Come and Get It! A Discussion of Family Mealtime Literature and Factors Affecting Obesity Risk^,,

Abstract

The L.E.A.D. (Locate, Evaluate, and Assemble Evidence to Inform Decisions) framework of the Institute of Medicine guided the assembly of transdisciplinary evidence for this comprehensive, updated review of family meal research, conducted with the goal of informing continued work in this area. More frequent family meals are associated with greater consumption of healthy foods in children, adolescents, and adults. Adolescents and children who consume fewer family meals consume more unhealthy food. School-aged children and adolescents who consume more family meals have greater intakes of typically underconsumed nutrients. Increased family meal frequency may decrease risk of overweight or obesity in children and adolescents. Frequent family meals also may protect against eating disorders and negative health behaviors in adolescents and young adults. Psychosocial benefits include improved perceptions of family relationships. However, the benefits of having a family meal can be undermined if the family consumes fast food, watches television at the meal, or has a more chaotic atmosphere. Although these findings are intriguing, inconsistent research methodology and instrumentation and limited use of validation studies make comparisons between studies difficult. Future research should use consistent methodology, examine these associations across a wide range of ages, clarify the effects of the mealtime environment and feeding styles, and develop strategies to help families promote healthful mealtime habits.

Introduction

Reciprocal determinism, a key construct of Bandura’s Social Cognitive Theory, posits that an individual’s characteristics, behaviors, and environment within which the behaviors occur simultaneously and reciprocally affect each other (1, 2). The environment provides both the setting and resources for individuals to use motivation, self-efficacy, and knowledge to perform behaviors. If, for example, environments do not support weight-management behaviors, it is difficult for individuals to avoid unhealthy weight gain (3–5).

An important, yet understudied, environment that profoundly affects health and body weight is the home, especially for children (6–8). Home environment factors include the physical environment, such as availability and accessibility of food and physical activity opportunities, as well as behavioral environments, such as self-efficacy to change, self-regulation abilities, and feeding practices parents use with their children.

A behavior that occurs within the home environment that deserves particular attention is sharing mealtimes. Evidence supporting the benefits of frequent family meals has grown to the point that family meals are recognized as being an important component of health promotion for children (9, 10). Moreover, the American Academy of Pediatrics recommends that families regularly eat meals together as part of childhood obesity prevention strategies (11).

Numerous cross-sectional studies and a handful of longitudinal analyses examined family meals. Published reviews of the effects of family meals tend to be older (12, 13), narrow in scope [e.g., examination of the anthropologic timeline of family meals in the United States (14), focused on a single population segment (9, 15, 16), limited breadth of outcomes (16)], or brief (9). Thus, this review was prepared to update and expand existing reviews and identify gaps in the literature with regard to the effects of family meals.

A comprehensive literature search, guided by the L.E.A.D. (Locate, Evaluate, and Assemble Evidence to Inform Decisions) framework of the Institute of Medicine (17) was conducted to describe family meal research methodology, identify links between family meals (frequency and atmosphere) and health, developmental, and BMI outcomes across the lifespan. The L.E.A.D. framework provides a suitable approach for the review reported here in that it calls for assembling evidence using a transdisciplinary perspective, assessing its quality, and putting it in a context that can be used to support decision making with regard to programming and research vis-à-vis obesity prevention and other public health problems (17, 18). The L.E.A.D. framework emphasizes selection of relevant “why,” “what,” and “how” questions to guide the gathering of evidence that will inform decision making (19).

Key search terms [i.e., family, meals, dinner, child(ren), youth, and/or parent(s)] were used to locate pertinent research papers. Because family meal research is conducted in a broad array of disciplines, such as nutrition, psychology, child development, and family studies, both PubMed and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were used to maximize the comprehensive, transdisciplinary nature of this review. Searches were limited to studies published in English from January 1999 to July 2013. The initial search yielded 1965 articles. A review of article abstracts to ensure congruence with the purpose of this review and an inspection of the bibliographies of these articles yielded 81 articles. Following the L.E.A.D. guidelines (17), a team of researchers reviewed the articles to identify salient findings, including differences in methodologies, possible interactions between factors, and gaps in the literature. Results were then organized by theme and summarized to inform decision making of researchers and practitioners and strengthen the evidence base associated with family meals.

What We Already Know about Family Meals

Family meal definitions used in research

Throughout history, family meals have taken many forms (20). In Table 1, it is indicated that the current concept of a family meal used by researchers is generally defined as those occasions when food is eaten simultaneously in the same location by more than 1 family member. Definitions vary with regard to the number of people who must be present to constitute a family meal (Supplemental Table 1), ranging from all or most family members (21–33) (or people living with you) (34–40) to at least 1 parent and 1 child (41–46). Other surveys simply ask about the “family” and do not provide a more specific definition (47–58). Definitions also vary with regard to the meal type, with some restricting the definition to only the dinner meal (30, 42, 45, 46, 50–52, 54–56, 58, 59) and others recognizing any eating occasion as potentially a family meal (21–24, 35–38, 40, 41, 43, 44, 57, 60). Inconsistencies in definition, instrumentation, and lack of validation studies limit the comparison of results across studies. Family meal consumption typically is assessed with self-report surveys, and, as discussed above, there are many differences in question formatting and wording. Self-report surveys also should undergo validation procedures (61), yet few studies discuss performing cognitive testing to ascertain that study participants interpret survey items as intended by researchers or use of other validation techniques or report using validated questions for family meal assessment (25, 45, 46, 53, 60, 62–68).

