Research

Hispanic Health Care International

2017, Vol. 15(2) 65-70
Parental Feeding Style and Pediatric ª The Author(s) 2017
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Obesity in Latino Families DOI: 10.1177/1540415317707739
journals.sagepub.com/home/hci

Genevieve Maliszewski, PhD1, Meredith Dreyer Gillette, PhD2,3,

Chris Brown, PhD4, and John D. Cowden, MD, MPH3,4

Abstract
Introduction: Pediatric obesity has become an epidemic in the United States. Previous research has shown that parenting factors
related to feeding style affect child weight and that Latino families are especially at risk for pediatric obesity. The goal of the
current study was to evaluate the relationship between parental feeding style and child body mass index (BMI) in Latino families.
Method: Latino parents of children between the ages of 2 and 8 (N ¼ 124) completed a survey on parental feeding styles,
acculturation, and demographics. The outcome variable was child BMI. Results: Among respondents, 89% were mothers, 72%
were overweight or obese, and 40% reported an indulgent feeding style. Children had a mean age of 59 months (SD ¼ 23.8) and a
mean BMI z score of 0.77 (SD ¼ 1.14). A demanding parental feeding style was associated with lower child BMI z score, r ¼ .179,
p < .05, and higher acculturation level, r ¼ .213, p < .05. Conclusions: Findings from the current study can be used to inform
health care practitioners of the need to use culturally sensitive interventions that consider parents’ feeding behaviors. Future
research is warranted in the area of ethnic variations of parenting and how these affect feeding and obesity in this highly vulnerable
population.

