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. Author manuscript; available in PMC: 2024 Jan 1.
Published in final edited form as: J Child Fam Stud. 2022 Jun 29;32(1):31–43. doi: 10.1007/s10826-022-02351-9

Associations Between Weight Talk and Biopsychosocial Outcomes in Children from Racially/Ethnically Diverse Households

Amanda C Trofholz 1, Allan Tate 2, Susan Telke 3, Katie A Loth 4, Gretchen J Buchanan 5, Jerica M Berge 6
PMCID: PMC9943526  NIHMSID: NIHMS1837932  PMID: 36824477

Abstract

Weight talk in the home—parents talking to their children about their weight, shape or size—has been associated with many negative health outcomes in children and adolescents, although the majority of research has been with adolescents. This study explored associations between weight talk in the home and a broad range of child biopsychosocial outcomes (e.g., weight status, diet quality, psychological well-being, peer problems), in addition to child sex and race/ethnicity. Parents of 5–7 year old children from six racial/ethnic groups (White, African American, Hmong, Latino, Native American, Somali) (n=150) completed an online survey and completed 24-hour dietary recalls on the child. Additionally, anthropometric measurements were taken on the 5–7 year old child and parent. Over one-third of parents reported engaging in weight talk with their child. Overall, weight talk was associated with child weight status, but not with child diet quality. The presence of weight talk differed by race/ethnicity and child weight status. Most psychological (e.g., emotional problems) and social (e.g., peer problems) outcomes differed significantly by race/ethnicity with the following pattern: (1) no significant associations between weight talk and biopsychosocial outcomes were found for Hmong and Latino children; (2) a negative association (e.g., less healthy functioning) was found for African American and Somali children; (3) a positive association (e.g., healthier functioning) was found for Native American children. Future research should investigate why psychological and social outcomes differ by race/ethnicity in children experiencing weight talk. This study confirms the need to develop best practices for helping parents concerned about their child’s weight to talk to children in a healthful way.

Keywords: biopsychosocial, weight talk, racially/ethnically diverse children, Native American children, child behavior, immigrant/refugee families

Introduction

Weight talk in the home—parents talking to their children about their weight, shape or size—has been associated with many negative health behaviors and outcomes in children and adolescents, including lower body satisfaction (Gillison et al., 2016; McCormack et al., 2011; Neumark-Sztainer et al., 2010), use of unhealthy weight control behaviors (Bauer et al., 2013; Fulkerson et al., 2002; Haines et al., 2008; Keel et al., 1997; Smolak et al., 1999), and higher weight status (Neumark-Sztainer et al., 2010; Trofholz, et al, 2018). Past research has also demonstrated associations between more weight talk in the home with poorer mental health outcomes in young people, including higher levels of depressive symptoms (Bauer et al., 2013; Eisenberg et al., 2003; Keery et al., 2005; Porter et al., 2013), and suicidal thoughts (Eisenberg et al., 2003).

There is a small body of research—mainly conducted by the first and last authors of this manuscript—that explores weight talk in the home of primarily African American 6–12 year old children (e.g., how parents qualitatively describe handling weight talk in the home) (Berge et al., 2015a, 2016; Trofholz et al, 2018), but the majority of research to date exploring weight talk in the home has focused on the impact of weight talk on adolescents (Yourell et al., 2021). Thus, it is important to broaden the literature on weight talk with regard to the population of study (e.g., child research) and also to expand the scope of the research (i.e., more comprehensive outcomes measured such as biopsychosocial outcomes).

Biopsychosocial Approach

Using the biopsychosocial model (Engel, 1977, 1981) as a guide, this study aimed to explore the associations between weight talk in the home with a wider range of biopsychosocial child behavior outcomes than examined in prior literature. Specifically, this study focused on outcomes representing all three dimensions of the biopsychosocial model, including biological (e.g., weight status, dietary intake), psychological (e.g., emotional problems, hyperactivity), and social (e.g., peer problems, prosocial behaviors) dimensions. A biopsychosocial approach has been utilized in other areas of weight-related child health research (e.g., overweight/obesity, body image) (Ricciardelli et al., 2003; Russell & Russell, 2019) and has been found to be a useful model for understanding how weight-related factors extend beyond biology to psychosocial factors such as child temperament or peer influences.

With regard to weight talk, prior studies have examined associations between weight talk and some dimensions of the biopsychosocial model (e.g., weight status). However, it is important to examine associations between weight talk and each of the three biopsychosocial dimensions of child health and well-being simultaneously to better understand whether weight talk has differential associations with each dimension to inform intervention development. In the current study, both child weight status and diet quality (determined by the child’s dietary intake) are considered to be biological constructs. While non-biological factors (e.g., parent feeding practices) also influence a child’s weight status (Berge, 2009), it is clear that these psychosocial factors work in combination with biological factors to influence weight status (Albuquerque et al., 2017; Davis et al., 2008). Additionally, while diet quality is not necessarily a biological construct per se, it is an input that has biological outcomes, and has been associated with weight status in children (Jennings et al., 2011).

