Stephanie R. Damiano

Parents and prevention: A systematic review of interventions involving parents that aim to prevent body dissatisfaction or eating disorders

OBJECTIVE To systematically review the literature on interventions involving parents that aim to prevent body dissatisfaction or eating disorders in children, and provide directions for future research by highlighting current gaps. METHOD The literature was searched for articles using key concepts: parents, prevention and eating disorders or disordered eating or body dissatisfaction. All English language publications between 1992 and 2013 were searched across a range of academic databases. Studies were reviewed if they: (i) delivered an intervention designed to reduce eating disorders or body dissatisfaction or their risk factors, in children or adolescents; (ii) provided some intervention component for parents; and (iii) included some outcome measure of intervention effectiveness on disordered eating or body dissatisfaction. A scoring matrix based on the Critical Appraisal Skills Program (CASP) screening questions was used to assess each studys sample representativeness, relevance and data quality. RESULTS From 647 novel records uncovered by the search, 20 separate studies met inclusion criteria. The CASP scoring matrix revealed eight studies provided no relevant data, four relevant and eight highly relevant data on the effects of involving parents in prevention programs. Two of four high-quality studies reported that parental involvement significantly improved child outcomes on measures of body dissatisfaction or disordered eating. DISCUSSION Although a greater focus on engaging and retaining parents is needed, this review demonstrates that a small number of prevention studies with parents have led to significant reductions in risk of body image and eating problems, and future research is indicated.

Relationships between body size attitudes and body image of 4-year-old boys and girls, and attitudes of their fathers and mothers.

BackgroundBody size attitudes and body image form early in life, and understanding the factors that may be related to the development of such attitudes is important to design effective body dissatisfaction and disordered eating prevention interventions. This study explored how fathers’ and mothers’ body size attitudes, body dissatisfaction, and dietary restraint are associated with the body size attitudes and body image of their 4-year-old sons and daughters.MethodsParticipants were 279 4-year-old children (46% boys) and their parents. Children were interviewed and parents completed questionnaires assessing their body size attitudes and related behaviours.ResultsSocially prescribed stereotypical body size attitudes were evident in 4-year-old boys and girls; however, prevalence of body dissatisfaction was low in this sample. Correlation analyses revealed that boys’ body size attitudes were associated with a number of paternal body image variables. In boys, attributing negative characteristics to larger figures and positive characteristics to thinner figures were associated with fathers having more negative attitudes towards obese persons. Attributing positive characteristics to larger figures by boys was associated with greater levels of paternal dietary restraint. In girls, attributing positive characteristics to thinner figures was only associated with greater maternal dietary restraint.ConclusionsFindings suggest the possibility that fathers’ body size attitudes may be particularly important in establishing body size attitudes in their sons. Further research is necessary to better understand the role of fathers in the development of children’s body size attitudes.

Parenting to prevent body dissatisfaction and unhealthy eating patterns in preschool children: A Delphi consensus study

Interventions to prevent body dissatisfaction and unhealthy eating patterns are needed in early childhood. Identifying effective parenting strategies would be useful for parents and prevention researchers. To develop expert consensus, an online Delphi study was conducted with experts (N=28, Mage=44.34) who rated statements describing potential parenting strategies gleaned from a systematic literature search. If 90-100% rated a statement as either Essential or Important, it was endorsed as a guideline. From a total of 335 statements 153 were endorsed. Despite some areas of disagreement, including whether parents should weigh their child or discourage weighing, experts were able to reach consensus on a wide range of issues, such as how to discuss healthy eating with children. The developed guidelines provide a novel and required resource for parents, and a framework for researchers developing interventions to prevent the onset of body dissatisfaction and unhealthy eating patterns in early childhood.

Maladaptive schemas in adolescent females with anorexia nervosa and implications for treatment

Recent research has highlighted the presence of Youngs Early Maladaptive Schemas (EMSs) in individuals with an eating disorder (ED). This study assessed the EMSs reported by adolescent females with Anorexia Nervosa (AN) compared with a community group. Thirty-six adolescent females diagnosed with AN or subthreshold AN and 111 female secondary school students completed a questionnaire that included the Young Schema Questionnaire, the Behavior Assessment System for Children Self-report of Personality, and the Eating Disorder Screen for Primary Care. Two independent AN subtypes and two community subtypes were derived from responses to the questionnaire, and significant differences between the four comparison groups were found. High Pathology AN participants reported the highest level of psychological maladjustment. Social Isolation and Emotional Inhibition appeared to be most characteristic of adolescent AN in this sample. The results suggest that EMSs may require attention in the treatment of AN in adolescent females, and that different AN subtypes may require individualized treatment approaches.

The Development of Body Image and Weight Bias in Childhood

Negative body image attitudes are related to the onset of disordered eating, poor self-esteem, general mental health problems, and obesity. In this chapter, we will review the nature of body image attitudes in girls and boys in early (approximately 3-7 years old) and later childhood (approximately 8-11 years old). The body image attitudes explored in this chapter include body image attitudes related to the self, with a focus on body dissatisfaction, and body image attitudes related to others, with a focus on weight bias. Issues of measurement of body image and weight bias will first be explored. In light of measurement considerations, the prevalence and predictors of body dissatisfaction and related concerns, and weight bias will be examined. The chapter will conclude with a review of promising directions in the prevention of body dissatisfaction and weight bias in children.

