Appetite 120 (2018) 491e499

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Appetite
journal homepage: www.elsevier.com/locate/appet

Predictors of obesity and overweight in preschoolers: The role of

parenting styles and feeding practices
H. Melis Yavuz a, *, Bilge Selcuk b
a
MEF University, Department of Psychology, Maslak Ayazag
a Cd No:4, 34396, Istanbul, Turkey
b
Koc University, Department of Psychology, Rumelifeneri Yolu, Sariyer, 34450, Istanbul, Turkey

a r t i c l e i n f o a b s t r a c t

Article history: Childhood obesity/overweight (OB/OW) displayed a rapid increase and high prevalence in the last few
Received 8 November 2016 decades in preschool-aged children, which raised health concerns across the world and motivated re-
Received in revised form searchers to investigate the factors that underlie childhood obesity. The current study examined
16 August 2017
parenting styles and child-feeding practices as potential predictors for OB/OW in preschool children,
Accepted 2 October 2017
Available online 5 October 2017
controlling for child's temperament, which has been shown to be linked with OB/OW. The sample
included 61 normal weight (NW) and 61 obese/overweight (OB/OW) Turkish pre-schoolers (M age ¼ 62.2
months; SD ¼ 7.64, range ¼ 45e80 months). Parenting styles (authoritarian, authoritative), child-feeding
Keywords:
Obesity
practices (restriction, pressure to eat, monitoring), and child's temperament (negative affectivity) were
Overweight measured with mothers' reports. Results showed that authoritarian parenting and maternal pressure to
Parenting styles eat were the two parenting variables that significantly predicted child's weight status; the odds of being
Child-feeding practices OB/OW was 4.71 times higher in children whose mothers used higher authoritarian parenting style, and
Child temperament was 0.44 times lower when mothers pressured their child to eat. These findings suggest that under-
standing the unique role of different aspects of parenting in the risk of early OB/OW status of children
would be important in developing more effective interventions from early years in life.
© 2017 Elsevier Ltd. All rights reserved.

Being overweight or obese in childhood has become an impor-
tant health concern across the world, even in preschool-aged
children (Wang & Lobstein, 2006), with the prevalence rate
increasing from 4.2% to 6.7% between 1990 and 2010 for children
younger than 5 years-old (De Onis, Blossner, & Borghi, 2010). This
rate of increase, especially in young children, is highly worrying
since being overweight or obese in childhood tend to persist into
adulthood (Magarey, Daniels, Boulton, & Cockington, 2003; Reilly
et al., 2003), and is related to various negative physiological (e.g.,
lower life expectancy, higher likelihood of coronary hearth dis-
eases) and psychological (e.g., higher anxiety, depression, conduct
behaviours) outcomes both concurrently and longitudinally
(Eschenbeck, Kohlmann, Dudey, & Schürholz, 2009; Reilly & Kelly,
2011). The prevalence rates are also high in children in Turkey, with
8.5% of children under the age of 5 being obese and 17.9% of them
being overweight (The Nutrition and Health Survey of Turkey,
2014); and this makes it important to investigate the factors that
* Corresponding author.
E-mail addresses: murenm@mef.edu.tr (H. Melis Yavuz), bselcuk@ku.edu.tr
(B. Selcuk).
are associated with being overweight or obese in early childhood
years. The current study examined the unique role of maternal
parenting styles and maternal feeding practices in weight status
(i.e., obesity or overweight [OB/OW] or normal weight [NW]) of
Turkish pre-schoolers while controlling for temperamental nega-
tive affect and parental BMI.
1. Parental child-feeding practices and childhood obesity/
overweight
Restriction, pressure to eat, and monitoring are the three most
widely studied parental child-feeding practices that are linked to
child's eating styles and weight status (Birch et al., 2001; Faith,
Scanlon, Birch, Francis, & Sherry, 2004b; Ventura & Birch, 2008).
‘Restriction’ represents parental constraint of child's access to or
intake of certain foods; ‘pressure to eat’ includes behaviours like
forcing child to eat certain foods and finishing up everything on
one's plate; and ‘monitoring’ refers to parents' keeping track of
child's food intake (Birch et al., 2001; Blissett, 2011).
Even though parents may aim to increase healthy eating via
pressuring their children to eat healthy foods, monitoring child's

