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Preventing Childhood Obesity: Health in the Balance
to involve them in decision-making so that they learn to apply limits for themselves; they should come to realize, for example, that they are responsible for their own health and need to practice health-promoting behaviors. But in the current food and activity environment—where palatable, energydense, and inexpensive foods are readily available and opportunities for sedentary behaviors are abundant—a degree of parental monitoring and limit setting is still needed to support eating and physical activity patterns that can maintain children’s energy balance at a healthy weight.
PARENTS AS ROLE MODELS
Parents’ eating behaviors can serve as models for children’s behavior (Fisher and Birch, 1995; Cutting et al., 1999). Such models, however, can be either positive or negative. The current epidemic of adult obesity and the epidemiological data on adults’ dietary and physical activity patterns suggest cause for concern (CDC, 2004a,b). But the public’s growing awareness of the obesity epidemic and of the health consequences of obesity, in children and adults alike, may change these patterns. When parents adopt a healthier lifestyle, they may foster the development of healthful behaviors and patterns in their children, in addition to positively affecting their own well-being. Researchers have provided evidence that modeling and enhanced familiarity have independent significant effects on food intake (Cullen et al., 2000, 2003). With respect to physical activity, the provision of instrumental support for children’s sports participation is associated with greater levels of physical activity among children (Davison et al., 2003).
Parents who consume fruits and vegetables, for example, have children who do the same (Cullen et al., 2001; Nicklas et al., 2001; Fisher et al., 2002). Comparable patterns are seen with milk intake, at least for mothers and daughters (Fisher et al., 2001). Similarly, parents who display their mastery of portion control can provide positive influences. Hill and colleagues have reported that mothers who diet or are restrained eaters tend to have daughters who show the same kinds of patterns (Hill et al., 1990; Pike and Rodin, 1991). Abramovitz and Birch (2000) found that mothers’ dieting is the best predictor of their 5-year-old daughters’ knowledge of dieting. Cutting and colleagues (1999) showed that familial similarities in mothers’ and daughters’ overweight status are mediated by similarities in “disinhibited overeating” (overeating in the absence of hunger).
As discussed earlier in this chapter, parents who are supportive of physical activity have children who are more physically active (Sallis et al., 1988; Davison et al., 2003). However, evidence for a direct effect of parent modeling on youth physical activity is inconsistent at best. This is in contrast to the stronger evidence for modeling regarding eating patterns. The discrepant findings may be explained by different mediators. If parents are