Recruitment strategies in a prospective longitudinal family study on parents with obesity and their toddlers.

BACKGROUND: Recruitment of participants with obesity is a real challenge. To reduce time and costs in similar projects, we investigated various recruiting strategies used in a longitudinal family study with respect to their enrolment yield and cost effectiveness. Results may help other research groups to optimize their recruitment strategies. METHODS: We applied different recruitment strategies to acquire families with children aged 6 to 47 months and at least one parent with obesity (risk group) or two parents of normal weight (control group) for a longitudinal non-interventional study. Based on four main strategies-via media, kindergartens, health professionals and focusing on the community-we examined 15 different subcategories of strategies. Based on enrolment yield and relative costs (e.g., material expenses, staff time) we analyzed the effectiveness of each recruitment strategy. RESULTS: Following different recruitment approaches, 685 families contacted us; 26% (n = 178) of these met the inclusion criteria. Of the four main strategies, the community-focused strategy was the most successful one (accounting for 36.5% of the sample) followed by contacts with kindergartens (accounting for 28.1% of the sample). Of the subcategories, two strategies were outstanding: Posters (community-focused strategies), and recruitment via kindergartens using phone contacts rather than emailing. Only a small number of participants were recruited via announcements in newspapers (lower cost strategy), advertisements on public transport or face-to-face recruitment at various places (higher cost strategies). CONCLUSIONS: Results revealed that only a combination of different active and passive methods and approaches led to a sufficient sample size. In this study, recruitment via posters and contacting kindergartens on the phone produced the highest numbers of participants (high enrolment yield) at moderate costs.

Maternal mentalization affects mothers' - but not children's - weight via emotional eating.

Previous research on childhood obesity has shown that maternal obesity is an important risk factor for this malady. Because biological and environmental factors are able to explain the transgenerational transmission of obesity only in part, psychological risk factors (e.g., emotional eating) have become more important in recent research. As maternal mentalization - which lays the foundation for the child's ability to regulate his/her emotions - has not yet been investigated, we examined the effects of mentalization on maternal and childhood obesity. By investigating groups of obese (n = 30) and normal-weight (n = 30) mothers and their children aged 18 to 55 months, we found, contrary to our expectations, that obese mothers' mentalization (Reflective Functioning Scale) was similar to that of mothers with normal weight and that mentalization showed no direct effect on the child's weight. However, we found hints of an indirect influence of mentalization via emotional eating on mothers' but not on children's weight and via mother-child attachment (Attachment Q-Set) on children's weight. Possible reasons for these inconclusive effects are discussed.

Obese parents--obese children? Psychological-psychiatric risk factors of parental behavior and experience for the development of obesity in children aged 0-3: study protocol.

BACKGROUND: The incidences of childhood overweight and obesity have increased substantially and with them the prevalence of associated somatic and psychiatric health problems. Therefore, it is important to identify modifiable risk factors for early childhood overweight in order to develop effective prevention or intervention programs. Besides biological factors, familial interactions and parental behavioral patterns may influence children's weight development. Longitudinal investigation of children at overweight risk could help to detect significant risk and protective factors. We aim to describe infants' weight development over time and identify risk and protective factors for the incidence of childhood obesity. Based on our findings we will draw up a risk model that will lay the foundation for an intervention/prevention program. METHODS/DESIGN: We present the protocol of a prospective longitudinal study in which we investigate families with children aged from 6 months to 47 months. In half of the families at least one parent is obese (risk group), in the other half both parents are normal weight (control group). Based on developmental and health-psychological models, we consider measurements at three levels: the child, the parents and parent-child-relationship. Three assessment points are approximately one year apart. At each assessment point we evaluate the psychological, social, and behavioral situation of the parents as well as the physical and psychosocial development of the child. Parents are interviewed, fill in questionnaires, and take part in standardized interaction tasks with their child in a feeding and in a playing context in our research laboratory. The quality of these video-taped parent-child interactions is assessed by analyzing them with standardized, validated instruments according to scientific standards. DISCUSSION: Strengths of the presented study are the prospective longitudinal design, the multi-informant approach, including the fathers, and the observation of parent-child interaction. A limitation is the variation in children's age.

Breastfeeding in Obese versus Normal-Weight German Mothers of Various Socioeconomic Status.

BACKGROUND: To a large extent, breastfeeding practices depend on cultural norms. It is thus of particular importance to examine these practices in various settings, especially when considering the effect of complex factors, such as body mass index (BMI) or socioeconomic status. OBJECTIVE: This study aimed to compare the breastfeeding practices of obese mothers with those of normal weight, taking into account social and economic status. METHODS: Obese (BMI ≥ 30 kg/m(2)) and normal-weight (18.5 kg/m(2) ≤ BMI < 25 kg/m(2)) mothers with children between the ages of 6 months and 3 years were recruited for this study in Leipzig, Germany, via newspaper ads and other means. Kaplan-Meier curves for portraying breastfeeding over time were analyzed using Cox regression after checking the proportional hazards model. RESULTS: Eighty obese and 70 normal-weight mothers were recruited. Significantly fewer obese mothers breastfed (84%) than normal-weight mothers (96%) (95% confidence interval [CI] for the difference is 3 to 22 percentage points, P = .02). Even after adjusting for the level of education and family income, breastfeeding duration was significantly shorter (2.7 months; 95% CI, 0.8-4.6 months; P = .005) in the obese group than in the normal-weight group. CONCLUSION: Our findings demonstrate that even at the earliest stages, breastfeeding behavior of obese mothers differs from that of normal-weight mothers.

