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. Author manuscript; available in PMC: 2021 Sep 1.
Published in final edited form as: Int J Eat Disord. 2020 May 19;53(9):1450–1459. doi: 10.1002/eat.23296

The interactive effects of parental self-efficacy and child eating styles in relation to naturalistically-assessed craving, overeating, and loss of control eating

Kathryn E Smith 1, Alissa Haedt-Matt 2, Elizabeth N Dougherty 2, Melissa Ivins-Lukse 2, Andrea B Goldschmidt 3
PMCID: PMC7937334  NIHMSID: NIHMS1671807  PMID: 32432827

Abstract

Parental factors have been linked to weight-related outcomes in children, though less is known regarding the role of parental self-efficacy (PSE) for promoting healthy dietary behaviors.

Objective:

This study examined associations between PSE for promoting healthy dietary behaviors and child reports of craving, overeating, and loss of control eating in daily life. The interactive effects of PSE and child eating style (emotional eating, external eating, and restraint) were also explored.

Method:

Thirty-eight youth (ages 8-14; 55.3% female) with overweight/obesity and their parents completed the Dutch Eating Behavior Questionnaire for Children (DEBQ-C) and Parental Self-Efficacy for Healthy Dietary and Physical Activity Behaviors Scale, respectively. Youth completed ecological momentary assessment (EMA) to report craving, overeating, and loss of control eating.

Results:

Generalized estimating equations indicated no consistent effects of PSE on EMA outcomes, but PSE interacted with DEBQ-C child eating styles to predict each EMA outcome. Among children of parents with lower PSE, (1) higher emotional eating was associated with greater overeating and loss of control eating; (2) higher external eating was associated with greater craving; and (3) higher restraint was associated with greater loss of control eating and craving. Conversely, these associations were attenuated among children of parents with higher PSE.

Discussion:

Together findings suggest the interplay of child characteristics and PSE regarding children’s eating behaviors warrants future investigation in the context of eating and weight disorders. In particular, further research is needed to examine the directionality of effects and mechanisms underlying these associations.

Keywords: ecological momentary assessment, parents, self-efficacy, loss of control eating, overeating, craving

Introduction

Pediatric obesity is a continually rising public health concern, with over 330 million children and adolescents worldwide estimated to have overweight or obesity (Di Cesare et al., 2019). Excess weight during childhood and adolescence is associated with a constellation of negative physical and psychological consequences, many of which may persist into adulthood (World Health Organization, 2019). Such evidence underscores an urgent need to identify factors in the daily lives of youth that promote or impede excess weight gain. While the causes of pediatric obesity are complex and multifaceted, obesity and weight gain have been consistently linked to increased food craving, dysregulated eating behaviors such as loss of control eating and overeating, and particular eating styles (i.e., the tendency to eat in response to external food-related cues [external eating] or negative emotions [emotional eating], and cognitive attempts to restrict food intake [restraint]; Boswell & Kober, 2016; Byrne, LeMay-Russell, & Tanofsky-Kraff, 2019; Halberstadt et al., 2016; Van Strien, Frijters, Bergers, & Defares, 1986; Webber, Hill, Saxton, Van Jaarsveld, & Wardle, 2009). As such, identifying and effectively targeting factors related to these domains in youth may improve the efficacy of prevention and intervention efforts.

Importantly, evidence suggests parents play an integral role in shaping children’s weight-related outcomes, especially given that many aspects of children’s eating and physical activity behaviors are often under parental control (Hubbs-Tait, Kimble, Hingle, Novotny, & Fiese, 2016; Rajjo et al., 2017). This is also supported by prior literature showing that certain parenting styles and feeding practices are linked to child weight-related behaviors and outcomes (Shloim, Edelson, Martin, & Hetherington, 2015; Sleddens, Gerards, Thijs, de Vries, & Kremers, 2011). In addition to parenting styles and feeding practices, emerging pediatric obesity research has also highlighted the importance of parental self-efficacy for promoting healthy dietary and physical activity behaviors in children (Bohman, Rasmussen, & Ghaderi, 2016; Hammersley, Okely, Batterham, & Jones, 2019; Rohde et al., 2018; Walsh, Hesketh, Hnatiuk, & Campbell, 2019).