TABLE 1.

Family meal definitions and response options used in reviewed articles

Definition category	Measurement and response options	Cognitive testing conducted	References
Main meal
Family eating any meal together	≤2, 3–4, ≥5 times per week	Not specified	(47)
Eating meal together as a family	≥4 d/wk, yes/no	Not specified	(48)
Child eats meals with parent or other family members	Never, rarely, sometimes, often, always	Internal consistency, test–retest	(62)
Meals eaten together as a family	Additive score [from a score of 0 (no meals eaten together) to a score of 3 (all meals eaten together)]	Not specified	(49)
Eat a meal together with all or most of the family in your house	Times in the past 7 d	Not specified	(21–24)
Eating a meal with most of the family members who currently live with you	0, 1–2, 3–4, 5–6, 7, >7 times per week	Not specified	(23, 35–39, 73, 79, 91)
Whole household family eats a meal together	0, 1–2, 3–4, 5–6, 7, >7 times per week	Not specified	(41)
Eat family meals together	None, 1 or 2, 3 or 4, 5 or 6, 7, ≥8 times per week		(9, 99)
Meals family food preparer shared with children, meals shared with spouse/partner	Meals per week during the past month	Not specified	(43)
Eating a meal with other members of your household	Frequency in the past 7 d	Yes	(60)
Number of family members eating each meal together	Frequency in the past 7 d	Content validity and test–rest reliability determined during pilot testing	(53)
Eating with partner and child	Hours per working day, Saturday and Sunday	Not specified	(70)
Eat any meal with at least 1 family member	Days per week	Not specified	(128)
Eating regular family meals	Open-ended	Pilot tested with focus groups	(64)
Eating a family meal together at a table	Always vs. sometimes vs. never	Validated 24-h food recall used	(82)
Family ate main meal together	Times per week	Not specified	(90)
Eat your main meal with all or most of your immediate family together	Yes/no	Yes	(25)
Eating any meal with family	Percentage of the time (0–100%)	Questions reviewed by health professionals and dietitians and pilot tested	(67)
Sit down together for a main meal	Never/rarely, <1, 1, 2, 3, 4, 5, or >5 times per week	Yes	(57)
Dinner
Family ate dinner together	Never, sometimes (1–3 times per week), most (4–6 times per week), and every day (daily)	Not specified	(51)
Family eats the evening meal together	0–7 d	Not specified	(55)
Family ate dinner together	1–2, 3–4, 5–6, 7 d per typical week	Not specified	(38)
Eat family dinner together at home	Number of days per week	Yes	(63, 65)
Sit down at a table to eat dinner together	Times per week	Not specified	(58)
At least 1 parent present during evening meal	≤3, 4–5, 6–7 meals per the past 7 d	Yes	(45, 46, 68)
All or most of the family in your house eat a meal together	Open-ended, times during the past 7 d	Not specified	(40)
Family meal (no additional definition)	0, 1–2, 3–4, 5–6, 7, >7 times per week	Not specified	(86)
Sit down to eat dinner or supper with other members of your family	Never, some days, most days, every day	Not specified	(69)
Eating dinner with their family	Never, frequently, very frequently	Not specified	(129)
Eating any meal with family	Percentage of the time (0–100%)	Questions reviewed by health professionals and dietitians and pilot tested	(67)
Eating dinner together as a family	Times per month (never, ≤1, 2–3) or times per week (1–3 or ≥4)	Face validity and pilot tested	(72)
Eating dinner with at least some of the family	>5 times/week, yes/no	Not specified	(59)
Family sitting down together for dinner	<1, 1–3, ≥4 times per week	Not specified	(50)
Family ate dinner together	Never, sometimes (1–3 times per week), most (4–6 times per week), and every day (daily)	Not specified	(51)
All or most of the people in your family who live with you eat dinner	0–1, 2–4, and 5–7 times per week in an average week	Not specified	(30)
Eat dinner with a parent or guardian	Never, hardly ever, sometimes, a lot/all the time	Not specified	(42)
Family ate dinner together	At least once a day, a few times a week, and approximately once or less than once a week	Not specified	(54)
Family ate dinner together at home	0–3, 4–6, 7 d per week or “depends”	Not specified	(52)
Do you have the family eat the evening meal together?	Yes/no	Yes	(66)
Breakfast or breakfast and/or dinner
Parent eating breakfast with child	Times per week	Not specified	(83)
Some of the family eats breakfast together	0–7 d	Not specified	(55)
Family eats breakfast and dinner	No one eats breakfast, no breakfast is served and everyone takes something to eat, breakfast is served but usually the family does not eat together, and breakfast is served and usually the family eats it together (same for dinner)	Not specified	(84)
All or most of the family in your home eat dinner or breakfast together	0, 1–2, 3–4, 5–6, 7 times during the past week	Not specified	(26–29, 31, 32, 34, 71)
At least some of the family eats dinner or breakfast together	Times per week	Not specified	(89)

