17].
Additionally, although injuries have been a leading cause of death
and hospitalisation for children, both in Australia [18] and
worldwide [19], the rates of child deaths and hospitalisations due
to preventable injury have generally decreased over time. Between
1986 and 2006 in Australia, the child mortality rate decreased
from 30 to 13 deaths per 100,000, a reduction mainly attributable
to a decrease in deaths from transport accidents [18]. Other
studies have shown that the rate of injury-related hospitalisations
for children aged 14 years or less has slowly but consistently
declined since the mid-19909s [20,21], and that the rate of serious
or fatal pedestrian injuries for children decreased by 7.4% each
year between 1998 and 2006 [22]. It is possible these declines have
occurred as a result of parents becoming more protective, although
other changes such as mandatory bicycle helmet laws and
improvements to vehicle safety could also explain improvements
in child safety.
As perceptions of child safety have become more conservative
over time, there have been other apparent generational shifts in
levels of physical activity undertaken and the prevalence of
overweight and obesity in children and adolescents. Though there
is limited research examining trends in overall physical activity
levels for Australian children over time, there is some evidence to
suggest that the aerobic fitness of Australian children has declined
by 4% per decade since 1970 [23,24]. Other research has shown
that among 9–13 year olds the frequency of walking or cycling to
or from school and the frequency of physical education classes
declined between 1985 and 2001, particularly amongst children
from low socio-economic status schools [25]. Other studies have
noted a downward trend in the proportion of children walking to
school or using other modes of active transport [26]. Though these
changes may help explain some of the decrease in child mortality
and hospitalisations, the downward trends in physical activity are
concurrent with increases in the prevalence of childhood obesity,
asthma and allergy, and some mental health problems, all of which
have been claimed to be at least partially due to the reduction in
time children spend being physically active and being outdoors
[27]. Of particular concern, and the main focus of this study, is the
increase in childhood obesity. In Australia, the prevalence of child
overweight and obesity more than doubled between 1985 and
1996, increasing from 10.2% to 21.6% for boys, and from 11.6%
to 24.3% for girls. Between 1996 and 2008 the estimated
prevalence plateaued at 23.7% for boys and 24.8% for girls
[28]. Though the increase in the prevalence of overweight and
obesity appears to have slowed, the prevalence rates are high and
remain a serious public health concern.
Beyond the overprotective parenting literature, there is an
increasing amount of evidence linking parental fear and the level
of physical activity in children. As discussed, parental fear is
thought to be a key factor in the decline in the amount of free and
outdoor play undertaken by children [14]. Australian research also
suggests that a significant number of parents identify ‘stranger
danger’ as a barrier to children’s independent mobility within their
community [29,30]. Other studies have shown that a fear of
stranger danger in parents was significantly associated with
parental rules for playing outside, and there was a significant
negative association between fear of stranger danger and children’s
frequency of outdoor physical activity in the neighbourhood [31],
though there was no significant association between fear of
stranger danger and other physical activity measures, amount of
screen time or BMI z-score. Parents who report being concerned
about road safety and stranger danger also limit the amount of
physical activity and active transport undertaken by children and
adolescents [32,33], and adolescents who spend more time
unsupervised after school have been reported to be more
physically active than those who spend less time unsupervised
[34]. Despite the links between parental fear and children’s
physical activity, no study as yet has linked overprotection or
parental fear with child overweight or obesity outcomes.
If there is a link between parental protectiveness and child BMI,
it is more likely to emerge as children become older and more
capable of independence. All young children require some level of
adult supervision; as such the differences in activity levels between
children with overprotective parents and those with average
protectiveness may be relatively minor. In contrast, higher levels of
parental supervision are not conducive to independent mobility
and physical activity in older children [27]. The differences in the
activities of older children with overprotective parents and those
with average parents will therefore be much wider, for example
between the children who are driven to school each day and those
who are allowed to walk or ride. Therefore the effects of
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protectiveness on child BMI would likely become more apparent
over time.
To summarise, the eviden ce sugge sts that the physical activit y
of children has declined over time as rates of child overweight
and obesity have increased. At the same time, there has been a
shift in perceptions of safety for children, even though children
arguably face the same or fewer risks today than in previous
decades. Parents have become more risk averse and protective
over time, and as a result children have enjoyed fewer
opportunities for active free play and independent mobility. It
is possible therefore, that one of the many factors related to a
decline in childre n’s physical activity levels and perhaps
contributing to the increase in obesity is the increase in parental
fear and protectiveness.
For this study, we aimed to determine if there was an association
between levels of parental protectiveness and child body mass
index (BMI), and if so, the nature of that relationship over time.
We also aimed to examine the demographic characteristics of
highly protective parents and to provide clarity to the questions
regarding the typical characteristics of highly protective parents.
We used data from Growing Up in Australia: The Longitudinal Study of
Australian Children (LSAC) to examine the study aims. The LSAC
followed the same children every two years from the age of 4–5
years to 10–11 years, allowing us to examine how the relationship
between protective parenting and child overweight and obesity
develops over time. For some families, higher levels of protective-
ness may be an appropriate response to the environment in which
they live. We therefore refer to parents as being highly protective,
rather than overprotective, to avoid the implication that such a
parenting style is undesirable for all families.
Methods
Study Design and Population
The LSAC is a nationally representative and multi-disciplinary
study of Australian children and their families. Commencing in
2004, data were collected every two years from two cohorts of
children; 5107 infants aged 3–19 months (B-cohort) and 4983
children aged 4 years 3 months to 5 years 7 months (K-cohort). In
order to follow children through a period of development where
highly protective parenting may have greater impact on the
development of obesity we focussed on the K-cohort for this study.
The K-cohort children were revisited in 2006 (Wave 2, age 6–7
years), 2008 (Wave 3, age 8–9 years) and 2010 (Wave 4, age 10–11
years). Of the 4983 families that participated at Wave 1, 4464
(89.6%) participated at Wave 2, 4332 (86.9%) at Wave 3 and 4164
(83.6%) at Wave 4.
The LSAC employed a two-stage clustered sample design, with
Australian postcode area as the primary sampling unit, and the
sampling frame drawn from the Medicare Australia enrolment
database. Approximately one in ten Australian postcode areas
were randomly selected and children were then randomly selected
within postcode areas ensuring that only one child per household
was selected (the study child). The initial response rate at Wave 1
was 47% for the K-cohort, with the initial sample broadly
representative of the Australian population of families with
children in the LSAC age groups when compared with 2001
Census data, but slightly under-representative of families who were
single-parent, non-English speaking, living in rental properties or
living in remote areas [35]. These same characteristics were also
over-represented in the sample that dropped out in subsequent
waves of the study [36]. Sample and longitudinal weights were
developed for the study to adjust for the initial response bias and
differential likelihood of ongoing participation [36]. The weights
were used in all analyses conducted for the current study.
Data collection methods included parent face-to-face interviews
in the home, self-complete parent questionnaires, interviewer
observations, direct measures of physical attributes and cognitive
development, time-use diaries and mailed out questionnaires for
childcare providers and teachers. The person who was interviewed
as the primary parent (Parent 1) was the parent who had the most
contact with the child, most typically the biological mother
(approximately 97% across waves). Questionnaires were also
offered to Parent 2, where there was another carer living with the
study child (approximately 85% of families). Parent 2 was most
typically the biological father of the study child (88–94% across
waves).