Additionally, the biopsychosocial model promotes the importance of examining other social constructs such as sex and race/ethnicity to better understand the whole person. A small body of research examining weight talk within the home of adolescent boys and girls has found that exposure to weight talk may impact boys and girls differently (Fulkerson et al., 2002; Gillison et al., 2016). Parent respondents in a qualitative study examining weight talk in the home of diverse children endorsed that their culture influenced the way they talk about weight in the home (Berge et al., 2015a). Regarding weight status, associations between weight talk in the home with child outcomes do not appear to have been explored by weight status; however, parents of children with overweight appear to engage in weight talk in the home more frequently than parents of children with non-overweight (Trofholz et al, 2018). Thus, in the current study, not only are biological, psychological, and social outcomes examined with weight talk but associations are also explored by child sex, race/ethnicity, and weight status (for all non-weight outcomes) (Borrell-Carrió et al., 2004; Engel, 1977). In the current study, weight talk is defined as a parent mentioning to their child that they should eat differently and/or exercise in order to lose weight/not gain weight or that the child weighs too much.

Using a racially/ethnically diverse sample of children ages 5–7, this study explored the following research questions: (1) What is the prevalence of weight talk in the home, and how does it vary by child sex, race/ethnicity, or weight status?; (2) What are the associations between weight talk in the home and biological-related outcomes (i.e., weight status, diet quality), psychological outcomes (i.e., emotional problems, hyperactivity, conduct problems), and social outcomes (i.e., peer problems, prosocial behavior)?; (3) Are these associations moderated by child sex, race/ethnicity, and/or weight status?

Materials and Methods

Data for the current study come from Phase I of the Family Matters study, a two-phased study investigating risk and protective factors for childhood obesity (Berge et al., 2017) in the home environment. Phase I was a cross-sectional, mixed-methods study; Phase II is an ongoing longitudinal study. Phase I participants (i.e., parent/child dyads) were recruited from primary care clinics in Minneapolis/St. Paul, MN between 2015 and 2016. The clinics identified 5–7 year old children with a recent well-child visit; the families of these children were then sent a recruitment letter inviting them to participate in the Family Matters study. Eligibility requirements for the study included: having a 5–7 year old child (study child) in the home full-time; having another child in the home between 6–12 years old; the parent/primary guardian (“parent”) had to share at least one meal per day with the study child, and the parent had to read in English, Spanish, Hmong or Somali. Additionally, to ensure a racially/ethnically diverse sample, the family had to identify as either White, African American, Native American, Latino, Hmong, or Somali (n=150, 25 per race/ethnicity). Additionally, to ensure equal representation by child weight status, recruitment was stratified so that half of the study children had nonoverweight status (>5th and <85th body mass index (BMI) percentile) and half had overweight/obese status (≥85th BMI percentile). Specifically, of the 25 children per race/ethnicity, approximately half had non-overweight status and half had overweight/obese status.

Procedures

Data were collected from families over the course of two in home visits, which occurred about 10 days apart (Berge et al., 2017). Data used for the current study are from anthropometric measurements, dietary recall interviews on the study child’s intake, and survey completed online by the primary parent. All participants were consented into the study prior to collection data.

Anthropometry:

At the first home visit, trained researchers took the height and weight of all family members in the home. Both height and weight were taken twice, and values needed to agree within 0.5 cm for height, and 0.5 kg for weight. BMI percentile values were calculated for the study child using the CDC calculator (Body Mass Index BMI (BMI) Percentile Calculator for Child and Teen | DNPAO | CDC, n.d.).

Dietary recall:

Three 24-hour dietary recalls—a common and reliable method for assessing dietary intake (Baxter et al., 2009; Freedman et al., 2014)—were conducted with the primary parent of the study child regarding the foods and drinks the child consumed in the previous 24 hours. Two of the recalls were conducted at the home visits; another recall was conducted via telephone in between home visits. Additional details on conducting dietary recalls for Phase I have been published elsewhere (Trofholz et al., 2018b, 2019). Using guidance from the Nutrition Coordinating Center (Healthy Eating Index (HEI), n.d.), data from the three dietary recalls was used to calculate Healthy Eating Index-2010 (HEI) scores, which are considered to be valid and reliable measures of overall diet quality (Guenther et al., 2013, 2014). HEI scores are calculated by averaging the three days of dietary recalls, computing scores for adequacy (Total Fruit, Whole Fruit, Total Vegetables, Greens and Beans, Whole Grains, Dairy, Total Protein Foods, Seafood and Plant Proteins, Fatty Acids) and moderation (Refined Grains, Sodium, Empty Calories) components. These individual scores were then summed to compute individual HEI scores. The possible HEI range was 0–100 with a higher score indicating a better diet quality.

Online survey:

The primary parent completed an online survey during the second home visit, which included questions about the home food environment, weight talk in the home (Berge et al., 2014), parent anxiety (Spitzer et al., 2006) and depression (Kroenke et al., 2001), the study child’s behavior as assessed by the validated Strengths and Difficulties Questionnaire (Goodman, 1997), and family demographics.