Assessment of family meal frequency in research

Considerable research focused on the effect of family meal frequency on health, developmental, and BMI outcomes. Reviewed studies typically assessed family meal frequency via retrospective self-report items instructing respondents to report how often family meals are eaten “usually” (29, 49, 56, 69, 70), were eaten “within the last week” (21, 22, 24, 26–28, 30, 31, 33, 40, 45, 46, 53, 60, 63, 65, 68, 71), or were eaten “within the last month” (43) (Table 1).

Parents typically supplied family meal frequency data in studies involving younger children, whereas older youth generally reported these data (31, 36, 48, 56, 72, 73). Reporting bias may affect the veracity of family mealtime frequency data: in a study of 902 adolescents and their parents, parents were significantly more likely to report eating ≥5 family meals per week than their adolescent children (57% vs. 47%) (34). In particular, 10% of the adolescents surveyed vs. 22% of parents surveyed reported having family meals 7 times per week (34). Alternately, differences in reporting could be due to inadequately pretested and validated survey items. Although self-report items benefit from validation and reliability studies (74), limited evidence could be located that discussed the development and psychometrics of family meal frequency assessments (23, 27, 28, 34, 36, 39, 41, 62, 71, 73, 75–78).

Temporal changes in family mealtime frequency

The decline in shared family time and shared meals is often lamented in popular media and by parents anecdotally comparing differences between their own childhood and that of their progeny (70). A detailed search of family meal frequency research found limited evidence that supports this notion. Extant evidence includes a longitudinal survey of >4000 Belgian families from 1966 to 1999 that reported that the number of family meals declined from 1.56 to 0.88 meals per day (44). Another study found that the frequency of family meals in a single age group remained the same from 1999 to 2012 yet showed declines in subgroups of girls, middle school students, and children from low socioeconomic backgrounds (79). A Gallup telephone survey of American adults found that, from February 1997 to December 2003, the number of adults with children aged <18 y who had family dinner 7 nights per week fell from 37% to 28% (52). However, because of the lack of published evidence, it is difficult to establish a solid assessment of family meal decline or stability in the United States over the past few decades.

Why family meals are important: effects of family meal frequency

The relations between frequency of family meals and nutrient intake, food intake, obesity, disturbed/disordered eating practices, and psychosocial effects have been reported in the literature. Most of these studies are cross-sectional and focused on adolescents.

Nutrient intake.

Three cross-sectional studies demonstrated improved nutrient intakes among school-aged and adolescent children as family meal frequency increased (35, 49, 69). Youths who had family dinner on most days in a week had significantly higher intakes of protein, fiber, calcium, iron, folate, and vitamins A, B-6, B-12, C, and E than those eating dinner with their family less often (35, 69). Fiber intake was significantly and positively correlated with family meal frequency among Mexican-American children and teens (49). The role of family meals in improving adolescents’ intake of calcium and iron is particularly noteworthy given that this group typically has a lower than recommended intake of these minerals (80).

Nutrient-dense food intake.

Research provides consistent evidence of a positive relation between frequent family meals and greater intake of dietary components related to improved health (i.e., fruits, vegetables, calcium-rich foods) among all age groups (27, 35, 40, 45, 48, 51, 57, 69, 81, 82). For example, among parents participating in the Special Supplemental Nutrition Program for Women, Infants, and Children, the number of servings of fruits, vegetables, and milk products they provided for their preschoolers at mealtime was significantly and positively associated with the number of family dinners per week (51). However, a study of 2- to 5-y-old children in the United Kingdom found that eating the same food as the parents was a better predictor of preschooler vegetable consumption than eating family meals (57). Research with older children and adolescents showed that those with greater frequencies of family meals ate more servings of fruits, vegetables, grains, and calcium-rich foods (35, 69). However, another study of adolescents found that family dinner frequency was positively associated with fruit intake only (27) and that having a parent present at dinner was associated with higher fruit and vegetable but not dairy intake among adolescents (45). Similar findings have been reported for parents. Adults who had family meals with greater frequency also ate more fruits and vegetables, with increases of 0.18 and 0.30 weekly servings of fruits and vegetables, respectively, per increase of 1 shared meal per week (40).

In addition to dinner meals, positive relations also exist between having breakfast as a family meal and intake of fruits and vegetables. Low-acculturated Latino children who ate breakfast with their family at least 4 times per week were significantly more likely to consume at least 5 servings of fruits and vegetables per week than those who ate family meals less often (48). Additionally, a study of limited-resource families also reported significant, positive associations between eating family breakfast at least 5–6 d/wk and consumption of milk by the oldest child (53).

