To our knowledge, this is the first study to examine pooled estimates of risk across studies that have examined the association between shared family meals and various nutritional health outcomes for children and adolescents. The authors of 1 study22
performed a systematic review on healthy eating, but to our knowledge, none have performed a meta-analysis. Overall, families that eat 5 or more meals together have children who are ~25% less likely to encounter nutritional health issues than children who eat ≤1 meal with their families. Shared family meals seem to operate as a protective factor for overweight, unhealthy eating, and disordered eating. Although cross-sectional studies have revealed a stronger reduction in unhealthy behaviors relative to longitudinal studies, the longitudinal studies included in this meta-analysis were few and focused mainly on overweight; more longitudinal studies need to be conducted to shed light on the potential long-term relationship between family meals and nutritional health.
Although the mechanisms for how shared family meals relate to positive outcomes have not yet been empirically revealed, researchers have suggested several possibilities. It is not surprising that eating family dinners together is inversely associated with eating ready-made dinners, which feature lower nutrient values.15
For children or adolescents with disordered eating, mealtimes may provide a setting in which parents can recognize early signs and take steps to prevent detrimental patterns from turning into full-blown eating disorders. Indeed, dieting has been recognized as a precursor for the development of eating disorders.23
In addition, family meals are predictive of family-connectedness,24
which may encourage adolescents to talk about such issues within their families.
Adolescents themselves associate shared family meals with healthier eating.25
In a focus-group study, adolescents believed that they would eat healthier if they ate more meals with their families.25
This result is consistent with the age effects found in this meta-analysis, which demonstrate that adolescents who eat with their families eat healthier foods. In a study that asked adolescents about their interest in having their parents participate with them in a health-promotion program, adolescents stated that they would most like their parents to prepare healthy meals at home.26
It seems that there is interest by adolescents as well as receptivity in participating in family mealtimes, eating healthy foods, and learning about nutrition.
Four of the 8 studies that examined overweight children and adolescents reported nonsignificant findings. All 4 of these studies examined adolescents. Fulkerson et al1
suggested that shared family mealtimes may be more nutritionally beneficial for younger children because they are normative events, whereas for adolescents, shared family mealtimes decrease. We tested age as a potential moderator, but it was not significant, which may be because of the large variability we had in age. Two of our studies examined preschool/kindergarten-aged children, whereas the others overlapped middle school– and high school–aged children and adolescents. Similarly, 4 of the 5 longitudinal studies examined adolescents, whereas only 1 examined younger children. The study that examined younger children seemed to be pulling the longitudinal studies in a significant direction. The longitudinal finding was quite small and not consistent with the findings of the studies overall. More longitudinal studies are needed, specifically with younger children, to determine if the risk persists over time.
Our discussion assumes that family time is quality time. For some families, shared time is another opportunity for conflict. Indeed, observational studies of mealtime suggest that effective affect management, interpersonal involvement, and communication in families relate to child health.27
In a focus-group study, some adolescents reported not having shared family meals together because of dissatisfaction with family relations.25
Other barriers to sharing family meals together include parent work schedules, difficulty in planning ahead, and dealing with picky eaters.28,29
Health professionals are advised to tailor their recommendations on the basis of their knowledge about particular family situations. The families that do sit down to meals together may be more likely to be families that get along and thus contribute to the positive relations presented in this study, in both the short-term and long-term. However, there is emerging evidence to suggest that mealtime interactions that include positive forms of communication are not solely markers of overall family functioning but may represent a unique contribution to children's health and well-being.30
There is a large amount of variability in the studies conducted on family mealtimes. In particular, 5 studies did not report any information on SES. Investigating ethnic and gender differences was determined to be beyond the scope of this study. However, study results have indicated that this is an area that warrants further attention.10,19,21
The way in which nutritional outcomes were measured in the studies also varied. For example, some studies that examined obesity would classify a child with a BMI at the >85th percentile as being obese, whereas others would classify a child with a BMI at the >95th percentile as obese (eg,9,11
). Furthermore, the question of how to measure family mealtimes has also varied from study to study. Some studies examined the extremes of shared family meal frequency, whereas others compared smaller increments, such as having 3 shared family meals per week versus less than 3. Several studies specifically asked about the frequency of shared family dinners, whereas others asked about shared family breakfasts and dinners, and others just asked more generally about shared family “meals.” In addition, even the definition of what constitutes “family” and who is present at the meal are frequently overlooked. Future research should include more precision in the measurement of not only the frequency of family mealtimes but structural aspects of the family and who is present during meals.