Health Education Research, Vol. 14, No. 6, 717-727,
December 1999
© 1999 Oxford University Press
What do mothers feed their children and why?
Nuffield Road Medical Centre, Nuffield Road, Cambridge CB4 1GL and
1 Department of General Practice, GKT, 5 Lambeth Walk, London SE11 6SP, UK
Correspondence to: J. Ogden
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Abstract |
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Health education interventions aimed at changing children's diets often target their mothers. However, little is known about what factors influence mothers' food choice for themselves and how this is related to their choice of food for their children. The present study aimed to examine the types of foods mothers eat themselves and their motivations for doing so in comparison with their choices for their primary school age children. In addition, the study aimed to assess whether the mother's dieting behaviour affected these differences. A questionnaire was completed by 218 (response rate 52%) mothers of children aged between 5 and 11 asking them about their behaviour and motivations for themselves and on behalf of their children. The results showed that mothers tend to feed their children in a less healthy way than they feed themselves. Specifically, they feed their children more sweet products, and more unhealthy breads and dairy products. However, whereas they are motivated more by practicality (e.g. availability, cost) and calories when choosing food for themselves, they state that health (e.g. nutritional value, long-term health) is more important when choosing for their children. In terms of the role of the mothers' dieting behaviour, dieters appeared to be more self-prioritizing than non-dieters in their differentiation between themselves and their children. The results are discussed in terms of the role of knowledge and cognitions in explaining the gaps between motivations and behaviour and the mothers' decisions for themselves and for their children. In addition, the implications for interventions are considered. In particular, it is suggested that changing a mother's own motivations and behaviour may not necessarily result in an improvement in their child's diet. Further, encouraging mothers to diet may be detrimental to their children's long-term health.
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Introduction |
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Many children's diets in the Western world are unsatisfactory. For example, the Bogalsua Heart Study in the US showed that the majority of 10 year olds exceeded the American Heart Association dietary recommendations for total fat, saturated fat and dietary cholesterol (Nicklas, 1995
). Likewise, a survey in the UK by the DHSS in 1989 showed a similar picture with 75% of children aged 10–11 exceeding the recommended target level for percentage of energy derived from fat (Buttriss, 1995). Furthermore, Wardle (Wardle, 1995) reported that 9- to 11-year-old British children showed inadequate intakes of fruit and vegetables, consumed less that half the recommended daily intake on average, and that only 5% of children exceeded the recommended intake.
Such poor diets are important in the light of increasing evidence using both cross-sectional and longitudinal studies that a person's diet has a profound influence on their health. For example, Trichopoulou et al. (Trichopoulou et al., 1995) reported that people who eat a Mediterranean style diet live longer, and Key et al. (Key et al., 1996) argued that longevity was related to the consumption of fruit and vegetables. Furthermore, increased salt consumption is associated with raised blood pressure, which increases the risk of cardiovascular disease (Elliott et al., 1996), and the consumption of certain foods may increase the risk of cancer (Silvester et al., 1997). In terms of longitudinal studies, research has shown that a person's adult health is influenced by their nutrition as a child. For example, Hales et al. (Hales et al., 1991) reported an association between poor fetal and infant growth and impaired glucose tolerance at age 64. Likewise, the development of atherosclerosis which begins in childhood (Moller et al., 1994) has been shown to relate to serum lipid levels in the child (Newman et al., 1986; Berenson et al., 1998). There is also some evidence that dietary habits acquired in childhood persist into adult life. For example, Steptoe et al. (Steptoe et al., 1995) showed that adults prefer to eat foods that they ate as children and longitudinal studies of food intake such as the Minnesota Heart Study (Kelder et al.. 1994) indicate that children who select the least healthy options at baseline continue to do so throughout the study. Further, the Bogalusa Heart Study (Nicklas, 1995) compared the dietary intake of 10 year olds with that of young adults, and found similarities with respect to protein, total fat, dietary cholesterol and sodium.