Longitudinal data suggest that the benefits of family meals extend into the teen and young adult years. For instance, sharing breakfast with parents when a child is 10 y old is associated with that child having more frequent breakfasts when aged 16 y (83). Young adults who ate ≥7 family meals per week during adolescence had 0.7 more servings of fruits and vegetables daily as young adults than peers who never shared family meals in adolescence (33).

Low nutrient-dense food intake.

Increased frequency of family meals is associated with decreased intakes of low nutrient density foods and beverages (27, 35, 69, 81, 84). Four cross-sectional studies examined soft drink consumption and family meal frequency in youth. Although 1 study found no association between regular soda consumption and family meal frequency (27), 3 studies reported significant inverse relations between soft drink intake and family meal frequency (35, 69, 84). Adolescents who never had family meals drank significantly more soda than those who had 7 or more family meals per week (35). Youth who had family dinners on most days had a 27% lower OR for drinking soda (as measured by 24-h food recall) than those who ate dinner with their families less often or never (69).

A cross-sectional study that examined relations between fried food, saturated fat, and trans fat intake and family meal frequency reported that youths who had family dinner on most days had a 33% lower OR for eating any fried foods away from home than those eating family meals never or only on some days (69). Youths eating family dinners on most days also had significantly lower intakes of saturated and trans fats as a percentage of total calories (69). However, another study of youths found no association between family meal frequency and high-fat food intake or fast food restaurant use (27). Fathers of adolescents also benefit from family meals: those who ate ≥7 family meals per week consumed significantly less fast food compared with those who ate fewer family meals (81).

Finally, a pooled OR from a cross-sectional study of “unhealthy” eating patterns indicated that younger children in families sharing at least 3 meals per week had 20% less chance of having unhealthy eating patterns than those who ate family meals less often (OR: 0.81%; 95% CI: 0.68, 0.95) (85). Unhealthy eating patterns included skipping breakfast and eating <2 servings of fruits or vegetables daily.

Both nutrient and food intake at family meals depends on the foods served (57). Indeed, serving fast food or takeout foods at family meals may negate the nutritional benefits associated with family meals. Youths whose family meals comprised fast food served at home at least once per week drank more soda and consumed more fat than those who ate less fast food at home (49). Adolescents in families in which fast food was served as family meals >3 times weekly were significantly less likely to have vegetables and milk served with meals at home than those in families serving fast foods less often (86). For parents of these adolescents, serving fast food at least 3 times per week was negatively associated with vegetable intake and significantly increased likelihood of overweight compared with parents with fewer fast food purchases (86). The effect of fast food and takeout food on food and nutrient intake, whether eaten in the restaurant or at home, or eaten with or separate from family members, is likely unrelated to family meal frequency. Meals and snacks prepared away from home supply more calories and fat per eating occasion and less fiber, calcium, and iron per calorie than foods prepared at home (87). Increased frequency of eating family meals at home is associated with lower family BMI, and increased frequency of family meals eaten away from home is associated with higher family weights (41).

Serving fast food at family meals may be potentiated by other, non-food characteristics. For example, children whose mothers consider their employment as their most important role eat at fast food restaurants more often than mothers who feel their family is more important than their work (88).

Obesity.

Associations between weight status and family meal frequency suggest that obesity may be less common among those who share more frequent family meals. For instance, 4-y-old children who engaged in at least 1 routine (such as having a shared family dinner 6 or 7 nights per week) had 23–25% lower odds of being obese than peers who did not have a routine (including the routine of family dinners 6 or 7 nights per week) (59). Among another group of young children, those who both watched more television and ate fewer family meals during kindergarten and grade 1 were more likely to be overweight in grade 3 than those who spent less time watching television and ate more family meals (89). Both male and female 17-y-old adolescents in South Africa who had infrequent family meals (never to once per week) had higher fat mass and BMI Z-scores (90). In a racially diverse sample of “at risk” adolescents, those who reported having no family meals the previous week were almost 3 times more likely to be overweight and 6 times more likely to be food insecure (defined as going hungry ≥1 mo during the past 12 mo) than those reporting having ≥5 family dinners per week (27). In addition, family meal frequency was significantly associated with weight status among younger white youths (analyses adjusted for gender, socioeconomic status, and age), with those reporting no family meals being at greater risk of overweight (OR: 2.3; 95% CI: 1.0, 5.5) than those having ≥3 family meals weekly (28).

However, longitudinal models indicate that family meal frequency is not associated with overweight status in adolescents (28). In addition, results from some cross-sectional studies are mixed. For example, white adolescents who had more frequent family dinners had a lower OR of being overweight, but this association did not hold true for black and Hispanic adolescents (56). Another survey reported an inverse correlation between frequency of family meals and BMI for the family unit yet was significant for sons and not daughters (41). Negative maternal attitudes toward eating together, not actual family meal frequency, increased the risk of overweight in Australian adolescents (54). Furthermore, a meta-analysis of 8 studies examining relations among shared family meals and overweight risk of children and teens (85) reported that half of the studies reported no significant relations (28, 46, 54, 56). However, when the data from 8 studies were combined (n = 44,106 children aged 4–17 y), there was a significant pooled OR (OR: 0.88; 95% CI: 0.81, 0.97), suggesting that children and adolescents were 12% less likely to be overweight if they shared ≥3 meals with their families each week than those who had family meals less often (85).