Measures

Biological measures (i.e., child weight status and child diet quality) were collected through objectively measured heights and weights and through 24-hour dietary recalls. Biological measures are described in more detail on Table 1. Additional survey measures were collected from the online survey. These include parent report of engaging in weight talk with their child (Berge et al., 2014) (Have you mentioned to [child] that he/she should eat differently in order to lose weight or keep from gaining weight?; Have you told [child] that he/she should exercise in order to lose weight or to keep from gaining weight?; Have you mentioned to [child] that he/she weights too much?); parent’s report of child’s Conduct Problems ([Child] often loses his/her temper; [Child] often fights with other children or bullies them; [Child] is often argumentative with adults]; [Child] is generally well-behaved, usually does what adults request; [Child] can be spiteful to others.); Emotional Problems ([Child] often complains of headaches, stomachaches, or sickness; [Child] has many worries or often seems worried; [Child] is often unhappy, depressed, or tearful; [Child] is nervous or clingy in new situations, easily loses confidence; [Child] has many fears, is easily scared.); Hyperactivity ([Child] is restless, overactive, cannot say still for long; [Child] is constantly fidgeting or squirming; [Child] is easily distracted, concentration wanders; [Child] can stop and think things out before acting; [Child] has a good attention span, sees work through to the end.); Peer Problems ([Child] is rather solitary, prefers to play alone; [Child] has at least one good friend; [Child] is generally liked by other children; [Child] is picked on or bullied by other children; [Child] gets along better with adults than with other children.); and Prosocial Behavior ({Child] is considerate of other people’s feelings; [Child] shares readily with other children, for example toys, treats, pencils; [Child] is helpful if someone is hurt, upset, or feeling ill; [Child] is kind to younger children; [Child] often offers to help others {parents, teachers, other children) (Goodman, 1997). Parents also reported on their own anxiety (Over the past 2 weeks, how often have you been bothered by not being able to stop or control worrying?) (Staples et al., 2019) and depression (Over the past 2 weeks, how often have you been bothered by feeling down, depressed, or hopeless?) (Löwe et al., 2005), as well as other demographic variables. All survey items are described in more detail on Table 1.

Table 1:

Description of Measures Used in the Current Analysis

Variable Response Options Operationalization of Variable
Weight Talk Variables 1
Have you mentioned to [child] that he/she should eat differently in order to lose weight or keep from gaining weight?b Never or rarely; A few times a year; A few times a month; A few times a week; Almost every day Presence of weight talk was determined a response other than ‘Never or rarely’ for any the weight talk variables. Absence of weight talk was ‘Never or rarely’ for all the weight talk variables.
Have you told [child] that he/she should exercise in order to lose weight or to keep from gaining weight?b
Have you mentioned to [child] that he/she weighs too much?b
Biological Variables 2
Child weight status Nonoverweight (<85th BMI percentile); Overweight (≥85th BMI percentile <95th BMI percentile); Obese (≥95th BMI percentile) Body mass index percentile values were calculated using an on-line CDC calculator.3
Healthy Eating Index-2010 (HEI) score The NDSR system aggregates foods into subgroups, and nutrient profiles are provided per day and per meal. The nutrient profiles of three 24-hour periods are averaged to produce all measures of dietary intake. Using 24-hour dietary intake data, HEI scores were created. HEI scores sum the scores of 12 categories: Total fruit; Whole fruit; Total vegetables; Greens and beans; Whole grains; Dairy; Total protein foods; Seafood and plant proteins; Fatty acids; Refined grains; Sodium; Empty calories.4
The possible HEI range is 0–100 with a higher score indicating a better diet quality.
Psychological Variables 2,d
Conduct Problems: Based on [child’s] behavior over the past six months… Not true; Somewhat true, Certainly true Response options are averaged to create a score ranging from 0–2.
[Child] often loses his/her temper
[Child] often fights with other children or bullies them
[Child] is often argumentative with adults
[Child] is generally well-behaved, usually does what adults request*
[Child] can be spiteful to others
Emotional Problems: Based on [child’s] behavior over the past six months… Not true; Somewhat true, Certainly true Response options are averaged to create a score ranging from 0–2.
[Child] often complains of headaches, stomachaches, or sickness
[Child] has many worries or often seems worried
[Child] is often unhappy, depressed, or tearful
[Child] is nervous or clingy in new situations, easily loses confidence
[Child] has many fears, is easily scared
Hyperactivity: Based on [child’s] behavior over the past six months… Not true; Somewhat true, Certainly true Response options are averaged to create a score ranging from 0–2.
[Child] is restless, overactive, cannot stay still for long
[Child] is constantly fidgeting or squirming
[Child] is easily distracted, concentration wanders
[Child] can stop and think things out before acting
[Child] has a good attention span, sees work through to the end*
Social Variables 2,d
Peer Problems: Based on [child’s] behavior over the past six months… Not true; Somewhat true, Certainly true Response options are averaged to create a score ranging from 0–2.
[Child] is rather solitary, prefers to play alone
[Child] has at least one good friend*
[Child] is generally liked by other children*
[Child] is picked on or bullied by other children
[Child] gets along better with adults than with other children
Prosocial Behavior: Based on [child’s] behavior over the past six months… Not true; Somewhat true, Certainly true Response options are averaged to create a score ranging from 0–2.
[Child] is considerate of other people’s feelings
[Child] shares readily with other children, for example toys, treats, pencils
[Child] is helpful if someone is hurt, upset or feeling ill
[Child] is kind to younger children
[Child] often offers to help others (parents, teachers, other children)
Additional Covariates
Child sex Female; Male Child sex was reported by parent at first home visit
Parent sex Female; Male Parent sex was self-reported at first home visit
Race/ethnicity White; African American; Native American; Latino; Hmong; Somali Parent identified family as one of the race/ethnicities during eligibility screening
Parent weight status Normal weight: BMI 18.5–24.9; Overweight: BMI is 25–29.9; Obese: BMI 30+ Parent BMI was calculated using the formula: weight (kg) / [height (m)]3
Household income
What is your yearly TOTAL HOUSEHOLD income? (i.e., income from ALL family members whose job helps support the family) This includes wages, cash assistance, Social Security, child support, etc.		 Less than $20,000; $20,000-$34,999; $35,000-$49,999; $50,000-$74,999; $75,000-$99,999; $100,000 or more Survey question; assessed as categorical variables
Parent Education
What is the highest grade or year of school that YOU have completed?		 Middle school or junior high,. Some high school, High school or GED, Vocational, technical, trade or other certification program, Associate degree, Bachelor degree, Graduate or professional degree (MS, MBA, MD, PhD, etc), Other Survey question; assessed as categorical variables
Parent anxiety
Over the past 2 weeks, how often have you been bothered by not being able to stop or control worrying?5 		Not at all; Several days; More days than not; Nearly every day Survey question; assessed as categorical variables
Parent depression
Over the past 2 weeks, how often have you been bothered by feeling down, depressed, or hopeless?6 		Not at all; Several days; More days than not; Nearly every day Survey question; assessed as categorical variables
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a.