Children's diets are therefore important both in terms of the child's health and their health in later life. However, the development of food preferences is complicated and not fully understood, although cognitive and social factors appear to be important (Birch, 1987). In terms of cognitive factors, Steptoe et al. (Steptoe et al., 1995) identified health, mood, convenience, sensory appeal, natural content, price, weight control, familiarity and ethical concern as being important for adults. Young children have also been shown to have a concept of healthy foods (Michela and Contento, 1986); however, in the Family Diet Study (Wardle 1995) children's own ratings of the importance of health in food choice were unrelated to the fat or sugar in their diet diaries. In terms of social factors, research has highlighted the role of peer group pressure (Birch, 1987) and television commercials (Peterson et al., 1984). In particular, there is also substantial evidence that parental influence is important. For example, Klesges et al. (Klesges et al., 1991) showed that children will select different foods when they are being watched by their parents compared to when they are not. Likewise, Olivera et al. (Olivera et al., 1992) showed a correlation between mothers' and children's food intakes for most nutrients in pre-school children, and suggested targeting parents to try to improve children's diets. In line with this, Wardle (Wardle, 1995) contends that, `Parental attitudes must certainly affect their children indirectly through the foods purchased for and served in the household, thereby also influencing the children's exposure and, hence, perhaps their habits and preferences'. Further, there is also some evidence that mothers' own motivations affect what they feed their children. For example, Contento et al. (Contento et al., 1993) found a relationship between mothers' health motivation and the quality of children's diets. In addition, research indicates that children choose to eat foods that they have been given the most often, and prefer what is available and acceptable in the parental household (Birch and Marlin, 1982). Further, Beauchamp and Moran (Beauchamp and Moran, 1982) reported that 6-month-old babies who were accustomed to drinking sweetened water chose to take more sweetened water compared to those babies who were not, suggesting that even the apparently inherent preference for sweet tastes may be modified by familiarity.
Therefore parental influences, particularly maternal influences, appear to play in role in children's food choice. Accordingly, one possible method of intervening in children's diets would involve targeting parents. This would be in line with the UK Government recommendations to reduce cardiovascular diseases and cancer, and would concord with the increasing emphasis on health promotion. However, interventions aimed at mothers implicitly assume that changing mothers' beliefs and behaviours would result in a subsequent change in their children's diets. Although, in the main, research has emphasized a positive association between mother's and their children's diets, there is some limited evidence that mothers may have different motivations when choosing food for their children than when choosing food for themselves. For example, Wardle (Wardle, 1995) reported that mothers rate health as more important for their children than for themselves. Further, given the contemporary concern about weight and shape, and research indicating that dietary restraint influences food choice in the individual (Ogden, 1995), it is possible that a mother's dietary restraint may differentially influence their choice of food for themselves and their choice on behalf of their children.
In summary, research indicates a role for maternal influence on children's diets. However, whether the association between mothers' behaviours and beliefs when considering themselves and their children is always a positive one remains unclear. Therefore, the aim of the present study was to examine differences between the types of foods mothers eat themselves and the types of food they feed their children. Further, the study aimed to see if different factors determine the mothers' choice of food for themselves compared with the factors which determine the choice of food for their children in terms of health, practicality, emotions and calories. Finally, the study aimed to assess whether the mothers' own dieting behaviour affected these differences.
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Method |
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Subjects
Mothers or female carers (n = 413) of primary school age children (aged between 5 and 11) who were registered at a Health Centre which served an area of housing estates on the outskirts of Cambridge with a high percentage of young families and of people from social classes IV and V were identified from the practice database. Most families in the practice were Caucasian and there was little racial mix. Men were excluded from the sample as (1) the study aimed to examine mothers, and (2) it was believed that men who made the food choices within the families would be in the minority and would therefore only be represented in small numbers. Two hundred and eleven completed questionnaires were returned, which after correcting for male responders (n = 7) who had probably completed the questionnaire either inadvertently or as a substitute for their partners and those subjects who had moved (n = 8) corresponded to a response rate of 52%.
Design
Mothers were asked to indicate the foods they chose, and their motivations for food choice for both themselves and their children. They were also asked to indicate their degree of dieting behaviour. Accordingly, the study used a within-subjects design with focus (mothers' focus on self versus mothers' focus on their children) as the within-subjects factor. The data was analysed to assess the impact of both focus as the within subjects factor and according to the mother's dieting status, with dieter versus non-dieter as the between subjects factor.
Procedure
Subjects were sent a postal questionnaire with reminders and repeat questionnaires sent at 2 week intervals for 6 weeks.