The effect of family meal frequency on parent weight status is less clear. The Cornell National Social Survey, an annual random digit dialing telephone survey of 1000 households (38), reported no significant associations between frequency of family meals and BMI, overweight, or obesity (39). However, family meal frequency was negatively associated with lower BMI among adults in households with children (39). Similarly, fathers’ BMI was found to be negatively correlated with family meal frequency (41). In contrast, a study of parents of adolescents found no significant BMI differences among parents who ate ≥7 meals per week compared with those who ate fewer (91).

Disturbed/disordered eating practices.

Some evidence indicates that increased family meal frequency may protect against disturbed or disordered eating practices among teens and young adults. A retrospective survey of females enrolled in college showed an inverse relation between frequency of having family dinners while growing up and bulimic behaviors (47). Findings from a longitudinal survey of adolescent girls indicated that those who had more frequent family meals 5 y earlier were less likely to use extreme weight control behaviors as peers who had less frequent family meals (73). A meta-analysis of pooled results from 3 studies found that teens who had ≥5 family meals per week had 45% lower odds of having an eating disorder (OR: 0.65; 95% CI: 0.58, 0.73) than their counterparts who had ≤1 shared meals weekly (85). Even mothers who had ≥7 family meals per week had fewer dieting and binge eating behaviors compared with those with fewer shared meals (91).

Psychosocial effects.

Several studies investigated associations between family meal frequency and psychosocial factors, including family relationships, academic performance, and risk-taking behaviors.

Family relationships.

Qualitative data indicate that family meals improve perceptions of family relationships (e.g., perceived family support, communication, and parental involvement). Focus groups with parents of children under the age of 5 y found that parents consider family meals to be an opportunity to teach children manners, social skills, how to clean up, share responsibility, and cook healthy meals (92). Parents also consider family meals to be an opportunity to increase family connectedness (92) and share values associated with food and eating (64). Parents identified lack of communication and lack of closeness among family members to be negative outcomes of not eating together (92). Working parents of school-aged children indicated that they enjoyed the opportunity to bond with their children during meals (26). Two-thirds of parents of 8- to 10-y-old children participating in focus groups reported that they enjoyed conversation, togetherness, relaxing, and laughing as a family unit during mealtimes (31). Adolescent focus group participants named family interactions as an important reason to have family meals (93).

Survey data support qualitative findings with regard to beneficial effects of shared meals on family relationships. Adolescents and their parents both viewed family meals in a positive light (34), with parents having a more positive view of family meals than adolescents (36). For both adults and adolescents, there is a significant positive association between family meal frequency and strength of family cohesion (40). Interestingly, 1 research group reported a significant negative association between family cohesion and teens’ intake of sweets, thereby suggesting that family meals may indirectly improve diet by strengthening feelings of family cohesion (40).

Academic success.

Sharing family meals may affect children’s cognitive development and academic achievement. Children’s participation in mealtime conversations provides them with an opportunity to acquire new vocabulary words, “practice producing and understanding stories and explanations, acquire general knowledge, and learn to talk in culturally appropriate ways” (94). Additionally, scores for effective communication within the family were higher for adolescents who had frequent family meals (42). Shared family mealtimes also provide an opportunity for parents to engage in “explanatory talk,” which allows children to ask questions and discuss topics and events with parents, who help expose children to new words and cause and effects (95, 96).

By enhancing communication skills, it follows that family mealtimes contribute to academic success. However, the 2 studies that assessed the relation between academic outcomes in children and family meal frequency had differing results. Analysis of cross-sectional data from 4746 adolescents revealed that frequency of family meals was inversely associated with low grade point average (97). In contrast, a large, longitudinal study (n = 21,400) from the United Kingdom found no relation between family meal frequency and academic outcomes in children followed from kindergarten to grade 8 (55). A third study cited by several academic studies as a secondary reference, a Lou Harris-Reader’s Digest poll of high school seniors in 1994, reported better academic scores among those who had more frequent and consistent family meals (98). (The original study could not be located for inclusion in the current literature review.)

Risk-taking behaviors.

Family mealtimes may help teens resist engaging in risky behaviors. Results from a longitudinal study indicate that having less frequent family meals at baseline was significantly and positively associated with substance use (i.e., cigarettes, alcohol, and marijuana) 5 y later in teen females (23). A cross-sectional study of teens reported no significant association between family dinner frequency and substance use, although teens who reported having ≥5 family dinners in the past week tended to use illegal substances less often than those eating family dinners less frequently (27). The impact of family meals on risk-taking behaviors may be due to the positive family cohesion influences attributed to family meals. Adolescents who had at least 5 family meals per week felt that they had significantly more positive life assets (e.g., family support, adult role models, self-esteem) than teens having ≤1 family meal weekly (30). Additional research should determine how other factors, such as income, may interact with and predict risky behaviors.

What Factors Mediate Family Meal Frequency?

