J Youth Adolescence (2013) 42:52–66
DOI 10.1007/s10964-012-9794-3
EMPIRICAL RESEARCH
Continuity in Primary School Children’s Eating Problems
and the Influence of Parental Feeding Strategies
Annelies Matton • Lien Goossens • Caroline Braet
Kim Van Durme
Received: 8 May 2012 / Accepted: 11 July 2012 / Published online: 17 July 2012
Ó Springer Science+Business Media, LLC 2012
Abstract Eating problems are highly prevalent and seem
to show continuity in children. Nevertheless, the effect of
different maternal and paternal feeding practices on chan-
ges in these problems is not fully understood yet. This
study examines short-term continuity in primary school
children’s overeating, loss of control (over eating), restraint
and concerns (about eating, body shape and weight) and the
predictive value of parental feeding strategies on change in
these eating problems. Children (8–12 years, n = 613,
46.5 % girls) completed the Child Eating Disorder Exam-
ination Questionnaire (ChEDE-Q) twice with the second
measurement (T2) taking place 6 months after the first
(T1). Parents (n = 714, 57.7 % mothers) completed the
Child Feeding Questionnaire (CFQ) at T1 to assess the
level of controlling feeding strategies. More overeating,
restraint and concerns at T1 predicted higher levels of the
same eating problems 6 months later, whereas more of loss
of control at T1 predicted lower levels of loss of control
6 months later. Additionally, the interaction between
maternal pressure and the gender of the child was predic-
tive for increases in overeating, whereas the interaction
between paternal monitoring and gender of the child was a
marginally significant predictor for decreases in overeating.
These findings point to the possible negative and positive
effects of parental feeding practices as well as to the pos-
sible larger influence of mothers on their daughters’ and of
fathers on their sons’ eating behaviors. The importance of
studying mothers and fathers, as well as daughters and
A. Matton (&)
L. Goossens
C. Braet
K. Van Durme
Department of Developmental-, Personality- and Social
Psychology, University of Ghent, Henri Dunantlaan 2,
9000 Ghent, Belgium
e-mail: annelies.matton@ugent.be
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•
sons, and of including different feeding strategies and
eating problems is discussed.
Keywords Eating problems
Childhood
Continuity