Variables marked with a * indicate that the response options were reverse coded.

b.

Weight-talk items were found to have good test-retest reliability (0.73, 0.56, and 0.71 respectively) in a previous study evaluating weight talk between parents and adolescents in a racially/ethnically diverse sample.1

c.

The Healthy Eating Index-2010 has been found to be both a valid and reliable measure of overall diet quality.7

d.

The Strengths and Difficulties Quesionnaire has been found to have good internal consistency (mean Cronback α 0.82) and retest stability (0.72).8

e.

The GAD-2 was found to have high sensitivity (71%) and specificity (69%) for Mini International Neuropsychiatric Interview diagnoses ≥3 in a sample of adults (mean age 43.1). Test-retest reliability was also high (0.79).5

f.

The PHQ-2 was found to have a sensitvity of 79% and specificty of 86% for any depressive disorder in adults (mean age 43.4 years).6

References:

1.

Berge JM, MacLehose RF, Loth K a., Eisenberg ME, Fulkerson J a., Neumark-Sztainer D. Parent-adolescent conversations about eating, physical activity and weight: prevalence across sociodemographic characteristics and associations with adolescent weight and weight-related behaviors. J Behav Med. 2014;38(1):122–135. doi:10.1007/s10865-014-9584-3

2.

Goodman R. The Strengths and Difficulties Quesionnaire: a research note. J Child Psychol Psychiatry. 1997;38(5):581–586.

3.

Growth Charts--Homepage. Center for Disease Control Web site. http://www.cdc.gov/growthcharts/. Accessed September 2, 2015.

4.

National Cancer Institute. Developing the Health Eating Index. https://epi.grants.cancer.gov/hei/developing.html. Accessed August 6, 2017.

5.

Staples LG, Dear BF, Gandy M, et al. Psychometric properties and clinical utility of brief measures of depression, anxiety, and general distress: The PHQ-2, GAD-2, and K-6. Gen Hosp Psychiatry. 2019;56(November 2018):13–18. doi:10.1016/j.genhosppsych.2018.11.003

6.

Löwe B, Kroenke K, Gräfe K. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res. 2005;58(2):163–171. doi:10.1016/j.jpsychores.2004.09.006

7.

Guenther PM, Kirkpatrick SI, Reedy J, et al. The Healthy Eating Index-2010 is a valid and reliable measure of diet quality according to the 2010 Dietary Guidelines for Americans. J Nutr. 2014;144(3):399–407. doi:10.3945/jn.113.183079

8.

Goodman R, Ford T, Richards H, Gatward R, Meltzer H. The development and well-being assessment: Description and initial validation of an integrated assessement of child and adolescent psychopathology. J Child Psychol Psychiatry Allied Discip. 2000;41(5):645–655. doi:10.1017/S0021963099005909

Statistical Analysis:

Descriptive analyses were performed to describe the sample and evaluate modeling assumptions. A total of 150 families participated in the Family Matters study. One caregiver did not fully complete the online survey and was excluded from analysis. The full sample (n=149) was used in calculating the frequency of weight talk in the home by child sex, race/ethnicity, and child weight status. However, because the reported prevalence of weight talk was almost nonexistent among White caregivers (n=1/25 (4%) engaged in any weight talk), the subpopulation of white families was excluded from regression models (Tables 3–5) to avoid extrapolating results due to little information they could provide about weight talk determinants in this sample. Thus, the final analytic population for regression models retained all other non-white participants (N=124). Associations between sex of child, race/ethnicity, and child weight status with weight talk (Y/N) were evaluated with chi-square tests for independence. Adjusted linear and logistic regression models with robust standard errors were used to examine whether weight talk (Y/N) was associated with child overweight status evaluated as a binary outcome and also continuous outcome including dietary intake (HEI-2010), and average psychological and social scores. Similarly, adjusted logistic and linear regression models with robust standard errors were used to examine whether gender and race interactions with weight talk (Y/N) were associated with child overweight status, dietary intake (HEI-2010), and average psychological and social scores. Huber-White sandwich estimator of robust standard errors account for the potential misspecification of the variance family (Huber & Janot, 1980). Marginal mean and probability differences and 95% confidence intervals were calculated for interactions. All models are adjusted for parent sex, parent weight status, parent anxiety and depression, parent education, household income, child sex, child overweight status and race/ethnicity (child weight status is removed for analysis of outcome of child overweight status). An example interpretation of results is included in each table to assist in the interpretation of study findings. All analyses were performed in Stata 17.0 MP (College Station, TX).

