Parental Weight-Related Behaviors and Adolescents’ Body Dissatisfaction: A Systematic Review
Julie Emmelkamp – 10889655 Bachelor thesis
University of Amsterdam
Assessor: Mw. Dr. A. L. van den Akker Date: 29-01-2016
Table of Contents
Abstract……….…...3
Parental Weight-Related Behaviors and Adolescents’ Body Dissatisfaction..….…...4
Method………...….6
Results………...…..………...7
Direct Weight-Related Behaviors………...…...…..7
Negative parental weight-related comments………...…...8
Parental encouragement to diet……….………...12
Indirect Weight-Related Behaviors……….……...…………..15
Parental dieting………...………15
Parental weight-talk……….……….17
Conclusion and discussion……….………...………...21
Abstract
A systematic review was conducted to determine the association between parental weight-related behaviors and adolescents’ body dissatisfaction. Furthermore, this review investigated a possible difference between direct and indirect parental weight-related behaviors. A literature search was conducted using Web of Science, PsychINFO and ERIC. Twenty-one studies, published between 2000 and 2016, addressing body dissatisfaction and parental weight-related behaviors were found eligible for inclusion. Results show that indirect parental weight-related behaviors are not associated with adolescents’ body dissatisfaction, for direct parental weight-related behaviors contradictory results are found. Limitations are the designs, measurement methods, and method of assessment of most included studies. Given the results of this review, it is important to provide parents with psycho-education about the potential negative association between parental direct weight-related behaviors and body dissatisfaction in adolescents.
Keywords: body dissatisfaction, parental comments, parental encouragement to diet, parental dieting, parental weight-talk.
Parental Weight-Related Behaviors and Adolescents’ Body Dissatisfaction: A Systematic Review
Body dissatisfaction is a common weight-related problem among adolescents (Neumark-Sztainer, Paxton, Hannan, Haines, & Story, 2006; Neumark-Sztainer et al., 2010). It is described as negative subjective evaluations of one’s physical body, including one’s weight, figure, and shape. Body dissatisfaction is of concern because of it’s high prevalence and because it is one of the strongest predictors of problematic eating behaviors (Stice & Shaw, 2002). Examples of these problematic eating behaviors are unhealthy weight-control behaviors (e.g. fasting, vomiting, or laxative abuse) and eating disorders. Furthermore, body dissatisfaction is associated with other negative outcomes, including obesity, low self-esteem, and depression (Johnson & Wardle, 2005; Stice & Shaw, 2002). Given the negative outcomes of body dissatisfaction, it is important to explore factors associated with the prediction of later body dissatisfaction.
Adolescence is a particularly vulnerable period, associated with various factors contributing to body dissatisfaction (Schaefer & Blodgett Salafia, 2014). Throughout adolescence there is a great importance of appearance for both boys and girls (Ata, Ludden, & Lally, 2007). An important developmental task in adolescence is feeling comfortable in a body that changes fast over a relatively small amount of time. Ata et al. (2007) conclude that during this time, with substantial social, physiological and cognitive changes, a lot of adolescents become acutely aware of their body shape, and weight. Especially during puberty, due to numerous physical changes of the body of the adolescent, there is an increase of concerns regarding one’s weight and shape (Ata et al., 2007). In puberty, when girls’ bodies change, they move further away from the thin ideal: a western cultural ideal about an acceptable body
(McCarthy, 1990). However, for both female and male adolescents, the desire to alter their body shape and weight is common (Riccardelli & McCabe, 2001). Therefore, for both genders, adolescence is an important time to focus on body dissatisfaction.
In the social institution of the family values, beliefs, behaviors, and attitudes are transmitted over time (Kluck, 2010). Parents are typically the first source of this socialization (Golan & Crow, 2004). In the weight-related socialization process parents influence their children in several ways. One example of the influence of the parents is through the diet of a child. Other examples are transferring knowledge of nutrition, and doing grocery shopping with the child (Golan & Crow, 2004). Furthermore, the family and specifically parents are essential for the promotion of healthy behaviors, because for children parents are the most important source of health care information (Ackard & Neumark-Sztainer, 2001). This parental influence continues into adolescence and early adulthood (Kluck, 2010). Because the parental role as first source of information in childhood, parents are of particular interest in the understanding of children’s attitudes towards their body.
