This study examined the role of parent weight-related behaviors and feeding practices within the context of adolescent BWC intervention, in which parents played a supportive role but were not themselves an intervention target. This study adds to the literature by examining the role of baseline levels of parent feeding practices and attitudes as well as parent involvement over the course of intervention (parent self-monitoring, parent weight change) as dimensions that may enhance adolescent weight control.
Overall, findings from this study suggest that even when parents are not directly targeted for weight control, greater parent weight loss is positively associated with greater teen weight loss. Parent BMI change emerged as the only independently significant predictor of adolescent BMI change in the linear regression. In addition, adolescents whose parents lost weight during the intervention were over 3 times as likely to lose at least 8 lb., as compared to adolescents whose parents either maintained or gained weight. This is notable, given that the criterion for parent weight loss over 4 months in analyses was modest (i.e., 2.2 lb.). Observations of adolescent weight change based on the “pairing” of adolescent and parent weight change () further support the hypothesis that parent weight management is important for adolescent BWC. Adolescents were the most successful with weight loss when both the adolescent and parent lost weight. While the observed associations between parent weight loss/self-monitoring and adolescent weight loss may have been due to the effects of parent behavior on adolescent weight loss, the opposite may also be true (i.e., adolescent weight loss may have led to parent weight loss).
Findings also supported the second hypothesis, in that adolescents whose parents completed a greater number of diet records during the first month of intervention tended to lose more weight. For each additional parent diet record that was completed, adolescents were 2.7 times as likely to lose at least 8
lb. (the minimum clinical goal). These results are consistent with previous findings of Germann and colleagues (2007)
linking any parental self-monitoring of their own eating and exercise behaviors during the beginning months of intervention to greater adolescent weight loss (Germann, Kirschenbaum, & Rich, 2007
). Results are also consistent with research suggesting the importance of parental adherence to BWC strategies for school-age youth (Wrotniak, Epstein, Paluch, & Roemmich, 2005
There are a couple of potential mechanisms through which parent self-monitoring may have facilitated adolescent weight loss. Given the positive correlation we observed between parent and adolescent self-monitoring, it is reasonable to consider that parent modeling of self-monitoring may have facilitated adolescents’ acquisition of their own self-monitoring behavior, thereby supporting greater adolescent weight loss. This hypothesis is consistent with social learning theory (Bandura, 1977
) and studies suggesting the importance of parent modeling for adolescent eating patterns (e.g., Lee & Reicks, 2003
). It is also possible that parents who self-monitored made healthier changes at home as a result of their self-monitoring, and that these environmental changes further supported adolescent weight loss. The current study did not include assessment of the home food and physical activity environment, which could be examined in subsequent research on parent and family factors in the context of adolescent weight control. Causal inferences cannot be drawn from this study. It is important to consider that parent self-monitoring may have simply been a sign of greater overall parent motivation and investment in the intervention. On the other hand, it is also possible that parents who self-monitored may have gained perspective regarding the challenges of self-monitoring, which may have helped to facilitate a more supportive yet firm parenting style (i.e., authoritative), which could play a protective role for adolescent BMI over time (Berge, Wall, Loth, & Neumark-Sztainer, 2010
The third aim of this study was to examine associations between baseline levels of parent-feeding practices and attitudes, and adolescent weight change over the course of intervention. Overall, findings suggest that parental pressure to eat, and to a lesser extent concern about adolescent overweight, are associated with less favorable adolescent weight loss. Adolescents lost less weight if parents reported greater levels of pressuring them to eat and being concerned about their weight prior to beginning treatment. Together these two feeding practices predicted 11% of the variance in adolescent BMI change over the course of treatment. This study did not examine potential changes in specific parent feeding practices (e.g., pressure to eat) over the course of the intervention, although this could be examined in future research.
Pressure to eat is one dimension of parent control related to child feeding (Birch et al., 2001
). Examples of items on the Pressure to Eat subscale were “My teen should always eat all of the food on his/her plate” and “I have to be especially careful to make sure my teen eats enough.” A pattern of controlling feeding practices is thought to interfere with the development of eating self-regulation (Birch et al., 2001
), and one could imagine that poor self-regulation may make weight loss efforts more difficult. It is quite possible that parents in this study who scored high on the Pressure to Eat subscale at baseline may have been the ones who benefited the most from the BWC intervention, in terms of learning how best to support their teen’s weight loss efforts (i.e., that it is important not to pressure their teen to eat). This relatively minor change could, potentially, have a substantial impact for an adolescent’s weight loss effort. It is important to keep in mind that this study measured parent feeding attitudes and practices at baseline
and did not evaluate potential changes in this variable over time. In addition, psychometric issues associated with low alpha reliability of the Concern about Weight and Pressure to Eat subscales may have introduced error variance that affected study findings.
This study should be considered in light of its limitations. First, it did not capture the full range of parent behaviors that may influence the course of adolescent BWC, including behaviors specific to parent weight control strategies (e.g., self-weighing) and nonspecific to weight control (e.g., parent–teen communication). Measuring these additional domains of parent behavior could be helpful in elucidating the ways in which parent behavior affect adolescent weight control. The study sample consisted of primarily Caucasian and female adolescents who successfully completed a 1-week dietary run-in period prior to randomization, and the outcome is limited to adolescent weight change immediately posttreatment. Long-term follow-up data would contribute to an understanding of how these parent variables affect adolescent weight change over time (e.g., 12- or 24-month follow-up). In addition, the adapted version of the CFQ used in this study has not been validated with adolescents, although subsequent to this study a highly similar version of the CFQ was validated in adolescents (Kaur et al., 2006
). Finally, parents participating in this study were almost exclusively mothers. There is a need for research examining the influence of fathers with respect to adolescent weight control.
In summary, despite increased autonomy in adolescence, study findings suggest that parents can still play an important role for promoting adolescent weight loss success. Findings suggest that parents play a role in BWC both through their own weight control behaviors (e.g., self-monitoring) over the course of the intervention and through their pre-existing feeding attitudes and behaviors. Future research is needed to more directly examine the role of parents in adolescent BWC, while attempting to disentangle the direction of the effect between parent and adolescent weight loss. For example, future research could evaluate specific mechanisms (e.g., parental attitudes about food and eating, parent modeling or promotion of stimulus control) linking parent involvement and teen weight loss success. As future research explores how to best involve parents in a supportive role for teen weight loss, another future research direction may involve directly targeting both the parent and adolescent simultaneously for weight loss.