Emotional availability, understanding emotions, and recognition of facial emotions in obese mothers with young children.

OBJECTIVE: Recent research has identified mother-child relationships of low quality as possible risk factors for childhood obesity. However, it remains open how mothers' own obesity influences the quality of mother-child interaction, and particularly emotional availability (EA). Also unclear is the influence of maternal emotional competencies, i.e. understanding emotions and recognizing facial emotions. This study aimed to (1) investigate differences between obese and normal-weight mothers regarding mother-child EA, maternal understanding emotions and recognition of facial emotions, and (2) explore how maternal emotional competencies and maternal weight interact with each other in predicting EA. A better understanding of these associations could inform strategies of obesity prevention especially in children at risk. METHODS: We assessed EA, understanding emotions and recognition of facial emotions in 73 obese versus 73 normal-weight mothers, and their children aged 6 to 47 months (Mchild age=24.49, 80 females). RESULTS: Obese mothers showed lower EA and understanding emotions. Mothers' normal weight and their ability to understand emotions were positively associated with EA. The ability to recognize facial emotions was positively associated with EA in obese but not in normal-weight mothers. Maternal weight status indirectly influenced EA through its effect on understanding emotions. CONCLUSION: Maternal emotional competencies may play an important role for establishing high EA in interaction with the child. Children of obese mothers experience lower EA, which may contribute to overweight development. We suggest including elements that aim to improve maternal emotional competencies and mother-child EA in prevention or intervention programmes targeting childhood obesity.

Maternal Weight Predicts Children's Psychosocial Development via Parenting Stress and Emotional Availability.

INTRODUCTION: Maternal obesity has been shown to be a risk factor for obesity in children and may also affect children's psychosocial outcomes. It is not yet clear whether there are also psycho-emotional mechanisms explaining the effects of maternal weight on young children's weight and psychosocial development. We aimed to evaluate whether maternal body mass index (BMI), mother-child emotional availability (EA), and maternal parenting stress are associated with children's weight and psychosocial development (i.e., internalizing/externalizing symptoms and social competence) and whether these predictors interact with each other. METHODS: This longitudinal study included three assessment points (~11 months apart). The baseline sample consisted of N = 194 mothers and their children aged 5-47 months (M = 28.18, SD = 8.44, 99 girls). At t 1, we measured maternal weight and height to calculate maternal BMI. We videotaped mother-child interactions, coding them with the EA Scales (fourth edition). We assessed maternal parenting stress with the Parenting Stress Index (PSI) short form. At t 1 to t 3, we measured height and weight of children and calculated BMI-SDS scores. Children's externalizing and internalizing problems (t 1-t 3) and social competence (t 3, N = 118) were assessed using questionnaires: Child Behavior Checklist (CBCL 1.5-5), Strengths and Difficulties Questionnaire (SDQ: prosocial behavior), and a checklist for behavioral problems at preschool age (VBV 3-6: social-emotional competence). RESULTS: By applying structural equation modeling (SEM) and a latent regression analysis, we found maternal BMI to predict higher BMI-SDS and a poorer psychosocial development (higher externalizing symptoms, lower social competence) in children. Higher parenting stress predicted higher levels of externalizing and internalizing symptoms and lower social competence. Better maternal EA was associated with higher social competence. We found parenting stress to serve as a mediator in the association between maternal weight and children's psychosocial outcomes. Moreover, children of mothers with an elevated BMI were at greater risk of lower social competence only when their mothers showed low levels of maternal EA (moderation). CONCLUSION: Interventional studies are needed that investigate the causal pathways between parenting stress, mother-child interaction quality and child outcomes. These aspects might be targets to improve the psychosocial development of the offspring of overweight or obese mothers.

Parent-child interaction during feeding or joint eating in parents of different weights.

The current study investigates parent-child interaction during feeding or during joint eating, and aimed to explore differences in feeding interactions between mothers and fathers, as well as between overweight, obese and not overweight parents. 148 mothers and 148 fathers with children aged between 7 and 47months were observed during feeding of or joint eating with their child in the laboratory. The videotaped mother-child and father-child dyads were coded using the Chatoor Feeding Scale. This scale consists of 5 subscales: Dyadic Reciprocity, Dyadic Conflict, Talk and Distraction during Feeding, Struggle for Control, and Non-Contingency. Compared to mothers, fathers showed higher readings on the Talk and Distraction scale; in all other subscales no differences were found. The comparison between overweight, obese and not overweight mother-child dyads revealed no significant differences. Differences in father-child dyads between overweight, obese and not overweight fathers were identified in the subscale Struggle for Control: overweight fathers were marked by a higher amount of Struggle for Control than obese and not overweight fathers. Taken together, differences found in the present observational study are small to moderate, and thus the current results support extant literature demonstrating that there are no differences in feeding behaviour between mothers and fathers or between obese and non-obese parents.