Given that there are several ways parents can influence their children through their own behavior this study will examine the weight-related behaviors of parents, which are subdivided into two main categories: direct behavior and indirect behavior (e.g. Haines, Neumark-Sztainer, Hannan, & Robinson-O’Brien, 2008). Both of these behaviors potentially influence adolescents’ body dissatisfaction. Examples of direct parental weight-related behaviors are: negative weight-related comments, and encouragement to diet. Negative weight-related comments are hypothesized to negatively influence a child’s level of body dissatisfaction, because negative attention is associated with lower self-esteem (Taylor et al., 2006). On the other hand, encouragement to diet is thought to be initially innocent, however this more positive
approach perhaps as well contributes to lower levels of body dissatisfaction (Armstrong & Janicke, 2012). Further, parents are thought to influence their child through indirect weight-related behaviors, such as parents talking about their own weight, and the own dieting behavior of parents. Whenever parents engage in these indirect behaviors, children might indirectly receive and internalize messages of the importance of thinness (Vincent & McCabe, 2000). Therefore, both direct and indirect parental behaviors are hypothesized to promote an internalization of the thin ideal in adolescents. Whenever the adolescent feels he or she does not meet this thin ideal, they may feel dissatisfied with their body (Blodgett Salafia & Gondoli, 2010). Possibly parents direct weight-related behaviors have a stronger association with adolescents’ body dissatisfaction than indirect weight-related behaviors, because of the more direct focus on the individual.
A significant amount of research has been conducted concerning parental weight-related behaviors and the influence on adolescents’ body dissatisfaction. However, inconsistent results have been found and systematic research is lacking concerning this subject. Therefore, the aim of this systematic review is to investigate the association between parental behaviors and adolescents’ body dissatisfaction. Furthermore this study will investigate the difference between direct and indirect parental weight-related behaviors. This will be researched by examining existing literature on parental direct and indirect weight-related behaviors and body dissatisfaction in adolescents.
Method
A systematic search was conducted to identify relevant articles addressing parental behaviors and adolescents’ body dissatisfaction. The selection of relevant articles was done in a two-step search strategy. First, a database search was conducted
in Web of Science using the following search terms: (“body dissatisfaction”), AND (parent*), AND (comment*) OR (diet*) OR (encourage* diet*) OR (teas*), AND (adolescent*), NOT (“qualitative”). With these search terms, a total of 88 articles
were found from 2000 till 2016. Second, after the Web of Science search, the
systematic search was conducted in ERIC and PsychINFO. Studies addressing parental weight-related behaviors and adolescents’ body dissatisfaction were eligible for inclusion. Important variables for included studies were: body dissatisfaction, and direct or indirect parental weight-related behaviors. Exclusion criteria were: articles not published in Dutch or English, articles without abstract, articles not focusing on adolescents, articles only focusing on participants with obesity, and articles that researched an intervention method. After excluding studies that fulfilled these criteria, 18 studies were found. Furthermore, the reference lists of the retrieved studies were reviewed to identify articles that were eligible for inclusion but did not show in the database search, three more studies were found eligible for inclusion. In sum, a total of 21 articles met the inclusion criteria for the aim of this systematic review.
Results
The results of the systematic search of 21 studies that investigated the association between parents’ weight-related behaviors and adolescents’ body dissatisfaction will be discussed in this section.
Direct Weight-Related Behaviors
In order to answer the first sub-question about the association between parents’ direct weight-related behavior and adolescents’ body dissatisfaction, 20 studies were found that investigated this relationship. As mentioned before, direct weight-related behaviors are subdivided in negative parental weight-related comments and parental encouragement to diet.
Negative parental related comments. Negative parental weight-related comments are comments made by parents about the child’s weight or appearance (e.g. teasing about weight or shape) (Keery, Boutelle, Van den Berg, & Thompson, 2005). Contradictory results are found in 12 articles that looked into the association between parental weight-related comments and adolescents’ body dissatisfaction (Bauer, Bucchianeri, & Neumark-Sztainer, 2013; Haines et al., 2008; Hanna & Bond, 2006; Helfert & Warschburger, 2010; Keery et al., 2005; Kluck, 2010; Rodgers, Faure, & Chabrol, 2009; Rodgers, Paxton, & Chabrol, 2009; Schaefer & Blodgett Salafia, 2014; Schneider et al., 2013; Turker, Bas, Saka, & Metin, 2012; Vincent & McCabe, 2000). Although most adolescents did not report parental weight-related comments, a substantial number of adolescents reported that their parents critically commented on their weight at least once (Haines et al., 2008; Keery et al., 2005; Schneider et al., 2013). One study looked into the difference between self- and parent-report, and found that fewer parents reported weight-related comments than adolescents (Haines et al., 2008).