Measurements
Subjects completed questionnaires consisting of the following items.
Demographics
Subjects recorded their age, sex, weight, height, total number of children, the age of the oldest child, the age of the youngest child and whether they owned their own home. Further, they rated the question `Do you take your weight into account with what you eat?' on a 5-point Likert scale ranging from `Never' (1) to `Very often' (5). This final question has been used as a measure of dieting behaviour (Van Strien et al., 1986) and has been shown to be highly correlated with other items designed to assess dieting behaviour (Ogden, 1993). For non-responders, age, BMI and number of children were identified from the Health Centre's computerized database.
Eating behaviour
Subjects were asked to rate a series of foods for how often they ate them themselves and for how often they fed them to their children on a five-point Likert scale ranging from `Never' (1) to `Every day' (5). Both more healthy and less healthy foods were included and adapted from Buttriss et al. (Buttriss et al., 1994). More healthy foods were generally low-fat, low-sugar, high-fibre and low-salt foods, and less healthy foods were generally the converse. Further, only foods were selected which were not considered predominantly either children's or adults foods (therefore excluding foods such as jelly, fish fingers and curry).
More healthy.
Fruit and vegetables(fresh oranges, boiled/steamed carrots, boiled/steamed peas); breads, cereals and potatoes (boiled potatoes, wholemeal bread, muesli); milk, cheese and yoghurt (skimmed milk, cottage cheese, natural yoghurt); meat, fish, poultry, eggs (roast chicken, grilled fish, boiled eggs); sweets, biscuits, soft drinks (orange or fruit drink, digestive biscuits). These were summated to produce a total healthy food score (mothers for themselves: 
= 0.6; mothers for their children: = 0.6).
Less healthy.
Fruit and vegetables (apple crumble, fried vegetables, fruit pie); breads, cereals and potatoes (chips, fried bread, cornflakes); milk, cheese and yoghurt (whole fat milk, cheddar cheese, strawberry yoghurt); Meat, fish, poultry, eggs (lamb chops, fried fish, fried eggs); sweets, biscuits, soft drinks (chocolate biscuits, crisps, Coca Cola or other soft drink). These were summated to produce a total less healthy food score (mothers for themselves: = 0.5; mothers for their children: = 0.43; it is possible this lower reflects particular families having a policy to not eat certain less healthy foods for reasons relating to factors such as caffeine or allergies).
Motivations
Subjects were asked to choose four foods that they had eaten the previous day and to indicate `to what extent did the following factors influence you in choosing this particular food'. They were then presented with a series of the motivational factors and asked to rate each one on a five-point Likert scale ranging from `Not at all' (1) to `Totally' (5). Then they were asked to do the same for four foods that they had chosen for their children. It was decided to ask the mothers to chose the foods rather than to provide them with a list of foods as a means to enable the mothers to place their motivations within the context of real food consumption as opposed to hypothetical food consumption. Therefore, the study aimed to access `on line' rather than `off line' cognitions (Gold et al., 1991). Accordingly, the foods chosen were used solely as a means to access the mothers' motivations and to facilitate the mothers' recall of these motivations rather than as indications of actual foods consumed. The motivational factors were based upon those identified as factors influencing people when they choose food for themselves and for their children (Steptoe et al., 1995; Wardle, 1995).
(i) Health (nutritional value, long-term health value, safety; for themselves: = 0.77; for children: = 0.8). (ii) Calories (calorie content). (iii) Practicality (cost, time taken or difficulty/ease of preparation, it was available, it is better to eat something which is not ideal than not to eat anything: for themselves: = 0.49; for children: = 0.43). (iv) Emotional (taste of food, it is a reward, it is a treat, comfort: for themselves: = 0.72; for children = 0.69).
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Results |
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The results were analysed in the following ways: (1) to describe differences between responders and non-responders, and to describe subjects' demographics using descriptive statistics,
2 for non-parametric data and one-way ANOVA for parametric data; (2) to examine differences between mothers' behaviours and motivations for themselves, and their behaviours and motivations on behalf of their children using paired t-tests; and (3) to examine the role of mothers' own dieting behaviour on the differences between the mothers' behaviours and motivations for themselves and those on behalf of their children using two-way repeated measures ANOVA. Focus (mother for self/mother for child) was included as the within subject factor and dieting status (dieter versus non-dieter) was included as the between subject factor. Tukey's post hoc tests were used to examine the direction of any differences.