https://doi.org/10.1016/j.appet.2017.10.001
0195-6663/© 2017 Elsevier Ltd. All rights reserved.
492 H. Melis Yavuz, B. Selcuk / Appetite 120 (2018) 491e499
food intake, and restricting non-healthy foods, previous research
has generally shown unintended consequences of especially pres-
suring and restricting behaviours on child eating patterns and
weight. For example, maternal restriction of certain foods was
linked to an increase, rather than a decrease, in child's preference
and consumption of that food, both concurrently in childhood and
longitudinally in adulthood (Birch, Fisher, & Davison, 2003; Faith
et al., 2004b; Fisher & Birch, 1999). Furthermore, these restrictive
behaviours decrease child's self-control over their eating behav-
iours (Johnson & Birch, 1994) and increase eating in the absence of
hunger (Birch et al., 2003). In return, children who are more
restricted tend to have higher BMI (Faith et al., 2004b; Taylor,
Wilson, Slater, & Mohr, 2011), although the direction of causation
is not clear.
In a similar vein, several studies have indicated that when
children were pressured to eat healthy foods, their consumption of
and preference for that food decreased, yet consumption and
preference for non-healthy foods increased (Galloway, Fiorito,
Francis, & Birch, 2006; Lee, Mitchell, Smiciklas-Wright, & Birch,
2001). When parents used high pressure for healthy foods, children
were found to eat unhealthy snacks more and fruits and vegetables
less, and were less willing to try new food (Brown, Ogden, Vo € gele, &
Gibson, 2008). Retrospective studies also revealed that young adult
participants reported disliking and not preferring to eat the food
that they were pressured to eat as children (Batsell, Brown,
Ansfield, & Paschall, 2002). However, this preference of non-
healthy foods did not always translate into higher BMI in child-
hood years; since several cross-sectional and longitudinal studies
showed the opposite effect, that children who were pressured to
eat had lower BMI (Birch et al., 2003; Blissett & Haycraft, 2008;
Faith et al., 2004a; Taylor et al., 2011). It must, however, be also
noted that some studies reported a positive influence of parental
pressure to eat over child eating behaviours, showing that children
ate more fruits and vegetables when they were pressured (e.g.,
Bourcier, Bowen, Meischke, & Moinpour, 2003). Therefore, the role
of pressure to eat in eating behaviours is not conclusive, and
although some studies linked being pressured to eat to unhealthy
eating behaviours, this was not always found to translate into
higher BMI in early childhood years.
Another parental feeding behavior that is relatively less exam-
ined is parental monitoring of child food intake. Parental moni-
toring has generally been found to have a positive influence on
children's eating habits and behaviours. Studies reported that when
mothers monitored their children's eating behaviours, they were
less likely to eat non-healthy and more likely to eat healthy foods
(Klesges, Stein, Eck, Isbell, & Klesges, 1991), and had lower BMIs
longitudinally (Faith et al., 2004a). On the other hand, there are also
some studies which did not find any significant link (e.g., Farrow &
Blissett, 2008), hence, the results for the role of monitoring in child
weight are not conclusive as well.
2. Parenting styles and childhood obesity
Parenting style is another aspect of parenting that has been
associated with childhood obesity. It is defined as “a constellation
of attitudes toward the child that are communicated to the child
and create an emotional climate in which the parent's behaviours
are expressed” (Darling & Steinberg, 1993, p. 493). Authoritative
and authoritarian parenting are two parenting styles that have
been widely investigated in relation to child outcomes. Authorita-
tive parents exert control over their child's behaviours but they also
display high warmth and responsiveness, whereas authoritarian
parents show high control and low levels of warmth/responsive-
ness. These parenting styles have been reported to influence chil-
dren's self-regulatory skills. Especially high levels of parental
control was found to limit children's ability to control themselves
over various situations, including eating, and self-regulation
problems are associated with weight problems (Francis &
Susman, 2009; Grolnick & Farkas, 2002). Therefore, several
studies linked these parenting styles with child weight status.
Longitudinally, the children reared by authoritative parents have
better health trajectories including lower risk for obesity, as well as
higher physical activity and lower sedentary behaviours compared
to children reared by authoritarian parents (Lohaus, Vierhaus, &
Ball, 2009). Even though some studies found no significant link
between authoritarian and authoritative parenting styles and child
weight-related outcomes (e.g., caloric intake, BMI; Agras, Lawrence,
Hammer, McNicholas, & Kraemer, 2004; Blissett & Haycraft, 2008;
De Bourdeaudhuij et al., 2009), other cross-sectional (Chen &
Kennedy, 2004; Kremers, Brug, de Vries, & Engels, 2003) and lon-
gitudinal studies (Lohaus et al., 2009; Rhee, Lumeng, Appugliese,
Kaciroti, & Bradley, 2006) have shown better dietary habits and
lower BMI in children who had authoritative parents (also see
Enten & Golan, 2008; Sleddens, Gerards, Thijs, De Vries, & Kremers,
2011 for reviews), and linked the presence of authoritarian and