Of the 12 articles that investigated the association between parental weight-related comments and body dissatisfaction in adolescents only six reported significant results (Haines et al., 2008; Hanna & Bond, 2006; Kluck, 2010; Rodgers, Paxton, & Chabrol 2009; Schaefer & Blodgett Salafia, 2014; Turker et al., 2012). In two large samples of adolescents and young adults, parental weight-related comments were significantly associated with higher body dissatisfaction, after controlling for Body Mass Index (BMI) (Kluck, 2010; Rodgers, Paxton, & Chabrol, 2009). When parents gave more weight-related comments higher levels of body dissatisfaction were reported in these samples. Additionally, Kluck (2010) examined the different influence between fathers and mothers, but no significant difference in weight-related
comments was found. However, both of these samples included young adults as well, which renders results difficult to interpret with respect to the association between comments and body dissatisfaction in adolescents only.
In addition to the studies of Kluck (2010), and Rodgers, Paxton, and Chabrol, (2009), four other studies found significant results in specific adolescent samples (Haines et al., 2008; Hanna & Bond, 2006; Turker et al., 2012; Schaefer & Blodgett Salafia, 2014). When focused on parental weight-related comments in general, not specified into paternal or maternal comments, a significant association was found in two adolescent samples (Haines et al., 2008; Turker et al., 2012). Moreover, this significant result was found for both parent- and adolescent-report of the comments (Haines et al., 2008). In a sample of 196 adolescent girls, maternal weight-related comments accounted for a small amount of the variance in body dissatisfaction (Hanna & Bond, 2006). Whenever mothers gave more weight-related comments, girls reported higher levels of body dissatisfaction (Hanna & Bond, 2006). Furthermore, for 80 female adolescents, both maternal and paternal negative weight-related comments predicted a small amount of the variation in body dissatisfaction, after controlling for BMI as moderator (Schaefer & Blodgett Salafia, 2014).
While the previously discussed studies reported positive associations between body dissatisfaction and weight-related comments, some other studies found inconsistent results (Keery et al., 2005; Rodgers, Faure, & Chabrol, 2009; Scheider et al., 2013; Vincent & McCabe, 2000). In a sample of adolescent girls, negative parental weight-related comments accounted for a small amount of the variance in body dissatisfaction, after controlling for BMI (Keery et al., 2005). When maternal and paternal weight-related comments are examined separately, it was found that paternal negative comments were a significant predictor of higher levels of body
dissatisfaction, whereas maternal negative comments were not. A possible explanation for this outcome is that fathers are considered models of later heterosocial interaction, and therefore negative comments from a male figure could be specifically damaging for adolescent girls (Keery et al., 2005). Furthermore, in a sample of 603 adolescents, both paternal and maternal comments were found to be significant predictors for body dissatisfaction in boys, but not in girls, after controlling for BMI (Vincent & McCabe, 2000). In another large sample of adolescent boys and girls, paternal and maternal weight-related comments explained a small amount of the variance in body dissatisfaction in girls, after BMI adjustment (Rodgers, Faure, & Chabrol, 2009). For boys, only paternal comments explained a small amount of the variance in body dissatisfaction: maternal comments were not significantly associated with higher levels of body dissatisfaction in boys. For girls, maternal comments were of greater impact than paternal comments (Rodgers, Faure, & Chabrol, 2009). On the other hand, one study found that paternal comments, statistically corrected for BMI, were associated with higher body dissatisfaction in girls, whereas maternal comments were not (Schneider et al., 2013). Instead of using a questionnaire, Schneider et al. (2013) used a 3D avatar software to measure body dissatisfaction by estimating one’s actual, and desired body. This measurement method perhaps gave a different outcome, because it focuses more on the perceptual-affective component of body dissatisfaction than on the cognitive components (Schneider et al., 2013).