The literature revealed numerous factors that appear to mediate the frequency of family mealtimes. The most commonly reported factors are described below.

Demographic characteristics

Myriad demographic characteristics appear to mediate the frequency of family mealtimes. For instance, parental employment and family meal frequency are inversely related (35, 39), whereas the opposite is true when parents are married (39) or have higher education amounts (21). Among high school–aged girls, those whose parents had earned at least a college degree had significantly more family meals per week compared with those whose parents had not completed high school (5.4 vs. 3.8 meals per week) (21). However, adolescent boys reported significantly greater totals of weekly family meals than girls (4.5 vs. 4.2 meals) (35).

When weekly family meals were compared by race, Asian-American families ate together most often and African-American families least often (5.3 vs. 4.1 meals per week) (35). Another study also found that African-American families had few family meals (44% consumed family meals ≤2 times per week) (99). Hispanic families with preschool-aged children ate significantly more family meals and fewer meals in front of the television than other ethnicities (65).

Socioeconomic status also may affect family meal frequency: a study of lower-income families reported that most (84%) families ate dinner together ≥5 times per week (53). However, when comparing families across socioeconomic status, others reported significantly fewer family meals per week for those at the lowest vs. highest socioeconomic status levels (4.2 vs. 4.9 meals per week) (35).

The age of children in the family also affects family meal frequency, with these meals occurring more often when children are young and declining in frequency as children move into adolescence (28, 34, 90). More than half of the children who were 4 y old (59), 9 y old (69), or in grades 6–8 (30) had family dinners at least 5 times weekly, whereas only approximately one-third of youths aged 14 y (69) or in grades 9–12 (30) did so. Parenting style is an additional influence on family meal frequency, with adolescents whose mothers demonstrate more authoritative parenting styles reporting more frequent family meals (22).

Mealtime environments

An individual’s interpersonal or social environment affects behaviors such as family mealtimes (2). If these environments do not support a behavior, it is difficult for individuals to engage in that behavior (3–5). Evidence from parents of children aged 3–12 y indicates that having a more “traditional” meal structure (e.g., frequent family meals eaten in the kitchen or dining room, no television on during meals) resulted in fewer problematic behaviors in their children at mealtimes (62). The ritual aspect of having family meals also provides a setting for parents to encourage healthful behaviors in their families (81). The interplay of environment and behavior underscores the importance of studying the setting in which family meals occur.

Mealtime atmosphere.

Positive, argument-free mealtime environments appear to promote greater daily energy intake, perhaps above what is required for energy balance, among preschoolers (100) (even after controlling for various variables) and offer adolescents protection against disordered eating behaviors (37, 73, 101). Although data are limited, factors, such as lingering at the table, pressure to eat more in the presence of others who do so, or a permissive parent feeding style that results in less mealtime arguing, may all lead to increased energy intake in a positive meal atmosphere (100). Thus, public health initiatives to curb obesity may need to emphasize the characteristics of healthful family meals, such as serving appropriate portions and limiting fast food, rather than simply promoting happy, family mealtimes.

Arguments at mealtime are common (72, 100). Among adults, arguments during dinner about eating behaviors are associated with higher fat consumption (50). Parents’ perceptions of mealtime atmosphere may differ from that of their children. A study of middle school students and their parents reported that the adults perceived more arguments during dinner than did their teens (72). The authors suggested that the varied levels of cognitive development among adolescent participants may have influenced ability to remember and estimate frequencies of mealtime events. Additional research is needed to clarify the environmental factors that affect mealtime behavior and understand the role of response or social desirability bias in reports of mealtime atmosphere.

Television.

Watching television during family meals appears to negate benefits associated with frequent shared meals (37, 52, 86–88). Individuals may be more likely to overeat when also watching television (102–110) and may learn unhealthy food habits from advertisements and programs (119–116). Four studies examined the influence of television being on during family meals (50, 73, 96, 106). Children never or rarely exposed to television during family meals were significantly less likely to consume soda and chips (48). Children who watched television during ≥2 meals per day consumed fewer servings of fruits, grains, green and yellow vegetables, beans, and nuts and more red and processed meat, salty snacks, soda, and pizza than children from families in which television was never on during mealtime or was on for only 1 meal daily (117). Fitzpatrick et al. (51) reported that, for each night television was on during family meals, the odds of serving vegetables and fruits at meals at least twice a day decreased significantly, thereby negating the increases in vegetables consumed as family dinner frequency increased. However, a unique interaction between television viewing and mealtime atmosphere also has been reported. Among a sample of 4-y-old children and their parents, more meal conflicts were predictive of less time watching television but improved fruit and vegetable consumption in the children (118). The authors hypothesized that parents may have spent more time scolding their children to eat better, which left limited time for television viewing and created the perception of an unpleasant mealtime atmosphere.