Keywords
pediatric obesity, Latino populations, parenting, feeding style

Introduction literature conducted by Kitzmann and Beech (2011) indicated

that the most important component of obesity intervention pro-
Pediatric obesity is a concerning health problem facing the
grams is not necessarily treating the child, but rather, it is
United States. In 2011-2012, 16.9% of U.S. youth 2 to 19 years
working with the parent to alter parenting behaviors and paren-
old were obese, with another 14.9% considered overweight
ting style. Furthermore, other research has indicated that work-
(Ogden, Carroll, Kit, & Flegal, 2014). Obese youth are at
ing directly with parents is equally if not more effective in
risk for a myriad of health problems, including metabolic syn-
treating pediatric obesity than working with the entire family
dromes such as insulin resistance, type 2 diabetes mellitus, and is likely to be more cost-effective for underserved popula-
polycystic ovarian syndrome, dyslipidemia, and hypertension
tions (Janicke et al., 2008; Janicke et al., 2009). Indeed, paren-
along with other serious conditions such as fatty liver disease,
ting is among the most important familial influences on the
obstructive sleep apnea, joint pain, impaired mobility, and frac-
healthy lifestyle development of young children and undoub-
tures (Wang, Gortmaker, & Taveras, 2011). In addition to these
tedly plays a role in the development of childhood obesity. As
medical problems, obese youth are at risk for a range of
such, the present study sought to investigate parenting and how
psychological and social concerns including eating disorders,
it affects child weight outcomes in the Latino population.
self-esteem problems, depression, and bullying (Acosta et al.,
2008). Of particular concern for health professionals is the
dramatic increase in overweight and obesity among racial and
ethnic minority groups. While research indicates that all minor-
ity groups are at high risk for obesity, Latinos have been shown
to be particularly vulnerable for a number of reasons, including 1
Children’s Hospital & Medical Center, Omaha, NE, USA
lower socioeconomic status, lower parental education, and lack 2
Center for Children’s Healthy Lifestyle & Nutrition, Kansas City, MO, USA
of health insurance (Bates, Acevedo-Garcia, Alegrı́a, & Krie- 3
Children’s Mercy Kansas City, Kansas City, MO, USA
4
ger, 2008). University of Missouri–Kansas City, Kansas City, MO, USA
While many risk factors related to obesity are not modifia-
Corresponding Author:
ble, parenting and the family environment have been shown to Genevieve Maliszewski, Children’s Hospital & Medical Center, 1000 N. 90th
be highly influential (Kitzmann & Beech, 2011; Payas, Budd, Street Suite 200, Omaha, NE 68114, USA.
& Polansky, 2010; Schmeer, 2012). In fact, a review of the Email: gmaliszewski@childrensomaha.org
66
Parenting Style
Parenting style is of particular salience to the current study
because it has been found to be highly influential on children
in all domains, including psychological, social, and behavioral
development (Steinberg, Mounts, Lamborn, & Dornbusch,
1991). Parenting style has traditionally been conceptualized
as belonging to one of four categories based on a parent’s
degree of responsive (i.e., warmth and support for the child)
and demanding (i.e., behavioral control over the child) dimen-
sions of behavior. Four main styles of parenting have been
identified: (a) authoritarian, which is marked by extremely
restrictive and controlling parenting with minimal nurturing
behaviors toward children; (b) permissive, which is highlighted
by setting few limits for children while remaining highly nur-
turing; (c) authoritative, which includes parents with both high-
control and high-nurturance behaviors toward their children;
and finally (d) uninvolved or neglectful, in which parents
demonstrate low control and low nurturing behaviors (Baum-
rind, 1971). Although general parenting style is an important
contributor to child health outcomes (Park & Walton-Moss,
2012; Sleddens, Gerards, Thijs, de Vries, & Kremers, 2011),
parental feeding style is a construct with special relevance to
healthy weight outcomes in children (Hennessy, Hughes, Gold-
berg, Hyatt, & Economos, 2010) and has emerged as an impor-
tant topic of research in recent years, particularly due to
inconsistencies found in the relationship between general
parenting style and childhood obesity (Sleddens et al., 2011).
Although parenting style generally refers to an overarching