Although most studies reported some significant associations, two studies that investigated the association between parental weight-related comments and adolescents’ body dissatisfaction found no significant associations (Bauer et al., 2013; Helfert & Warschburger, 2011). In a sample of 218 mother-daughter dyads, no significant association was found between mother-report of negative comments and
adolescent self-reported body dissatisfaction (Bauer et al., 2013). A possible explanation for this difference in findings is the use of mother-report for questions regarding weight-related comments (Bauer et al., 2013). Another study that did not report any significant associations is a prospective study (Helfert & Warschburger, 2011). In this study parental weight-related comments were found to be no significant predictor for higher body dissatisfaction in either boys or girls over time, after controlling for BMI. This contradictory result in comparison with most other studies could perhaps be explained by the prospective nature of the study (Helfert & Warschburger, 2011).
In conclusion, contradictory results are found regarding negative parental weight-related comments and body dissatisfaction in adolescents. Studies that looked into potential differences between adolescent boys and girls also reported contradictory results. Further, most of the studies that investigated differences between parental comments, reported paternal comments to be of greater influence than maternal comments. Most studies that investigated the association between weight-related comments and adolescents’ body dissatisfaction found significant results, however two studies that investigated this association reported no significant associations at all. First of all the method of assessment of the parental weight-related comments is important: when these comments are measured with adolescent-report, studies show significant associations. On the other hand, when parental weight-related comments are measured with mother-report no significant associations are found. Furthermore, the design of the study is important, because only cross-sectional studies found significant associations, and there was no prospective association found between parental weight-related comments and body dissatisfaction in adolescents. In sum, there is a reasonable chance that adolescent-report of parental weight-related
comments predict a small amount of body dissatisfaction in adolescents, but this association is not found for mother-report or in studies with a prospective design.
Parental encouragement to diet. Another form of direct weight-related behavior of parents is parental encouragement to diet. Contradictory results are found with respect to the association between parental encouragement to diet and body dissatisfaction, which was investigated in 12 studies (Armstrong & Janicke, 2012; Blodgett Salafia & Gondolli, 2010; Haines et al., 2008; Helfert & Warschburger, 2011; Hillard, Gondoli, Corning, & Morrissey, 2016; Kelly, Wall, Eisenberg, Story, & Neumark-Sztainer, 2005; Kluck, 2010; Neumark-Sztainer et al., 2010; Riccardelli & McCabe, 2001; Van den Berg, Keery, Eisenberg, & Neumark-Sztainer 2010; Vincent & McCabe, 2000; Wertheim, 2002). Five to approximately 50% of adolescents reported that their parents encouraged them to diet at least once (Haines et al., 2008; Neumark-Sztainer et al., 2010; Wertheim, 2002). Furthermore, contradictory results were found when assessment methods were compared. One study found that far fewer parents reported encouragement to diet than their child, but another study found the contrary (Haines et al., 2008; Van den Berg et al., 2010).
Four studies that looked into the association between encouragement to diet and adolescents’ body dissatisfaction reported significant results (Blodgett Salafia & Gondoli, 2010; Haines et al., 2008; Helfer & Warschburger, 2011; Kluck, 2010). One study found adolescent-reported encouragement to diet to be the strongest predictor of body dissatisfaction in girls, after controlling for BMI. However, this sample did not include adolescents only, and did not give separate conclusions for adolescents (Kluck, 2010). When looking at both parent- and adolescent-report, encouragement to diet was found to be significantly associated with higher levels of body dissatisfaction, but this study had a small sample size of only 73 adolescents (Haines
et al., 2008). Furthermore, two longitudinal designs showed that parental encouragement at time one, significantly predicts body dissatisfaction at time two, when corrected for BMI (Blodgett Salafia & Gondoli, 2010; Helfert & Warschburger, 2011). However, the sample size of Blodgett Salafia and Gondoli (2010) was small as well with 85 adolescent girls.