Etiology
Parental feeding practices
Introduction
Eating problems and obesity are frequently observed
problems in primary school children, often persisting into
adolescence (Field et al. 2001; Stice 2002) and potentially
causing severe psychological and physical consequences
that may interfere with children’s and adolescents’ devel-
opment (Brownell et al. 2009; Brunner and Resch 2006;
Falkner et al. 2001; Yanover and Thompson 2008).
Enhancing scientific insight into these problems seems
necessary given the high prevalence of disturbed eating,
such as overeating, binge eating/loss of control over eating,
restrained eating and concerns about eating, body shape
and weight, even in primary school children. Tanofsky-
Kraff et al. (2004) found, for example, that 20.4 % of
children between 6 and 13 years old experienced episodes
of overeating, defined as eating a large amount of food
without loss of control (Tanosfky-Kraff et al. 2007). In the
same study, 3.1–6.2 % of the children reported episodes of
binge eating, described as eating an objective or subjective
large amount of food while experiencing loss of control
over eating (Diagnostic and Statistical Manual of Mental
Disorders, 4th ed., text rev. (DSM-IV-TR); American
Psychiatric Association [APA] 2000). Prevalence numbers
concerning dieting in children widely vary between studies.
Some authors found over 40 % of girls at the end of pri-
mary school to engage in dieting behavior (Rhee et al.
2010), others report 25.0 and 13.8 % of 9 to 14 year old
J Youth Adolescence (2013) 42:52–66
girls and boys respectively to be infrequent dieters, whereas
frequent dieting appears to occur in 4.5 % of these girls and
in 2.2 % of these boys (Field et al. 2003). Girls and boys in
the same age range as the previous study appeared to diet in
33.5 and 14.8 % of the cases, respectively, according to a
third study (Field and Colditz 2001). Moreover, Schur et al.
(2000) found 50 % of primary school children to report
worries about their weight. Although these prevalence
numbers vary widely between studies, they all indicate that
eating problems are frequently occurring in children and
should be taken seriously.
The relatively high prevalence of eating problems in
children seems especially alarming given that their exis-
tence might interfere with developmental tasks that typi-
cally are observed in primary school children (6–12 years).
These tasks may be jeopardized since, for example, over-
eating and overweight are associated with less acceptance
by peers (Brownell et al. 2009; Falkner et al. 2001) and
eating problems, such as concerns about weight and shape,
may interfere with scholastic performance (Yanover and
Thompson 2008) due to concentration problems. More-
over, eating problems at a young age may lead to full
blown eating disorders in adolescence (Field et al. 2001;
Stice 2002) and appear to remain relatively stable over
time, even in children. For example, the results of a recent
study, which assessed eating behavior when children were
4 and 10 years old, indicated individual continuity in eat-
ing behaviors, such as the tendency to overeat (Ashcroft
et al. 2008). Another study, conducted by Davison, Markey
and Birch (2003), provided evidence for rank stability in
weight concerns and body dissatisfaction in girls when they
were 5, 7 and 9 years old. In addition, the girls who
reported high weight concerns and body dissatisfaction
when they were 5 and 7 years old were more at risk for
being on a diet and having developed maladaptive eating
attitudes by the age of 9. Similarly, a third study found
moderate stability for eating in the absence of hunger in
girls, measured when they were 5 and 7 years old (Fisher
and Birch 2002). More studies concerning continuity or
stability in eating problems were conducted in older sam-
ples of adolescents and young adults. Also in these popu-
lations, support for continuity in eating problems is often
found. For example, results of a 10 year follow-up study
supported continuity in eating problems in the general
adolescent population between the ages of 12 and 23 years
(Neumark-Sztainer et al. 2011). Moreover, the prevalence
of eating problems was already high at the first measure-
ment of this study, when participants were at the end of
childhood. Also in adolescents, restrained eating appears to
be predictive of restrained eating 5 years later, again
indicating continuity in these behaviors (Neumark-Sztainer
et al. 2007). Taken together, several studies are supportive
for continuity in eating problems in children, although it
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should be noted that short-term fluctuations often are not
examined and that most studies focus on young children or
on adolescents. Moreover, although body satisfaction has
been examined before, concerns about eating, body shape
and weight, thought to form the core features of disturbed
eating (Fairburn et al. 2003), are seldom included. There-
fore, the first aim of the present study was to replicate this
finding of continuity, conceptualized as stability or
increases in the level of eating problems, on a short-term
basis in a group of primary school children (8–12 years),
heading towards adolescence and all developmental chan-
ges involved in that life stage. Indeed, one might expect
that, in the absence of any kind of intervention, eating
problems would not diminish over time, but would stay
stable or increase, as indicated by the findings mentioned
above. Nevertheless, to our knowledge, this has not yet
been explicitly examined, although often assumed, in pri-
mary school children for a range of eating problems,
including cognitive features.
If this continuity is indeed observed, it is relevant to gain
insight into naturally occurring factors influencing it. More
specifically, detrimental factors may lead to increases in
eating problems, resulting in continuity in them, whereas
there are also probably protective factors that are able to
decrease eating problems (Haines et al. 2010). The ques-
tion regarding which factors influence continuity in eating
problems is very relevant as the answer to this question
could provide us with important information concerning
prevention and intervention.
Among the various naturally occurring factors that may
influence primary school children’s food intake, parental
influence seems particularly important in children since
their energy intake is mainly influenced by the family
context (Moens et al. 2007). As such, several authors have
focused on the role of controlling parental feeding strate-
gies. Controlling feeding strategies are regarded as
attempts by parents to monitor the child’s eating behavior
by pressuring the child to eat certain foods or to empty his
plate and by restricting the intake of high fat food (Patrick
et al. 2005). According to Costanzo and Woody (1985),
parents are more likely to use these controlling feeding
strategies in eating domains that are perceived as prob-
lematic for themselves or for their child. From this point of
view, controlling feeding practices may be adaptive, since
they may protect, for example, the development of over-
weight by restricting the food intake in children who are
prone to overeat (Moens et al. 2007). On the other hand,
detrimental effects of such a controlling attitude are
reported as well. Indeed, Birch and colleagues repeatedly
found that controlling feeding strategies led to a deficit in
children’s self-regulation capacities, which enhanced the
risk of overeating and loss of control over eating (Birch and
Fisher 2000; Johnson and Birch 1994). In other words, it
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seems that controlling feeding strategies have both a pro-
tective and a detrimental potential. Although this might
seem contradictory, this perspective is consistent with the
developmental goodness-of-fit approach, postulating that
the effects of certain parental behaviors depend on the
nature of the child and cannot be classified as positive or
negative an sich (Braet and Prins 2008).
Although the influence of parental control on children’s
eating behavior has been the subject of many studies, the
focus is often solely on the development of overweight and
most studies seem to follow the view on controlling strat-
egies as being detrimental in this area. For example, a
cross-sectional study found evidence for a negative asso-
ciation between maternal controlling feeding strategies,
more specific restriction and monitoring of the daughter’s
intake of fat food, and control over food intake in the
daughter (Birch and Fisher 2000). Moreover, mothers of
daughters with overweight reported more controlling
feeding strategies than mothers whose daughters were not
overweight, indicating an important role for weight status
in the association between parental feeding practices and
children’s eating behavior.
Although the direction of the association between
parental feeding strategies and children’s eating behavior is
unclear from this study, other studies explicitly provide
evidence for controlling feeding practices to cause eating
problems in children. For example, Fisher and Birch (2002)
found a positive link between restriction by parents when
their daughter was 5 years old and eating in the absence of
hunger when she was 7 years old, even after controlling for
the weight status of the child. Similar results are reported
by Birch et al. (2003), who found that maternal restriction
of the child’s food intake at 5 years predicted more eating
in the absence of hunger when the child was 7 and 9 years
old, especially in overweight children. These findings are
completely in line with the idea that controlling strategies
enhance the risk for the development of obesogenic eating
and obesity in children. However, a third longitudinal
study, conducted by Francis and Birch (2005), indicated a
positive association between restriction by the mother and
restrained eating by the daughter at 5, 7, 9 and 11 years. As
such, it seems that overcontrolling feeding practices may