emotional climate in which a child is raised, parental feeding
style is conceptualized as a subtype of parenting style related to
feeding and mealtime. One’s parenting style may not be con-
gruent with his or her feeding style (Blissett, 2011). Previous
research has shown that although parenting style was not sig-
nificantly associated with child body mass index (BMI), paren-
tal feeding style was (Hennessy et al., 2010).
Current research on parental feeding style has resulted in
mixed findings with regard to its impact on child health outco-
mes, particularly among minority groups (Hughes, Shewchuk,
Baskin, Nicklas, & Qu, 2008; Patrick, Nicklas, Hughes, &
Morales, 2005; Shloim, Edelson, Martin, & Hetherington,
2015; Vollmer & Mobley, 2013). Whereas some studies have
demonstrated that for African American and Latino children,
authoritative feeding practices are associated with healthier
eating behaviors and indulgent/permission feeding style was
associated with higher child BMI (Hughes et al., 2008; Patrick
et al., 2005), others have found that authoritarian feeding style
was associated with healthier eating behaviors in low-income
children (Hoerr et al., 2009). These latter researchers have
concluded that high levels of parental demandingness when it
comes to feeding behaviors may result in healthier weight out-
comes for cultural and socioeconomic minority groups. These
findings suggest that the construct might not be straightforward
when examined in ethnic minority groups with varying levels
of acculturation. In particular, at least one study indicated that
using categories of parental feeding style does not function
Hispanic Health Care International 15(2)
well in studies with Latino families and that a dimensional
approach (i.e., responsiveness vs. demandingness) may be
more appropriate (Domenech Rodrı́guez, Donovick, &
Crowley, 2009).
Given the high prevalence of pediatric obesity for Latino
youth (Ogden et al., 2014), as well as the mixed findings related
to the impact of parental feeding style for ethnic minority
groups, the current study used a dimensional approach to inves-
tigate the influence of demanding and responsive feeding styles
on child BMI for a sample of Latino children. A further aim
was to determine the degree to which parents’ acculturation
level affected this relationship.
Method
Participants, Recruitment, and Inclusion Criteria
Participants were eligible if they were Latino parents of chil-
dren 2 through 8 years of age. One parent from each family was
invited to participate. Parents who spoke either Spanish or
English were eligible for participation. With regard to recruit-
ment, an eligibility report was used to determine eligible chil-
dren for the study (i.e., Latino children 2-8 years). A secondary
screening procedure was done to confirm that the person filling
out the survey (a) was the child’s legal guardian and (b) iden-
tified as Latino. The primary author obtained this information
by asking the adult these questions at recruitment.
Procedure
The current study was approved by the Children’s Mercy Insti-
tutional Review Board. Parents meeting eligibility criteria (i.e.,
based on age of child and previous self-reported ethnicity in the
medical record) were recruited from the waiting room at a
primary care clinic in a children’s hospital in a large metropol-
itan area. Parents were explained the purpose of the study in
either English or Spanish based on their preference, and those
who were 18 years or older and who had a child between the
ages of 2 and 8 years were invited to complete a questionnaire
assessing their acculturation level, parental feeding styles, and
demographics. The questionnaire was provided in either
English or Spanish, based on parent preference. A bilingual
researcher was available to answer questions and provide assis-
tance when necessary.
Measures
Acculturation. Parental acculturation level was assessed with the
five-item language use subscale of the Short Acculturation
Scale for Hispanics (Marin, Sabogal, Marin, Otero-Sabogal,
& Perez-Stable, 1987). Sample items of the language use subs-
cale include, “In general, what language(s) do you read and
speak?” and “In which language(s) do you usually think?” with
responses ranging from 1 (only Spanish) to 5 (only English).
The scale was scored by summing the items, with higher scores
indicating greater acculturation to United States culture. The
original authors reported an internal consistency alpha
Maliszewski et al. 67