While the previously discussed studies found significant associations only, some other studies showed partly significant, and partly non-significant associations (Ricardialli & McCabe, 2001; Van den Berg et al., 2010; Wertheim, 2002). Maternal encouragement to diet was found to significantly predict higher levels of body dissatisfaction for both adolescent boys and girls, while paternal encouragement to diet only significantly predicts boys’ higher levels of body dissatisfaction (Riccaridalli & McCabe, 2001). Unfortunately, a major flaw of this study is that in did not take BMI in as possible moderator, while this can have a moderating effect (e.g. Wertheim, 2002). Further, another study found that both paternal and maternal encouragement to diet were significantly associated with higher body dissatisfaction in adolescent boys and girls, but after controlling for BMI, only maternal encouragement remained significant (Wertheim, 2002). A possible explanation is that paternal encouragement may reflect the larger BMI of the adolescent, while maternal encouragement is partially independent of adolescents’ BMI (Wertheim, 2002). A longitudinal study showed mother-report of maternal behaviors to significantly be associated with higher levels of body dissatisfaction, while adolescent-report of maternal behaviors was not associated (Van den Berg et al., 2010). However, this study included maternal dieting in the analyses, and did not show separate results for encouragement.
non-
significant associations, there are studies that only reported non-significant associations between encouragement to diet and adolescents’ body dissatisfaction (Armstrong & Janicke, 2012; Hillard et al., 2016; Kelly et al., 2005; Neumark-Sztainer et al., 2010; Vincent & McCabe, 2000). For 2357 girls, no significant results were found for the association between encouragement and body dissatisfaction, after controlling for BMI (Kelly et al., 2005). Maternal encouragement to diet was not significantly associated with body dissatisfaction in a small sample of 94 boys and girls (Armstrong & Janicke, 2012). Another study showed that for both mothers and fathers, no significant association was found between encouragement to diet and body dissatisfaction in adolescent girls (Neumark-Sztainer et al., 2010). Furthermore, when looked separately at adolescent boys and girls, the association between encouragement to diet and body dissatisfaction was non-significant, after controlling for BMI (Vincent & McCabe, 2000). Moreover, a longitudinal study showed no significant associations between maternal encouragement to diet at time one and body dissatisfaction at time two, after controlling for BMI and prior body dissatisfaction (Hillard et al., 2016).
To conclude, the results of associations between parental encouragement to diet and adolescents’ body dissatisfaction differ from each other. When looking at the results of the 12 studies that looked into the association between parental encouragement to diet and adolescents’ body dissatisfaction, no strong conclusions can be drawn. One third of the articles found significant associations between parental encouragement to diet and adolescents’ body dissatisfaction, while the other studies did not report significant associations only. Nonetheless, two out of four articles that reported significant results had a very small sample size compared to the other studies (Blodgett Salafia & Gondoli, 2010; Haines et al., 2008). Furthermore, one article that
reported a significant association did not report separate results for adolescents, thus that result cannot be generalized to an adolescent population (Kluck, 2010). Given that most studies that reported significant results have some methodological flaws it is possible that parental encouragement to diet and adolescents’ body dissatisfaction are not strongly associated.
As a general conclusion for direct parental weight-related behaviors, there is insufficient evidence to confirm the association between the parental behaviors and adolescents’ body dissatisfaction. For both negative weight-related comments and encouragement to diet, contradictory results were found. However, there appears to be more evidence for an association between weight-related comments and body dissatisfaction in adolescents, than there is for encouragement to diet and adolescents’ body dissatisfaction.
Indirect Weight-Related Behaviors
In order to find out whether there is a different association with body dissatisfaction between direct and more indirect weight-related behaviors, the second sub-question of this systematic review is about the association between parental indirect weight-related behaviors and adolescents’ body dissatisfaction. Twelve studies were found that investigated this relationship. As mentioned before, indirect weight-related behaviors are subdivided in parental dieting, and parental weight-talk.