Participation in interventions to increase family meal frequency

Although the literature suggests that family meals have many benefits, only 2 studies could be located that taught families about the importance of family meals. The “Promoting Family Meals” materials incorporated multiple modes of nutrition education to promote family mealtimes among Special Supplemental Nutrition Program for Women, Infants, and Children families, resulting in significant increases in family meal frequency (60). The Healthy Home Offerings via the Mealtime Environment program, a randomized intervention trial focusing on healthy cooking and creating positive family meals in families with 8- to 10-y-old children, successfully improved several outcomes among children, including food preparation skills and intake of dietary fiber, as well as parent meal preparation self-efficacy (29).

Parental cognitions of family meals

No studies could be located that investigated parents’ family meal cognitions (i.e., attitudes toward family meals, barriers to family meals, and strategies for overcoming barriers to family meals). Thus, to address this literature gap, trained researchers conducted qualitative interviews with 25 demographically diverse parents who had at least 1 child aged 2–5 y (mean ± SD age: 32 ± 7 y; 34% had a high school degree or less) (119). Standard methods were used to analyze qualitative data for themes and trends (120, 121).

Attitudes toward family meals.

Parents overwhelmingly stated that they enjoyed and valued sharing meals with their families. The majority either agreed or strongly agreed with the statement “I look forward to eating family meals.” Parents felt that family meals gave them a time to encourage healthy eating, form closer family bonds, “reconnect” with their family, support and value their children, practice social skills and manners, and enjoy and learn from each other (119). These results are similar to previous findings: among families with children and adolescents, family meals are important opportunities to improve communication and family closeness (31, 64, 92, 93). However, 2 Canadian surveys also found that one-fifth of married mothers considered the dinner meal to be the most stressful event of their day (122), and another reported that one-sixth found family meals to be unpleasant and regularly involved arguments between family members (100). Focus groups of employed mothers indicated that many women feel pressure to provide family meals and have difficulty making healthy meals although they recognize their importance (66).

Perceived barriers to family meals.

Parents named numerous barriers to having frequent family meals, with work schedules and children’s after-school activities being the most commonly cited barriers (119). Other barriers included lack of meal planning, not having a regular time for meals, inability of young children to sit still at meals, family members being hungry at different times, and picky eaters making mealtimes difficult (119).

Adoption of strategies for overcoming barriers to family meals.

When asked “what helps you have family meals often,” parents reported using several strategies, including making grocery lists and planning meals (119). They also reported making meals ahead of time and storing them for use later in the week and using time/effort-saving appliances, such as slow cookers and microwave ovens. Some indicated that they found “pockets” of time to prepare foods, such as when children were napping. Those who successfully had family meals frequently did so by creating a family mealtime culture with the expectation that family members were to be present at meals, developing a structured mealtime routine (e.g., set the table, institute a regular time to eat each day), and communicating work and after-school schedules with family members (119). A Canadian study reported that parents having high cooking self-efficacy were more likely to overcome barriers and have significantly more family meals than those with low self-efficacy (68).

Other parents indicated that a strategy they used to overcome resistance to attending family meals was making meals enjoyable and minimizing mealtime stress (119). Enjoyment-heightening and stress-reduction techniques included serving foods that children enjoy, getting children involved in food preparation and shopping, and keeping mealtime conversation fun and interesting for the whole family. Some parents used strategies that were incongruent with recommended child feeding methods (123), such as rewarding children for eating and insisting children eat specific foods, such as vegetables.

Implications for Research and Development of Uniform Family Meal Interventions and Assessment Tools

The overarching goal of the L.E.A.D. framework is to use evidence to inform continued work in this area (18, 19). Although growing evidence points to the importance of family meals in promoting health and well-being (9, 10), the present review also highlights gaps and future research that is needed. Varying definitions of family meals make it difficult to compare study findings. Thus, a standard definition used by all researchers would facilitate cross-study comparisons. A possible standard definition for family meal is “meals eaten at the same time in the same location by all or most family members living in the same household.” In addition, there are numerous studies that assess meal frequency in adolescents, yet few involve preschool-aged samples, and even fewer include adults. There also are limited data on temporal changes in family mealtime frequency, which precludes the possibility of determining how family meal frequency has evolved and its associations with other changes in society and health outcomes. Recent evidence with children and adolescents suggests that classifications of <3 vs. ≥3 meals per week eaten as a family could assess nutritional health and classifications of ≤1 to ≥5 (85). Additional research should confirm the applicability of these findings across demographic groups.

Variations in items used to assess frequency of family meals, as well as a dearth of psychometric data, further complicate comparisons of study results. Standard language used by all family meal researchers, such as, “How many meals did all or most of the family members living in your household eat together in the past month?”, would enhance the ease of comparison of data across studies and strengthen the evidence base. In addition, cognitive testing of this definition across age groups as well as test–retest reliability studies could improve the usefulness of mealtime frequency assessments and reduce the degree of incongruence in family mealtime frequency reporting by parents and their children (34, 74). Although all self-reported data are subject to bias, use of consistent, validated questionnaires would facilitate evidence building and comparisons between studies.