highly controlling parenting to unhealthy eating and higher BMI
(Kakinami, Barnett, Seguin, & Paradis, 2015; Kim et al., 2008; Rhee
et al., 2006). Most of these studies controlled for maternal educa-
tion (e.g., De Bourdeaudhuij et al., 2009) and maternal BMI (e.g.,
Kim et al., 2008), suggesting that these associations are present in
different demographic groups; whereas some studies did not
control for such demographic factors (e.g., Agras, Hammer,
McNicholas, & Kraemer, 2004; Kremers et al., 2003); with some
showing the influence of parenting styles and some not showing,
regardless of the control variables.
The results from intervention studies that incorporated general
parenting styles in their child obesity programs are also promising:
Several studies reported benefits of targeting parenting styles on
child weight-related outcomes (Bocca, Corpeleijn, Stolk, & Sauer,
2012; Brotman et al., 2012; Quattrin et al., 2012; Stark et al.,
2011). When parents with preschool children received a training
to increase positive parenting (i.e., increased responsiveness and
decreased negative control), children displayed lower increase in
BMI over the course of 5 years, and had lower BMI and obesity in
the longitudinal follow-up after 5 years (Brotman et al., 2012).
These findings suggest further investigation of the role of maternal
parenting styles in childhood OB/OW problems.
3. Temperament and childhood obesity
Although environmental characteristics like the availability of
energy dense foods and ease of sedentary lifestyles contribute to the
development of OB/OW, some children are more susceptible to
developing weight problems than others. Temperamental charac-
teristics reflect constitutionally based and relatively stable individ-
ual differences that are apparent from early years of life and are
generally stable across contexts (Sanson, Hemphill, Yagmurlu, &
McClowry, 2011). Previous research suggested that children's
temperamental characteristics might be associated with their OB/
OW problem. Among temperamental characteristics, the children
who have high negative affectivity in infancy were suggested to have
higher risk for obesity. The infants with negative affectivity are
fussier in general and are harder to soothe. In return, the parents who
have infants with negative temperamental affectivity were sug-
gested to be more likely to feed their infant with the aim of soothing,
as compared to the satiety cues of the baby (Stifter, Anzman-Frasca,
Birch, & Voegtline, 2011), which increases the likelihood of devel-
oping emotional eating. Therefore, it is argued that the feeding with
the aim of soothing increase child's eating as a response to emotions
rather than hunger in later years as well and cause poorer self-
 H. Melis Yavuz, B. Selcuk / Appetite 120 (2018) 491e499
regulation in eating; all of which contribute to early and sustained
obesity (Anzman-Frasca, Stifter, & Birch, 2012). Although this link is
not conclusive and literature presents mixed results about the role of
negative temperamental characteristics in obesity (see Anzman-
Frasca et al., 2012 for a review); in the current study we aim to
investigate whether temperamental negative affectivity is related to
OB/OW problems in preschool years or not and, more importantly, to
control for temperamental negative affectivity when we try to
differentiate the role of parenting styles and parental child feeding
behaviours in childhood OB/OW problems.
4. Childhood obesity/overweight and parenting in Turkey
Turkish children display high prevalence of OB/OW in preschool
years (17.9%; The Nutrition and Health Survey of Turkey, 2014) even
more so than the rates in developing (6.1%; e.g., Egypy, Cambotia,
Albania) and developed (11.7%; e.g., Europe and North America)
countries (De Onis et al., 2010). Previous studies revealed that when
Turkish mothers perceive their child as overweight, they do not
further encourage their child to eat or feed their child upon
emotional distress of the child (e.g., Yilmaz, Erkorkmaz, Ozcetin, &
Karaaslan, 2013). However, Turkish parents generally regard
chubby children as healthier (Yilmaz & Osaz, 2009), do not regard
overweightedness in childhood as a health problem, and are not
aware of obesity in their children (e.g., Peker, et al., 2014; Savashan,
Sarı, Aydogan, Erdal, & &, 2015; Yilmaz et al., 2013). In a meta-
analyses conducted with 69 articles including samples across the
globe (e.g., USA, Australia, Italy, Turkey), it is found that half of the
parents of 2-16-year-old children underestimated their child's
weight (Lundahl, Kidwell, & Nelson, 2014). Studies in Turkey show
that this rate is even higher. For instance, only 2% of the parents of
obese children (2-14-year-olds) perceived their child as obese,
whereas 33% of them perceived that their child had ideal weight,
and 55% of parents who had overweight children and 90% of par-
ents who had obese children perceived their child as thinner than
the he/she is (Peker et al., 2014). Another study revealed that 65% of
Turkish mothers (of 6-11-year-old children) who had an obese child
and 75% of mothers who had an overweight child were happy with
the weight of their child and reported that they did not perceive
their child as overweight (Savashan et al., 2015). These findings
were independent from parental education and BMI (Peker et al.,
2014; Savashan et al., 2015), while higher income was related to
higher risk of obesity (Savashan et al., 2015). It is plausible that this