Ethics Statement
The LSAC is conducted in a partnership between the
Department of Social Services (DSS), the Australian Institute of
Family Studies (AIFS) and the Australian Bureau of Statistics
(ABS). The study has ethics approval from the Australian Institute
of Family Studies Ethics Committee. The Ethics Committee is
registered with the Australian Health Ethics Committee, a
subcommittee of the National Health and Medical Research
Council (NHMRC). As the study children were all minors at the
time these data were collected, written informed consent was
obtained from the caregiver on behalf of each of the study
children. The signed consent forms are retained by the field
agency (ABS). Individual and organisational licenses to access the
confidentialised data sets are available upon application to the
DSS [37].
Maternal Protectiveness
The parental protectiveness measures were collected in the
Parent 1 and Parent 2 Questionnaires at Wave 2 (6–7 years) and
Wave 3 (8–9 years). Due to lower response rates from fathers on
the Parent 2 Questionnaire at Waves 2 (78%) and 3 (72%), and to
ensure that no additional response bias would be introduced
through the exclusion of lone-parent families, we restricted
analysis to respondents who were mothers of the study child.
Including data from fathers would reduce the analytic sample by
approximately 30%.
The protective parenting measure consisted of 3 items that were
selected for the LSAC from a larger, validated 8-item overprotec-
tive parenting scale [4]. The items were; ‘‘How often do you try to
protect this child from life’s difficulties?’’, ‘‘How often do you put
this child’s wants and needs before your own?’’ and ‘‘How often
does leaving this child with other people upset you no matter how
well you know them?’’ Parents could respond 1 = never/almost
never; 2 = rarely; 3 = sometimes; 4 = often or 5 = almost
always/always. Scores were summed to produce a total protec-
tiveness score at Wave 2 (6–7 years) and Wave 3 (8–9 years).
Scores could range from 3 to 15, with higher scores reflecting
higher levels of protectiveness. The distribution of each total score
was close to a normal distribution with only a slight negative skew.
To facilitate interpretation, total scores were standardised to have
a mean of 0 and standard deviation of 1. The internal consistency
of responses to the three items at Wave 2 and Wave 3 was low
(Wave 2 a = 0.57, Wave 3 a = 0.57), though Cronbach’s alpha
can be an inaccurate measure of reliability when the number of
items is small [38]. The between-item correlations ranged from
r = 0.24 to r = 0.41 at Wave 2 and from r = 0.26 to r = 0.40 at
Wave 3 (see Table 1). The correlation between the total summed
scores at Wave 2 (6–7 years) and Wave 3 (8–9 years) was r = 0.55,
indicating that maternal protectiveness scores were reasonably
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Table 1. Correlation matrix of scale items and total scores on the protective parenting scale at Wave 2 (6–7 years) and Wave 3 (8–9 years).
Wave 2 Protectiveness Wave 3 Protectiveness
(6–7 years) (8–9 years)
Protect Wants and Needs Leaving Child Total Wave 2 Score Protect Wants and Needs Leaving Child Total Wave 3 Score
Wave 2 Protectiveness
(67 years)
Protect 1.00
Wants and needs .41 1.00
Leaving child .26 .24 1.00
Total Wave 2 Score .75 .68 .75 1.00
Wave 3 Protectiveness
(89 years)
Protect .43 .26 .24 .42 1.00
Wants and needs .24 .43 .20 .37 .40 1.00
Leaving child .17 .17 .53 .42 .27 .26 1.00
Total Wave 2 Score .37 .37 .46 .55 .73 .69 .76 1.00
Protect = How often do you try to protect this child from life’s difficulties?
Wants and needs = How often do you put this child’s wants and needs before your own?
Leaving child = How often does leaving this child with other people upset you no matter how well you know them?
All correlation values are significant at p , .05.
doi:10.1371/journal.pone.0100686.t001
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consistent between Wave 2 (6–7 years) and 3 (8–9 years), given the
measures were collected approximately two years apart. A very
strong correlation between waves is not necessarily expected
because the construct could reasonably change over time as family
circumstances change, for example as families expand or as
mothers increase their participation in the workforce.
The properties of the protective parenting measure used in the
LSAC were also assessed in another study using data from the
B-cohort to examine the extent to which maternal separation
anxiety, overprotective parenting and maternal mental health
were related or separate constructs [5]. In that study, maternal
separation anxiety (at age 3–19 months) had a low, but statistically
significant correlation with total maternal protection scores when
children were 2–3 years of age (r = 0.32). Maternal protectiveness
also had a low and significant correlation with maternal mental
health (r = 0.14). Cooklin et al. [5] concluded that although the
3-item scale has limited sensitivity and less than optimal internal
consistency, the items adequately assessed the construct and had
discriminant validity from separation anxiety and maternal mental
health.
Child BMI, overweight and obesity
BMI is a widely accepted measure for identifying children and
adolescents with excess weight [39]. Child BMI was calculated as
weight in kilograms divided by the squared height in metres
(weight/height
2
). Measures of child height and weight were
collected at each wave by the interviewers. Children were weighed
in light clothing to the nearest 50g using glass bathroom scales
provided by the interviewer. Two height recordings were
collected, without shoes, using a portable rigid stadiometer. The
average of the two height measurements was used for analyses.
Where the two measurements differed by more than 0.5
centimetres, a third measurement was taken and the average of
the two closest measures was used. International Obesity
Taskforce (IOTF) age- and sex-specific BMI cut-points [40] were
used to determine if children fell into the normal, overweight or
obese BMI range at each wave.
Maternal and family characteristics
The variables described below were assessed to determine their
association with maternal protectiveness, and were also included as
potential covariates that relate to child BMI. Most of the
covariates were repeatedly collected at each wave, however
variables that largely remained stable over time were taken from
Wave 1 (4–5 years) measures to coincide with the intercept of the
longitudinal model. Less stable factors, such as maternal employ-
ment or mental health status, were aggregated over time and are
described in further detail below.
Measures from Wave 1 (4–5 years). Covariates included
maternal BMI, calculated from self-reports of height and weight (up
to 25 or normal, 25 up to 30 or overweight, and 30 plus, or obese),
mother’s age at the birth of her first child (up to 19 years, 20–24 years,
25–29 years and 30 years or older) and mother’s highest educational
attainment (less than Year 12, Year 12, post-school qualification).
Household income was included as a measure of family wealth. At
Wave 1, family income was collected in broad categories, and are
grouped here as up to
$599 per week, $600–$999 per week,
$1000–$1999 per week and $2000 per week or more. Socio-economic
index for areas (SEIFA) was used to examine the effects of relative
neighbourhood disadvantage. SEIFA is a summary measure of the
socio-economic conditions of people living in an area, derived by
the Australian Bureau of Statistics. It is scored on a continuum of
disadvantage (low values) to advantage (high values) which is
derived from census variables related to both advantage and
disadvantage such as income and tertiary education. SEIFA values
were divided into tertiles at each wave (low, middle and high).
Measures collated over time. Maternal employment pattern was
a derived variable summarising the degree of employment over the
four waves. Employment status was collected at each wave and
given a score. Mothers who were not working (either unemployed
or not in the labour force) received a score of 0. Mothers on
maternity leave received a score of 1, those in part-time work (up
to 30 hours per week) a score of 2, and those with full-time
employment (more than 30 hours per week) a score of 3. These
scores were summed across all four waves, resulting in a total score
that could range from 0 (never employed) to 12 (always full-time).