Parental dieting. Given that adolescents learn a lot of behavior by watching their parents it is thought that parents’ own behavior regarding eating habits might influence adolescents’ body dissatisfaction (e.g. Neumark-Sztainer et al., 2010). Eight articles looked into the association between parental dieting and adolescents’ body dissatisfaction (Haines et al., 2008; Helfert & Warschburger, 2011; Keery, Eisenberg, Boutelle, Neumark-Sztainer, & Story, 2006; Kelly et al., 2005; Neumark-Sztainer et
al., 2010; Van den Berg et al., 2010; Vincent & McCabe, 2000; Wertheim, 2002). According to adolescent report, approximately 15 to 75% of their parents dieted at least once (Haines et al., 2008; Keery et al., 2006; Neumark-Sztainer et al., 2010; Van den Berg et al., 2010; Wertheim, 2002). Studies that looked into differences between fathers and mothers, found adolescents reported that their mothers dieted more than their fathers (Haines et al., 2008; Neumark-Sztainer et al., 2010). Further, some studies found higher adolescent-report than parent-report of parental dieting, while other studies found the opposite (Keery et al., 2006; Neumark-Sztainer et al., 2010; Van den Berg et al., 2010).
Two studies that investigated the association between parental dieting and body dissatisfaction in adolescents found partly significant results, however these results were contradictory (Haines et al., 2008; Van den Berg et al., 2010). In a small sample of 73 adolescents, higher levels of body dissatisfaction were reported when parents dieted more according to adolescent-report, after controlling for BMI. But, for parent-report of dieting, no significant associations were found between parental dieting and adolescents’ body dissatisfaction (Haines et al., 2008). A longitudinal study, on the other hand, showed only mother-report of maternal behavior to be significantly associated with higher levels of body dissatisfaction after controlling for BMI, while adolescent-report was not associated (Van den Berg et al., 2010). This study included encouragement to diet in the analyses, but did not show separate results for maternal dieting. Which makes it more difficult to interpret a possible separate association between maternal dieting and adolescents’ body dissatisfaction.
In contrast to the associations found in the two previously discussed studies, all other studies that looked into this relationship found no significant results (Helfert & Warschburger, 2011; Keery et al., 2006; Kelly et al., 2005; Neumark-Sztainer et
al., 2010; Vincent & McCabe, 2000; Wertheim, 2002). For two large samples of adolescent girls, both maternal and paternal dieting did not correlate significant with body dissatisfaction, after controlling for BMI (Kelly et al., 2005; Neumark-Sztainer et al., 2010). Furthermore, in two large samples of both adolescent boys and girls, both paternal and maternal dieting were found to be no significant predictor for higher levels of body dissatisfaction, after controlling for BMI (Vincent & McCabe, 2000; Wertheim, 2002). Further, Keery et al. (2006) found no significant correlation between dieting of mothers and body dissatisfaction in 810 adolescent boys and girls, for neither adolescent- nor mother-report. Moreover, when looking prospective at parental dieting, there was no significant association with higher levels of body dissatisfaction found in either boys or girls (Helfert & Warschburger, 2011).
In conclusion, most studies found no significant association between either maternal or paternal dieting and higher levels of body dissatisfaction in adolescents. For both boys and girls, most studies reported no significant associations. Furthermore, for both paternal and maternal dieting, most of the studies reported no significant associations either. Only two studies showed significant associations, but one of these articles had a notable small sample size compared to most other studies (Haines et al., 2008). The other study that found partly significant associations lacked a separate analysis about the association between dieting and adolescents’ body dissatisfaction (Van den Berg et al., 2010). Despite these two partly significant results, it is reasonable to assume that parental dieting and adolescents’ body dissatisfaction are not significantly associated.
Parental weight-talk. It is hypothesized that parents’ talking about their own weight and shape affects the development of body dissatisfaction in adolescents (e.g. Blodgett Salafia & Gondoli, 2010). Only five studies investigated the association
between parental weight-talk and body dissatisfaction in adolescents (Bauer et al., 2013; Blodgett Salafia & Gondoli, 2010; Haines et al., 2008; Hillard et al., 2016; Neumark-Sztainer et al., 2010). Twenty-two to approximately 90% of adolescents reported that their parents talked about their own weight at least once (Bauer et al., 2013; Haines et al., 2008; Neumark-Sztainer et al., 2010). One study looked into differences between fathers and mothers, and found that mothers talked more about their own weight than fathers (Neumark-Sztainer et al., 2010). Further, Haines et al. (2008) reported slightly higher mother-report than adolescent-report of maternal weight-talk.