misperception of child weight would be related to maternal child
feeding problems. More specifically, if mothers perceive their child
to be thinner than the child is, and if they regard chubby children as
healthier, they might be prone to overfeed their child. To date, very
few studies were conducted to investigate the role of maternal
child-feeding practices and childhood obesity. Yet, these studies
reached to a common conclusion that Turkish mothers who restrict
their child's eating have children with higher BMIs, and those who
pressure their child to eat have children with lower BMIs (Camci,
Bas, & Buyukkaragoz, 2014; Cebeci & Guven, 2014). In these
studies, maternal monitoring was not found to be related with child
BMI.
Regarding parenting styles, Turkish mothers are found to
display high warmth but also high controlling behaviours and po-
wer assertion in order to secure obedience in their children
(Kagitcibasi, 2010; Sen, Yavuz, & Yagmurlu, 2013). However, within
cultural differences are present, with mothers who have higher
education using less negative control with their children as
compared to mothers with lower education (e.g., Nacak, Yagmurlu,
Durgel, & van de Vijver, 2011). Still, within this context, the mothers
who are more controlling to their children might display high
control in eating settings as well, diminishing child's development
493
of self-regulation in eating, and increasing the risk for obesity. To
the best of our knowledge, the present study is the first attempt to
investigate the association between parenting styles and the OB/
OW problems of Turkish pre-school children.
5. Present study
Even though biological factors such as genes and genomic dis-
positions, as well as metabolic and hormonal dysregulations are
associated with the development of obesity (Snyder et al., 2004;
Speiser et al., 2005), they cannot fully explain the rapid increase
in obesity in the last decades. Understanding the factors related to
the OB/OW in preschool years would be highly helpful in devel-
oping early and cost effective intervention programs (Heckman,
2006) that may prevent a host of negative psychological and
physiological outcomes concurrently and in later years. Parenting
appears as an important factor that is targeted in childhood obesity
programs. Examining both general parenting styles as well as
specific parental feeding practices for their role in childhood
obesity and overweight problems might benefit such programs by
revealing which specific parenting aspects are more influential,
hence, should be targeted. Different from the majority of earlier
studies, in this research, we focused on early childhood years dur-
ing which children develop eating habits that prevail in later stages
of life (Faith et al., 2012) and are more susceptible to parental in-
fluence (Clark, Goyder, Bissell, Blank, & Peters, 2007). And we
examined the roles of both parenting styles and child-feeding
practices in weight status of children (i.e., being OB/OW vs NW),
controlling for child temperamental negative affectivity. We also
took mother and father BMI, and maternal education as control
variables, since studies have reported that these are important
demographic information that predict child BMI (Gibson et al.,
2007; Patrick & Nicklas, 2005; Reilly et al., 2005) and since previ-
ous studies also controlled for these effects (e.g., Kim et al., 2008).
Despite the high prevalence and the misperception of parents'
views of their child's weight, to the best of our knowledge, no
studies to date have investigated the role of parenting in OB/OW
outcomes in young Turkish children and most studies in the liter-
ature are based on Western samples. The current study will
improve upon previous studies by providing further information
from a non-Western culture. Based on the extant literature, we
hypothesized that parenting styles and parental feeding practices
would contribute to child's weight status. There are very few
studies conducted with Turkish population and they only investi-
gated the role of maternal child feeding behaviours in child BMI,
which suggested that higher restriction and lower pressuring being
related to higher BMI in children (e.g., Camci et al., 2014). Therefore,
we also expected children to have OB/OW problems more when
they had mothers who reported using more restrictive feeding, and
less pressuring in feeding. The studies conducted with Turkish
samples did not show the any associations between monitoring and
child BMI, therefore we investigated the role of monitoring without
a directional hypothesis. As reported above, to the best of our
knowledge, no studies investigated the influence of parenting
styles on child weight outcomes in Turkish populations. However,
we expect that the role of parenting would be similar in the Turkish
culture therefore as shown in the studies conducted with Western
populations, we hypothesize that the mothers who were more
authoritarian would be more likely to have OB/OW children and
mothers who were authoritative would be more likely to have NW
children. Moreover, although very few in number, some studies
have suggested for an interaction between parenting styles and
feeding practices as well as parental feeding practices in predicting
childhood OB/OW (Rhee, 2008; Taylor et al., 2011). These interac-
tion effects were also explored.
494 H. Melis Yavuz, B. Selcuk / Appetite 120 (2018) 491e499