Description of subjects
Responders versus non-responders
Responders were significantly older (mean age 35.6 versus 34.2, P < 0.01) and had a significantly lower BMI (mean BMI 24.2 versus 26.2, P < 0.0005) than the non-responders. However, the two groups were matched in terms of numbers of children (mean no. 2.44 versus 2.59, P = 0.31). (It is important to note that age, BMI and number of children were taken from the practice records from the non-responders, and were based upon self-report for the responders).
Demographics
Subjects' demographic factors are shown in Table I. On average the subjects were in their 30s and of a healthy weight. The subjects were equally divided in terms of owning their own home or not. In addition, about half answered `often' or `very often' to the question `how often do you take your weight into account with what you eat?'. These latter people were categorized as being dieters.
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Differences in mothers' behaviours and motivations for themselves and for their children
Behaviour
The mothers' own food intake compared with the foods they fed to their children are shown in Table II
. In terms of the individual items, the results showed that mothers feed their children significantly more sweet products (both more and less healthy), more of the less healthy breads, cereals and potatoes, more of the less healthy dairy products, and more of the healthier meat, fish and poultry products than they feed themselves. In addition, they tended to feed themselves significantly more of the healthier breads, cereals and potatoes, more of the healthier dairy products, and more of the less healthy meat products. In terms of the overall scores the results showed that mothers feed themselves significantly more healthy foods than their children and they feed themselves significantly less of the less healthy foods. The results showed that mothers did not differentiate between themselves and their children for either healthier or less healthy fruit and vegetables.
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Motivations
The mothers provided details of a range of foods for both themselves and their children. However, these were not used as a means to determine actual food intake as they were often insufficiently clear in terms of how they were prepared or what they consisted of (e.g. chicken dinner, vegetables, sweet). Accordingly, they were used solely to enable the mothers to focus on their motivations. The differences between the mothers' motivations for themselves and on behalf of their children are shown in Table III
. The results showed that for individual items, mothers reported they were significantly more motivated by calorie content, availability, cost and time taken/difficulty of preparation for themselves than when choosing food for their children. In contrast, when choosing food for their children they were significantly more motivated by the long-term health value and nutritional value. In terms of the overall scores, the results showed that mothers were significantly more motivated by calories and practicality when choosing food for themselves, and significantly more motivated by health factors when choosing food for their children. The mothers did not differentiate in terms of safety, the belief that it is better to eat something than nothing or any aspects of emotion-based motivations.
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Effect of mother's dieting status on reported behaviour and motivations
On the basis of the question `how often do you take your weight into account with what you eat?', subjects were divided into dieters (scored `often' or `very often', n = 93) and non-dieters (scored `never', `seldom' or `sometimes', n = 103). Table IV
shows the results for the total scores for behaviour and motivations for dieters and non-dieters. The results showed a significant main effect of dieting on the behaviour of choosing less healthy food, and the motivations of health and calories. Therefore, regardless of focus, dieters reported choosing fewer of the less healthy foods, and rated health and calories as more important than the non-dieters. The results also showed a significant main effect of focus (i.e. was the choice for self or for child) for the behaviours of choosing healthy and unhealthy food, and the motivations health, practicality and calories. This indicates that regardless of dieting status, the mothers differentiated between these factors when considering themselves and when considering their children. The results also showed significant diet group by focus interactions for the behaviours relating to choosing healthy and unhealthy food, and the motivations relating to health, calories and emotion. Post hoc tests (Tukey) were used to examine the direction of these differences. For healthy food, the results indicated that whereas non-dieters reported no difference between their choice of healthier food for themselves and for their children (P > 0.05), dieters indicated that they chose more of the healthier foods for themselves than for their children (P < 0.005). Dieters and non-dieters did not differ in the amount of healthier food they chose for their children (P > 0.05). For less healthy food, both dieters and non-dieters indicated that they chose more of the less healthy foods for their children than for themselves (P < 0.0001); however, the difference between self and child was greater for the dieters (P < 0.001). Dieters and non-dieters did not differ in the amount of less healthy food they chose for their children (P > 0.05).