Two studies that looked into the association between parental weight-talk and adolescents’ body dissatisfaction found significant or partly significant results (Blodgett Salafia & Gondoli, 2010; Haines et al., 2008). In a small sample of 85 adolescent girls, a significant longitudinal association was found between weight-talk of both mothers and fathers, and adolescents’ body dissatisfaction, after controlling for BMI (Blodgett Salafia & Gondoli, 2010). When parents talked more about their own weight in 5th grade of the adolescent girls, girls reported higher levels of body dissatisfaction in 6th grade (Blodgett Salafia & Gondoli, 2010). Further, in another small sample of adolescents, partly significant and partly non-significant associations were found when considering the association between parental weight-talk and adolescents’ body dissatisfaction (Haines et al., 2008). For adolescent-report but not for parent-report of parental weight-talk, a significant association was found between parental weight-talk and body dissatisfaction. When parents talked more about their own weight according to adolescent-report, higher levels of body dissatisfaction were reported. However, when parents reported to talk more about their own weight, adolescents did not report higher levels of body dissatisfaction (Haines et al., 2008).
In contrast to the significant associations found in these two studies, three other studies found no significant associations between parental weight-talk and body dissatisfaction in adolescents, after controlling for BMI (Bauer et al., 2013; Hillard et al., 2016; Neumark-Sztainer et al., 2010). For adolescent girls no significant associations were found between either maternal or paternal weight-talk, and girls’ body dissatisfaction, after controlling for BMI (Neumark-Sztainer et al., 2010). Of this same population of adolescent girls, 218 mothers also completed a parent survey. Therefore the study of Bauer et al. (2013) used the sample of 218 mother-daughter dyads for their research. No significant correlation was found between mother-report of weight-talk and body dissatisfaction in adolescent girls (Bauer et al., 2013).
In line with the previously discussed cross-sectional studies that found no significant associations, one longitudinal study did not find significant associations between weight-talk of mothers and girls’ body dissatisfaction as well (Hillard et al., 2016). This sample of 89 adolescent girls was collected from the same data as the study of Blodgett Salafia and Gondoli (2010), but a contradictory finding was found. A possible explanation for this contradictory results is that Blodgett Salafia and Gondoli (2010) looked at a different time, they investigated the girls in 5th and 6th grade, while the study of Hillard et al. (2016) investigated the girls in 6th and 8th grade. Moreover, Hillard et al. (2016) found maternal weight-talk to be a moderator in the association between maternal encouragement to diet and body dissatisfaction in adolescents. Maternal weight-talk alone was found to be disadvantageous for girls’ body dissatisfaction, but whenever mothers talked about their own weight and encouraged their child to diet, weight-talk lowered the association between encouragement to diet and body dissatisfaction in adolescents (Hillard et al., 2016). Possibly this indicates that girls conceive encouragement less severe when they feel
that mothers are not only encouraging the adolescents’ diet but are as well dissatisfied with their own weight.
To conclude, most studies did not find significant associations between parental weight-talk and higher levels of body dissatisfaction in adolescents. One study reported only significant associations between parental weight-talk and body dissatisfaction, and another study found partly significant results. But the other three studies that looked into this relationship did not find significant results. Only one study investigated boys as well, but this study did not investigate differences between boys and girls, therefore nothing could be concluded about this potential difference (Haines et al., 2008). Further, one study looked into the differences between paternal and maternal weight-talk and the association with body dissatisfaction in adolescents, and found no differences (Neumark-Sztainer et al., 2010). Only two studies showed significant associations, but both had small sample sizes in comparison to most other studies that investigated the association between parental weight-talk and adolescents’ body dissatisfaction. Furthermore, a possible explanation for the different results reported in the studies is the range of ethnicities in the sample groups. A major part of the studies that looked into the association between parental weight-talk and adolescents’ body dissatisfaction had ethnically and socio-economically diverse samples (Bauer et al., 2013; Haines et al., 2008; Neumark-Sztainer et al., 2010). Therefore, it is possible that the ethnic or socio-economical background of participants played an important role in the difference in findings. In sum, given that most studies did not report significant associations, it is reasonable to assume that parental weight-talk and adolescents’ body dissatisfaction are not associated.
When looking at the studies that investigated the association between parental indirect weight-related behaviors and adolescents’ body dissatisfaction, it could be
concluded that they are not associated, although there are some factors (e.g. ethnicity of samples) that might contribute to complexity of results.