6. Method on their ages. The children whose BMIs were between 85th and
95th percentile were defined as overweight and the children whose
6.1. Participants BMIs were above 95th percentile were defined as obese.

The sample included two groups of pre-schoolers: The first
group was composed of normal weight (NW) children and the
second group was composed of children who were obese or over-
weight (OB/OW) according to the international standards for OB
and OW differentially specified for age and sex of children (Cole,
Bellizzi, Flegal, & Dietz, 2000). Both groups were composed of 61
children (29 girls in each group). The OB/OW group was composed
of 13 obese (4 girls) and 48 overweight (25 girls) children. Mean
zBMI for NW group was 06 (SD ¼ 0.78) and was 2.13 (SD ¼ 0.87)
for OB/OW group (F(1,121) ¼ 211.75, p < 0.001, h2p ¼ 0.64).
The majority of the children in the OB/OW (85.2%) and NW
(91.8%) groups were coming from intact families. The mothers' age
ranged from 24 to 45 years for the whole sample (Mage ¼ 35.05,
SD ¼ 4.12), was between 25 and 44 for NW group (Mage ¼ 35.33,
SD ¼ 3.86) and between 24 and 45 for OB/OW group (Mage ¼ 34.89,
SD ¼ 4.30). Statistics show that, in Turkey, educational level of
women is low, with only 14.4% of women (25-year-old or older)
completing high school education and only 10.7% of women
obtaining a 2-or 4-year university education (The Statistical
Institute of Turkey, 2013). In the current sample, mothers' mean
years of schooling was about 14 in both groups (see Table 1 for
descriptive statistics for each group), which coincides with a 2-year
or 4-year university education. Therefore, the majority of the
mothers in our sample were coming from middle-high educated
group of mothers in Turkey.
6.2. Measures
6.2.1. Background information
Mothers completed a demographic information form to provide
information on their child's age, their own educational status, their
height and weight. Fathers also completed a demographic form
providing information on their height and weight. Height and
weight information were utilized to calculate mother and father
BMIs (weight/height2).
6.2.2. Body mass index and obesity status
The BMI of children was calculated based on the information of
their height and weight measured during home visits. Childhood
overweight and obesity were defined by the cut-off points specified
by Cole et al. (2000) separately for female and male children based
6.2.3. Maternal child-feeding practices
The Child-feeding Questionnaire (CFQ; Birch et al., 2001) was
used to measure maternal behaviours regarding parental control
over child feeding. Three subscales of CFQ that were used in the
current study were Restriction (8 items; e.g., ‘I intentionally keep
some foods out of my child's reach’), Pressure to eat (4 items; ‘My
child should always eat all of the food on her plate’), and Moni-
toring (3 items; e.g., ‘How much do you keep track of the high-fat
foods that your child eats?’). All items were rated on a 5-point
Likert scale, ranging from 1 (disagree/never) to 5 (agree/always).
Item scores were averaged to compute the total scores for each
subscale. The Cronbach's alphas were 0.83, 0.79, and 0.89 for Re-
striction, Pressure to eat, and Monitoring, respectively.
6.2.4. Maternal parenting styles
The Parenting Styles and Dimensions Questionnaire (PSDQ;
Robinson, Mandleco, Olsen, & Hart, 1995) was used to measure the
level of authoritarian and authoritative parenting styles of mothers.
Authoritarian Parenting subscale was composed of 12 items that
measured verbal hostility, physical coercion, and non-reasoning
(e.g., ‘Use physical punishment as a way of disciplining the child’).
Authoritative Parenting subscale was composed of 16 items
measuring warmth, inductive reasoning, and autonomy granting
(e.g., ‘Give comfort and understanding when child is upset’). The
items were rated on a 5-point Likert scale ranging from 1 (never) to
5 (always). The total scores were computed by averaging the items
in each scale. PSDQ was previously used with Turkish samples and
shown to have good reliability and validity (Onder & Gulay, 2009).
In the current study, internal consistency values of the subscales
were moderate. Cronbach's alpha was.75 for Authoritarian and 0.65
for Authoritative Parenting.
6.2.5. Child temperament
Children's temperamental negative affectivity was measured via
maternal reports, using the Negative Affect subscale (12 items; e.g.,
‘Seems to feel depressed and unable to accomplish some tasks’) of
the very short form of Child Behavior Questionnaire (CBQ; Putnam
& Rothbart, 2006). The items were rated on a 7-point Likert scale,
ranging from 1 (extremely untrue for the child) to 7 (extremely true
for the child). The scores for each item were averaged to compute
total Negative Affect score. The CBQ has previously been shown as a