coefficient for the language use subscale that was almost iden- Table 1. Sample Characteristics, N ¼ 124.
tical to the full scale (.90 and .92, respectively; Marin et al.,
M (SD) or
1987). For the current study, Cronbach’s alpha for the language Characteristic n (%)
use subscale was .91.
Parent age (years), M (SD) 31.59 (6.54)
Parental feeding style. Parental feeding style was measured using Child age (months), M (SD) 59.02 (23.82)
the Caregiver’s Feeding Style Questionnaire (CFSQ; Hughes, Respondent type, n (%)
Biological mother 110 (88.7)
Power, Fisher, Mueller, & Nicklas, 2005). The CFSQ is a 19-
Biological father 10 (8.1)
item scale that measures parents on their feeding styles along Adoptive parent 2 (1.6)
two dimensions (i.e., parental demandingness/parent-centered Child gender, n (%)
and parental responsiveness/child-centered regarding their Male 65 (52.4)
child’s eating). Parents responded on a Likert-type scale rang- Female 59 (47.6)
ing from 1 (never) to 5 (always), with higher scores indicating Participant ethnicity, n (%)
greater levels of parental demandingness or parental responsi- Mexican, Mexican American, Chicano 71 (57.3)
Puerto Rican 1 (0.8)
veness. Once scored along the two dimensions, parents can be
Cuban 2 (1.6)
placed into appropriate feeding style categories (i.e., indulgent/ Other Latino 43 (34.6)
permissive being high responsiveness and low demandingness, Participant born in the United States, n (%)
authoritative being high responsiveness and high demanding- Yes 21 (16.9)
ness, authoritarian being low responsiveness and high deman- No 94 (75.8)
dingness, and uninvolved being low demandingness and low Length of time in United States, if not U.S.-born 12.12 (5.07)
responsiveness. The Cronbach’s alphas for the current study (years), M (SD)
Child BMI z score, M (SD) 0.77 (1.14)
were .75 for the demandingness scale and .72 for the responsi-
Child weight status, n (%)
veness scale. Underweight 2 (1.6)
Healthy weight 70 (56.4)
Child BMI. Height and weight data were collected by medical Overweight 24 (19.4)
staff using standard procedures (e.g., shoes removed, light clot- Obese 28 (22.6)
hing) as part of the child’s clinical visit. Height and weight data Parent BMI, M (SD) 28.93 (5.46)
were used to compute BMI and BMI z score. BMI z score was Parent weight status, n (% who responded)
Normal 21 (28.8)
used in all quantitative analyses to promote standardization by
Overweight 23 (31.5)
age and gender, while BMI percentile was used to classify Obese 29 (39.7)
participants into a weight status (i.e., normal, overweight,
obese). The Baylor College of Medicine’s BMI-percentile- Note. BMI ¼ body mass index. Variation in sample size for respondent type,
child and parent ethnicity, country of origin, years living in the United States,
for-age calculator was used for computing BMI z score based
and parent BMI exists because some participants chose not to respond to
on the Centers for Disease Control and Prevention’s BMI Age- certain items.
for-Growth Charts (available online at https://www.bcm.edu/
cnrc-apps/bodycomp/bmiz2.html).
four parental feeding styles on the dependent variable of child
Demographic information. Parents reported their age, gender, BMI z score. This analysis was not significant, F(3, 120) ¼
ethnicity (i.e., country of origin), length of time living in the 1.13, p ¼ .34. As recommended by Domenech Rodrı́guez et al.
United States, annual family income, and education level. Par- (2009), the dimensions of parental feeding style were further
ents self-reported their own height and weight to calculate their investigated. Bivariate correlations were examined to assess
BMI. the relationship between dimensions of parent demandingness,
parent responsiveness, and child BMI z score. These findings
revealed child BMI z score was negatively related to the parent
Results demandingness, r ¼ .179, p < .05, suggesting that parents
with more demanding feeding styles tended to have children
Data Screening and Primary Analyses with lower BMI z scores. Parental responsiveness was not
The analyses were performed using Statistical Package for the related to child BMI z score.
Social Sciences (SPSS) Software, Version 23. A total of 124 In addition, parent demandingness was positively associated
participants (93% of all those approached) completed the with acculturation level, r ¼ .213, p < .05, suggesting that
measures with six dropouts. The majority of participants parents who were more acculturated tended to report more
(88.7%) were biological mothers. See Table 1 for a complete demanding feeding styles. Furthermore, parents’ acculturation
summary of the participants’ demographic characteristics. To level was associated with their education (r ¼ .324, p < .01) and
first assess the relationship between the parental feeding style annual family income (r ¼ .334, p < .01). Acculturation level
categories and child BMI z score, a one-way analysis of on its own was unrelated to child BMI z score. See Table 2 for
variance with planned comparisons was run, comparing the the correlation matrix.
68 Hispanic Health Care International 15(2)