Mothers were then broadly grouped according to their total score;
not working (1 point or less); some part-time employment (2–5
points); consistent part-time (6–8 points) or mostly full-time (9
points or more).
To address any concerns that the measure of maternal
protectiveness may reflect an underlying anxiety disorder, a
measure of maternal mental health was included. This was measured
using the Kessler K6 scale [41], a commonly used 6-item
assessment of psychological distress and anxiety disorder. Scores
on the scale can range from 0 to 24, with higher scores
representing poorer psychological functioning. In line with other
studies [42,43] this study used a cut-off of 8 to signal likely
psychological distress. The proportion of mothers with likely
psychological distress was 16% at Wave 1 (4–5 years), 11% at
Wave 2 (6–7 years), 14% at Wave 3 (8–9 years) and 13% at Wave
4 (10–11 years). The measure was collated across waves to provide
a summary indication of mental health, in terms of the number of
waves mothers had likely psychological distress; 0, 1–2 or 3–4
waves. Finally, the sibling position of the study child was also
examined, and taken as at Wave 4 (10–11 years), to account for
the introduction of new siblings over time. The categories included
none (only child), youngest child, middle child and eldest child.
Data Analysis
SAS 9.3 was used to conduct all analyses. Basic descriptive
analyses were used to examine how standardised maternal
protectiveness scores varied according to family and demographic
characteristics. Multivariate regression models were also fitted to
determine the characteristics that were independently associated
with higher maternal protectiveness scores. A generalised estimat-
ing equations (GEE) model, often used for repeated measures data
as it accounts for the within-subject correlation between observa-
tions across time and can allow for missing data in the outcome
measure [44], was used for the longitudinal model. An unstruc-
tured working correlation matrix was specified for the model.
Because of the relatively large sample size and the small number of
covariance parameters, an unstructured correlation matrix does
not adversely impact the power of the study compared with a more
prescriptive covariance structure. Child age group (or wave) was
used as the key predictor representing time. The longitudinal
model estimated the odds of the study child being overweight or
obese at Wave 1 (4–5 years), and the change in these odds at Wave
2 (6–7 years), Wave 3 (8–9 years) and Wave 4 (10–11 years),
according to the predictor variable set. These change estimates
were then used to determine the overall odds of child overweight
and obesity at each wave for each predictor in the model.
Covariates that were significantly associated with the odds of
overweight or obesity, either at Wave 1, or in the change in odds
at subsequent waves were retained in the final model. Variables
that were not significantly associated with child overweight and
obesity were excluded so that the most parsimonious model was
achieved.
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With attrition across waves and missing data on the Parent 1
questionnaire at Wave 2 (6–7 years) and 3 (8–9 years) where the
protective parenting measure was collected, the final analytic
sample consisted of 2,933 families. All analyses were weighted
using the longitudinal study weights provided with the LSAC data
set.
Results
Maternal protectiveness and demographic characteristics
Table 2 provides the Wave 2 (6–7 years) and Wave 3 (8–9 years)
unadjusted mean protectiveness scores by demographic charac-
teristics, along with estimates from the multivariate linear
regression analyses. There was a clear socio-economic gradient,
with higher standardised protectiveness scores observed for
mothers with greater levels of disadvantage. For example, the
mean standardised protectiveness score when children were 6–7
years (Wave 2) was 0.16 for mothers in the lowest income
category, and 20.34 for those in the highest income category. This
difference translates to a gap of 0.5 of a standard deviation in
protectiveness scores for families in the highest and lowest income
categories, a moderate effect size. In the adjusted multivariate
regression models, the difference was 0.18 (p = .023) after
accounting for maternal education, employment, age at first child,
mental health and neighbourhood disadvantage. Significantly
higher standardised protectiveness scores were also found for
mothers with lower levels of education, younger first-time mothers,
mothers with mental health difficulties at multiple waves, mothers
who were not working, and those living in neighbourhoods with
greater disadvantage.
Maternal protectiveness and child overweight and
obesity
The proportions of children in the normal, overweight and
obese BMI categories at each wave are provided in Table 3. The
proportion of overweight children increased from 15% at Wave 1
(4–5 years) to 20% at Wave 4 (10–11 y ears). Around 5–6% of
children were obese at each wave, and approximately 65% of
study children were always in the no rmal BMI range. Only 1.5%
of children were obese at all four waves (not shown). Table 3 als o
shows that children who were overweight or obese children at
any gi ven wave had significantly higher Wave 2 (6–7 years) and
Wave 3 (8–9 years) maternal protectiveness s cores than children
of normal weight.
All of the covariates examined in Table 2 were included in
the initial longitudinal model. Covariates with a p-value greater
than p = .10 for both Wave 1 (4–5 years) estimates and change
estimates at later waves were removed until the most parsimonious
model was achieved. Including both the Wave 2 (6–7 years) and
Wave 3 (8–9 years) measures of maternal protectiveness in the
model resulted in unstable estimates for both predictors. When
entered into the model separately, the Wave 3 measure of
maternal protectiveness was a statistically significant predictor of
child overweight and obesity but the Wave 2 measure was not.
The Wave 2 measure was therefore excluded from further
analysis, and all further references to the effects of maternal
protectiveness refer to the measure collected at Wave 3 (8–9 years).
The longitudinal GEE model results estimating the odds ratios
of child overweight and obesity at each wave are provided in
Table 4, and the extent to which those odds ratios changed at each
wave are provided in Table 5. There was no significant association
between maternal protectiveness and child overweight and obesity
at age 4–5, 6–7 or 8–9 years. At 10–11 years, a 1 standard
deviation increase in maternal protectiveness was associated with a
13% increase (OR = 1.13, p = .018) in the likelihood of the child
being overweight or obese. An increase of 2 standard deviations,
for example those 1 standard deviation above the mean compared
to 1 standard deviation below the mean, was associated with a
29% increase (OR = 1.29, p = .018) in the odds of children being
overweight or obese. These results were observed after controlling
for maternal BMI, household income, maternal mental health and
sibling position.
The strongest predictor of child overweight and obesity was
maternal BMI. Children were more than twice as likely (OR =
2.19, p , .001) to be overweight or obese at age 4–5 years if their
mother was obese compared to children of mothers in the normal
weight range. These odds ratios increased to 2.99 (p , .001) at age
6–7 years, 2.81 (p , .001) at age 8–9 years and 3.38 (p , .001) at
age 10–11 years. The odds ratios were significantly higher at
Waves 2, 3 and 4 (see Table 5), indicating that the effect of
maternal BMI significantly increased over time.
Household income was also associated with the odds of child
overweight and obesity. Children in the lowest category of
household income (up to
$599 per week) for example, were nearly
1.5 times more likely (OR = 1.47, p = .047) than children in the
highest income category (
$2000 or more per week) to be
overweight or obese at age 4–5 years. At subsequent waves,
children in the lowest income category were approximately twice
as likely to be overweight or obese as children in the highest
income category (e.g. 10–11 years OR = 2.08, p , .001). These
effects did not significantly increase over and above the effect
observed for Wave 1 (4–5 years, see Table 5).
The effects of maternal mental health depended on the
persistence of problems across time. Children of mothers who
had likely psychological distress at one or two waves were no more
or less likely to be overweight or obese at any wave than children
whose mother never had likely psychological distress. Children of
mothers with likely psychological distress at three or four waves
had significantly lower odds of child overweight or obesity at age
6–7 years (OR = 0.40, p = .003), 8–9 years (OR = 0.52, p =
.013) and 10–11 years (OR = 0.48, p = .003, see Table 4).