Table 1
Descriptive statistics for OB/OW and NW children and ANOVAs for group comparison (N ¼ 122).

Demographics Children with NW (n ¼ 61) Children with OB/OW (n ¼ 61) F h2

M SD Min Max M SD Min Max

Child age (in months) 61.97 7.76 45 80 62.26 7.66 45 80 0.05 0.00
Mother education (in years) 14.80 4.25 5 23 14.51 3.89 5 22 0.15 0.00
Mother BMI 22.67 4.03 18.34 37.20 24.56 4.06 15.94 35.56 6.40* 0.05
Father BMI 26.92 4.00 20.76 41.21 28.82 5.58 21.91 55.51 4.31* 0.04
Child Temperament
Negative affect (1e7) 4.53 0.80 2.67 6.17 4.70 0.75 2.92 6.17 1.39 0.01
Child-feeding Practices (1e5)
Restriction 3.64 0.95 1.13 5.00 3.88 0.83 1.00 5.00 1.98 0.02
Pressure to eat 3.60 1.05 1.00 5.00 3.21 1.11 1.50 5.00 3.71þ 0.03
Monitoring 4.48 0.63 2.00 5.00 4.53 0.73 2.00 5.00 0.14 0.00
Parenting Style (1e5)
Authoritarian 1.65 0.37 1.00 2.50 1.84 0.46 1.17 2.92 6.19* 0.05
Authoritative 4.37 0.34 3.41 4.94 4.42 0.25 3.76 4.76 0.63 0.01