Broadly, self-efficacy refers to beliefs in one’s capabilities to reach goals through one’s actions (Bandura, 1997). Self-efficacy is a centrally important construct in the context of social cognitive theory (SCT), a framework that underlies many pediatric obesity interventions (Bagherniya et al., 2017; Nixon et al., 2012). In brief, social cognitive theory (SCT) posits individuals adopt and maintain behavior through external and internal reinforcement processes (Bandura, 1997). This includes interactions between individual factors, behaviors, and the environment, with a particular focus on social influences such as observational learning (i.e., the notion that witnessing and observing behaviors can lead to modelling of similar behaviors). According to SCT, individuals are more likely to engage in behaviors if they believe their actions will have a desired effect. Perceived self-efficacy is thus a central component of this framework (Bandura, 1997). Parental self-efficacy in particular refers to parents’ belief in their ability to influence their children’s behaviors, which may influence children’s behaviors indirectly via positive parenting practices (Jones, & Prinz, 2005). In line with this possibility, higher parental self-efficacy is consistently associated better social, emotional, behavioral, academic, and physical health outcomes in children (Albanese, Russo, & Geller, 2019; Jones & Prinz, 2005). Notably, self-efficacy can be domain and context-specific; that is, self-efficacy beliefs may vary across areas of functioning (e.g., self-efficacy for academic vs. health behaviors) and fluctuate based on contextual factors such as emotional stress and time limitations (Bandura, 2012).

Higher parental self-efficacy regarding children’s eating behaviors may be a key factor that facilitates the implementation of adaptive parenting practices that mitigate excess weight gain in youth. For example, a prior study showed that greater parental efficacy for healthy weight-related behaviors in children was associated with less sugary beverage consumption, greater fruit and vegetable intake, and higher physical activity levels as measured by parent self-report questionnaires (Wright et al., 2014). The Parental Self-Efficacy for Healthy Dietary and Physical Activity Behaviors Scale (PDAP) is a recently developed self-report measure of self-efficacy for promoting healthy dietary behaviors (HDBs) and physical activity in children, which specifically takes into account contextual factors that may facilitate or impede successful performance of these behaviors (Bohman et al., 2016). Initial research using the PDAP indicated parental self-efficacy for promoting HDB was associated with healthier eating patterns (e.g., greater fruit and vegetable intake, as measured by parent self-reports) in young children without overweight or obesity (Bohman et al., 2016; Rohde et al., 2018).

However, it is unknown how PDAP for HDBs may relate to other relevant eating-related factors (including cravings and dysregulated eating behaviors such as loss of control eating and overeating), measured in children’s natural environment, or the how associations may differ among older children (i.e., during middle childhood and adolescence) with overweight or obesity. Further, the processes by which parental self-efficacy regarding children’s eating behaviors may mitigate obesity-related behaviors and excess weight have not been adequately considered. Higher parental self-efficacy may facilitate adaptive parental control over child eating behaviors, which in turn could also enhance children’s self-regulation over eating (potentially via modeling effects and/or by moderating the availability of and cues related to palatable energy-dense foods). This is consistent with earlier studies showing greater parental modeling of fruit/vegetable intake and availability of fruits/vegetables were associated with lower weight and greater fruit/vegetable intake among their children (Alia et al., 2012; Cullen et al., 2001). Further, adolescents who perceived their parents to engage in more healthy dietary behaviors and physical activity reported healthy dietary and physical activity behaviors, which in turn predicted lower body mass index (Zarychta, Mullan, & Luszczynska, 2016). In sum, higher parental self-efficacy may buffer associations between potential risk factors for pediatric obesity (e.g., child eating styles) and children’s engagement in obesogenic eating behaviors. This is also supported by literature indicating that associations between parenting style and child weight outcomes may depend on child characteristics (Sleddens et al., 2011).

Therefore, the goal of the present pilot study was to provide a first step in examining these proposed associations using ecological momentary assessment (EMA) in a sample of youth with overweight or obesity and their parents. EMA is an ambulatory assessment strategy that involves repeated measurement of experiences and behaviors over the course of a day in the natural environment, which enhances ecological validity of findings and reduces recall bias associated with traditional self-report assessments (Shiffman, Stone, & Hufford, 2008). Further, this approach eliminates reliance on parental observations of youth’s eating behavior, which have formed the basis of prior studies on parental self-efficacy in relationship to children’s eating. Elucidating the conditions under which parental self-efficacy for promoting HDBs relates to eating phenomena among children in naturalistic settings will lend important insights into how parental self-efficacy should be conceptualized and potentially targeted in future work. It was hypothesized that higher parental self-efficacy for promoting HDBs would be associated with lower EMA-measured overeating, loss of control eating, and food craving among their children (Aim 1). In addition, it was expected that higher parental self-efficacy would buffer the associations between child eating styles (i.e., emotional eating, external eating, and restraint) and EMA-measured cravings and dysregulated eating behaviors (Aim 2).