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In terms of motivation, for `health' post hoc tests indicated that although non-dieters rated health as more important for their children than for themselves (P < 0.001), dieters showed no difference between their ratings for themselves and for their children. However, both dieters and non-dieters rated health for their children equally (P > 0.05). For the motivation `calories', post hoc tests indicated that whereas non-dieters rated calories as equally important for both themselves and their children (P > 0.05), dieters rated calories as more important for themselves than for their children (P < 0.001). However, both dieters and non-dieters rated calories as equally important for their children. Finally, for the motivation `emotion', post hoc tests failed to identify any significant differences.
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Discussion |
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The present study aimed to examine the types of foods mothers eat themselves and their motivations for doing so in comparison with their choices for their primary school age children. In addition, the study aimed to assess whether mothers' dieting behaviour effected these differences. However, there are some limitations with the present study which need to be addressed. Firstly, the response rate was quite low. This was probably because the questionnaire was long and mothers with young children are a busy population to sample. Further, there were also some differences between the responders and non-responders in terms of age and BMI. This may indicate that the sample was not representative of mothers in general and that older, lighter mothers are more motivated to complete a questionnaire on food intake. However, these differences may reflect the discrepancy between self-report BMI (for the responders) and BMI based upon practice records (for the non-responders). Furthermore, the classification of the subjects into dieters and non-dieters was based upon a single item. However, this item has been shown to be highly correlated with other measures of dieting behaviour (Ogden, 1993
) and the distribution of responses to this single item had face validity. Further research could attempt to address these issues by accessing mothers directly (possibly at school meetings or when visiting the GP) and by including more complex measures of dieting behaviour.
In terms of the differences between mothers' food choice for themselves and for their children, mothers recorded feeding themselves significantly more healthy foods than they did their children and recorded feeding their children significantly more less healthy foods than they fed themselves. In particular, they reported feeding their children less healthy dairy products, breads, cereals and potatoes, and fewer of the healthy equivalents to these foods. Research indicates that children have less healthy diets than recommended (Buttriss, 1995). The present study indicates that this may be a result of the foods their mothers are choosing for them. Further, the results indicate that encouraging mothers to eat healthily may not directly translate into an improvement in their children's diets. In terms of the differences in motivations, the mothers reported factors such as calories and practicality including costs, time and availability as more important for themselves, and health including nutrition and long-term health as more important for their children. These motivations have been shown to be important when adults are choosing food for themselves (Steptoe et al., 1995) and when choosing food for their children (Wardle, 1995). The results from the present study indicate that the relative importance attached to these different motivations may vary according to whether the food choice is for the mother or on behalf of the child.
There seems, however, to be a contradiction in these results. Mothers stated that they fed their children less healthy foods than they feed themselves and yet in contrast reported health as being a more important motivator when making food choices on behalf of their children. There are several possible explanations for this. Firstly, these results may be a product of questionnaire completion. Accordingly, the mothers may have answered the behaviour aspect of the questionnaire honestly but may have been influenced by social desirability when answering the more transparent motivations section. Research using methods such as observation or involving a laboratory controlled environment are needed to explore this further. Secondly, the results may reflect a genuine gap between motivations and behaviour, and indicate a role for knowledge. In line with this explanation, it is possible that mothers may be motivated by health for their children and believe that they are feeding their children healthily, but do know what constitutes a healthy diet. Such an explanation concords with health education interventions which aim to target mothers' knowledge as a means to improve their children's diets and would support the suggestion that improved maternal knowledge would result in mother's making food choices which were in line with their healthy motivations. However, this does not explain why mothers appear to be eating a healthier diet themselves. Thirdly, these results may reflect a gap between motivations and behaviour, not in terms of knowledge, but in terms of cognitions which impinge upon the translation of motivations into behaviour. Social cognition models such as the Health Belief Model (Becker and Rosenstock, 1987) and the Theory of Reasoned Action (Fishbein and Azjen, 1975) assume that motivations are translated into behaviour. However, in contrast, research focusing on eating behaviour describes both how the motivation to eat healthily may not be translated into healthy eating (Povey et al., 1998) and even that the motivation to eat less may result in eating more (Ogden, 1995). The results from the present study support this approach and suggest that motivations may not result in corresponding behaviour, particularly if the motivations relate to food intake; possibly because other cognitions intrude. In the light of contemporary concerns about weight and shape, and the complex context within which eating takes place, perhaps cognitions relating to weight concern can explain the motivation/behaviour gap. Perhaps such cognitions can also help to explain the gap between motivations and behaviours for the mother themselves and those for their children. The results from the assessment of the role of dietary restraint provide some support for this suggestion.