Conclusion and discussion
The aim of this systematic research was to investigate the association between parental behaviors and adolescents’ body dissatisfaction. First, direct behaviors of parents were examined, and second indirect parental behaviors were examined. For the association between all direct parental weight-related behaviors and adolescent body dissatisfaction contradictory results were found. Nonetheless, it is reasonable to assume that there is a cross-sectional association between negative parental weight-related comments and body dissatisfaction in adolescents. When looking at indirect parental weight-related behaviors, both parental dieting and weight-talk are most likely not to be associated with adolescents’ body dissatisfaction. For parental weight-related behaviors in general, no firm conclusion can be given.
The findings of this systematic review do not strongly support the notion that parental weight-related behaviors are associated with body dissatisfaction. As stated in the introduction an important developmental task in adolescence is feeling comfortable with your body, and it is generally assumed that parents have an important socialization role in this process. However, it was found that parental weight-related behaviors are less strongly associated with adolescents’ body dissatisfaction than assumed.
There are two alternative explanations that should be considered. A first possible alternative explanation is heritability, because parents and their children share both environment and genes (Snoek, Engels, Janssens, Van Strien, 2007). It is important to take into consideration that for the aim of this study, it is hard to distinguish the parental weight-related behaviors (environmental factors) from the
genetic factors. A second alternative explanation is the possibility that parental behaviors are not that great of an influence during adolescence. According to the tripartite influence model, there are three factors that contribute to body dissatisfaction and eating disorders: parents, peers, and media (Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). Shroff and Thomspon (2006) found in a sample of 391 adolescent girls, that peer and media influences were significantly associated with the outcome variables (including body dissatisfaction), while the parent variable was not significantly associated. Influences of peers and media increase over time, while on the other hand the parental influence decreases. This could possibly explain why there is a lack of association found between parental weight-related behaviors and body dissatisfaction in adolescents.
The findings of this systematic review should be interpreted in the light of several limitations. First, most studies that looked into the association between parental weight-related behaviors and adolescents’ body dissatisfaction were cross-sectional studies. This type of design makes it impossible to determine causality (e.g. Kelly et al., 2005). Another limitation is the measurement methods used in the studies for both body dissatisfaction, and the parental weight-related behaviors constructs. For both constructs, most measurement methods were questionnaires. A lot of studies used one-item questionnaires to measure the parental weight-related behaviors constructs, but multi-item measures are necessary to establish reliable estimations of such constructs (Menzel et al., 2010). A third limitation is that a limited number of studies looked at parent-report for the measurement of the parental weight-related behaviors. Because most studies only looked at adolescent-report, they perhaps did not examine the actual weigh-related behaviors of parents, but the adolescents’ perception of this behavior (Keery et al., 2006). When this parent-report is considered
as well, it provides an additional perspective above only the perception of the adolescent. A final limitation is the lack of samples with ethnic minorities. Most samples of studies that investigated the association between parental weight-related behaviors and body dissatisfaction of adolescents existed of primarily ethnic majorities. It is suggested that white girls from ethnic majorities show higher levels of body dissatisfaction compared to for example African American girls (Neumark-Sztainer et al., 2002). Therefore, the results of this review cannot be generalized into populations with diverse ethnicities.
For future research about the association between parental weight-related behaviors and adolescents’ body dissatisfaction, it is important to take all these limitations in consideration. A suggestion for future research is to create longitudinal studies with large enough, ethnically diverse samples, because it is important to investigate potential differences between all types of cultural background. Furthermore, it is possible that adolescents with lower levels of self-esteem are more vulnerable to parental weight-related behaviors. Therefore, future research should include self-esteem as a possible moderator.
In general it can be concluded that indirect parental weight-related behaviors were not found to be associated with body dissatisfaction in adolescents. In everyday life it seems more important to focus on direct parental weight-related behaviors. Therefore, findings from this review suggest the importance for parents to not engage in direct weight-related behaviors with their adolescent child. These behaviors might have adverse effects on the level of body dissatisfaction of their child, which in its turn could lead to eating disorders and other types of psychopathology. An implication from this review is to provide psycho-education to parents about direct weight-related behaviors, because of their potential association with body
dissatisfaction in adolescents. The focus on these direct parental weight-related behaviors, might decrease body dissatisfaction, and ideally will lead to a decrease in eating disorders among adolescents.
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