not only lead to obesogenic eating styles such as overeating
and loss of control over eating, but also may lead to
restrained eating. This is in fact not surprising, since
overeating, loss of control over eating and restrained eating
are linked with each other. More specifically, restrained
eaters are assumed to be more prone to overeating and loss
of control over eating when they experience negative
emotions compared with unrestrained eaters, who are more
prone to decrease their food intake when under stress
(Herman and Polivy 1975). In other words, perceived
lapses in restrained eating due to negative emotionality are
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thought to trigger overeating or loss of control episodes
(Goldschmidt et al. 2008).
In line with this perspective, Neumark-Sztainer et al.
(2007) proposed a model in which restrained eating is a
precursor of loss of control over eating and found support
for a positive association between restrained eating and
loss of control over eating 5 years later. This was further
empirically supported by Field et al. (2003) as well. A
similar idea to that of Neumark-Sztainer et al. (2007) is
also proposed by Fairburn et al. (2003). These authors
stated that concerns about eating, body shape and weight
lead to dieting, which in turn might trigger loss of control
episodes. Taken together, several empirically supported
theories assume that there are associations between over-
eating, loss of control over eating and restrained eating, as
well as with concerns over eating, body shape and weight,
indicating that it is not completely surprising to find an
effect of parental overcontrol on both obesogenic and
restrained eating behavior. Moreover, these findings imply
that it might be important to study the effect of parental
control not only on overeating and loss of control over
eating, but also on restraint and even on concerns about
eating, body shape and weight.
One study that explicitly examined the role of maternal
feeding practices on children’s restrained eating found that
more maternal pressure to eat was associated with less
restrained eating (Rhee et al. 2010). These findings do
suggest not only that parental feeding strategies may affect
eating behavior other than overeating and loss of control
over eating, but also that parental controlling feeding
practices may not be detrimental per se and may have a
protective effect when it comes to restrained eating in some
cases. This finding is in line with a goodness-of-fit
approach, although originally not expected within the
parental feeding practices domain, and suggests that it is
important to include not only different eating problems, but
also different parental feeding strategies. Nevertheless,
most studies measure controlling feeding strategies as
restriction of the child’s food intake and few include other
strategies such monitoring and pressure to eat.
Beside these shortcomings, an additional gap pertains to
the gender differences in both maternal versus paternal
feeding practices on both boys’ and girls’ eating behavior.
Although one can assume that mothers will have larger
effects than fathers on children’s eating behavior in gen-
eral, this seldom has been examined explicitly. A first
reason for a possible larger maternal effect might be the
general greater involvement of mothers in family meals
and in the food intake of their children on the one hand. On
the other hand, Francis and Birch (2005) showed that
mothers who were more preoccupied with their own weight
and eating exhibited more control over the food intake of
their daughters than women who were less preoccupied
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with their weight and eating. Maternal eating problems
may thus be linked to overcontrol concerning the eating
behavior of the child (Francis and Birch 2005) and since
eating problems are more observed in women than in men
(Hoek and van Hoeken 2003; Hudson et al. 2007), this
might result in a larger maternal impact on children’s
eating behavior. Nevertheless, as previously mentioned,
this rarely has been examined. A similar remark can be
made regarding gender differences in the impact on
daughters versus sons. It is unclear whether controlling
feeding practices by parents have a larger or a similar
impact on daughters versus sons, as most studies focus
solely on daughters.
Aims and Hypotheses
Based on the above mentioned considerations and short-
comings of previous research, the first goal of the current
study was to prospectively investigate whether evidence
could be found for continuity in different eating problems
(overeating, loss of control over eating, restrained eating
and concerns about eating, body shape and weight) in
primary school children (8–12 years) on a 6 months basis.
We first wanted to establish, and not simply assume, the
continuity in eating problems at primary school level, as
this forms the basis of our second question, namely whe-
ther an additive predictive effect of three different parental
feeding practices on these eating problems could be found,
thereby focusing on possible differential influences of
mothers versus fathers and controlling for weight status.
To answer the question whether there is evidence for
short-term continuity in eating problems at the end of
childhood, associations between eating problems at a first
measurement moment and eating problems 6 months later
were examined, as positive associations would suggest that
the intra-individual level of eating problems remained the
same or increased over time. Given the short time-span and
the lack of any manipulation or intervention, we did not
expect eating problems to decrease but hypothesized that
all eating problems at baseline would be positively asso-
ciated with eating problems 6 months later, indicating
continuity in them.
Regarding our second question, namely whether
maternal and paternal controlling feeding strategies could
produce change in the level of eating problems, we added
maternal and paternal feeding strategies to examine their
additive effect. This additive predictive effect of parental
feeding practices was expected to depend on the gender of
both parent and child. More specifically, we hypothesized
that mothers would have more effect on their child’s eating
behavior than fathers and these effects also were expected
to be larger in daughters than in sons, given the higher risk
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for the development of eating problems in girls (e.g.
Goossens et al. 2009; Field et al. 2008). Regarding the
specific parental strategy used, we expected that more
restriction would be associated with increases in both
obesogenic eating behaviors (overeating and loss of control
over eating) and in restrained eating, based on the results
mentioned above (Birch and Fisher 2000; Birch et al. 2003;
Fisher and Birch 2002; Francis and Birch 2005). We also
hypothesized that restriction might lead to increases in
concerns about eating, body shape and weight, as restric-
tion by parents might give children the message that they
eat too much and should worry about their weight, espe-
cially since restriction is more reported by mothers with
overweight children (Birch and Fisher 2000). Pressure to
eat was expected to be associated negatively with
restrained eating and concerns about eating, body shape
and weight, in line with the findings of Rhee et al. (2010).
Additionally, pressure to eat was hypothesized to relate to
increases in overeating and loss of control over eating,
since by forcing children to eat they may learn to ignore
feelings of hunger and satiety, leading to episodes of
overeating and loss of control over eating. The last strat-
egy, namely monitoring, was expected to lead to increases
in overeating and episodes of loss of control over eating,
based on the findings of Birch and Fisher (2000). Since
monitoring could be seen as a less strong controlling
feeding strategy compared to either putting pressure on the
child to eat or restrict the child’s eating behavior, it was
unclear in advance which effect this strategy would have
on restrained eating and concerns about eating, body shape
and weight.
Taken together, in general, we expected that controlling
strategies would not have a global detrimental impact on
all eating problems, but that the effect would depend on the
specific strategy and the specific eating problem, as well as
on the gender of both parent and child. Moreover, these
effects were expected to be small, since eating problems at
the first measurement moment were hypothesized to be the
strongest predictors for eating problems 6 months later.
Methods
Participants and Procedure
Children of the third, fourth and fifth grade from seven
Flemish elementary schools (mean age 9.05 years,
SD = .86; range 8–11 years) were contacted for partici-
pation in the current study, which is part of a larger pro-
spective project. Only schools who offer primary education
were included. Children from the third grade who were
younger than 8 years were excluded to optimize the reli-
ability of the results. We chose to include children with a
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maximum age of 11 years at T1 because several of these
children would have reached the age of 12 years at T2,
which marks the upper boarder of childhood (Mönks and
Knoers 1990).
The permission of parents was obtained through passive
informed consents. Children provided active informed
consents at the start of the testing. This resulted at the first
measurement moment (T1) in a sample of 688 children
(46.5 % girls). At T1 also 714 parents (57.6 % mothers)
participated, after receiving active informed consents.
Six months after T1, children were contacted again. At
this second measurement moment (T2), passive consent
was obtained from parents and active consent from chil-
dren, similar to the procedure at T1. Of the 688 children
participating at T1, 613 children (46.5 % girls) participated