Table 2. Pearson Coefficients of Study Variables.

Variable 1 2 3 4 5 6 7 8 9

Child age
Child BMI z score .153
Parent age .318** .089
Parent BMI .135 .273* .169
Acculturation level .101 .054 .382** .002
Demandingness .120 .179* .104 .126 .213*
Responsiveness .122 .148 .034 .092 .150 .199*
Parent education level .058 .077 .245** .116 .324** .098 .090
Yearly income .212* .121 .099 .070 .334** .007 .142 .216*
Years living in United States .031 .146 .090 .049 .516** .253* .155 .004 .264*
Note. BMI ¼ body mass index. Parent BMI is based on a subsample (n ¼ 73) who provided height and weight information.
*p < .05. **p < .01.

Discussion scores than authoritarian and authoritative parents. Although

these differences were not significant in this study, there is past
The present study investigated the relationship between the
research that has found them to be significant (Olvera & Power,
parental feeding style dimensions of demandingness and res-
2010). It is possible that distinguishing authoritarian and aut-
ponsiveness and child BMI in Latino parents. Consistent with
horitative feeding styles for this population is less important
previous research recommending the use of a dimensional
than determining how demanding a parent is with regard to his
model of parental feeding style for Latino families (Domenech
or her feeding style. In addition, while nonauthoritative paren-
Rodrı́guez et al., 2009), the dimensional model proved to be
ting style in general is associated with negative child outcomes
superior to the categorical approach at explaining the relation-
(Patrick et al., 2005; Steinberg et al., 1991; Sleddens et al.,
ship between feeding style and BMI z scores. Findings suggest
2011), this might not be true for nonauthoritative (i.e., autho-
that parents who reported more demanding feeding styles had
ritarian) parental feeding style.
children with lower BMIs. A high level of demandingness is
These findings are supported by previous research sugges-
characteristic of both authoritative and authoritarian feeding
ting that traditional parenting style labels may not accurately
style. To differentiate between authoritarian and authoritative
describe individuals of Latino background, and that researchers
styles, Baumrind (2012) noted that authoritative parents engage
should describe parents using demandingness and responsive-
in confrontive power (i.e., power that is reasoned, negotiable,
ness dimensions as opposed to categories (Domenech Rodrı́-
outcome-oriented, and concerned with regulating a child’s
guez et al., 2009; Hughes et al., 2006). Hughes et al. (2006)
behavior), whereas authoritarian parents engage in coercive
reported that Latino parents used more parent-centered/high-
power (i.e., power that is arbitrary, overbearing, unreasonable,
control and more child-centered feeding styles than African
and concerned more with maintaining a hierarchical status
American parents. The authors concluded that because both
between parent and child). Whereas confrontive power has
of these strategies involve encouraging children to eat, this
previously been found to be efficacious in maintaining a pos-
could be the reason for the overall higher risk for pediatric
itive parent–child relationship and changing maladaptive child
obesity in this population. Hughes et al. (2006) also found that
behaviors, coercive parenting often backfires, resulting in wor-
parents of obese children were less likely to use high-control
sening of child behavior (Baumrind, 2012).
feeding strategies. This lack of demandingness when parenting
Demandingness, as measured by the CFSQ, includes both
children who are already overweight is supported by the current
confrontive (i.e., fair and reasoned) and coercive (i.e., unrea-
finding that demandingness is negatively correlated with child
sonable and overbearing) powers. Therefore, high demanding-
BMI, and suggests yet again that demandingness is both a risk
ness on the CFSQ included parents who were either
factor and a protective factor for obesity in the Latino popula-
authoritarian or authoritative—the difference lying in parents’
tion: Being too demanding puts children at risk for obesity,
endorsed responsiveness level. Because responsiveness was not
whereas not being demanding enough for already overweight
related to child BMI z score, we are unable to determine
and obese children may actually perpetuate their weight prob-
whether confrontive or coercive forms of demandingness were
lem. Further research in this area is necessary to better under-
most influential for the child BMI outcomes. There is minimal
stand the impact of demanding feeding styles on Latino
research on this difference for Latino families, but the finding
children.
that demandingness was negatively correlated with child BMI
could be interpreted to mean that for the Latino population,
demanding parental feeding styles are beneficial for child BMI
outcomes, regardless of how child-centered (i.e., “responsive”) Acculturation
the parents’ behaviors are. Indulgent parents (i.e., parents with The current study found that parents who were more accultu-
low demandingness) had children with relatively higher BMI z rated demonstrated more demanding feeding styles. This is
Maliszewski et al.
inconsistent with previous research demonstrating that less
acculturated mothers tend to use high-pressure, demanding
feeding styles while more acculturated parents show an indul-
gent (i.e., less demanding) feeding style (Evans et al., 2011). It
is important to note, however, that Evans et al. (2011) used
categorical feeding styles to describe Latino parents. Given
evidence that dimensional analyses are more appropriate for
Latino families, more research is needed to determine the
impact acculturation may have on parents’ feeding styles.
Implications for Treatment
The study findings offer several important implications for
health care practitioners working in pediatric primary care set-
tings. Pediatricians and other primary care health professionals
should be aware of cultural variations in Latino parenting and
their impact on pediatric obesity. In particular, providers
should assess the family’s acculturation level prior to giving
recommendations by asking about the family’s length of time
living in the United States, primary language, and the foods
most frequently eaten. Providers should also inquire about fee-
ding styles and parenting practices and use this information to
tailor healthy lifestyle recommendations so that they are more
culturally informed. Specific examples of how to use appropri-
ate parental control during mealtime include ignoring child
complaints or attention-seeking behaviors, reinforcing child’s
positive eating behavior, exposing the child to a variety of
foods on a regular basis, and using effective discipline strate-
gies such as time out and rewards. Parents should also avoid
making “extra” meals for children and instead give choices
among foods that are already prepared.
Future Research
Parental feeding style is a new construct with minimal research
in relation to the Latino population. As such, it is imperative
that future researchers continue exploring parental feeding
style and how it relates to child outcomes in the area of BMI
and healthy lifestyle. In particular, future research might exam-
ine what aspects of demandingness, or “control” (i.e., confron-
tive vs. coercive), are beneficial for the Latino population.
Further exploration of other factors related to eating (i.e., time
spent, nutritional choices, amount of food available) and their
relationship with demandingness is warranted.
Limitations
The study used a convenience sample. All of the participants
were recruited from the same metropolitan children’s hospital
within a 2-month time period. This potentially limits the gene-
ralizability of the results. Additionally, because data were col-
lected using self-report surveys, social desirability bias may
have led parents to report what they believed was the most
desired parenting style versus what they actually do. The
researchers sought to mitigate this risk through voluntary par-
ticipation and protecting parents’ confidentiality. Though
69
researchers offered parents assistance when completing the
survey, it is possible that some parents with minimal literacy
completed the survey without assistance, leading to small risk
of poor data validity due to lack of respondent comprehension.
Finally, we did not collect information regarding the diet of the
families in the study, and it is possible that the dietary quality of
the families and access to healthy foods had a larger impact on
BMI z score than feeding style.
Conclusions
The current study adds to a growing literature examining
parental feeding styles and pediatric obesity among persons
of ethnic minority backgrounds. In addition, the results should
provide an impetus for future research, especially a closer exa-
mination of how parental demandingness may specifically
relate to child overweight among Latino families. Finally, the
results suggest that addressing parental feeding styles and
beliefs may aid in bringing down barriers to healthy lifestyles
common among Latino and other minority families with lower
socioeconomic status.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
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