Finally, the study child’s position amongst their siblings was also
associated with the likelihood of overweight and obesity. Com-
pared to being an only child, children with siblings were
significantly less likely to be overweight or obese, and for children
who had younger siblings in particular. Study children who were
the middle child, for example, were about half as likely (OR =
0.48, p = .003) to be overweight or obese at age 10–11 years than
children without siblings.
Discussion
The literature on overprotective parenting and the potential
impacts on child outcomes has been gaining momentum in recent
years. As parents increasingly perceive the world to be a dangerous
place for children [45], parenting styles have adapted and become
more protective over time [3,27]. At the same time, other changes
appear to have occurred, including a decline in physical activity
[23,24,25,26,27], a decline in the amount of outdoor play [14,15]
and an increase in the prevalence of childhood obesity [28].
Though these patterns might suggest that higher levels of
protective parenting could be linked to child BMI, there is no
direct evidence to support this hypothesis and certainly none that
examines the relationship from a longitudinal perspective. There
has also been conflicting evidence regarding the family and
demographic characteristics that are associated with a highly
protective parenting style [1,10,11]. In this study, we aimed to
determine if any link could be drawn between protective parenting
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Table 2. Mean standardised maternal protectiveness scores at Wave 2 (6–7 years) and Wave 3 (8–9 years) by demographic characteristics, and adjusted multivariate regression
coefficients.
Wave 2 (6–7 Years) Wave 3 (8–9 Years)
Factor N Mean Score (SE) Regression Coefficient p-value N Mean Score (SE) Regression Coefficient p-value
Mother’s highest education
Post-school 1575 20.20 (0.03) Ref 1660 20.22 (0.03) Ref
Year 12 459 20.03 (0.05) 0.08 .192 496 0.02 (0.05) 0.15 .012
Less than Year 12 1130 0.17 (0.04) 0.22 ,.001 1254 0.13 (0.03) 0.23 ,.001
Maternal employment pattern
Not working 345 0.28 (0.06) Ref 387 0.19 (0.06) Ref
Some part-time 593 20.01 (0.05) 20.22 .008 647 0.02 (0.05) 20.13 .120
Mostly part-time 1059 20.05 (0.03) 20.19 .008 1129 20.05 (0.03) 20.15 .039
Mostly full-time 1144 20.09 (0.03) 20.22 .002 1234 20.08 (0.03) 20.16 .012
Mothers age at first child
30 years or more 1131 20.13 (0.03) Ref 1162 20.10 (0.03) Ref
25–29 years 1297 20.05 (0.03) 0.02 .677 1376 20.06 (0.03) 0.00 .960
20–24 years 578 0.17 (0.04) 0.18 .003 668 0.08 (0.04) 0.08 .188
Less than 19 years 155 0.34 (0.10) 0.23 .023 199 0.24 (0.08) 0.13 .155
No. of waves maternal mental health
problem
None 2358 20.06 (0.03) Ref 2524 20.11 (0.02) Ref
One-Two 675 0.14 (0.05) 0.13 .010 736 0.17 (0.04) 0.22 ,.001
Three-Four 138 0.14 (0.09) 0.16 .105 163 0.32 (0.10) 0.38 ,.001
Household income
$2000 or more per week
422 20.34 0.05) Ref 447 20.32 (0.04) Ref
$1000–$1999 per week
729 20.09 (0.04) 0.15 .018 772 20.10 (0.04) 0.12 .038
$600–$999 per week
1348 0.04 (0.03) 0.19 .003 1464 0.04 (0.03) 0.18 .001
Up to
$599 per week
495 0.16 (0.06) 0.18 .023 548 0.11 (0.05) 0.14 .046
Neighborhood disadvantage (SEIFA)
Least disadvantaged tertile 1027 0.16 (0.04) Ref 945 20.21 (0.04) Ref
Middle tertile 1235 20.01 (0.04) 0.08 .147 1336 20.01 (0.03) 0.09 .056
Most disadvantaged tertile 909 20.20 (0.04) 0.15 .017 1142 0.12 (0.04) 0.14 .016
Included in initial models but removed due to non-significance: Maternal BMI, family structure, position of child amongst siblings and child gender.
doi:10.1371/journal.pone.0100686.t002
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and child overweight and obesity, and if so the nature of that
relationship over time. We also aimed to address the uncertainty
regarding the social and demographic correlates of maternal
protectiveness.
There are two noteworthy features of our study. The first was
our finding that higher maternal protectiveness was associated
with an increased likelihood of child overweight and obesity over
time, after the effects of household income, maternal BMI,
maternal mental health, maternal education and position amongst
siblings were controlled for. Though there has been speculation
about this connection [2], this is the first study to our knowledge to
provide evidence of this link. Maternal protectiveness was not
significantly associated with child overweight and obesity at
younger ages, however at 10–11 years of age a one standard
deviation increase in maternal protection scores was associated
with a 13% increased likelihood of child overweight and obesity.
Though this may be considered a small or negligible effect, more
than a quarter of 10–11 year old children were overweight or
obese in our study, which is on par with population-level estimates
[28]. A small increase in the likelihood of overweight and obesity
may therefore be relevant for a large number of children, and
particularly as highly protective parenting becomes the norm for
an increasing number of families.
The use of longitudinal data, a particular strength of this study,
was also important in identifying how this relationship emerged
over time. Maternal protectiveness was not significantly associated
with child overweight and obesity until children were 10–11 years
of age. While it is possible that this pattern of results was due to the
timing of the protectiveness measure, collected when children were
aged 8–9 years, the finding supports our hypothesis that any effects
of maternal protectiveness would not emerge until a stage where
children can reasonably be expected to become more independent
of their parents. This is a particularly interesting finding in the
context of other research suggesting that a large component of
childhood obesity is established by the age of 5, where children
who were overweight at age 5 were four times as likely as normal-
weight children to become obese by age 14 [46]. Our pattern of
results contributes to previous research by suggesting that while
there are many factors that contribute to obesity trajectories from
an early age, there are other factors that influence those
trajectories throughout childhood beyond early developmental
periods. Protective parenting styles, which could be characterised
by a reluctance to allow children to be independently mobile and
therefore less active, provides a potential explanation for later
emergence of overweight and obesity.
Our results for maternal protectiveness were adjusted for
maternal mental health. This approach was taken to address
concerns that the protectiveness measure may have reflected
general anxiety rather than protectiveness, particularly as one of
the items related to parents becoming upset at leaving the child
with other people irrespective of how well they knew them. In
addition, we found that mothers with mental health difficulties also
had higher protectiveness scores on average than mothers without
such difficulties. Despite these similarities, the results of the
longitudinal model showed that there was no significant difference
in the odds of child overweight or obesity for mothers who had a
likely psychological distress at one or two waves of the study
compared to mothers who did not have psychological distress at
any wave. Furthermore, for mothers enduring likely psychological
distress at 3 or 4 waves, their children had lower odds of being
overweight or obese relative to children whose mother did not
have a mental health problem at any wave. As the results for
maternal mental health were opposite to those for maternal
protectiveness, there is little doubt that the results for maternal
Table 3. Proportion of children categorised as being normal weight, overweight or obese at each wave, with mean Wave 2 (6–7
years) and Wave 3 (8–9 years) standardised maternal protectiveness scores.