again, resulting in a response rate of 89 %. The mean age at
T2 was 9.56 years (SD = .96; range 8–12 years). Of these
613 children, both parents participated in 290 cases
(48.6 % girls), in 121 cases (49.6 % girls) only the mother
participated and in 13 cases (46.2 % girls) only the father
participated. For 189 children (41.3 % girls) neither
maternal nor paternal data were available.
At both T1 and T2, the children’s questionnaire was
administered in class by trained research assistants. The
assistants remained present during the entire period and
answered the children’s questions when necessary. This
study was approved by the university’s research ethics
committee.
Materials
Adjusted Body Mass Index (ABMI)
At T1, children were weighed and measured by the
researcher outside the classroom in order to calculate the
children’s ABMI. The actual Body Mass Index (BMI) as
calculated for adults is thereby divided by percentile 50
(P50) of the BMI-scores of children of the same age and
gender as the subject. This number is subsequently multi-
plied by 100, resulting in the ABMI. The P50 is based upon
Dutch grow-charts by Fredriks et al. (2000). An ABMI score
equal to or smaller than 85 is considered as underweight, a
score equal to or greater than 120 as overweight, and a score
equal to or greater than 140 as obese (Van Winckel and Van
Mil 2001). As such ABMI is comparable to z-BMI used in
most studies to operationalize weight status in children (e.g.
Birch et al. 2003; Fisher and Birch 2002) and used before by
Verbeken et al. (2012) among others.
Eating Behavior
The Dutch version of the Children’s Eating Disorder
Examination Questionnaire (ChEDE-Q) by Decaluwé and
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Braet (1999) was used at T1 and T2. The ChEDE-Q was
developed to measure pathologic eating styles in children
and contains 23 items divided in four subscales, namely
restraint, concerns about eating, concerns about body shape
and concerns about weight. All items concern the last
4 weeks and are to be answered on a seven point scale,
with minimum score 0 and maximum score 6. The mean
scores on the different subscales were used, resulting in a
minimum score of 0 and a maximum score of 6 on each
subscale. The higher the score, the more frequent and the
more intense the eating problem. Some item examples are
‘‘On how many days out of the past 28 days have you tried
to avoid eating foods which you like in order to influence
your shape or weight?’’ (restraint) and ‘‘Over the past
4 weeks (28 days) how much would it upset you if you had
to weigh yourself once a week for the next 4 weeks?’’
(concerns about weight). Cronbach alpha’s at T1 were .81
for restraint, .77 for concerns about eating, .88 for concerns
about body shape and .76 for concerns about weight. At T2,
cronbach alpha’s were .85, .80, .85 and .70 for restraint and
concerns about eating, body shape and weight respectively.
Three diagnostic items from the ChEDE-Q were also
used, namely (objective) overeating (eating an objective
large amount of food without loss of control), objective binge
eating (eating an objective large amount of food while
experiencing loss of control over eating), and subjective
binge eating (eating an subjective large amount of food while
experiencing loss of control over eating). These behaviors
are assessed via three questions: ‘‘Over the past month, did
you have the feeling that you ate a very large amount of food?
So an amount of food that would be considered large by other
people as well?’’ (overeating), ‘‘When you were eating too
much, did you have the feeling that you could no longer
control what or how much you were eating? So, did it feel
like you could not stop eating once you had started (e.g. like a
ball rolling down a hill, going faster and faster)?’’ (objective
binge eating) and ‘‘During the past month, were there other
times when you had the feeling that you could not stop eat-
ing, although you were not eating an abnormal large amount
of food?’’ (subjective binge eating). These items have to be
answered with yes or no and in the case of a yes, by indicating
how often these behaviors have been performed during the
past month. Both overeating and binge eating were registered
because, according to Goldschmidt et al. (2008), loss of
control signals increased impairment independent of over-
eating. Making the distinction between loss of control over
eating and overeating without loss of control is therefore
important.
Parental Feeding Practices
At T1, parents completed the Dutch translation of the Child
Feeding Questionnaire (CFQ; Birch et al. 2001). The CFQ
J Youth Adolescence (2013) 42:52–66
was developed to register parental attitudes, beliefs and
feedings strategies concerning their children’s eating
behavior and is appropriate for children aged 2–11 years
(Birch et al. 2001). The total scale consists of four sub-
scales to measure parental beliefs about their children’s
eating behavior and three to measure parental control of the
child’s food intake. In the present research, the latter three
were used, namely restriction of the child’s food intake or
‘‘restriction’’, pressuring the child to eat or ‘‘pressure’’ and
monitoring the child’s eating behavior or ‘‘monitoring’’,
based on previous research in which these scales are used
to operationalize controlling feeding practices (e.g. Faith
et al. 2004). These feeding strategies refer to restriction of
the child’s high fat food, pressure put on the child by
parents to empty his plate or finish his meal, and moni-
toring the child’s intake of high fat food. Some item
examples are ‘‘I intentionally keep some foods out of my
child’s reach’’ (restriction), ‘‘My child should always eat
all of the food on her plate’’ (pressure) and ‘‘How much do
you keep track of the snack food (potato chips, Doritos,
cheese puffs) that your child eats?’’. Each item of the CFQ
(Birch et al. 2001) has five answer alternatives, with scores
ranging from 1 to 6. As we used the means scores on each
subscale, the total scores ranged from 1 to 6, with higher
scores indicating the more frequent use of the specific
strategy. Cronbach alpha’s in this study were .62 and .54
for restriction, .60 and .56 for pressure and .93 and .92 for
monitoring for mothers and fathers respectively. Given
these relatively low internal consistencies for restriction
and pressure, we performed confirmatory factor analysis on
the items and did all following analyses with both the
original and the factor scores on the three subscales. Since
both gave the same results, the scales seemed useable and
as such we will further report our findings based on the
original scores.
Statistics
Missing Values
Missing items within a single questionnaire were estimated
by calculating the mean score based on the other items of
the questionnaire. This was only done when less than 20 %
of the items of one subscale were missing.
Data Reduction
To limit the number of variables and to maintain clarity,
scores on the subscales concerns about eating, concerns
about body shape and concerns about weight were added and
the average score was calculated to form one Concern vari-
able, representing the cognitive part of eating problems. This
57
choice was based on previous research in adults and ado-
lescents, suggesting that concerns about body shape and
weight should form one subscale (Peterson et al. 2007;
Waller et al. 2008) and on the theoretically widely accepted
view that concerns about eating, body shape and weight form
the core (cognitive) feature of eating problems (Goldschmidt
et al. 2008; Fairburn et al. 2003). Likewise, objective and
subjective binge eating were taken together to form the
variable Loss of control over eating (further called Loss of
control) as this is the most prominent characteristic of both
objective and subjective binge eating and is considered more
important than the actual amount of food eaten in a binge
episode (Goldschmidt et al. 2008; Marcus and Kalarchian
2003).
Data analytic Plan
Both Overeating and Loss of control were included as
dichotomous variables, with Overeating and Loss of con-
trol considered as present when at least one episode was
reported during the last 4 weeks. This procedure was based
on Tanofsky-Kraff et al. (2004) and was followed since it
was probably less difficult for children to indicate whether
they had an episode of overeating or loss of control or not
than to say how many episodes they experienced. Restraint
and Concerns were included as continuous variables.
In order to detect possible differences between children
who participated at both times of measurement versus
children who only participated at T1, both groups were
compared using an ANOVA for Age, ABMI, Restraint and
Concerns at T1. A Chi-quadrate analysis was computed for
the categorical variables Gender, Overeating and Loss of
control at T1. To detect possible control variables in pre-
dicting eating problems at T2 an ANOVA was conducted
for Age and ABMI.
Concerning our first research question, we examined the
predictive value of eating problems at T1 for the same
eating problems at T2 as an indication of continuity.
Therefore, hierarchical logistic regressions were used to
establish these associations for Overeating at T1 and T2, as
well as for Loss of control at T1 and T2. Two hierarchical
linear regressions were performed to establish the predic-
tive value of Restraint and Concerns at T1 for Restraint and
Concerns at T2 respectively. To answer the second
research question, two hierarchical regressions were con-
ducted for each eating problem separately, one to distin-
guish the predictive value of maternal feeding practices
(maternal model), and one to distinguish the predictive
value of paternal feeding practices (paternal model). Both
models additionally included an interaction term between
the feeding strategy of the parent and the gender of the
child, as well as the variable Gender of the child to
examine to moderating role of the child’s gender.
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Results Preliminary Results