Methods

Participants

Participants included 38 children and adolescents (55.3% female, n=21) with overweight/obesity (BMI [kg/m2] ≥ 85th percentile for age and sex) and their caregivers. Youth ranged in age from 8 to 14 years (M=11.21, SD=1.91). The majority of youth self-identified as Black or African American (65.8%, n=25), followed by Hispanic or Latino (15.8%, n=6), White (15.8%, n=6), and Asian (2.6%, n=1). The majority of caregivers were female (92.1%, n=35) and either single or divorced (55.3%, n =21). Exclusion criteria for youth included current use of medications that could affect appetite or weight, current involvement in weight loss treatment, the presence of a medical condition that could affect appetite or weight, and the presence of an eating disorder other than binge eating disorder. Inclusion criteria included fluency in written and spoken English and the ability to read at or above a third-grade reading level. The Child Eating Disorder Examination (Child EDE; Bryant-Waugh, Cooper, Taylor, & Lask, 1996) was used to assess eating disorder symptoms and rule out eating disorders other than binge eating disorder. Based on the Child EDE, no participants met full criteria for BED, and participants who endorsed loss of control eating on the Child EDE did not differ from participants without EDE-measured loss of control eating on EMA-measured loss of control eating or overeating severity (see Goldschmidt et al., 2018).

Procedures

Study procedures were approved by the institutional review boards of the University of Chicago and Illinois Institute of Technology. Caregivers provided informed consent, and youth provided informed assent. Participants were recruited from the community, pediatricians’ offices, and previous studies. Following a phone screen, eligible youth were invited to attend an in-person visit with their caregivers, during which they completed baseline assessments and received training on the EMA procedures. The first day of EMA was considered a practice day. Youth completed signal-contingent, interval-contingent, and event-contingent EMA recordings (Wheeler & Reis, 1991). Signal contingent recordings were completed in response to semi-random prompts that occurred five times/day on weekends (8:00am-9:00pm) and three times/day on weekdays (7:00am-8:00am, 3:00pm-4:00pm, and 6:00pm-7:00pm to avoid youth ratings during the school day). Interval-contingent recordings were completed once daily, before bed. Event-contingent recordings were completed after eating episodes. At all EMA signals, youth responded to questions about craving as well as overeating and loss of control eating during their most recent eating episode that had not been previously recorded.

Measures

Anthropometrics.

Weight and height were measured using a calibrated digital scale and a stadiometer, respectively. Participants wore light clothing without shoes. Measurements were used to calculate BMI (kg/m2) which were then converted to BMI z-scores (z-BMI) using the Center for Disease Control and Prevention growth charts (Kuczmarski et al., 2000).

Parental self-efficacy.

This study used two PDAP subscales (PDAP facilitate HDB and PDAP impede HDB) that assess parental self-efficacy for promoting HDBs (Bohman et al., 2016). Parents rate items in response to stems using an 11-point Likert scale (0 = “not at all confident,” and 10 = “completely confident”). The PDAP facilitate subscale measures self-efficacy under circumstances that facilitate parental promotion of HDBs. For this subscale, parents respond to the stem “How confident are you that you can…” and rate the items: “…Prioritize spending money on purchasing healthy foods and beverages, instead on purchasing foods and beverages high in saturated fat or sugar?”; “…Prioritize spending time on locating healthy foods and beverages for purchase when such products are not immediately available?”; “…Prepare and serve healthy foods and beverages in an appetizing way?; “…Create a positive atmosphere when having meals with healthy choices?”; and “…Be a role model for your child about healthy eating and drinking?”. The PDAP impede subscale measures self-efficacy under circumstances that impede parental promotion of HDBs. For this subscale, parents rate the following items in response to the stem “How confident are you that you can get your child to eat healthy foods and drink healthy beverages…”: “When your child wants to consume foods and beverages that are not healthy?”; “When you are tired, stressed, emotionally upset, or affected by daily hassles?”; “When your child is having a friend over?”; and “When your child is acting defiant?”. The PDAP has high internal consistency and good convergent validity (Bohman et al., 2016). In the current sample, Cronbach’s alphas for the PDAP facilitate and PDAP impede subscales were .92 and .82, respectively.

Eating Styles.

The Dutch Eating Behaviors Questionnaire for Children (DEBQ-C) was used to assess child eating styles (van Strien & Oosterveld, 2008). The DEBQ-C is a 20-item child self-report measure that consists of three subscales: emotional eating, external eating, and restrained eating. Items are rated on a 3-point scale (1 = “no,” 2 = “sometimes,” and 3 = “yes”). The DEBQ-C has shown good internal consistency and convergent validity in community samples of youth aged 7-16, with DEBQ-C scores demonstrating positive associations with both dysregulated eating behavior and BMI (Czepczor-Bernat & Brytek-Matera, 2019; van Strien & Oosterveld, 2008). In the current sample, Cronbach’s alpha was .74 for the emotional eating subscale, .70 for the external eating subscale, and .65 for the restrained eating subscale.

EMA-measured craving, overeating, and loss of control eating.