Results

Description of sample:

The majority of the primary caregivers who participated in this study were female (91%) and identified as the study child’s mother (87%). Participants had a mean age of 34.5 years (SD: 7.1). The average BMI of the primary parent was 30.9 (SD: 7.2), with 23% having nonoverweight status, 25% having overweight status, and 51% having overweight/obesity status. Regarding educational attainment of the primary parent, 61% had some high school or a high school diploma, 18% had a vocational or associate degree, 7% had a bachelor’s degree, 9% had a graduate/professional degree, and 3% responded “other”. Additional demographic details have been published elsewhere (Berge et al., 2017)

Percent of weight talk in the home:

Over one-third of parents (38%) reported engaging in weight talk with their child (Table 2). Engaging in weight talk with the study child was reported by only one parent who was White compared to about half of African American, Latino, and Somali parents (p=0.003). Parents of overweight children were three times more likely to report engaging in weight talk compared to parents of children with nonoverweight status (p<0.001). The data do not suggest differential parental weight talk by child sex for the children in the Family Matters study (children ages 5–7 years).

Table 2:

Frequency of Weight Talk in the Home by Child Sex, Race/Ethnicity, and Child Weight Status

Weight Talk in Home
No Yes Percent p-value1
Total Sample (n=149) 93 56 0.38
Child Sex
Boy 51 28 0.35 0.6
Girl 42 28 0.40
Race/Ethnicity
White 24 1 0.04 0.003
African American 16 8 0.33
Hmong 12 13 0.52
Latino 12 13 0.52
Native American 16 9 0.36
Somali 13 12 0.48
Child Weight Status
Not Overweight 62 15 0.19 <0.001
Overweight 31 41 0.57
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1

Chi square test for independence

Example interpretation: Weight talk (Y/N) was 3 times more prevalent with overweight children compared to not overweight children within our sample (p<0.001).

Associations between weight talk in the home and biological outcomes:

There was a significant positive association between parental weight talk and child weight status (p=0.001). The magnitude of association between weight talk in the home with child weight status was slightly attenuated but still remained significant after adjusting for parent sex, parent weight status, parent anxiety, parent depression, parent education, household income, child sex, and race (p=0.001) (Table 3). A significant association between weight talk in the home and child diet quality was not observed. Child sex, race/ethnicity, or child weight status were not found to modify the association between weight talk in the home and child weight status or child diet quality.

Table 3:

Adjusted Associations Between Weight Talk in the Home with Biological Variables1 and by Child Sex, Race/Ethnicity, and Child Weight Status

Weight Status2 Child Diet Quality3
Weight Talk Probability 95% CI p-value Mean 95% CI p-value
No 0.33 (0.21, 0.45) 0.001 57.24 (55.34, 59.14) 0.057
Yes 0.67 (0.52, 0.81) 56.28 (54.02, 58.54)
Weight Talk Probability Difference 95% CI p-value Mean Difference 95% CI p-value
Boys 0.33 (0.15, 0.52) 0.564 −1.19 (−5.88, 3.51) 0.879
Girls 0.26 (0.04, 0.47) −0.73 (−4.84, 3.38)
African American 0.27 (−0.09, 0.62) 0.181 2.01 (−4.13, 8.16) 0.397
Hmong 0.50 (0.20, 0.8) −0.84 (−8.39, 6.71)
Latino 0.36 (0.12, .0.61) −2.03 (−7.98, 3.93)
Native American −0.05 (−0.38, 0.28) −6.78 (−14.83, 1.26)
Somali 0.22 (−0.76, 0.51) 2.52 (−3.05, 8.09)
Nonoverweight N/A N/A N/A −4.02 (−8.7, 0.67) .0491
Overweight/Obese 1.88 (−2.62, 6.38)
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1

All analyses excluded White race/ethnicity because of small numbers (n=1) reporting any weight talk. Therefore, the analyses sample was reduced from 149 to 124.

2.

Adjusted for parent sex, parent weight status, parent anxiety, parent depression, household income, child sex, and race. Parent education was removed as an adjustor because of co-linearity with household income.

3.

Adjusted for parent sex, parent weight status, parent anxiety, parent depression, parent education, household income, child sex, race, and child overweight status.