Notes. OB/OW ¼ Obese-overweight; NW¼ Normal weight; BMI ¼ Body Mass Index.
*p < 0.05; þ p < 0.10.
 H. Melis Yavuz, B. Selcuk / Appetite 120 (2018) 491e499
reliable and valid instrument for Turkish preschool-aged children
(Batum & Yagmurlu, 2007; Gunduz, Yagmurlu, & Harma, 2015).
Internal consistency of the negative affect subscale was acceptable
in the current study (Cronbach's a ¼ 0.70).
6.3. Procedure
Ethics approval for the study was received from the Institutional
Review Board of the University. The families were recruited from
preschools in Istanbul (the largest metropolitan of Turkey) via
convenience sampling. Mothers or fathers provided verbal and
written consents for their and their children's participation to the
project before the data collection. Female research assistants con-
ducted home visits to collect data on child's weight and height and
to collect the completed questionnaires.
6.4. Statistical analyses
The data were analysed with SPSS. To examine the differences
between the OB/OW and NW groups on study variables, we con-
ducted ANOVAs. For investigating preliminary associations be-
tween the study variables, we conducted Pearson correlation
analysis. And we ran logistic regression analysis with binary group
status (i.e., OB/OW vs NW) as the outcome to investigate whether
parenting styles (authoritarian, authoritative parenting) and
maternal child-feeding practices (monitoring, restriction, pressure
to eat) had unique and significant influences on child OB/OW group
status, when demographic factors (mother education, mother BMI,
father BMI), and child temperament (negative affect) were
controlled for.
7. Results
7.1. Preliminary analyses and group differences in study variables
Descriptive statistics for OB/OW and NW children and the
ANOVA results comparing the two groups are presented in Table 1.
Child age and maternal education levels were similar in children
with NW and with OB/OW; but maternal and paternal BMI were
significantly higher in children who were OB/OW as compared to
NW (see Table 1). In both samples, mothers reported moderate
levels of negative affectivity for their children. ANOVAs revealed
that the children in the OB/OW and NW groups had similar levels of
negative affect (see Table 1).
There were no significant group differences in maternal child-
feeding practices and parenting styles, except that mothers of OB/
OW children reported significantly higher levels of authoritarian
parenting than mothers of NW children (see Table 1). There were
no sex differences in the variables.
Correlational analysis showed significant positive associations
between child BMI and father BMI, child temperamental negative
affectivity, and authoritarian parenting. Also there were significant
and positive associations between authoritarian parenting style
and restrictive and pressuring feeding practices, and significant
negative associations between authoritative parenting style and
pressuring and monitoring. There was also a significant and posi-
tive association between restrictive and pressuring feeding styles.
Among control variables, mother and father BMI, and child negative
affect had significant and positive correlations and maternal edu-
cation had significant and negative correlation with authoritarian
parenting. Mother education was negatively associated with
maternal pressure of the child to eat, while father BMI and child
temperamental negative affect were positively related to restrictive
feeding practices (see Table 2).
495
7.2. Hierarchical logistic regression analyses
Hierarchical logistic regression analysis was conducted to
examine the role of maternal feeding practices and parenting styles
in binary outcome of child's being in OB/OW (designated as 1) or
NW (designated as 0) groups, when maternal education, BMI of
parents, and temperamental negative affect of child were
controlled. In the first block, maternal education, mother BMI and
father BMI were entered in the model. In the second block, child
temperamental negative affect was added, and in the third block,
maternal child-feeding practices (pressure to eat, restriction,
monitoring) were entered in the analyses. In the fourth block,
maternal parenting styles (authoritarian, authoritative) were added
to the regression equation. Even if some of the predictor variables
were significantly inter-correlated, the coefficients were not very
high (see Table 2), and the results did not indicate multicollinearity
based on standards for the Variance Inflation Factor (above 2.5) and
the tolerance values (below 0.40) (Allison, 1991).
In the first block, maternal BMI was related to child weight
status; OB/OW children had mothers with higher BMI, while none
of the other demographic variables were significantly related to
child group status. In the second block, negative affect did not
significantly predict child's OB/OW status. In the third block, when
maternal child-feeding practices were added to the model,
maternal restriction and pressure to eat were found to be signifi-
cant, with children in the OB/OW group having mothers who were
more restricting and less pressuring of their children to eat. In the
final block, when all variables were in the model, maternal BMI,
pressure to eat, and authoritarian parenting significantly predicted
child's weight status, but restrictive feeding had a marginally non-
significant effect (see Table 3). Post-hoc power analyses that were
conducted using the GPower software with a sample of 122,
p < 0.05, and controlling for the other covariates in the model using
a correction factor revealed a power of 0.99 for authoritarian
parenting, and 0.93 for pressure to eat variables; indicating
adequate power for the study with the current sample size. Only
maternal BMI did not have adequate power with the current
sample size.
Holding all other variables constant, the odds of being OB/OW
was 4.71 times higher when the child had a mother who had a
more authoritarian parenting style and 1.14 times higher when
mothers had higher BMI. The odds of being OB/OW was 0.44 times
lower where mothers reported using higher levels of pressuring
their child to eat. Neither of the other demographic variables, child
temperament, or other child-feeding practices and parenting styles
was significantly related to child OB/OW status. And neither of the
parenting style-by-feeding practice interactions predicted child's
OB/OW status.
8. Discussion
This study investigated unique roles of maternal child-feeding
practices and parenting styles in the weight status of preschool-
aged Turkish children, controlling for child negative affect. The
results revealed that mothers who reported higher levels of
authoritarian parenting, who put less pressure on their child to eat,
and who had higher BMIs themselves were more likely have OB/
OW children. Maternal child feeding practices were important in
the development of OB/OW problems in preschool years; yet,
authoritarian parenting style also appeared as another important
risk factor over and above specific child-feeding behaviours.
Indeed, among the measured variables, authoritarian parenting
represented the greatest risk factor for childhood OB/OW prob-
lems; it was related to almost five-fold increase in the risk to be OB/
OW in Turkish pre-schoolers. These results were in line with several
496 H. Melis Yavuz, B. Selcuk / Appetite 120 (2018) 491e499