At each EMA recording, youth reported current craving for food and indicated the extent to which their most recent eating episode involved overeating and loss of control eating. These items were derived from previous EMA studies of eating behavior in adults and children (Goldschmidt et al., 2014; Ranzenhofer et al., 2014). Overeating was measured with a single item: “While you were eating, to what extent do you feel that you overate?”. Loss of control eating was measured with four items (“While you were eating, how much do you feel a sense of loss of control?”; “While you were eating, how much did you feel that you could not stop eating once you had started?”; “While you were eating, how much did you feel like you could not resist eating”; “While you were eating, how much did you feel like a car without brakes, you just kept eating and eating?”). Loss of control eating items were summed to create a total score for each episode (α=.91). Current cravings were measured with a single item that asked participants to rate the extent to which they agreed with the following statement: “I am craving food.” All EMA items were rated on a 5-point Likert scale (1 = “not at all,” and 5 = “a lot”).

Statistical Analyses

Generalized estimating equations (GEEs) examined (1) the extent to which PDAP facilitate and impede scores were related to children’s EMA-reported craving, loss of control eating severity, and overeating severity, and (2) the degree to which PDAP scores interact with children’s eating styles (i.e., DEBQ-C emotional eating, external eating, and restraint subscales) to predict EMA outcomes. Separate GEEs were conducted for each EMA outcome and DEBQ-C subscale, such that each GEE included the independent effects of PDAP facilitate and PDAP impede scores, DEBQ-C subscale score, and the two-way interactions between PDAP scores and the DEBQ-C subscale score. Child age, z-BMI, race, and gender were included as covariates. Continuous independent variables were grand-mean centered. GEEs employed a gamma link function to account for skewed distributions of outcome variables and an AR1 serial autocorrelation given dependencies within the data. Given this was a pilot study, alpha was set at .05. Analyses were conducted without imputation in SPSS version 25.

Results

The sample (N=38) included 21 girls and 17 boys. There was an average of 41.17±19.88 completed EMA ratings (across all types of signals) per participant across the 2-week protocol. The total number of completed EMA ratings was not related to participant age, z-BMI, DEBQ-C scores, or EMA variable ratings (ps=.305-.968), and compliance did not differ between boys and girls (p=.659). Table 1 shows descriptive information and Pearson correlations among questionnaire variables. PDAP facilitate and PDAP impede scores were moderately correlated (r=.45), and there were moderate to strong associations among DEBQ-C subscales (rs=.38-.64). The correlations between PDAP and DEBQ subscales were small in magnitude (rs=−.03-.20).

Table 1.

Descriptive statistics and Pearson correlations among variables (N=38)

1 2 3 4 5 6 7 8 9 10
1. Age - −0.10 −.35* −0.22 −.37* −0.26 −0.04 −0.03 0.01 −0.04
2. zBMI - −0.16 0.01 0.01 0.07 0.24 0.20 −0.24 0.21
3. Craving - .64** .66** 0.21 0.19 0.12 0.12 0.06
4. Overeating - .90** 0.30 .39* .37* 0.11 −0.02
5. LOC eating - .37* .44** 0.24 0.01 −0.08
6. DEBQ-C emotional - .64** .38* 0.19 −0.08
7. DEBQ-C external - .50** 0.07 −0.03
8. DEBQ-C restraint - 0.20 0.11
9. PDAP Facilitate HDB - .45**
10. PDAP Impede HDB -
Mean 11.21 2.07 1.38 1.24 4.60 8.26 10.39 13.58 35.32 22.76
SD 1.91 0.50 0.65 0.39 1.40 2.09 2.65 3.06 11.61 9.10
Minimum 8.00 1.15 1.00 1.00 4.00 7.00 6.00 8.00 6.00 5.00
Maximum 14.00 2.89 4.28 2.95 10.36 17.00 17.00 18.00 50.00 40.00
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Note. zBMI=standardized body mass index; LOC=loss of control; DEBQ-C= Dutch Eating Behavior Questionnaire for Children; PDAP Facilitate HDB= Parental Self-Efficacy for Healthy Dietary and Physical Activity Behaviors circumstances that facilitate parental self-efficacy for promoting healthy dietary behaviors in children subscale; PDAP Impede HDB=PDAP circumstances that impede parental self-efficacy for promoting healthy dietary behaviors subscale in children. Variables measured via ecological momentary assessment (i.e., craving, overeating, LOC eating) were aggregated within-person.