Wave 2 (6–7 Years) Wave 3 (8–9 Years)
N (weighted %) Mean Score (SE) p-value Mean Score (SE) p-value
Wave 1 (45 years)
Normal 2431 (79.6) 20.03 (0.02) ref 20.08 (0.03) ref
Overweight 461 (15.4) 0.07 (0.05) .350 20.06 (0.05) .777
Obese 147 (5.0) 0.15 (0.09) .034 0.19 (0.09) .005
Wave 2 (67 years)
Normal 2499 (81.5) 20.03 (0.02) ref 20.08 (0.03) ref
Overweight 392 (13.1) 0.06 (0.06) .145 20.06 (0.06) .730
Obese 148 (5.4) 0.20 (0.09) .019 0.30 (0.09) ,.001
Wave 3 (89 years)
Normal 2368 (76.7) 20.05 (0.02) ref 20.09 (0.03) ref
Overweight 497 (16.8) 0.07 (0.05) .028 20.03 (0.05) .281
Obese 174 (6.5) 0.26 (0.08) ,.001 0.31 (0.08) ,.001
Wave 4 (1011 years)
Normal 2132 (73.6) 20.07 (0.03) ref 20.10 (0.03) ref
Overweight 555 (20.1) 0.04 (0.05) .036 20.06 (0.05) .421
Obese 156 (6.3) 0.29 (0.09) ,.001 0.34 (0.08) ,.001
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Table 4. Estimated odds of children being overweight or obese at each wave, according to maternal protectiveness and other family characteristics.
Wave 1 (4–5 Years) Wave 2 (6–7 Years) Wave 3 (8–9 Years) Wave 4 (10–11 Years)
OR 95% CI p OR 95% CI p OR 95% CI p OR 95% CI p
Maternal protectiveness
At age 8–9 Years + 1 SD 0.97 (0.87, 1.08) .578 1.02 (0.91, 1.14) .758 1.07 (0.96, 1.19) .203 1.13 (1.02, 1.26) .018
At age 8–9 years +2 SD 0.94 (0.75, 1.17) .578 1.04 (0.82, 1.31) .758 1.15 (0.93, 1.42) .203 1.29 (1.04, 1.58) .018
Maternal BMI (Wave 1)
Normal Ref Ref Ref Ref
Overweight 1.82 (1.42, 2.31) ,.001 1.96 (1.51, 2.55) ,.001 2.19 (1.83, 2.78) ,.001 2.37 (1.89, 2.98) ,.001
Obese 2.19 (1.66, 2.88) ,.001 2.99 (2.24, 3.98) ,.001 2.81 (2.15, 3.68) ,.001 3.38 (2.62, 4.38) ,.001
Household Income (Wave 1)
$2000 or more per week
Ref Ref Ref Ref
$1000–$1999 per week
1.05 (0.74, 1.49) .795 1.25 (0.84, 1.87) .276 1.02 (0.72, 1.45) .899 1.21 (0.86, 1.71) .281
$600–$999 per week
1.03 (0.74, 1.42) .869 1.29 (0.89, 1.86) .184 1.05 (0.76, 1.44) .786 1.40 (1.02, 1.92) .039
Up to
$599 per week
1.47 (1.00, 2.15) .047 2.06 (1.34, 3.15) ,.001 1.91 (1.32, 2.78) ,.001 2.08 (1.42, 3.04) ,.001
No. of waves maternal mental
health problem
None Ref Ref Ref Ref
One-two 0.89 0.68, 1.16 .384 0.85 0.64, 1.13 .261 1.21 0.94, 1.55 .133 1.21 0.95, 1.53 .125
Three-four 0.92 0.56, 1.49 .723 0.40 0.21, 0.73 .003 0.52 0.32, 0.87 .013 0.48 0.29, 0.78 .003
Position among siblings
Only child
Youngest child 0.77 0.53, 1.12 .172 0.65 0.44, 0.94 .023 0.74 0.52, 1.04 .086 0.85 0.61, 1.18 .328
Middle child 0.72 0.47, 1.10 .131 0.57 0.37, 0.88 .012 0.51 0.33, 0.77 .001 0.48 0.33, 0.72 .003
Eldest child 0.84 0.57, 1.22 .349 0.65 0.44, 0.95 .027 0.65 0.45, 0.93 .018 0.59 0.42, 0.83 .003
OR = Odds ratio; CI = Confidence Interval. Included in initial models but removed due to non-significance: Family structure, maternal employment pattern, maternal age at birth of first child and neighbourhood disadvantage.
Maternal protectiveness at Wave 2 (6–7 years) removed due to collinearity.
doi:10.1371/journal.pone.0100686.t004
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Table 5. Estimated change in the odds of children being overweight or obese at Wave 2 (6–7 years), Wave 3 (8–9 years) and Wave 4 (10–11 years) according to materna l
protectiveness and other family characteristics, relative to Wave 1 (age 4–5 years).
Interaction Terms
Wave 2 (6–7 Years) Wave 3 (8–9 Years) Wave 4 (10–11 Years)
OR 95% CI p OR 95% CI p OR 95% CI p
Reference Group (intercept) 0.77 (0.52, 1.12) .173 1.11 (0.74, 1.66) .631 1.06 (0.68, 1.64) .811
Maternal protectiveness
At age 8–9 Years 1.05 (0.95, 1.16) .322 1.11 (1.00, 1.22) .049 1.17 (1.04, 1.31) .007
Maternal BMI (Wave 1)
Normal Ref Ref Ref
Overweight 1.08 (0.87, 1.34) .475 1.21 (0.96, 1.52) .111 1.31 (1.02, 1.67) .033
Obese 1.36 (1.09, 1.71) .007 1.29 (1.01, 1.64) .045 1.55 (1.18, 2.03) .002
Household Income (Wave 1)
$2000 or more per week
Ref Ref Ref
$1000–$1999 per week
1.19 (0.87, 1.63) .270 0.98 (0.71, 1.35) .884 1.15 (0.81, 1.66) .433
$600–$999 per week
1.25 (0.92, 1.70) .151 1.02 (0.75, 1.38) .915 1.36 (0.97, 1.90) .074
Up to
$599 per week
1.40 (0.98, 2.00) .064 1.30 (0.90, 1.88) .157 1.42 (0.94, 2.13) .098
No. of waves maternal mental health problem
None Ref Ref Ref
One-two 0.96 (0.77, 1.19) .687 1.36 (1.06, 1.75) .016 1.36 (1.04, 1.77) .025
Three-four 0.43 (0.25, 0.75) .003 0.57 (0.36, 0.92) .022 0.52 (0.30, 0.91) .021
Position among siblings
Only child Ref Ref Ref
Youngest child 0.84 (0.61, 1.16) .288 0.96 (0.67, 1.37) .806 1.10 (0.75, 1.61) .622
Middle child 0.80 (0.56, 1.12) .195 0.71 (0.48, 1.05) .082 0.67 (0.44, 1.03) .070
Eldest child 0.78 (0.56, 1.08) .128 0.78 (0.54, 1.11) .164 0.71 (0.49, 1.03) .073
OR = Odds ratio; CI = Confidence Interval. Included in initial models but removed due to non-significance: Family structure, maternal employment pattern, maternal age at birth of first child and neighbourhood disadvantage.
Maternal protectiveness at Wave 2 (6–7 years) removed due to collinearity.
doi:10.1371/journal.pone.0100686.t005
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protectiveness are independent of any underlying mental health
problem among mothers.
