Observed assertive and intrusive maternal feeding behaviors increase child adiposity

Background: Few studies have examined observed maternal feeding behaviors and their potential association with child adiposity. The association between maternal prompting to eat and child adiposity has been inconsistent. Objectives: This study sought to identify factors associated with maternal feeding behaviors and to test the hypothesis that more maternal prompts to eat, more assertive prompts, and more intrusiveness are associated with greater child adiposity. Design: Children (n = 1218) and their mothers were videotaped eating a standardized snack at ages 15, 24, and 36 mo. Maternal prompts to eat, the percentage of prompts that were assertive, and intrusiveness were coded. Adjusted regression analyses evaluated predictors of prompts, the percentage of assertive prompts, and intrusiveness and the relation of each of these factors with child adiposity (weight-for-length z score at 15 mo and BMI z score at 24 and 36 mo) after control for the child's race-ethnicity and sex, family income-to-needs ratio, and maternal education, weight status, and depressive symptoms. Results: At 36 mo, mothers gave an average of 9.3 prompts; 61% of prompts were assertive, and 48% of mothers were intrusive. Lower maternal education and minority race-ethnicity were associated with a greater percentage of assertive prompts and intrusiveness. A greater percentage of assertive prompts and intrusiveness, but not total prompts, was associated with higher child adiposity. Conclusions: Assertive prompting and an intrusive style had small but significant associations with greater child adiposity. Future work should focus on maternal motivations for assertive and intrusive feeding styles and mechanisms through which these feeding styles might increase child adiposity. Am J Clin Nutr 2012;95:640-7.