*

p<.05

**

p<.01

Table 2 displays GEE results. In models examining DEBQ-C emotional eating, there were no main effects of PDAP scores predicting EMA-measured overeating, loss of control eating severity, or craving (ps=.116-.974). There was a significant main effect of DEBQ-C emotional eating predicting EMA-measured loss of control eating severity (p=.005), such that greater emotional eating was associated with greater loss of control eating severity; there were not significant main effects of emotional eating for overeating (p=.055) or craving (p=.368). However, there were significant interactions of DEBQ-C emotional eating and PDAP facilitate scores predicting both EMA-measured overeating (p=.016) and loss of control eating severity (p=.022). As shown in Figures 1a and 1b, among youth of parents with lower PDAP facilitate scores, those who had higher emotional eating tendencies reported greater overeating and loss control eating severity compared to those with lower emotional eating; however, among youth whose parents reported higher self-efficacy in this domain, those with high and low emotional eating tendencies were more similar in their severity of overeating and loss of control eating. However, interactions with PDAP impede scores were not significant for EMA-measured overeating (p=.729) or loss of control eating severity (p=.544), nor were there any significant interactions between PDAP scores and emotional eating predicting EMA-measured craving (ps=.137-.166).

Table 2.

Generalized estimating equation results

Overeating LOC eating Craving
95% CI Wald 95% CI Wald 95% CI Wald
B SE Lower Upper χ2 p B SE Lower Upper χ2 p B SE Lower Upper χ2 p
Intercept 0.31 0.11 0.10 0.53 8.12 0.004 1.55 0.08 1.40 1.70 410.44 <0.001 0.47 0.17 0.14 0.80 7.72 0.005
Gender −0.06 0.08 −0.21 0.09 0.62 0.432 −0.14 0.07 −0.28 0.00 4.06 0.044 0.01 0.11 −0.21 0.22 <0.01 0.948
Race −0.11 0.13 −0.36 0.14 0.70 0.401 0.03 0.10 −0.17 0.24 0.10 0.750 −0.23 0.18 −0.59 0.12 1.66 0.197
Age −0.03 0.03 −0.08 0.02 1.39 0.238 −0.04 0.02 −0.08 <0.01 3.28 0.070 −0.08 0.03 −0.14 −0.01 5.29 0.021
zBMI <0.01 0.07 −0.13 0.14 <0.01 0.967 −0.02 0.06 −0.13 0.10 0.09 0.771 −0.21 0.10 −0.40 −0.02 4.58 0.032
PDAP Facilitate <0.01 <0.01 −0.01 0.01 <0.01 0.974 <−0.01 <0.01 −0.01 <0.01 2.47 0.116 <−0.01 0.01 −0.01 0.01 0.46 0.498
PDAP Impede <−0.01 <0.01 −0.01 0.01 0.13 0.721 <−0.01 <0.01 −0.01 <0.01 0.48 0.490 0.01 0.01 −0.01 0.02 1.31 0.252
DEBQ-C Emotional 0.05 0.03 <−0.01 0.10 3.67 0.055 0.06 0.02 0.02 0.11 7.96 0.005 0.02 0.03 −0.03 0.08 0.81 0.368
PDAP Facilitate x DEBQ-C Emotional −0.01 <0.01 −0.01 <−0.01 5.85 0.016 <−0.01 <0.01 −0.01 <−0.01 5.22 0.022 <−0.01 <0.01 −0.01 <0.01 2.21 0.137
PDAP Impede x DEBQ-C Emotional <0.01 <0.01 −0.01 0.01 0.12 0.729 <−0.01 <0.01 −0.01 <0.01 0.37 0.544 −0.01 <0.01 −0.02 <0.01 1.92 0.166
Intercept 0.28 0.12 0.04 0.52 5.35 0.021 1.57 0.09 1.40 1.75 309.80 <0.001 0.46 0.16 0.15 0.78 8.22 0.004
