Maternal and child characteristics are shown in . As intended in the sampling procedure, there was high ethnic diversity with 38% of mothers classified as non-white; compared with national statistics (ONS, 2005, www.ons.gov.uk
). There were no significant differences in children’s characteristics betwee those whose parents responded or did not respond to the parental questionnaire. Differences in BMI SD-scores between boys and girls approached significance (t=(211)1.89, p=.06), with girls (M=−.07, SD=1.29) being slightly thinner than boys (M=.26, SD=1.28). Prevalence of overweight and obesity (16%) was lower than the general population (33%) (www.dh.gov.uk
), which may be due to families with heavier children choosing not to participate in the study.
Mother and child characteristics in the sample
Trend analysis: Maternal feeding practices across child weight groups
Linear trend analysis demonstrated a significant negative trend across child weight groups for ‘pressure to eat’ in the adjusted (F(3,190)=3.78, p=.012) and unadjusted models (F(1,208)=6.93, p=.003), and a significant positive trend across weight groups for ‘restriction’ in the adjusted (F(3,189)=2.95, p=.034) and unadjusted models (F(1,206)=6.25, p=.01). No significant trends were found for ‘monitoring’ across the weight groups in either unadjusted or adjusted models. Mean CFQ subscale scores by child weight group are presented in .
Mean maternal feeding score by child weight category (adjusted for maternal education, ethnicity, child age and sex).
Maternal perceptions and concerns by child weight category are presented in . Most mothers (n=169) perceived their child to be ‘normal weight’. Only 41% of underweight children were perceived as underweight, and only 44% of overweight or obese children were perceived as overweight. For concern about overweight, 50% of mothers of children classified as overweight/obese were concerned or very concerned about their child staying or becoming overweight in the future.
Number and percentage of children in each weight category by maternal perception and concern groups (n=210).
Trend analysis: Maternal perceptions and concerns across child weight groups
There was a significant linear trend for perceived weight across child weight groups in unadjusted (F(1,209)=76.69, p<.001) and adjusted (F(3,188)=28.51, p<.001) analyses, indicating that although mothers’ perception of their child’s weight was often incorrect, relative perception was correct. Concern about overweight showed a significant linear trend across child weight groups in the unadjusted (F(1,209)=33.48, p<.001) and adjusted models (F(3,202)=17.49, p<.001).
Trend analysis: Maternal feeding practices across child weight perception and concern groups
Mean CFQ subscale scores across categories of perceived weight and concern for overweight are illustrated in . There was a significant linear trend for ‘pressure to eat’ across perceived weight categories in the adjusted (F(2,188)=4.79, p= .009) and unadjusted models (F(1,208)=11.15, p=.001), with lower use of pressure for children who were perceived to be more overweight. No significant trends were found for restriction or monitoring across perceived weight groups.
Mean CFQ subscale scores across perceived weight and concern for overweight categories*
There was a significant linear trend for ‘restriction’ across categories of concern about overweight in both unadjusted (F(1,206)=21.24, p<.001) and adjusted models (F(2,188)=9.60, p<.001), with restriction increasing among mothers who were more concerned about overweight.
illustrates the bivariate correlations between BMI SD-score, perceptions, concerns and maternal feeding practices. BMI SD-score, perception of child weight and maternal pressure to eat were intercorrelated, as was BMI SD-score, concern and restriction; fulfilling the criteria to test mediation and were taken forward into two separate mediation analyses. Monitoring was not included, because it was not associated with BMI SD-score or mediators.
Correlation matrix of the associations between BMI SD-score (predictor), perceptions and concerns (mediator), and maternal feeding practices (outcome).
Linear regression analysis showed that BMI SD-score significantly predicted ‘pressure to eat’ (β=0.23, p=.001), restriction (β=.16, p=.02), concern about weight (β=.39, p<.001), and perception of weight (β=.56, p<.001). Perception of weight significantly predicted ‘pressure to eat’ (β=−.023, p=.001), and concern about overweight significantly predicted ‘restriction’ (β=.31, p<.001) 1
Following Baron and Kenny’s criteria (Baron and Kenny, 1986
), mediation analysis was appropriate for ‘pressure to eat’ and ‘restriction’. ‘Restriction’ was the only feeding practice significantly associated with both child weight group and maternal concern about overweight, and ‘pressure’ was the only feeding practice associated with both child weight group and perception of child weight. presents results of change in associations between BMI SD-score, and maternal feeding practices upon the addition of maternal perceptions or concerns.
Linear regression results of the effect of maternal concern or perception of overweight on the association between child BMI SD-score and maternal feeding practice.
When concern for child overweight was added into the regression model, the association between child BMI SD-score and ‘restriction’ became non-significant (β=.04, p=.44), but concern remained a significant predictor (β=.30, p<.001), with the full model explaining 9.9% of the variance. Using bootstrapping, the Sobel test confirmed the significance of an indirect effect of the association between child adiposity and restriction (z=3.29, p=.001), indicating that maternal concern about child overweight mediates the relationship between the child’s actual weight and parental use of restrictive feeding.
When perception of child weight was added to the model to predict ‘pressure to eat’, the effect was reduced, but the association between child BMI SD-score and pressure remained significant (β=−.17, p=.04) with the full model explaining 7.1% of the variance. The Sobel test did not demonstrate a significant indirect effect.