Descriptives Dropout

At T1, 5.3 % of the girls and 1.9 % of the boys were
underweight, 75.4 % of the girls and 82.8 % of the boys fell
in the normal weight range, 16.5 % of the girls and 12.8 % of
the boys had overweight and 2.8 % of the girls and 2.5 % of
the boys were obese. The mean ABMI of the total sample was
104.29 (SD = 15.27, range 69.55–171.78). For girls the
mean ABMI was 104.15 (SD = 15.96, range 71.46–171.78),
for boys the mean ABMI was 104.41 (SD = 14.66, range
69.55–157.20). The difference in mean ABMI for girls
versus boys was not significant with t(586) = .20, p [ .05.
Regarding the prevalence of eating problems, the num-
ber of children reporting episodes of Overeating and Loss
of control as well as the number of children reporting
Restraint and Concerns on a weekly basis or more (mean
score [ 2) are presented in Table 1 for boys and girls at T1
and T2 separately. The means scores on the eating prob-
lems did not significantly differ between boys and girls,
with v2(1) = 1.08, p [ .05 and v2(1) = 1.01, p [ .05 for
Overeating at T1 and T2 respectively, v2(1) = 2.08,
p [ .05 and v2(1) = .07, p [ .05 for Loss of control at T1
and T2 respectively, t(573) = 1.12, p [ .05 and t(596) =
1.07, p [ .05 for Restraint at T1 and T2 respectively, and
t(572) = .35, p [ .05 and t(596) = .12, p [ .05 for Con-
cerns at T1 and T2 respectively. The mean scores, standard
deviations, t- and v2-statistics are depicted in Table 1.
Concerning the Social Economic Status (SES) of the
participating families, 37.2 % could be situated in the
upper class, 30.5 % in the upper-middle class and 31.6 %
in the middle class based on the Hollingshead Index
(Hollingshead 1965). Only 0.01 % of the families could be
placed in the lower middle category and none in the lower
class.
Age, ABMI and Gender did not predict drop-out at T2,
with F(1,686) = 1.30, p [ .05 for Age, F(1,653) \ 1,
p [ .05 for ABMI and v2(1) = .00, p [ .05 for Gender.
Likewise, eating problems at T1 were not predictive for
drop-out with F(1) \ 1, p [ .05 for Restraint and for
Concerns, v2(1) = .02, p [ .05 for Overeating and
v2(1) = .59, p [ .05 for Loss of control.
Control Variables
Neither Age nor ABMI seemed to predict Overeating or
Loss of control at T2, though ABMI, but not Age, did
significantly predict Restraint, with b = .016, p \ .001, as
well as Concerns, with b = 0.46, p \ .001.
Predictive Value of Eating Problems at T1 for Eating
Problems at T2
The presence of Overeating at T1 predicted the presence of
Overeating at T2 with Wald(1) = 35.33, p \ .001, Nage-
lkerke R2 = .11. Loss of control at T1 also significantly
predicted Loss of control at T2, with Wald(1) = 40.34,
p \ .001, Nagelkerke R2 = .12, although the negative
regression coefficient indicated a decrease of Loss of
control. After controlling for ABMI, higher levels
of Restraint at T1 appeared to predict higher levels of
Restraint at T2, with t = 13.53, p \ .001. R2 for ABMI and
Restraint at T1 was .34, with Restraint at T1 accounting for
23 % of the variance in Restraint at T2. Similarly, higher
levels of Concerns at T1 significantly predicted more
Concerns at T2 after controlling for ABMI with t = 15.49,
p \ .001 for Concerns. R2 for ABMI and Concerns at T1