Gender −0.06 0.08 −0.21 0.09 0.59 0.442 −0.13 0.07 −0.26 0.01 3.34 0.068 −0.02 0.12 −0.26 0.22 0.03 0.863
Race −0.10 0.12 −0.33 0.13 0.71 0.399 −0.01 0.09 −0.20 0.17 0.02 0.880 −0.20 0.15 −0.49 0.09 1.77 0.183
Age −0.03 0.02 −0.08 0.01 2.13 0.144 −0.04 0.02 −0.08 <−0.01 4.61 0.032 −0.07 0.03 −0.13 <−0.01 4.14 0.042
zBMI −0.04 0.07 −0.18 0.10 0.30 0.586 −0.04 0.07 −0.17 0.10 0.29 0.592 −0.20 0.11 −0.40 0.01 3.48 0.062
PDAP Facilitate <0.01 <0.01 <−0.01 0.01 0.43 0.512 <−0.01 <0.01 −0.01 0.01 0.10 0.758 <−0.01 0.01 −0.01 0.01 <0.01 0.956
PDAP Impede <−0.01 <0.01 −0.01 0.01 0.09 0.770 <−0.01 <0.01 −0.01 <0.01 1.87 0.172 <0.01 0.01 −0.01 0.01 0.36 0.548
DEBQ-C External 0.04 0.02 0.01 0.08 5.29 0.021 0.04 0.02 0.01 0.07 8.02 0.005 0.02 0.02 −0.02 0.06 1.07 0.301
PDAP Facilitate x DEBQ-C External <−0.01 <0.01 <−0.01 <0.01 2.36 0.125 <−0.01 <0.01 <−0.01 <0.01 1.30 0.254 <−0.01 <0.01 <−0.01 <0.01 0.66 0.416
PDAP Impede x DEBQ-C External <0.01 <0.01 <−0.01 <0.01 1.05 0.306 <−0.01 <0.01 <−0.01 <0.01 0.86 0.353 <0.01 <0.01 −0.01 <−0.01 9.17 0.002
Intercept 0.34 0.19 −0.04 0.72 3.13 0.077 1.63 0.15 1.33 1.92 114.56 <0.001 0.53 0.22 0.09 0.97 5.65 0.017
Gender −0.05 0.09 −0.23 0.12 0.35 0.553 −0.19 0.08 −0.35 −0.03 5.63 0.018 −0.06 0.12 −0.29 0.17 0.24 0.623
Race −0.15 0.18 −0.52 0.21 0.70 0.402 −0.03 0.15 −0.32 0.27 0.03 0.867 −0.23 0.21 −0.65 0.18 1.22 0.270
Age −0.04 0.03 −0.09 0.01 1.97 0.160 −0.05 0.02 −0.10 −0.01 5.61 0.018 −0.07 0.04 −0.14 <0.01 3.38 0.066
zBMI <0.01 0.07 −0.14 0.14 <0.01 0.974 0.01 0.06 −0.11 0.13 0.03 0.866 −0.20 0.09 −0.38 −0.01 4.31 0.038
PDAP Facilitate <0.01 0.01 −0.01 0.02 0.17 0.677 <0.01 0.01 −0.01 0.01 0.40 0.527 <0.01 0.01 −0.02 0.02 <0.01 0.972
PDAP Impede <−0.01 <0.01 −0.01 0.01 0.27 0.606 −0.01 <0.01 −0.02 <−0.01 4.13 0.042 <0.01 0.01 −0.01 0.02 0.26 0.612
DEBQ-C Restraint 0.01 0.01 −0.01 0.04 1.45 0.228 <−0.01 0.01 −0.02 0.02 0.01 0.904 <0.01 0.02 −0.03 0.03 0.07 0.793
PDAP Facilitate x DEBQ-C Restraint <0.01 <0.01 <−0.01 <0.01 0.01 0.942 <0.01 <0.01 <−0.01 0.01 2.68 0.102 <0.01 <0.01 <0.01 0.01 0.42 0.518
PDAP Impede x DEBQ-C Restraint <0.01 <0.01 <−0.01 <0.01 0.18 0.671 <−0.01 <0.01 −0.01 <−0.01 5.45 0.020 <−0.01 <0.01 −0.01 <−0.01 4.03 0.045
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Note. zBMI=standardized body mass index; LOC=loss of control; DEBQ-C= Dutch Eating Behavior Questionnaire for Children; PDAP Facilitate HDB= Parental Self-Efficacy for Healthy Dietary and Physical Activity Behaviors circumstances that facilitate parental self-efficacy for promoting healthy dietary behaviors in children subscale; PDAP Impede HDB=PDAP circumstances that impede parental self-efficacy for promoting healthy dietary behaviors subscale in children. Continuous independent variables were grand-mean centered. Gender and race were coded such that boys and Caucasian were reference categories (vs. girls and non-Caucasian, respectively).