Example interpretation: Weight talk occurred nearly twice as often with overweight children compared to not overweight children after controlling for parent sex, parent weight status, parent anxiety and depression, household income, child sex, and race

Associations between weight talk in the home and psychological outcomes:

Weight talk in the home was significantly associated with child conduct problems (Table 4); the mean score of conduct problems was 0.25 (Cohen’s d = 0.35) higher for children experiencing weight talk in the home compared to those not experiencing weight talk. Race/ethnicity significantly modified the association between weight talk and emotional problems, hyperactivity, and conduct problems Specifically, weight talk in the home was associated with lower scores (i.e., healthier functioning) in each psychological category for Native American children experiencing weight talk in the home, Hmong and Latino children’s psychological scores were not associated with weight talk in the home; and weight talk in the home was associated with higher scores (i.e., less healthy functioning) in African American and Somali children. Neither child sex nor weight status modified the association between weight talk in the home and the examined psychological outcomes.

Table 4:

Adjusted1,2 Associations Between Weight Talk in the Home with Psychological Variables and by Child Sex, Race/Ethnicity, and Child Weight Status

Emotional Problems Hyperactivity Conduct Problems
Weight Talk Mean 95% CI p-value Mean 95% CI p-value Mean 95% CI p-value
No 0.33 (0.24, 0.42) 0.097 0.65 (0.54, 0.75) 0.196 0.4 (0.32, 0.48) <0.001
Yes 0.45 (0.35, 0.55) 0.76 (0.64, 0.88) 0.65 (0.54, 0.75)
Weight Talk1 Mean Difference 95% CI p-value Mean Difference 95% CI p-value Mean Difference 95% CI p-value
Boys 0.14 (−0.05, 0.33) 0.838 0.02 (−0.2, 0.24) 0.273 0.11 (−0.08, 0.31) 0.109
Girls 0.11 (−0.11, 0.33) 0.21 (−0.06, 0.48) 0.38 (0.14, 0.61)
African American 0.29 (0.02, 0.85) 0.004 0.29 (0.03, 0.81) 0.016 0.55 (0.21, 0.89) 0.009
Hmong 0.2 (−0.02, 0.43) 0.14 (−0.15, 0.43) 0.21 (−0.01, 0.43)
Latino −0.06 (−0.34, 0.23) 0.13 (−0.23, 0.48) 0.11 (−0.16, 0.38)
Native American −0.32 (−0.58, −0.06) −0.53 (−1.01, −0.06) −0.25 (−0.59, 0.1)
Somali 0.33 (0.04, 0.63) 0.43 (0.13, 0.73) 0.56 (0.25, 0.86)
Not Overweight 0.15 (−0.04, 0.34) 0.773 0.06 (−0.16, 0.28) 0.616 0.27 (0.08, 0.46) 0.776
Overweight 0.1 (−0.14, 0.34) 0.16 (−0.14, 0.46) 0.22 (−0.04, 0.47)
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1.

Adjusted for parent sex, parent weight status, parent anxiety, parent depression, parent education, household income, child sex, race, and child overweight status.

2.

All analyses excluded White race/ethnicity because of small numbers (n=1) reporting any weight talk. Therefore, the analyses sample was reduced from 149 to 124.

Example interpretation: Weight talk is associated with higher mean conduct problem scores (p=0.001) with differences by race/ethnicity (p=0.009) after controlling for demographic variables and parent anxiety/depression.

Associations between weight talk in the home and social outcomes:

For the analytic sample (n=124), weight talk in the home was significantly associated with peer problems; the mean peer problems score was 0.13 (Cohen’s d = 0.39) points higher for children experiencing weight talk compared to those who did not experience weight talk (p=0.026) (Table 5). Race/ethnicity also modified the association between weight talk in the home and peer problems. Similar to psychological outcomes, weight talk in the home was associated with lower scores (i.e., healthier functioning) in Native American children and higher scores (i.e., less healthy functioning) in African American, Hmong and Somali children. The data do not suggest an association between weight talk in the home and peer problems for Latino children. Girls who experienced weight talk in the home had lowered mean prosocial scores (p<0.05).

Table 5:

Adjusted1,2 Associations By Weight Talk in the Home with Social Variables and by Child Sex, Race/Ethnicity, and Child Weight Status

Peer Problems Prosocial Behavior
Weight Talk Mean 95% CI p-value Mean 95% CI p-value
No 0.41 (0.34, 0.47) 0.026 1.57 (1.48, 1.66) 0.173
Yes 0.54 (0.45, 0.62) 1.47 (1.36, 1.57)
Weight Talk1 Mean Difference 95% CI p-value Mean Difference 95% CI p-value
Boys 0.09 (−0.09, 0.26) 0.420 0.03 (−0.17, 0.23) 0.0499
Girls 0.18 (0.03, 0.33) −0.25 (−0.46, −0.04)
African American 0.29 (0.01, 0.35) 0.002 0.29 (−0.65, 0.07) 0.380
Hmong 0.23 (−0.02, 0.48) −0.12 (−0.38, 0.14)
Latino 0.1 (−0.22, 0.42) 0.12 (−0.24, 0.49)
Native American −0.21 (−0.39, −0.04) 0.08 (−0.23, 0.38)
Somali 0.33 (0.08, 0.58) −0.26 (−0.59, 0.07)
Not Overweight 0.11 (−0.08, 0.29) 0.703 −0.19 (−0.42, 0.03) 0.336
Overweight 0.16 (−0.01, 0.32) −0.03 (−0.26, 0.2)
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1.

Adjusted for parent sex, parent weight status, parent anxiety, parent depression, parent education, household income, child sex, race, and child overweight status.

2.