Correlates of parental feeding practices with pre-schoolers: Parental body image and eating knowledge, attitudes, and behaviours

Parental feeding practices have been linked to eating and weight status in young children; however, more research is needed to understand what influences these feeding practices. The aim of this study was to examine how parental feeding practices that are linked to unhealthy eating patterns in young children, are related to parental body image and eating knowledge, attitudes, and behaviours . Participants were 330 mothers of a 2- to 6-year-old child. Mothers completed measures of knowledge of child body image and eating patterns, overvaluation of weight and shape, internalization of general media and athletic ideals, dieting, and parental feeding practices. Higher maternal knowledge of strategies to promote positive child body image and eating patterns predicted lower weight restriction, instrumental, emotional, and pushing to eat feeding practices. Overvaluation of weight and shape predicted use of fat restriction. Maternal internalization of the athletic ideal predicted instrumental and pushing to eat feeding practices. As these feeding practices have been associated with long-term risk of childrens weight gain and/or disordered eating, these findings highlight the need for prevention interventions to target knowledge, attitudes, and behaviours of parents of pre-schoolers.

Development and validation of parenting measures for body image and eating patterns in childhood

BackgroundEvidence-based parenting interventions are important in assisting parents to help their children develop healthy body image and eating patterns. To adequately assess the impact of parenting interventions, valid parent measures are required. The aim of this study was to develop and assess the validity and reliability of two new parent measures, the Parenting Intentions for Body image and Eating patterns in Childhood (Parenting Intentions BEC) and the Knowledge Test for Body image and Eating patterns in Childhood (Knowledge Test BEC).MethodsParticipants were 27 professionals working in research or clinical treatment of body dissatisfaction or eating disorders, and 75 parents of children aged 2–6 years, who completed the measures via an online questionnaire. Seven scenarios were developed for the Parenting Intentions BEC to describe common experiences about the body and food that parents might need to respond to in front of their child. Parents ranked four behavioural intentions, derived from the current literature on parenting risk factors for body dissatisfaction and unhealthy eating patterns in children. Two subscales were created, one representing positive behavioural intentions, the other negative behavioural intentions. After piloting a larger pool of items, 13 statements were used to construct the Knowledge Test BEC. These were designed to be factual statements about the influence of parent language, media, family meals, healthy eating, and self-esteem on child eating and body image. The validity of both measures was tested by comparing parent and professional scores, and reliability was assessed by comparing parent scores over two testing occasions.ResultsCompared with parents, professionals reported significantly higher scores on the Positive Intentions subscale and significantly lower on the Negative Intentions subscale of the Parenting Intentions BEC; confirming the discriminant validity of six out of the seven scenarios. Test-retest reliability was also confirmed as parent scores on the two Parenting Intentions subscales did not differ over time. Eleven out of the 13 Knowledge Test items demonstrated sufficient discriminant validity and test-retest reliability.ConclusionsOverall, results indicated that the six-scenario Parenting Intentions BEC and the 11-item Knowledge Test BEC are valid and reliable measures for parents of young children.

Media exposure in very young girls: Prospective and cross-sectional relationships with BMIz, self-esteem and body size stereotypes.

Media exposure among young children has been suggested to influence self-concept and the adoption of social stereotypes regarding body weight, as well as being associated with increased weight. The aim of this study was to examine the role of TV/DVD viewing in the development of positive stereotypes toward thinness, self-esteem and body mass index standardized for child age and gender (BMIz) in very young girls. A sample of 143 girls completed interviews at ages 3, 4, and 5 years old. The interviews assessed positive stereotypes about thinness among girls, as well as age 5 dietary restraint. Parents reported on their daughters’ self-esteem and TV/DVD viewing. Objective height and weight were obtained for the children. A cross-lagged model exploring TV/DVD viewing as a predictor of lower self-esteem, greater BMIz, and endorsement of positive stereotypes about thinness was tested, including dietary restraint as an outcome at age 5. Findings revealed partial support for the theoretical model, with relationships emerging most strongly between the ages of 4 and 5 years old. Greater TV/DVD viewing was weakly related to greater endorsement of positive stereotypes about thinness between ages 3 and 4. In addition, greater TV/DVD viewing at age 4 predicted BMIz increases at age 5, as well as greater dietary restraint. Our results suggest that the impact of media exposure on body image and weight-related variables may start at a very early age. Findings contribute to the body of literature suggesting that early childhood may be an important developmental period for media exposure.

Empirically derived subtypes of full and subthreshold anorexia nervosa in adolescent females: understanding general psychopathology and treatment implications.

The aim of this study was to derive clinically relevant subtypes of anorexia nervosa (AN) and subthreshold AN using general psychopathology variables and to determine how they differ on eating pathology. Participants were 39 adolescent females aged 13 to 18 years, diagnosed with AN or subthreshold AN. Cluster analysis revealed two subtypes that differed significantly in eating pathology. Cluster 1 patients were typically underweight with no clinical elevations on eating or psychopathology measures. Cluster 2 patients were mostly of healthy weight with greater eating and psychological problems. Findings allow clinicians to classify and understand AN beyond diagnostic criteria, and implement interventions that consider presentation beyond eating pathology.

Achieving body confidence for young children: Development and pilot study of a universal teacher-led body image and weight stigma program for early primary school children

ABSTRACT Negative body image attitudes develop in early childhood and there is a need for school-based resources during the early school years, but no teacher-delivered curriculum-based resources exist to mitigate these attitudes in young children. Achieving Body Confidence for Young Children (ABC-4-YC), a universal body dissatisfaction and weight stigma prevention program, was developed and then delivered in a pilot study. Fifty-one 5- to 8-year-old children completed pre- and post-intervention interviews assessing body image attitudes, and seven teachers provided feedback. Significant improvement in body esteem and positive teacher feedback were found. The results provide preliminary support for ABC-4-YC to improve children’s body image attitudes, but extensive evaluation is needed.