Our second key finding was that maternal protectiveness was
higher on average among more disadvantaged families, including
those with lower household incomes, lower maternal education,
living in disadvantaged neighbourhoods, where mothers were not
employed and where mothers have mental health issues. Our
findings support the scant literature and continue to point to the
discrepancy with what is more widely believed about highly
protective parents namely that it is a feature of advantaged
families [10]. The ‘typical’ highly protective parent is more likely
to be found in disadvantaged circumstances [1,12].The relation-
ship between socioeconomic disadvantage and parental protec-
tiveness is perhaps not unexpected, current literature notwith-
standing, given the potential circumstances and environments that
less advantaged families may experience on a daily basis. Families
with lower levels of education and income, for example, may have
fewer housing options and therefore live in neighbourhoods that
are less safe or in areas that contain busy streets and highways. In
such contexts parental anxiety about child safety may be more
justified.
The relationship with maternal employment pattern, where
maternal protectiveness was lower on average for mothers in the
workforce could have several underlying explanations. One is that
mothers with lower feelings of protectiveness are more likely to
return to the workforce after having children because they feel
more secure leaving their child in the care of others. In contrast,
mothers who have a financial need to return to work may need to
suppress feelings of anxiety in order to cope with separation.
There are limitations to the study. Though it is possible that
higher maternal protectiveness leads to poorer weight outcomes
through limited physical activity or independent mobility for older
children, the mechanisms that link high protection and child BMI,
and the direction in which these mechanisms operate, remain
unclear. While some research certainly points to evidence that
suggests that children of highly protective parents are less active
[47], such a link is not informed by the data in this study. As such,
alternative explanations are also possible. For example, highly
protective parents may be more likely to indulge their child’s
preferences for sweets and junk food, which could potentially
explain the link between protectiveness and child overweight and
obesity. As with most observational studies, we cannot make
conclusions regarding causal relationships, and further research is
needed to understand these relationships in more detail. Estab-
lishing the mechanism(s) may be a difficult task, however, given the
lack of clarity surrounding the biological mechanisms that
underpin weight loss [48].
Another limitation relates to the measure used to assess
protectiveness. The protective parenting scale adopted for the
LSAC has only had limited assessments of reliability or validity. It
is therefore possible that the items measure a construct other than
maternal protectiveness. Though the scale only had limited items
and the internal consistency was unclear, the scale showed good
consistency two years apart. We also addressed potential mental
health and anxiety problems in mothers by including a maternal
mental health measure in our models. Furthermore, the LSAC is
an omnibus survey that restricts the inclusion of a broader scale
assessing the highly protective parenting construct in greater
detail. The advantage of this approach however, is the availability
of a wide range of contextual information that may help to
understand the emergence of highly protective parenting.
Finally, as this was a longitudinal study the effects of attrition
and response bias on the results need to be considered. With each
subsequent wave of data collection, the sample became less
representative of lone-parent families, non-English speaking
families, those living in rental properties or in remote areas. We
attempted to correct for these biases by weighting all analyses, with
greater weight being provided to the children and families that
were less likely to participate at all four waves of the study, and
note that the inclusion of study weights did not substantially alter
the results of the study.
There are several avenues of further research that will help to
shed more light on the impacts of highly protective parenting.
Further research is needed to understand the mechanisms through
which maternal protectiveness is related to child obesity. One
potential avenue for this research is the examination of data
collected in the LSAC time-use diaries. These diaries do not
provide information on the level of physical activity undertaken by
children, but they do provide some information on the types of
activities undertaken by children, along with whether these
activities were outdoors and if an adult was nearby. Other
avenues of research may examine additional factors that are
associated with overweight and obesity, such as diet, and the
extent to which the diets of children vary for different levels of
protectiveness. Finally, this study was restricted to examining
maternal protectiveness. Fathers also play a critical role in child
development [49], and research indicates that fathers are
increasingly spending more time caring for their children [50]
and are typically more oriented towards play and activities that
encourage risk-taking than mothers [51]. Therefore it is important
to extend this research to examine the impacts of paternal
protectiveness and how this interacts with maternal protectiveness.
For example, how do child development trajectories vary when
fathers, or both parents, exhibit highly protective parenting styles?
Our findings show that high maternal protection is linked to
increasingly higher odds of child overweight and obesity, and this
relationship is independent of other family characteristics that are
associated with both maternal overprotection and child BMI.
However, as maternal protectiveness was also more prevalent in
disadvantaged families, any current public health initiatives that
aim to increase children’s physical activity need to consider the
safety of children living in less advantaged areas, and that parents
may well have legitimate safety concerns for their children.
Acknowledgments
The Longitudinal Study of Australian Children is conducted in partnership
between the Australian Government Department of Social Services (DSS),
the Australian Institute of Family Studies, and the Australian Bureau of
Statistics. All views expressed in this paper are the authors’, and do not
represent the views of DSS, the Australian Institute of Family Studies or the
Australian Bureau of Statistics. We thank all those participating in the
LSAC who gave their time to provide the data used in this manuscript.
Author Contributions
Conceived and designed the experiments: KJH DL. Analyzed the data:
KJH. Wrote the paper: KJH DL SRZ.
References
1. Thomasgard M, Metz WP (1997) Parental overprotecti on and its relation to
perceived child vulnerability. Am J Orthopsychiatry 67: 330–335. doi: 10.1037/
h0080237
2. Eager D, Little H (2011) Risk Deficit Disorder. Proce edings of IPWEA
International Public Works Conference. Canberra, Australia. Available: http://
www.academia.edu/1479806/Risk_defic it_disorder. Accessed 2014 May 8.
Protective Parenting and Child Overweight and Obesity
PLOS ONE | www.plosone.org 11 June 2014 | Volume 9 | Issue 6 | e100686
Page 11
3. Ungar M (2009) Overprotective parenting: Helping parents provide children the
right amount of risk and responsibility. Am J Fam Ther 37: 258–271. doi:
10.1080/01926180802534247
4. Bayer JK, Sanson AV, Hemphill SA (2006) Parent influences on early childhood
internalizing difficulties. J App Dev Psychol 27: 542–559. doi: 10.1016/
j.appdev.2006.08.002
5. Cooklin AR, Giallo R, D’Esposito F, Crawford S, Nicholson JM (2013)
Postpartum maternal sepa ration anxiety, overprot ective parenting, an d
children’s social-emotional well-being: Longitudinal evidence from an Australian
cohort. J Fam Psychol 27: 618–628. doi: 10.1037/a0033332
6. Givertz M, Segrin C (2012) The association between overinvolved parenting and
young adults’ self-efficacy, psychological entitlement, and family communica-
tion. Commun Res. doi: 10.1177/0093650212456392
7. Schiffrin H, Liss M, Miles-McLean H, Geary K, Erchull M, et al. (2013) Helping
or hovering? The effects of helicopter parenting on college students’ well-being.
J Child Fam Stud: 1–10. doi: 10.1007/s10826-013-9716-3
8. Gabriel T (2010) Students, welcome to college; parents, go home. The New
York Times. Available: http://www.nytimes.com/2010/08/23/education/
23college.html?_r = 0. Accessed 2013 October 29.
9. Paton G (2012) Children no longer allowed to fail, Tanya Byron warns. The
Telegraph. Available: http://www.telegraph.co.uk/education/educationnews/
9725022/Children-no -longer-a llowed-to-f ail-Tanya-Byro n-warns.html. Ac-
cessed 2013 October 29.