All analyses excluded White race/ethnicity because of small numbers (n=1) reporting any weight talk. Therefore, the analyses sample was reduced from 149 to 124.

Example interpretation: Weight talk is associated with higher mean peer problem scores (p=0.03) with differences by race/ethnicity (p=0.002) after controlling for demographic variables and parent anxiety/depression.

Discussion

The main aim of this paper was to examine the associations between weight talk in the home and biological, psychological, and social outcomes in diverse children. Additionally, this paper explored whether observed associations differed by child sex, race/ethnicity, and child weight status. Overall, about one third of parents (38%) reported engaging in weight talk with their child; race/ethnicity and child weight status modified this association. Use of weight talk in the home differed by race/ethnicity with only one White parent reporting engaging in weight talk with their child. It may be that White parents address weight with their children but just in a manner different than was assessed in the current study (e.g., a parent discussing dissatisfaction with their own weight). It may also be that White families receive more messaging (e.g., from health care providers, in the media) about the negative outcomes associated with weight talk (Yourell et al., 2021) than other racial/ethnic groups and have reduced weight talk in the home in response to recommendations; similarly, health care messaging regarding best practices for talking about weight may be more tailored to White families. These results indicate the need for education and the development of best practices—both for parents, as well as for providers working with families with young children—for how to limit harmful weight talk in the home. This finding supports a recent scoping review of best practices for discussing child weight with families in a healthcare setting which found there was a strong need for guidance on implementing best practices for weight conversations with children from diverse cultures (McPherson et al., 2017).

Similar to previous research, weight talk in the home was associated with higher child weight status (Trofholz et al, 2018). However, because our study was cross-sectional the direction of these associations (e.g., weight talk in the home and child weight status) is unknown. For example, children who experienced weight talk may become overweight; conversely, children with overweight may have exposure to more weight talk (e.g., encouragement to increase physical activity in order to lose weight). Clear guidance for parents needs to be developed for how parents can best address any child weight concerns they have with their child without engaging in harmful weight talk. Specifically, health care providers should have guidelines developed on how to shift conversations away from weight (Gillison et al., 2016; McPherson et al., 2017) and toward healthy lifestyle behaviors (e.g., the healthy benefits of exercise that are unrelated to weight). Tailored, culturally relevant guidance may be particularly useful for Hmong, Latino, and Somali parents who had the highest frequency of weight talk with their child in the current study. Additionally, parents and healthcare providers should be made aware of other potential harmful outcomes of children exposed to weight talk, including lower body satisfaction (Gillison et al., 2016; McCormack et al., 2011; Neumark-Sztainer et al., 2010), or the use of unhealthy weight control behaviors (Bauer et al., 2013; Fulkerson et al., 2002; Haines et al., 2008; Keel et al., 1997; Smolak et al., 1999).

These study results expand the previous literature base on weight talk by additionally examining weight talk in the home with psychological and social outcomes. Only one previous article was identified that found an association between general weight teasing (i.e., not specific to parental weight talk) and conduct problems in children (Zuba & Warschburger, 2017). In the current study, weight talk in the home was associated with conduct problems (e.g., my child often loses his/her temper) and peer problems (e.g., my child is not well liked by other children) for the full sample. As with weight status, the direction of these associations is unknown; for example, does exposure to weight talk in the home contribute to conduct problems, or does having a child with conduct problems prompt a frustrated parent to engage in weight talk? More research is needed, but the current study suggests that weight talk in the home is associated with children experiencing negative outcomes beyond the weight-related outcomes that have been explored in previous research (Bauer et al., 2013; Fulkerson et al., 2002; Gillison et al., 2016; Haines et al., 2008; Keel et al., 1997; McCormack et al., 2011; Neumark-Sztainer et al., 2010; Smolak et al., 1999; Trofholz et al, 2018). Providers working with parents with child behavior challenges may consider providing anticipatory guidance on how to positively approach with these challenges without involving weight shaming. Further, general messages about how parents should focus on healthy lifestyle behaviors may not be as salient for children with prominent behavior challenges. Future research should investigate how parents concerned about weight can best talk to children with psychological or social behavior issues in a healthful way (McPherson et al., 2017).

Most of the psychological and social variables in our study differed significantly by race/ethnicity, with this general pattern: exposure to weight talk in the homes of African American and Somali children being associated with a negative impact on psychological and social outcomes; no associations were found between weight talk in the home and psychological and social outcomes in Hmong and Latino children; and exposure to weight talk in the homes of Native American children was associated with healthier functioning in psychological and social outcomes. This pattern was seen for emotional problems, hyperactivity, conduct problems, and peer problems. Providers working with families on child behavior may want to consider asking about the occurrence of weight talk in the home, particularly when working with African American and Somali families. Results from the current study also present a clear avenue for future research. Specifically, research should investigate why there are differences in psychological and social outcomes in children experiencing weight talk in the home by race/ethnicity. Qualitative exploration may be helpful in understanding how parents are specifically discussing weight with their child and differences that may emerge by race/ethnicity. In addition, future research should further investigate weight talk in the homes of Native American children. Surprisingly, our data suggests that psychological and social outcomes in Native American children were improved in the presence of weight talk. Weight talk in Native American homes may look very different from weight talk in other family’s homes, which may decrease the negative impacts other studies have found related to weight talk. Alternatively, weight talk may be similar amongst different race/ethnicities, but be perceived differently by Native American children. It is also possible that the weight talk questions used in the current study were not as relevant to a Native American population. Future research should qualitatively investigate weight talk in the homes of Native Americans and children’s response to the weight talk to better understand the ways in which weight talk may be functioning in these households. Additionally, there are other constructs related to child health where outcomes appear to differ across racial/ethnic group. For example, African American children who experience higher levels of authoritarian parenting may have more positive outcomes (e.g., more independence, increased self-regulation) as compared to White children experiencing similar levels of authoritarian parenting. (Authoritarian parenting is usually associated with more negative child outcomes) (LeCuyer & Swanson, 2017). Exploring other such areas of child health that differ—perhaps counterintuitively—by race/ethnicity, may be useful in understanding why Native American children appear to have less negative psychosocial outcomes when exposed to weight talk in the home.