Table 1 The prevalence of

Girls (n = 285) Boys (n = 328) t v2
overeating (absent or present),
loss of control over eating % M (SD) % M (SD)
(absent or present), restraint Yes/[weekly Yes/[weekly
(weekly), concerns about eating,
body shape and weight (weekly) T1
and gender differences in the Overeating 15.1 / 18.6 / / 1.08ns
mean scores on T1 and T2
Loss of control 13.7 / 17.7 / / 2.08ns
ns
Restraint 30.5 .63 (1.04) 33.8 .72 (1.07) 1.12 /
n = number of subjects in the Concerns 11.6 .83 (.97) 12.8 .86 (1.06) .35ns /
sample, M = mean score,
T2
SD = Standard deviation,
T1 = first measurement Overeating 15.1 / 18.0 / / 1.01ns
moment, T2 = second Loss of control 18.2 / 18.9 / / .07ns
measurement moment Restraint 26.0 .41 (.70) 29.3 .47 (.73) 1.07 ns
/
* p \ 0.05; ** p \ 0.01; *** Concerns 4.9 .56 (.67) 4.3 .56 (.64) .12ns /
p \ 0.001; ns = not significant

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J Youth Adolescence (2013) 42:52–66 59

was .40, with Concerns accounting for 27 % of the vari-
ance in Concerns at T2.
Predictive Value of Parental Feeding Practices at T1
for Eating Problems at T2
For Overeating at T2, the maternal model indicated that
Overeating at T1 was a significant predictor with
v2(1) = 18.09, p \ .001, Nagelkerke R2 = .09. Adding
Gender of the child and the three maternal feeding prac-
tices Restriction, Pressure and Monitoring did not signifi-
cantly improve the model, nor did the interaction terms
between Gender and the maternal feeding practices. Nev-
ertheless, when looking at the separate variables, the
interaction term between maternal Pressure and Gender of
the child was significant, with Wald(1) = 3.96, p = .047,
indicating that more maternal pressure led to increases in
Overeating by daughters. In the paternal model, Overeating
at T1 again appeared to be a significant predictor for
Overeating at T2, with v2(1) = 19.23, p \ .001, Nage-
lkerke R2 = .13. Gender of the child, the three paternal
feeding practices and the interaction with Gender of child
were no significant predictors for changes in Overeating.
However, the interaction term between paternal Monitoring
and Gender of the child did reach marginal significance,
with Wald(1) = 3.73, p = .053 suggesting that more
paternal Monitoring might have led to less Overeating in
sons. In Table 2 the regression coefficients, standard
deviations, Wald-statistics and Exp(b) are presented.
The maternal model concerning Loss of control by the
child at T2 also indicated that the control variable, Loss of
control at T1, was significant with v2(1) = 21.82,
p \ .001, Nagelkerke R2 = .10. Gender of the child, the
three maternal feeding practices and the interaction of these
practices with the Gender of the child did not contribute
significantly to the predictive value of the model. In the
paternal model, Loss of control at T1 again appeared to be
a significant predictor for Loss of control at T2, with
v2(1) = 15.66, p \ .001, Nagelkerke R2 = .10. Gender of
the child, the three paternal feeding practices and the
interaction with Gender of child had no significant additive
predictive value for change in Loss of control. In Table 3
the regression coefficients, standard deviations, Wald-sta-
tistics and Exp(b) are shown.
Considering Restraint by the child at T2, the maternal
model indicated that the control variables, Restraint and
ABMI at T1, were significant, with F(2,365) = 93.87,
p \ .001, adjusted R2 = .34 indicating that both higher
ABMI and Restraint at T1 were predictive for higher
Restraint at T2. Gender of the child, the three maternal
feeding practices and the interaction of these with Gender
of the child were no significant additive predictors for
changes in Restraint at T2. Similar conclusions can be
drawn concerning the paternal model. Here, the control
variables again were significant predictors, with
F(2,267) = 66.17, p \ .001, R2 = .33, but Gender of the
child, paternal feeding practices and their interaction with
Gender of the child were not. The regression coefficients,
standard errors, standardized regression coefficients and
t values are presented in Table 4.
Looking at Concerns by the child at T2, the results of
both the maternal and the paternal model showed that the
control variables, Concerns and ABMI at T1, were sig-
nificant predictors with F(2,366) = 115.07, p \ .001,

Table 2 Hierarchical logistic regression concerning the effect of parental feeding practices and the interaction with the gender of the child on
overeating by the child at T2
Maternal model OO (T2) Paternal model OO (T2)
B SE Wald Exp(b) B SE Wald Exp(b)

Block 1: Nagelkerke R2 = .09 Block 1: Nagelkerke R2 = .13

OO T1 1.30 .31 17.96*** 3.66 OO T1 1.57 .37 18.21*** 4.80
Block 2: Nagelkerke R2 = .11 Block 2: Nagelkerke R2 = .15
RESN T1 .05 .17 .10ns 1.06 RESN T1 .08 .20 .15ns 1.08
ns
PRES T1 -.12 .16 .58 .89 PRES T1 -.15 .18 .65ns .86
MONI T1 .08 .17 .24ns 1.09 MONI T1 -.21 .21 1.02ns .81
Gender child .36 .31 1.38ns 1.43 Gender child .47 .39 1.50ns 1.60
Block 3: Nagelkerke R2 = .12 Block 3: Nagelkerke R2 = .18
RESN T1 9 gender child .04 .17 .04ns 1.04 RESN T1 9 gender child .11 .22 .22ns 1.11
PRES T1 9 gender child .33 .16 3.96* 1.39 PRES T1 9 gender child -.01 .22 .00ns .99
MONI T1 9 gender child -.01 .17 .00ns .99 MONI T1 9 gender child -.45 .23 3.73? .64
OO = objective overeating, T1 = first measurement moment, T2 = second measurement moment, RESN = restriction, PRES = pressure,
MONI = monitoring
* p \ .05; ** p \ .01; *** p \ .001, ?marginally significant, ns = not significant

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Table 3 Hierarchical logistic regression concerning the effect of parental feeding practices and the interaction with the gender of the child on
loss of control over eating by the child at T2
Maternal model LC (T2) Paternal model LC (T2)
B SE Wald Exp(b) B SE Wald Exp(b)