Figure 1.

Figure 1.

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1a-1b. Interactions of PDAP facilitate and DEBQ-C emotional eating scores predicting overeating (1a) and loss of control eating (1b). High and low values reflect 1 SD below and above sample means.

For models assessing DEBQ-C external eating, there were also no main effects of PDAP scores (ps=.172-.956). Higher DEBQ-C external eating was independently associated with greater EMA-measured overeating (p=.021) and loss of control eating severity (p=.005), but there was not a significant effect for craving (p=.301). However, there was a significant interaction between DEBQ-C external eating and PDAP impede scores predicting EMA-measured craving (p=.002). Similar tothe pattern of the previous interactions, among children of parents with lower PDAP impede scores, those with higher external eating reported greater craving compared to those with lower external eating; however, yet children’s external eating levels were not associated with craving among children whose parents reported higher PDAP impede scores (Figure 2). No other interactions between PDAP and DEBQ-C external scores were significant (ps=.125-.416)

Figure 2.

Figure 2.

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Interaction of PDAP impede and DEBQ-C external eating scores predicting craving. High and low values reflect 1 SD below and above sample means.

With respect to models examining DEBQ-C restraint, there was a significant main effect of PDAP impede scores predicting EMA-measured loss of control eating severity (p=.042), such that lower impede scores were related to greater loss of control eating severity, though there were not main effects for overeating (p=.606) or craving (p=.612). There were no main effects of DEBQ-C restraint for any EMA outcome (p=.228-.90). However , significant interactions between DEBQ-C restraint and PDAP impede scores emerged in predicting EMA-measured loss of control eating severity (p=.020) and craving (p=.045). Among children of parents with lower PDAP impede scores, those with higher restraint reported more loss of control eating severity and craving compared to those with lower restraint; however, among children of parents with higher PDAP impede scores, those with higher restraint reported reduced loss of control eating and craving compared to those with lower restraint (Figures 3a–3b). In other words, among children with higher levels of restraint, those whose parents had lower PDAP impede scores reported greater loss of control eating and craving compared to those whose parents had higher PDAP impede scores. There were no other significant interactions between PDAP and DEBQ-C restraint scores (ps=.102-.942).

Figure 3.

Figure 3.

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Interactions of PDAP impede and DEBQ-C restraint scores predicting loss of control eating (3a) and craving (3b). High and low values reflect 1 SD below and above sample means.

To summarize results with respect to the study objectives, contrary to the Aim 1 hypothesis, there were no consistent main effects of PDAP scores predicting EMA-measured loss of control eating, overeating, or craving. However, as hypothesized in Aim 2, the associations between higher DEBQ-C scores and higher EMA-measured outcomes were generally reduced at higher levels of parental self-efficacy measured by the PDAP.

Discussion

The current study examined the extent to which parental self-efficacy for promoting HDBs in children was related to naturalistically-assessed cravings and dysregulated eating behaviors among youth with obesity, and explored whether higher parental self-efficacy in this domain would mitigate the association between child eating styles (i.e., emotional eating, external eating, restraint) and cravings and dysregulated eating. Contrary to expectations, there were no consistent main effects of parental self-efficacy for any outcome variable, which suggests parental self-efficacy related to children’s eating behaviors is not universally associated with child-reported cravings and eating behaviors. However, significant interactions between PDAP scores and child eating styles emerged for each outcome, which is generally consistent with prior work highlighting the interplay between parent and child factors in predicting weight-related behaviors and outcomes (Sleddens et al., 2011).

In line with hypotheses, higher parental self-efficacy under circumstances that facilitate HDBs buffered the association between trait-level emotional eating and momentary disordered eating behaviors (i.e., overeating and loss of control eating). That is, for children of parents with low self-efficacy in this domain, those who had higher emotional eating tendencies reported higher overeating and loss of control eating ratings during the EMA protocol compared to those with lower emotional eating. However, for children of parents with higher self-efficacy, overeating and loss of control eating were more similar across high and low levels of emotional eating. Given that emotion-related factors have not been as consistently linked to the momentary occurrence of disordered eating behaviors in youth compared to adults (Goldschmidt et al., 2018; Hilbert, Rief, Tuschen-Caffier, de Zwaan, & Czaja, 2009; Ranzenhofer et al., 2014), it may be that parent-related factors partly account for this inconsistency.

A similar interactive effect was observed between parental self-efficacy under circumstances that impede HDBs and external eating in predicting EMA-measured craving. That is, among children whose parents reported less confidence to promote HDBs specifically in the face of impeding factors (e.g., when eating out; when feeling tired or stressed), those who evidenced higher external eating tendencies reported higher craving levels compared to children of parents who reported lower external eating. Conversely, among children of parents with higher self-efficacy in this domain, craving levels did not vary based on external eating tendencies. This is consistent with research in adults showing that external eating is positively associated with food craving (Burton, Smit, & Lightowler, 2007; Hill, Weaver, & Blundell, 1991), though this relationship may be more nuanced in youth. The present study results suggest that heightened reactivity to external food cues may be more likely to trigger cravings among children whose parents experience more difficulty encouraging healthy eating in the face of circumstances that promote more convenient and/or more palatable options. That is, over time children may come to develop stronger stimulus – response (i.e., food cue – craving) associations if parents feel ineffective in regulating children’s eating behaviors in such situations.