There were many strengths to this study. First, this appears to be the first study to evaluate weight talk in the home with broader biopsychosocial outcomes. Additionally, this study was conducted with a diverse sample of younger aged children, allowing associations to be examined by child sex, race/ethnicity, and child weight status. Additionally, the study benefitted from objective measurements of child weight status and child dietary intake. There were also limitations that need to be considered. Many of the variables were assessed through survey measures, which may increase social desirable responses from participants; some parents may feel uncomfortable reporting weight talk with their children. This may be particularly true for White families, who may receive more messaging about weight talk in the home. White families may also be more influenced by social desirability bias compared to the other race/ethnicities in this study. Additionally, the exact content of what is being said to the child is unknown, and the weight talk measures do not capture all weight talk that might occur in the home environment (e.g., parents talking to each other about their own weight.) Related, while child weight status in the current study was categorized as a biological variable, it is clear that there are many aspects beyond biology that could influence a child’s weight status (Berge, 2009). Furthermore, this is a cross-sectional study and thus temporality of associations is unknown. While this study adjusted for many variables (e.g., demographics, parent mental health), weight is a dynamic and complicated process, and it is possible that there are additional variables not examined that influence the association between weight talk in the home and child biopsychosocial outcomes. Additionally, while the current study’s sample size was large enough to detect interaction effects by racial/ethnic group, the sample size of each individual racial/ethnic group was small (n=25). Future research should use the current study data to inform sample size estimation, particularly for any non-significant outcomes that had large, clinically meaningful effects.

Previous research indicates that there may be ways for parents to approach their children if they have weight concerns that are potentially beneficial for the child, for example, by encouraging healthy eating behaviors (Berge et al., 2013, 2014, 2015b; Gillison et al., 2016). Future research should investigate how parents talk to their children about weight concerns in specific racial/ethnic groups and within the presence of child behavior concerns. It may be that some strategies are more effective in some racial/ethnic groups in promoting positive biopsychosocial outcomes compared to others. Weight talk in the home is also something providers may want to assess when working with families around child behavior concerns. Finally, best practices need to be developed for providers working with families in different contexts (e.g., different race/ethnicities, child behavioral concerns) about how to best talk to their children about weight concerns.

Conclusions

Results from this study indicate that weight talk in the home is associated with biopsychosocial outcomes (e.g., conduct problems, peer problems) for young children beyond the weight-related outcomes explored in previous research with older children. In addition, race/ethnicity moderated associations between weight talk and biopsychosocial outcomes for most results. Findings provide guidance for future research, including the need to better understand how parents of different race/ethnicities talk about weight, and whether children of different race/ethnicities perceive weight talk differently.

Highlights:

  • The presence of weight talk in the home differed by race/ethnicity, with Latino, Hmong, and Somali parents reporting the most weight talk.

  • There was a significant association between parental weight talk and child weight status; a significant association was not found between parental weight talk and child diet quality.

  • Negative and significant associations (e.g., increased emotional problems) were found between weight talk in the home and biopsychosocial outcomes for African American and Somali children; no associations were found for Hmong and Latino children.

  • Positive and significant associations (e.g., reduced conduct problems) were found between weight talk in the home and biopsychosocial outcomes for Native American children.

Funding:

Research is supported by grant number R01HL126171 from the National Heart, Lung, and Blood Institute (PI: Berge). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung and Blood Institute, the National Institute of Child Health and Human Development or the National Institutes of Health. The authors declare that they have no other conflicts of interest to report.

Footnotes

Additional Conflicts of Interest: None to disclose

Informed Consent: All family participants consented/assented to being in the study, and Family Matters protocols were approved by the University of Minnesota’s Institutional Review Board.

Contributor Information

Amanda C. Trofholz, Department of Family Medicine and Community Health at the University of Minnesota, Minneapolis, MN, USA..

Allan Tate, College of Public Health, University of Georgia, Athens, GA..

Susan Telke, Department of Family Medicine and Community Health at the University of Minnesota, Minneapolis, MN, USA..

Katie A. Loth, Department of Family Medicine and Community Health at the University of Minnesota, Minneapolis, MN, USA..

Gretchen J. Buchanan, Department of Family Medicine and Community Health at the University of Minnesota, Minneapolis, MN, USA..

Jerica M. Berge, Department of Family Medicine and Community Health at the University of Minnesota, Minneapolis, MN, USA..

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