Block 1: Nagelkerke R2 = .10 Block 1: Nagelkerke R2 = .10

LC T1 -1.52 .32 22.92*** -.22 LC T1 -1.4 .36 16.30*** .24
Block 2: Nagelkerke R2 = .11 Block 2: Nagelkerke R2 = .10
RESN T1 -.18 .16 1.17ns .84 RESN T1 .02 .18 .01ns 1.02
ns
PRES T1 -.02 .16 .01 .98 PRES T1 .00 .18 .00ns 1.00
ns ns
MONI T1 .23 .17 1.83 1.25 MONI T1 .11 .19 .35 1.12
Gender child -.11 .30 .15ns .89 Gender child -.28 .33 .70ns .76
Block 3: Nagelkerke R2 = .11 Block 3: Nagelkerke R2 = .13
RESN T1 9 gender child -.07 .17 .19ns .93 RESN T1 9 gender child -.22 .19 1.28ns .81
ns
PRES T1 9 gender child -.04 .16 .07 .96 PRES T1 9 gender child -.30 .19 2.64ns .74
MONI T1 9 gender child .01 .17 .00ns 1.01 MONI T1 9 gender child .25 .20 1.47ns 1.28
LC = loss of control over eating, T1 = first measurement moment, T2 = second measurement moment, RESN = restraint, PRES = pressure,
MONI = monitoring
* p \ .05; ** p \ .01; *** p \ .001, ns = not significant

Table 4 Hierarchical linear regression concerning the effect of parental feeding practices and the interaction with the gender of the child on
restraint by the child at T2
Maternal model REST (T2) Paternal model REST (T2)
B SE b t B SE b t

Block 1: adjusted R2 = .34 Block 1: adjusted R2 = .33

REST T1 .34 .03 .50 11.31*** REST T1 .29 .04 .43 8.32***
ABMI T1 .01 .00 .19 4.20*** ABMI T1 .01 .00 .30 5.74***
Block 2: change R2 = .01 Block 2: change R2 = .01
RESN T1 -.00 .03 -.01 -.11ns RESN T1 -.03 .04 -.04 -.74ns
ns
PRES T1 .01 .03 .01 .26 PRES T1 .00 .04 .00 .05ns
ns
MONI T1 -.05 .03 -.06 -1.36 MONI T1 -.04 .04 -.05 -.96ns
ns
Gender child -.04 .03 -.06 -1.28 Gender child -.03 .04 -.05 -.89ns
2 2
Block 3: change R = .01 Block 3: change R = .01
ns
RESN T1 9 gender child 0.03 .03 .04 .88 RESN T1 9 gender child .04 .04 .05 .92ns
ns
PRES T1 9 gender child .01 .03 .01 .17 PRES T1 9 gender child .03 .04 .04 .70ns
ns
MONI T1 9 gender child .04 .03 .06 1.18 MONI T1 9 gender child -.06 .04 -.08 -1.48ns
REST = restraint, T1 = first measurement moment, T2 = second measurement moment, ABMI = Adjusted Body Mass Index,
RESN = restriction, PRES = pressure, MONI = monitoring
* p \ .05; ** p \ .01; *** p \ .001, ns = not significant

R2 = .39 for the maternal model and F(2,268) = 85.85, Discussion

p \ .001, R2 = .39 for the paternal model. In line with the
findings regarding Restraint, these results suggested that
both higher ABMI and more Concerns at T1 were pre-
dictive for more Concerns at T2. The feeding practices and
the interaction with Gender of the child had no significant
additive value, nor in the maternal nor in the paternal
model. Table 5 shows the regression coefficients, standard
errors, standardized regression coefficients and t-values for
these regressions.
Eating problems frequently are observed in children and
adolescents and may interfere with their scholastic and
social development (Brownell et al. 2009; Falkner et al.
2001; Yanover and Thompson 2008). Previous studies have
examined the continuity of eating problems in childhood
and adolescence, showing evidence for stability or
increases in them over time and underscoring the impor-
tance of early intervention and prevention of disturbed

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Table 5 Hierarchical linear regression concerning the effect of parental feeding practices and the interaction with the gender of the child on
concerns by the child at T2
Maternal model CON (T2) Paternal model CON (T2)
B SE b t B SE b t

Block 1: adjusted R2 = .39 Block 1: adjusted R2 = .39

CON T1 .36 .03 .57 13.12*** CON T1 .36 .03 .56 11.17***
ABMI T1 .00 .00 .11 2.52* ABMI T1 .01 .00 .15 2.94**
Block 2: change R2 = .01 Block 2: change R2 = .01
RESN T1 .05 .03 .07 1.56ns RESN T1 .01 .03 .002 .37ns
PRES T1 -.01 .03 -.02 -.43ns PRES T1 -.02 .03 -.04 -.71ns
ns
MONI T1 -.05 .03 -.08 -1.74 MONI T1 -.05 .03 -.07 -1.37ns
ns
Gender child .00 .03 .00 .04 Gender child -.02 .03 -.04 -.74ns
2 2
Block 3: change R = .01 Block 3: change R = .01
RESN T1 9 gender child .04 .03 .06 1.44ns RESN T1 9 gender child .04 .03 .07 1.29ns
PRES T1 9 gender child .02 .03 .02 .56ns PRES T1 9 gender child .02 .03 .03 .54ns
ns
MONI T1 9 gender child .00 .03 .00 .07 MONI T1 9 gender child -.03 .03 -.05 -1.01ns
CON = concerns, T1 = first measurement moment, T2 = second measurement moment, ABMI = Adjusted Body Mass Index,
RESN = restriction, PRES = pressure, MONI = monitoring
* p \ .05; **p \ .01; ***p \ .001, ns = not significant

eating (e.g. Ashcroft et al. 2008; Neumark-Sztainer et al.
2011). To achieve this, greater insight into the etiology of
eating problems and in factors potentially affecting this
continuity is needed.
In this area, several researchers have focused on the role
of parental feeding strategies. An important idea in this
domain is that controlling parental feeding strategies may
cause deficiencies in children’s self-regulation capacities,
leading to more overeating and loss of control over eating
(Birch and Fisher 2000). Several studies have tested this
hypothesis in children and found support for it (e.g. Birch
and Fisher 2000). Nevertheless, it should be acknowledged
that the effects of controlling strategies may be double-
sided. As Costanzo and Woody (1985) and the general idea
of goodness-of-fit (Braet and Prins 2008) in developmental
psychology suggest, controlling strategies may be benefi-
cial for some children as well, depending, for example, on
the eating problem under consideration (Rhee et al. 2010).
This idea, although recognized before (e.g. Moens et al.
2007), has been hard to examine since most studies focus
only on overeating and loss of control over eating.
Restrained eating is far less included and to our knowledge
the cognitive features of disturbed eating, namely concerns
about eating, body shape and weight, are never included.
This is unfortunate, given the theoretical and empirically
supported link between these different problems (e.g.
Fairburn et al. 2003; Neumark-Sztainer et al. 2007).
Moreover, little is known about gender differences in these
influences, since most studies exclusively focus on mothers
and daughters. Additionally, most studies operationalize
controlling feeding strategies as the strategy of pressuring
the child to eat, whereas fewer studies include the level of
monitoring the child’s food intake or restricting the child’s
intake of fat food. This is in contradiction with the findings
of the few studies that did assess these strategies and found
support for their influence (Birch and Fisher 2000; Rhee
et al. 2010).
Given these shortcomings in current literature, the aim
of this study was to examine whether both overeating and
loss of control over eating, as well as restraint and concerns
about eating, body shape and weight showed continuity
over a short time-frame and whether maternal and paternal
restriction, pressure and monitoring had an effect on
increases in these problems. Additionally, the possible
moderating role of the gender of the child was brought into
account, since little is known about the effect of parental
feeding strategies on boys. Following a developmental
goodness-of-fit approach, one might expect that these
strategies are not detrimental in every case, but that the
effect might depend on the specific nature of the eating
problem under consideration as well as on the child’s
gender, among other characteristics such as weight status.
First, our hypothesis of continuity was supported for
three out of the four registered eating problems, namely
overeating, restrained eating and concerns about eating,
body shape and weight. This suggests that the children who
scored high on overeating, restraint or concerns about
eating, body shape and weight at T1 were still scoring high
at T2. Although the time-span of the present study was
limited to only 6 months, these findings do indicate that
eating problems are not only prevalent in primary school
children, but also need to be taken seriously as they do not