10. Valentine G (2004) Public space and the culture of childhood. Aldershot:
Ashgate Publishing Ltd.
11. Cooklin AR, Lucas N, Strazdins L, Westrupp E, Giallo R, et al. (2013)
Heightened maternal separati on anxiety in the postpartum: the role of
socioeconomic disadvantage. J Fam Issues. doi: 10.1177/0192513x13481776
12. Cooklin AR, Rowe HJ, Fisher JRW (2012) Paid parental leave supports
breastfeeding and mother-inf ant relationship: a prospective investigation of
maternal postpartum employment. Aust N Z J Public Health 36: 249–256. doi:
10.1111/j.1753-6405.2012.00846.x
13. Wilson DK, Kirtland KA, Ainsworth BE, Addy CL (2004) Socioeconomic status
and perceptions of access of safety for physical activity. Ann Behav Med 28: 20–
28. doi: 10.1207/s15324796abm2801_4
14. Gray P (2011) The decline of play and the rise of psychopathology in children
and adolescents. Am J Play 3: 443–463.
15. Clements R (2004) An investigation of the status of outdoor play. Contemp
Issues Early Childhood 5: 68–80. doi: 10.2304/ciec.2004.5.1.10
16. Shutt EJ, Miller MJ, Schreck CJ, Brown NK (2004) Reconsidering the leading
myths of stranger child abduction. Criminal Justice Studies 17: 127–134. doi:
10.1080/0888431042000217688
17. Snyder HN (2000) Sexual assault of young children as reported to law
enforcement: Victim, incident, and offender characteristics. Washington: Bureau
of Justice Statistics.
18. AIHW (2012) A picture of Australia’s children 2012. Cat. No. PHE 167.
Canberra: AIHW.
19. Peden M, Oyegbite K, Ozanne-Smith J, Hyder AA, Branche C, et al. (2008)
World Report of Child Injury Prevention. Geneva, Switzerland
20. AIHW National Injury Surveillance Unit (2012) Trends in hospitalised
childhood injury in Australia 1999-07. Injury research and statistics series
no. 75. Cat. No. INJCAT 151. Canberra: AIHW.
21. Mitchell R, Schmertmann M, Sherker S (2009) Trends and future projections of
child injury in New South Wales: A tool for advocacy? J Paediatr Child Health
45: 754–761. doi: 10.1111/j.1440-1754.2007.01157.x
22. Doukas G, Olivier J, Poulos R, Grzebieta R (2010) Exploring differential trends
in severe and fatal child pedestrian injury in New South Wales, Australia (1997–
2006). Accid Anal Prev 42: 1705–1711. doi: 10.1016/j.aap.2010.04.010
23. Tomkinson GR, Olds TS (2007) Secular changes in aerobic fitness test
performance of Australasian children and adolescents. Med Sport Sci 50: 171–
185. doi: 10.1159/0000101361
24. Tomkinson GR, Olds TS (2007) Secular changes in pediatric aerobic fitness test
performance: the global picture. Med Sport Sci 50: 46–66. doi: 10.1159/
000101075
25. Salmon J, Timperio A, Cleland V, Venn A (2005) Trends in children’s physical
activity and weight status in high and low socio-economic status areas of
Melbourne, Victoria, 1985–2001. Aust N Z J Public Health 29: 337–342. doi:
10.1111/j.1467-842X.2005.tb00204.x
26. Harten N, Olds TS (2004) Patterns of active transport in 11–12 year old
Australian children. Aust N Z J Public Health 28: 167–172. doi: 10.1111/j.1467-
842X.2004.tb00931.x
27. Zubrick SR, Wood L, Villanueva KP, Wood G, Giles-Corti B, et al. (2010)
Nothing but fear itself: Parental fear as a determinant impacting on child
physical activity and independent mobility. Melbourne: Victorian Health
Promotion Foundation (VicHealth). Available: http://www.vichealth.vic.gov.
au/Publications/Phys ical-Activity/A ctive-trans port/Nothin g-But-Fear-Itself .
aspx. Accessed 2013 October 29.
28. Olds TS, Tomkinson GR, Ferrar KE, Maher CA (2010) Trends in the
prevalence of childhood overweight and obesity in Australia between 1985 and
2008. Int J Obes 34: 57–66. doi: 10.1038/ijo.2009.211
29. Veitch J, Bagley S, Ball K, Salmon J (2006) Where do children usually play? A
qualitative study of parents’ perceptions of influences on children’s active free-
play. Health Place 12: 383-393. doi: 10.1016/j.healthplace.2005.02.009
30. Karsten L (2005) It all used to be better? Different generations on continuity and
change in urban children’s daily use of space. Children’s Geogr 3. doi: 10.1080/
14733280500352912
31. Ding D, Bracy NH, Sallis JF, Saelens BE, Norman GJ, et al. (2012) Is fear
among strangers related to physical activity among yo uth? Am J Health Promot
26: 189–195. doi: 10.4278/ajhp.100701-QUAN-224
32. Carver A, Timperio A, Crawford D (2008) Playing it safe: The influence of
neighbourhood safety on children’s physical activity - a review. Health Place 14:
217–227. doi: 10.1016/j.healthplace.2007.06.004
33. Carver A, Timperio A, Hesketh K, Crawford D (2012) How does perceived risk
mediate associations between perceived safety and parental restriction of
adolescents’ physical activity in their neighborhood? Int J Behav Nutr Phys Act
9: 1–7. doi: 10.1186/1479-5868-9-57
34. Page AS, Cooper AR, Griew P, Davis L, Hillsdon M (2009) Independent
mobility in relation to weekday and weekend physical activity in children aged
10–11 years: The PEACH Project. Int J Behav Nutr Phys Act 6: 1–9. doi:
10.1186/1479-5868-6-2
35. Soloff C, Lawrence D, Misson S, Johnstone R (2006) Wave 1 weighting and
non-response: LSAC technical paper No. 3. Melbourne: Australian Institute of
Family Studies.
36. Sipthorp M, Misson S (2009) Wave 3 weighting and non-response (LSAC
technical paper, No. 6). Melbourne: Australian Institute of Family Studies.
37. Department of Social Services (2014) Access to DSS Longitudinal Datasets.
Available: http://www.dss.gov. au/our-responsibili ties/families-and-children/
programs-services/access-to-dss-longitudinal-datasets. Accessed: 2014 March 6
38. de Vaus D (2002) Analyzing Social Science Data. London: Sage Publications.
39. United States Preventative Services Task Force (2010) Screening for obesity in
children and adolescents: US Preventive Services Task Force Recommendation
Statement. Pediatr. doi: 10.1542/peds.2009-2037
40. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard
definition for child overweight and obesity worldwide: international survey. BMJ
320: 1240. doi: 10.1136/bmj.320.7244.1240
41. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mrocrek DK, et al. (2002) Short
screening scales to monitor population prevalence and trends in non-specific
psychological distress. Psychol Med 32: 959–976. doi: 10.1017\S00332917 02006 074
42. Strazdins L, Shipley M, O’Brien LV, Broom DH (2010) Job quality and
inequality: Parents’ jobs and children’s emotional and behavioural difficulties.