In terms of the overall effect of dieting, dieters recorded choosing less of the less healthy foods overall and rated health and calories as more important motivations than non-dieters. This provides support for research indicating that dieters eat more healthily than non-dieters (e.g. Laessle et al.; 1989) but conflicts with the suggestion that dieting results in overeating and the consumption of more of the foods they are attempting to avoid (Ogden, 1995). However, the results showed that this pattern was related to whether the mother was considering themself or their children. In particular, dieters rated calories as more important for themselves and reported feeding themselves more healthy foods than they fed their children. Further, dieters reported feeding their children more unhealthy foods than they fed themselves when compared to the non-dieters. In contrast, non-dieters rated health as more important for their children than themselves. Therefore, overall, the dieters appeared to be more self-prioritizing than the non-dieters, and showed greater differentiation between themselves and their children than the non-dieting women. A possible interpretation of these results is that dieting mothers are restraining their own food intake, but finding release from the tensions this causes by feeding their children some of the foods that they themselves are forbidden. Dieters have been shown to overeat in situations where their mood is low or when they have consumed a food believed to be forbidden (Ogden, 1994). It is conceivable that dieters with children might displace this behaviour onto their children so that the mothers maintain their own healthy food intake, but feed their children less healthy foods. Further evidence for this comes from the observation that dieters had a higher health motivation than non-dieters when choosing food for themselves, but did not feed their children more healthily than non-dieters. It would seem, therefore, that the gap between motivations and behaviour may be dependent upon whether the mother is a dieter or not; dieters show greater health motivations than non-dieters but are even less likely to feed their children healthy foods. Further, in terms of the gap between the mothers motivations and behaviours for themselves and those for their children, the results indicate that this gap may also related to the mother's dieting status; the gap between self and child is particularly apparent in dieting women.
To conclude, the results indicate that mothers feed themselves differently than they feed their children. The results also show that mothers differentiate between themselves and their children in terms of their motivations for these food choices. Specifically, mothers feed their children less healthy foods but state that health is a more important motivator. The results also indicate a role for the mother's dieting status. In particular, the results suggest that cognitions relating to weight concern may interfere with the translation of motivations into behaviour. The results also indicate that the gap between self and child may be particularly apparent in women who diet, with dieters being more self-prioritizing. Such findings have implications for research. For example, future research could further explore the factors which may impinge upon the translation of motivations into behaviour and in addition examine how this translation may differ according to whether self-directed or other directed cognitions are being considered. This is particularly relevant for research using social cognition models with their emphasis on using cognitions to predict both motivations and behaviour [e.g. (Povey et al., 1998)]. In addition, such an approach could also be relevant to the study of other health-related behaviours such as smoking and drinking, and particularly be applicable to behaviours in which mothers act as a role model or educator for their children. The results also have implications for the development of health-related interventions. Primarily, the results suggest that interventions aimed solely at changing mothers' own food choices and motivations may have limited effectiveness for improving their children's diets. Secondly, the results suggest a potential conflict between the goals of different health-related interventions. On the one hand, interventions are designed to improve the content of children's diets. On the other hand, interventions are also designed to promote weight loss. However, it is possible that encouraging mothers to diet may be detrimental to their child's food intake, both by increasing the gap between the mothers' motivations and behaviour, and by promoting a tendency to self-prioritize. Therefore, whereas interventions aimed at changing mothers' own motivations and behaviours may be ineffective, interventions designed to promote weight loss may be harmful. Accordingly, interventions to promote healthy diets in childhood should be aimed at changing mothers' motivations and behaviour on behalf of their children. Furthermore, interventions aimed to promote weight loss in mothers of young children should only be implemented if the possible gains to the mother outweigh the possible costs to the child. Research is needed to address these issues further.
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Acknowledgments |
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This project was completed as part assessment for the MSc in General Practice, UMDS (T. St J. A.).
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Received on September 18, 1998; accepted on January 24, 1999
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