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seem to just disappear. However, opposite to our expec-
tations, loss of control over eating at T1 was negatively
related to loss of control over eating at T2 indicating that
higher levels of loss of control at T1 were predictive for
lower levels at T2. This might reflect reality since, for
example, loss of control over eating, when observed, might
lead to direct action by parents or therapists, which was not
brought into account here. Another explanation for this
unexpected finding might be that the concept of loss of
control over eating was too difficult for the children to
understand, leading to errors in their reports (Loeb et al.
1994). Indeed, according to Decaluwé and Braet (2004),
the use of the ChEDE-Q appears to be less reliable com-
pared to the use of the Eating Disorder Examination
(Bryant-Waugh et al. 1996), the semi-structured interview
on which the ChEDE-Q is based. Nevertheless, this is not
only true for the ChEDE-Q but for other self-report ques-
tionnaires concerning eating behavior as well and seems to
be a problem related to self-report measures in general
(Tanofsky-Kraff et al. 2003). Although it should be rec-
ognized that this forms a limitation of the current study, it
was not possible to use interviews given the size of the
sample. Moreover, in the child version of the EDE-Q used
here, the concept of loss of control is explained more fully
to the children compared to the adult version (Goossens
et al. 2011) and this explanation is based on previous
research regarding children’s understanding of the concept
of loss of control over eating (Tanofsky-Kraff et al. 2004).
As an additional aid, research assistants were present dur-
ing the entire time to provide more information when
children did not understand certain questions. This means
that, although it is still possible that children misunderstood
the concept of loss of control over eating, this risk was
minimized.
With regard to our second research question, we found
only one additive predictive effect of parental feeding
strategies on children’s eating behavior. More specifically,
the interaction between pressure by the mother and the
gender of the child seemed to predict increases in over-
eating by the child 6 months later, especially in girls.
Beside this result, a marginally significant effect also was
found for the interaction between monitoring by the father
and the gender of the child, suggesting that more paternal
monitoring led to decreases in overeating depending on the
gender of the child, with boys appearing to report more
decreases in overeating when greater paternal monitoring
was reported. First, the fact that more maternal pressure
seemed to result in more overeating in girls, is in line with
the assumption that overcontrol leads to more disinhibited
eating (Birch and Fisher 2000). However, given the
absence of a significant main effect of maternal pressure, it
seems that this strategy might by only detrimental in girls,
which might be understood by the possible greater
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J Youth Adolescence (2013) 42:52–66
vulnerability of girls to develop eating problems compared
to boys (e.g. Goossens et al. 2009; Field et al. 2008). It is
also possible that parents exercise more control over the
eating behavior of their daughters, for example due to our
cultural context in which being thin is considered more
important for girls than for boys (Rodgers and Chabrol
2009). Nevertheless, a post-hoc independent samples t test
revealed no significant difference in the mean scores of
maternal pressure between boys and girls, indicating that
the amount of pressure might be the same for boys and
girls, while the effect might be different.
Second, although it was our hypothesis that mothers
would be more influential in general, our data seemed to
suggest that mothers were more influential on daughters
and fathers on sons when we take the marginally significant
effect of paternal monitoring into account as well.
Although we did not make such a prediction, this is in line
with the gendered transmission model (Rodgers and
Chabrol 2009), postulating that mothers will have more
effect on their daughters’ eating behavior and fathers more
on their sons’ eating behavior, possibly due to the greater
identification of children with the same-sex parent. Nev-
ertheless, it should be noted that the effect of parental
strategies found is this study was limited. As such, it would
be premature to conclude that this kind of gendered
transmission was supported by our data, though our find-
ings suggested that future research should further investi-
gate this path.
Beside the effect of maternal pressure on children’s
overeating, no other additive predictive effects of maternal
and paternal feeding practices on children’s loss of control
over eating, restraint or concerns was found, contrary to
our expectations. This finding might indicate that feeding
practices as such may be especially influential at younger
ages. Once in primary school, eating problems appear to be
relatively stable, leaving little room for external or internal
influences leading to change. Consistent with this expla-
nation, earlier research supporting the role of parental
feeding practices is conducted mostly in children younger
than our sample (e.g. Birch and Fisher 2000; Faith et al.
2004; Fisher and Birch 2002). Moreover, the possibility
that our sample was already too old to observe effects of
parental feeding practices, finds support in the relatively
high prevalence of eating problems at T1. These problems
already may have been established for the greatest part
earlier in life, and therefore parental strategies may have no
or very little influence anymore on changes in eating
behavior of these children. It is also possible that other
factors take the place of parental feeding practices when
children grow older. Recent research suggests, for exam-
ple, that parental acceptance of and conflict with their
adolescent son or daughter influences weight concerns in
daughters (Lam and McHale 2012). On the other hand, it is
J Youth Adolescence (2013) 42:52–66
also important to note that we only could examine change
in eating behavior over a 6 months period. In other words,
the effects found here may indicate that, by the end of
primary school, there might be less room for change, as
well as that parental influence might be more pronounced
over a longer period in time.
Beside our main results, some additional findings are
worth mentioning as well. First, the prevalence of all eating
problems was high at both time points and in line with
previous findings (e.g. Field and Colditz 2001; Tanofsky-
Kraff et al. 2004). This underscores the alarming fact that
eating problems do occur in primary school girls and boys,
which is often neglected. Moreover, our results are some of
the few providing recent prevalence numbers for different
eating problems in primary school boys and girls. Given
that our results are based on classes of different ages,
coming from seven different schools of different regions in
Flanders, these numbers seem to indicate that the eating
problems are widespread in primary school children.
Concerns about eating, body shape and weight appear to be
less frequently reported by children compared to overeat-
ing, loss of control over eating and restrained eating, which
could be explained by the cognitive nature of the first
versus the behavioral nature of the latter three. Moreover,
restrained eating was reported most frequently at both T1
and T2. This again underscores the importance of not only
investigating obesogenic eating behaviors in children. It
also should be noted that no gender differences could be
observed in the mean scores on all four eating problems,
neither at T1 nor at T2. It is possible that gender differ-
ences in the prevalence of eating problems do not become
pronounced before adolescence, although further exami-
nation is necessary given the inconsistent findings regard-
ing these gender differences. For example, Tanofsky-Kraff
et al. (2007) found no gender differences in the number of
overeating and loss of control episodes reported by chil-
dren and adolescents, whereas Goossens et al. (2009) as
well as Field et al. (2003) found that girls were more prone
to report episodes of loss of control over eating compared
to boys. Since the prevalence of eating problems rarely is
examined in primary school children and often only girls
are brought into account, it is not possible yet to conclude
whether gender differences in the prevalence of eating
behaviors are present or absent in children.
Second, although weight was not of main interest to this
study, the ABMI of the children at T1 seemed to predict both
restraint and concerns 6 months later. Again, this finding
should not be neglected as it indicates that children with
higher ABMIs may form a high risk group for developing
eating problems, which is in line with previous findings (e.g.
Davison et al. 2003), though seldom longitudinally tested.
Our results provide evidence that the ABMI of primary
school children is predictive for their level of dieting and
63
concerns about eating, body shape and weight 6 months
later. This means that, already in primary school, children
appear to be sensitive for weight- and body related issues.
The present study has several strengths. The prospective
design and inclusion of ABMI as a control variable can be
considered as an asset. Also, different eating behaviors
were examined separately, giving us an idea of which
eating problems may or may not be influenced by parental
strategies. Although concerns about eating, body shape and
weight, restrained eating, overeating and loss of control
over eating have clear links with each other (Fairburn et al.
2003), most studies regarding parental feeding strategies
focus solely on overeating and loss of control over eating.
This is unfortunate given the importance of the cognitive
aspects and restrained eating. Moreover, given the lack of
research concerning eating problems in primary school
children and of an inclusion of mothers, fathers, daughters
and sons, our study can be considered a valuable contri-
bution to the field of eating behavior.
Nevertheless, some limitations have to be noted as well.
First, participants were mainly children from middle and
higher SES families, which limits the generalizability of
the results. Future research might want to include a more
varied sample concerning economic backgrounds. Second,
all data concerning eating behaviors and parental strategies
were gathered using self-report measures, which might
have biased the results due to socially desirable answers or
lack of accurate self-perception on this topic. Moreover,
Cronbach alpha’s on the CFQ-subscales restriction and
pressure (Birch et al. 2001) were low, especially for
fathers, and not in line with the level of internal consis-
tency originally reported by the authors of the question-
naire, which ranged from .70 to .92 (Birch et al. 2001).
Again this might have caused bias in the results. Slight
influences of parental feeding practices on children’s eating
problems may not have been observed due to these low
Cronbach alpha’s. It might be relevant in future research to
include not only parents’ report on their feeding practices,
but also children’s perceptions of these and to visit parents
at home to let them complete the questionnaire or to reg-
ister the questionnaire in a group of parents together so
they can be motivated and supervised by the researchers.
Indeed, it is possible that the low internal consistencies are
due to low motivations to complete the questionnaire.
Nevertheless, Cronbach alpha’s were much better for the
monitoring subscale compared to the other subscales,
which might indicate that there could be some substantive
problem with the latter two as well. Especially since pre-
vious studies have reported an internal consistency of .60
for restriction as well (Moens and Braet 2007), future
research is needed to clarify this.
Additionally, it might be important for future research to
not only study continuity in children’s eating behaviors, but
123
64
also continuity in parents’ feeding practices. This might
improve our insight into the direction of the effects,
especially since these may be bidirectional, as already
suggested before by Birch and Fisher (2000). Another way
to bring more clarity into the role of both maternal and
paternal feeding practices is by using experimental designs
and by studying parental influence on change in eating
problems over a longer time-span. Indeed, the lack of
findings concerning the effect of parental feeding practices
might be partially explained by the absence of any
manipulation of the feeding strategies practiced by the
parents as well as by the short time-span between the two
measurement moments. Regarding the latter remark, it
should be acknowledged that a time-span of 6 months is
indeed relatively short compared to other studies examin-
ing the continuity of eating behaviors (e.g. Ashcroft et al.
2008; Davison et al. 2003; Fisher and Birch 2002). Nev-
ertheless, a period of 6 months might be very relevant to
study in primary school children since they are heading
towards adolescence, with all the rapid developmental
changes involved in that life stage. Moreover, in primary
school children, 6 months is already a relatively large
proportion of their lives, compared to 6 months in an
adults’ life. In line with this, several other authors have
used a time-span of 6 or 9 months to study changes in
psychopathology as well as in quality of life in children and
young adolescents without any kind of intervention or
manipulation (e.g. Jozefiak et al. 2009; Uhrlass et al. 2009;
Wright et al. 2010). The finding of significant effects of
ABMI as well as of maternal pressure on a 6 months basis
also seems to support the idea that a time-span of 6 months
might provide useful information.
It also should be noted that the present research focused
exclusively on the influence of parental feeding strategies,
while other mechanisms probably play a role in the
development and continuity of eating problems as well. For
example, messages from the media and peer related factors
(Field et al. 2001, 2008) as well as social problems expe-
rienced by the child may influence eating behavior
(Goldschmidt et al. 2010). Moreover, recent evidence in
overweight children suggests that parents’ own eating
problems may have a detrimental effect on weight and
shape concerns in their children (Sinton et al. 2012). Future
research might want to include several such factors to
determine whether some are more or less influential com-
pared to parental feeding practices, depending on the age or
the gender of the child.
A final remark has to be made concerning the absence of
most expected associations between the three maternal and
paternal feeding strategies and children’s eating behavior.
Indeed, one might wonder whether the finding of a single
significant additive effect of maternal pressure on over-
eating is not spurious. Nevertheless, it might be possible
123
J Youth Adolescence (2013) 42:52–66
that of all three strategies under examination, pressure is
the only strategy that still has effect on children within the
age range examined here. Further research is needed to
clarify this.
We can conclude that eating problems in primary school
boys and girls are highly prevalent and seem to show short-
term continuity in the case of overeating, restrained eating
and concerns about eating, body shape and weight,
although this is less clear for loss of control over eating.
Parental feeding strategies may influence this continuity, as
indicated by the significant interaction effect between
maternal pressure to eat and the gender of the child, sug-
gesting that more maternal pressure might lead to increases
in overeating by the daughter. Nevertheless, future studies
are warranted to further clarify these patterns. We recom-
mend future researchers to further consider the possibility
of a goodness-of-fit principle regarding the effects of
parental strategies on children’s eating behavior. Never-
theless, it should be recognized that parental feeding styles
are not the only source of influence on children’s eating
problems and that these sources of influence may change
by the end of childhood and the beginning of adolescence.
With regard to prevention and intervention, it therefore will
be necessary to keep searching for the optimal variables to
include, as in line with the conclusions of previous
research, the present results at least underscore the
importance of early detection and prevention of disordered
eating in primary school children.
Acknowledgments The first author is research assistant at the
Research Foundation Flanders (FWO). The second and fourth author
were sponsored by the Special Research Funds of Ghent University
(BOF).
Conflict of interest The authors declare that they have no conflict
of interest.
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Author Biographies
Annelies Matton is a PhD student at the University of Ghent. She is
currently working on her dissertation concerning the role of reward
and punishment sensitivity in adolescents’ and eating disordered
patients’ eating behavior and weight. Her major interests concern the
etiology of eating disorders and especially the role of temperament in
this, with a focus on adolescents.
Lien Goossens is doctor-assistant at the University of Ghent. She
received her PhD in eating problems in overweight youngsters, with a
focus on loss of control over eating. Her major research interests
include eating problems in children and the role of attachment and
environmental factors, such as media influence.
Caroline Braet is professor at the University of Ghent. She received
her PhD in the psychological aspects of childhood obesity. Professor
Braet is currently head of the department of developmental-,
personality- and social psychology. Her major research interests
include depression and obesity in children and adolescents, and the
role of attachment.
Kim Van Durme is a PhD student at the University of Ghent. She is
currently working on her dissertation concerning the role of
attachment in eating problems in children and young adolescents.
She has a special interest in the role of emotion regulation and
cognitive schema’s in this relation.