Soc Sci Med 70: 2052–2060 doi: 10.1016/j.socscimed.2010.02.041
43. Hancock K, Mitrou F, Shipley M, Lawrence D, Zubrick S (2013) A three
generation study of the mental health relationships between grandparents,
parents and children. BMC Psychiatry 13: 299. doi:10.1186/1471-244X-13-299
44. Hedeker D, Gibbons RD, editors (2006) Longitudinal Data Analysis. Hoboken,
NJ: John Wiley & Sons Inc.
45. Tulloch MI (2004) Parental fear of crime: a discursive analysis. J Sociol 40: 362–
377 doi: 10.1177/1440783304048380
46. Cunningham SA, Kramer MR, Narayan KMV (2 014) Incidence of childhood
obesity in the United States. N Eng J Med 370: 403–411. doi: 10.1056/
NEJMoa1309753
47. Jones RA, Okely AD, Caputi P, Cliff DP (2010) Relationships between child,
parent and community characteristics and weight status among young children.
Int J Pediatr Obes 5: 256–264. doi: 10.3109/17477160903271971
48. Hafekost K, Lawrence D, Mitrou F, O’Sullivan TA, Zubrick SR (2013) Tackling
overweight and obesity: does the public health message match the science? BMC
Medicine 11. doi:10.1186/1741-7015-11-41
49. Lamb ME (2010) The Role of the Father in Child Development. 5 ed. Hoboken:
Wiley.
50. Craig L, Powel A, Smyth C (2014) Towards intensive parenting? Changes in the
composition and determinants of mothers’ and fathers’ time with children 1992–
2006. Brit J Sociol doi: 10.1111/1468-4446.12035
51. Brussoni M, Olsen LL, Creighton G, Oliffe JL (2013) Heterosexual gender
relations in and around childhood risk and safety. Qual Health Res 23: 1388–
1398. doi: 10.1177/1049732313505916.
Protective Parenting and Child Overweight and Obesity
PLOS ONE | www.plosone.org 12 June 2014 | Volume 9 | Issue 6 | e100686
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    • "This illustrates the importance of considering child characteristics as well as parenting styles when assessing obesity risk. Within the Australian longitudinal cohort where protective parenting was used to predict BMI over a period of 5 years (data collected three times), high maternal protectiveness measured at 4–5 years old was not significantly associated with weight until children reached the ages of 10–11 years (Hancock et al., 2014). By this time, protectiveness was associated with a higher odds ratio of the child being overweight or obese. "
    [Show abstract] [Hide abstract] ABSTRACT: Childhood is a critical period in the development of obesity. Eating patterns established early in life track into later life. Therefore, parental approaches to feeding in their general parenting style, feeding styles, and specific feeding practices will have a profound impact on how children eat and grow. A systematic research review following PRISMA guidelines was conducted to identify, discuss and integrate recent research investigating the relationship between parenting styles, feeding styles, feeding practices, and body mass index (BMI) in children. Medline (Ovid), PsycINFO, Web of Science, and Food Science and Technology Abstracts were systematically searched using sensitive search strategies. Studies were limited to papers published in English between 2010 and February 2015 with participants aged 4-12 years old with outcomes including obesity, change in weight, or BMI. The search yielded 31 relevant quantitative peer-reviewed papers meeting all inclusion criteria: seven longitudinal, 23 cross-sectional, one randomized control trial. Associations between parenting style and child BMI were strongest and most consistent within the longitudinal studies. Uninvolved, indulgent or highly protective parenting was associated with higher child BMI, whereas authoritative parenting was associated with a healthy BMI. Similarly for feeding styles, indulgent feeding was consistently associated with risk of obesity within cross-sectional studies. Specific feeding practices such as restriction and pressure to eat were linked to BMI, especially within cross-sectional studies. Where child traits were measured, the feeding practice appeared to be responsive to the child, therefore restriction was applied to children with a high BMI and pressure to eat applied to children with a lower BMI. Behaviors and styles that are specific to the feeding context are consistently associated with child BMI. However, since obesity emerges over time, it is through longitudinal, carefully measured (through questionnaire and observation) studies which take account of child appetite and temperament that the association between parenting style, feeding style, specific feeding practices, and child obesity will be understood.
    Full-text · Article · Nov 2015 · Frontiers in Psychology
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    • "Despite increases in readily accessible information about how to achieve goals across time, children may have fewer opportunities to practice selfdirection today than in previous eras. In addition to changes in technological access, growing societal emphasis on early skill acquisition and heightened parental vigilance have contributed to reductions in the time children spend in unsupervised activities, including independent travel and play (Clements, 2004; Hancock, Lawrence & Zubrick, 2014). Activities such as outdoor play have increasingly been supplanted by media activities, such as video game play, computing, and television watching (Vandewater et al., 2007; Johnson, 2010; Bavelier et al., 2010; Hofferth, 2010 ), which are often more passive, and potentially offer fewer opportunities for child decisionmaking , than other forms of leisure. "
    [Show abstract] [Hide abstract] ABSTRACT: How do children become increasingly self-directed across development, achieving their goals without help from others? How might such developments be impacted by societal changes in how children spend their time? Children's abilities to achieve their goals are supported by developing executive functions (EFs), cognitive processes that predict important life outcomes. Efforts to improve children's EFs have benefitted their externally driven executive functioning, where goals and instructions are provided by others. Less is known about self-directed EF, when children must decide independently what to do and when. We present recent findings demonstrating that children are better at engaging self-directed EF when they have good understanding of options to choose among, and if they spend time in activities that they play a large role in directing. Within this context, we discuss the potential role of opportunities to plan, mind-wander, and play, and present the critical next steps in investigating the influence of changing environments on self-directed EF.
    Full-text · Article · Jun 2015 · Mind Brain and Education
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    [Show abstract] [Hide abstract] ABSTRACT: Early life may be a "critical period" when appetite and regulation of energy balance are programmed, with lifelong consequences for obesity risk. Insight into the potential impact of modifying early-life risk factors on later obesity can be gained by evaluating their combined effects. The objective was to examine the relation between the number of early-life risk factors and obesity outcomes among children in a prospective birth cohort (Southampton Women's Survey). Five risk factors were defined: maternal obesity [prepregnant body mass index (BMI; in kg/m(2)) >30], excess gestational weight gain (Institute of Medicine, 2009), smoking during pregnancy, low maternal vitamin D status (<64 nmol/L), and short duration of breastfeeding (none or <1 mo). Obesity outcomes examined when the children were aged 4 and 6 y were BMI, dual-energy X-ray absorptiometry-assessed fat mass, overweight, or obesity (International Obesity Task Force). Data were available for 991 mother-child pairs, with children born between 1998 and 2003. Of the children, 148 (15%) had no early-life risk factors, 330 (33%) had 1, 296 (30%) had 2, 160 (16%) had 3, and 57 (6%) had 4 or 5. At both 4 and 6 y, there were positive graded associations between number of early-life risk factors and each obesity outcome (all P < 0.001). After taking account of confounders, the relative risk of being overweight or obese for children who had 4 or 5 risk factors was 3.99 (95% CI: 1.83, 8.67) at 4 y and 4.65 (95% CI: 2.29, 9.43) at 6 y compared with children who had none (both P < 0.001). Having a greater number of early-life risk factors was associated with large differences in adiposity and risk of overweight and obesity in later childhood. These findings suggest that early intervention to change these modifiable risk factors could make a significant contribution to the prevention of childhood obesity.
    Full-text · Article · Feb 2015 · American Journal of Clinical Nutrition