The pattern of findings was more complex with respect to restrained eating styles. For children of parents who reported lower self-efficacy under circumstances that impede HDBs, higher restraint was associated with greater craving and loss of control eating. Conversely, for children of parents with higher self-efficacy in this domain, higher restraint was related to lower levels of EMA-measured craving and loss of control eating. Although cognitive attempts to limit intake among children with overweight or obesity have been associated with dysregulated eating behaviors and weight gain (Goossens, Braet, & Bosmans, 2010; Halberstadt et al., 2016), it could be that greater parental confidence to promote HDB in the face of impeding circumstances may facilitate more adaptive forms of restraint in children (potentially via parental modeling), which in turn could result in lower craving and loss of control eating levels. These findings are also important to consider in light of the literature on cognitive restraint measures among individuals with eating and/or weight disorders. That is, restraint is a multifaceted construct that includes both rigid (putatively maladaptive) and flexible (putatively adaptive) dimensions (Hagan, Forbush & Chen, 2017; Schaumberg et al., 2016), and while some theoretical frameworks suggest restraint predicts eating-related psychopathology and negative health outcomes, empirical support for these associations has been inconsistent (Schaumberg et al., 2016). Given the pattern of the present interactive effects, this highlights a clear need to investigate how parental self-efficacy can enhance adaptive forms of cognitive restraint among youth without creating rigid, controlled eating environments, which have previously been linked to negative outcomes in youth (Johnson & Birch, 1994).Together these results further highlight the importance of considering different contextual factors related to parental self-efficacy as well as the particular characteristics of children’s eating styles.

It is important to note limitations of the present study. The sample size was modest given that this was a pilot study, and participants were limited to children and young adolescents with overweight or obesity, who generally reported low levels of eating disorder psychopathology based on the Child EDE. Therefore future research should assess these effects and psychometric properties of the PDAP in larger samples of youth across the age and weight spectrum, as well as in samples with more variability in disordered eating symptoms. Variables were examined cross-sectionally, and therefore the directionality of effects cannot be determined without future prospective research. For example, it is possible that the presence of dysregulated eating behavior in children also affects parents’ sense of self-efficacy in a transactional process. Overeating and loss of control eating were also based on participants’ self-reports; while this is consistent with prior EMA studies (Goldschmidt et al., 2012), these measures may not be accurate indicators of the objective quantity of food consumed or the subjective experience of loss of control as conceptualized in DSM-5 (American Psychiatric Association, 2013). EMA-measured craving and overeating were also assessed using single items, which may not have captured all dimensions of these constructs. In addition, the internal consistency of the DEBQ-C restraint subscale was suboptimal, and therefore these findings should be interpreted with some caution. Caregiver characteristics that were not assessed in the present study (e.g., BMI, eating behaviors) also may have impacted the present findings, and therefore deserve further consideration in future replication studies. Lastly, further study is also needed to explore additional mechanisms (e.g., parental modeling and/or feeding practices) that explain links between parental self-efficacy and weight-related outcomes.

Nonetheless, the present study offers meaningful insights into the interplay between trait-level parenting factors and child characteristics in relation to children’s momentary food cravings and eating behaviors. In addition, the methodology lends ecological validity to findings via the use of naturalistic assessment. Importantly, parental self-efficacy for promoting HDBs was only associated with children’s cravings and eating behaviors when children’s eating styles were considered. Consistent with predictions, parental self-efficacy in these domains generally buffered the association between eating styles and eating behaviors and cravings in daily life, though the temporal direction of such effects cannot be determined.

These findings also have important implications for research going forward. As noted previously, other factors that contribute to parental self-efficacy warrant further investigation. In particular, parental stress and emotional functioning may be key “upstream factors” in light of prior research showing that (1) lower parental self-efficacy for promoting healthy weight-related behaviors in children was associated with poorer parental mental health (i.e., higher depression, anxiety, and stress; Nelson & Davis, 2012); (2) stress is broadly implicated in the development and maintenance of obesity, in part via influences on dietary an physical activity behaviors (Tomiyama, 2019); and (3) parental modeling is an important factor that is associated with children’s weight-related behaviors (Alisa et al., 2013; Cullen et al., 2001; Zarychta et al., 2016). Thus, parents with higher stress levels likely experience lower self-efficacy to promote HDB in their children and are more prone to engage in maladaptive eating behaviors themselves, which may independently and/or interactively impact children’s eating habits. Further, given that the majority of parents in the present study were single or divorced mothers, it would be helpful to explore the potential role of social support in shaping parental self-efficacy for HDB. Lastly, it is necessary to examine directional pathways by which self-efficacy may exert effects on eating behaviors in children. As suggested by prior research, parenting styles and practices may be key mediating variables that explain associations between parental self-efficacy and children’s eating behaviors. Further, it is important to elucidate potential bi-directional links (i.e., frequent dysregulated eating and/or eating in response to food cues in children predicting parental stress and self-efficacy) in order to fully understand the dynamic processes by which parent and child factors interactively impact risk for eating and weight disorders.

Acknowledgments

Funding

This research was funded by grants from the National Center for Advancing Translational Sciences (UL1-TR000430) and the National Institute of Diabetes and Digestive and Kidney Diseases (K23-DK105234).

Footnotes

Data Availability Statement

The data that support the findings of this study are available upon reasonable request from the authors.

Conflicts of Interest

The authors declare no conflicts of interest.

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