Future research also should explore factors that mediate family meal frequency. Parental employment, marital status, education amount, ethnicity, parenting style, and child age appear to affect family meal frequency. In addition, mealtime distractions, such as arguments and television viewing during mealtimes, may lead to unhealthy family mealtimes by promoting overeating and less healthy foods. Although there is limited evidence about the effects of mealtime atmosphere on intake, the available data suggest that education about basic meal planning and nutrition principles, rather than simply promoting a happy, family mealtime environment, could benefit many families.

Despite the limitations and gaps in the current peer-reviewed literature, research findings demonstrated many benefits of family meals. These confirm conclusions made by Fulkerson et al. (124) in their recent study, published after the literature search for the current review was conducted. Children and adolescents who have more frequent family meals appear to have higher intakes of nutrients and dietary components related to improved health (i.e., fruits, vegetables, calcium-rich foods) and decreased intake of foods experts recommend consuming in limited amounts (i.e., soft drinks, fast foods) (27, 33, 35, 40, 45, 48, 49, 51, 57, 69, 85). However, family meal benefits may be attenuated by the foods served at the mealtimes. Families who eat fast foods at family meals (either at home or away) do not have improved nutrient intakes and may be more overweight (86, 88), although additional research is needed to determine whether the foods eaten or factors that influence families to serve fast foods at family meals cause the nutrient differences noted.

Cross-sectional studies indicate that children and adolescents who consume more family meals have healthier BMIs (28, 41, 56, 59, 85). The mechanism for this association may be related to parental control of the eating environment and maintaining routines for children, but this association appears to be less clear in adults (38, 39, 41). Sharing family meals during adolescence may be a protective factor against the development of disturbed and disordered eating, especially among females (47, 73, 85). Sharing family meals also appears to help families create stronger bonds and improve family communication with children and adolescents, and these improvements are valued by parents and children (26, 31, 34, 36, 40, 64, 92, 93). Finally, teens who have more frequent family meals appear to engage in less risk-taking behaviors, including drinking alcohol and using illegal substances (23, 27). This may be because of the presence of more positive life influences among those with more frequent family meals (30).

Parents of young children value family meals and use many positive strategies to overcome barriers to them (125). However, their repertoire of strategies for overcoming barriers is fairly limited. Thus, parents could benefit from learning additional strategies and knowing recommended child feeding methods. Health care practitioners should work with patients/clients to encourage participating in family mealtimes. It is important to encourage the consumption of healthy meals and avoid fast food and television watching to achieve the benefits. Practitioners can work with families to overcome barriers to family meals, such as time management and improving cooking skills.

There are many areas of family meal research that may be expanded and explored de novo to strengthen evidence and conclusions. These include the following. 1) Consistent, validated methods of measuring family meals are needed, because the ability to relate a health behavior or practice to outcomes depends on accurate assessments (126). This includes a common definition of what a family meal is (e.g., who is present, which meals). 2) Most of the family meal studies are cross-sectional; thus, temporality cannot be determined. Additionally, more retrospective and longitudinal research is needed to more firmly establish whether family meal consumption has declined in the past decades. Finally, additional grounded theory and other qualitative research is needed to improve understanding of factors affecting family mealtimes and inform the development of more effective interventions. 3) The majority of research on family meals has been conducted with adolescents and teens. There is a need to provide more evidence of potential benefits with younger children, low-income, food-insecure, and adult populations, especially with obesity risk, and to determine whether family meal interventions could improve health outcomes in these groups. 4) No studies could be located that assessed benefits of family meals for older adults. As the population in the United States ages, this unstudied area warrants attention. 5) There is no current agreement how many family meals per week are needed to reap the benefits associated with “frequent” family meals (10). Thus, dose–response studies are needed to inform the development of future family meal recommendations. 6) It is important that future research incorporate assessment of potential confounding and mediating factors affecting family meal effects (15). For example, some research suggests that maternal attitudes toward family eating and diet may exert a greater influence on obesity status than sharing meals (54). Data such as these can inform the development of population-specific and potentially more effective interventions and strategies that help parents overcome common barriers to family mealtime. 7) On balance, research findings support the value of family meals. Thus, efforts to promote family meals and implement methodologically sound interventions encouraging frequent family meals that comprise nutrient-dense foods in portions appropriately matched to energy expenditure and served in conflict-free and television-free environments are indicated.

In conclusion, greater family meal frequency is associated with increased intake of dietary components related to improved health (e.g., fruits, vegetables) and decreased intake of components that are recommended to be consumed in limited amounts (e.g., soft drinks, fried foods) (27, 33, 35, 40, 48, 51, 69, 80, 85, 125) among children, adolescents, and adults. Youths who have more frequent family meals tend to have lower BMIs. Increased family meal frequency also may be a protective factor against negative health behaviors (e.g., alcohol consumption, illegal substance use) among adolescents. Family meals also offer child development and family bonding benefits that are valued by parents. Despite the many benefits, few interventions have focused on increasing family meal frequency.

Given the benefits of family meals, continued research is justified to confirm and expand present knowledge. Currently, there are numerous interventions underway to improve family mealtime frequency and environment (29, 60, 64, 127, 128); these and future projects could greatly contribute to our understanding of family meals by using consistent, validated measures that permit comparisons across studies.