Table 2
Zero-order correlations between variables (N ¼ 122).

Child BMI Mother education 1 2 3 4 5 6 7

1. Mother BMI 0.16þ -0.20* e

2. Father BMI 0.27** -0.11 0.17þ e
3. Negative affect 0.19* -0.18* 0.22* 0.17þ e
4. Restriction 0.16þ -0.16þ 0.06 0.22* 0.21* e
5. Pressure to eat -0.16þ -0.41*** 0.14 -0.10 0.06 0.39*** e
6. Monitoring 0.03 0.06 -0.12 -0.11 -0.01 0.16þ -0.06 e
7.Authoritative 0.06 0.04 0.05 -0.15 -0.05 0.11 -0.18* -0.19* e
8. Authoritarian 0.23* -0.40*** 0.21* 0.25** 0.22* 0.34*** 0.38*** 0.11 -0.17þ

***p < 0.001; **p < 0.01; *p < 0.05; þ p < 0.10.

Table 3
Logistic regression analyses predicting child OB/OW (n ¼ 61) or NW (n ¼ 61) status.

Block 1 Block 2 Block 3 Block 4

B (SE) Odds OR 95% CI B (SE) Odds OR 95% CI B (SE) Odds OR 95% CI B (SE) Odds OR 95% CI
Ratio Ratio Ratio Ratio
Lower Upper Lower Upper Lower Upper Lower Upper
(OR) (OR) (OR) (OR)
Bound Bound Bound Bound Bound Bound Bound Bound

Constant 5.23 0.01 5.93 0.00 6.35 0.00 8.59 0.00

(1.97) (2.23) (3.39) (5.32)
Demographics
Mother 0.03 1.03 0.94 1.14 0.04 1.04 0.94 1.15 -0.01 0.99 0.88 1.11 0.03 1.03 0.91 1.16
education (0.05) (0.05) (0.06) (0.06)
Mother BMI 0.12* 1.12 1.03 1.25 0.11* 1.10 1.01 1.24 0.15* 1.16 1.03 1.31 0.13* 1.14 1.01 1.29
(0.05) (0.05) (0.06) (0.06)
Father BMI 0.07 1.07 0.98 1.17 0.06 1.07 0.98 1.16 0.03 1.03 0.93 1.13 0.02 1.02 0.91 1.14
(0.04) (0.05) (0.05) (0.06)
Child Temperament
Negative 0.18 1.20 0.72 2.02 0.03 1.03 0.59 1.80 -0.02 0.98 0.56 1.74
affect (0.26) (0.28) (0.29)
Child-feeding Practices
Restriction 0.72* 2.05 1.14 3.68 0.59þ 1.81 0.98 3.33
(0.30) (0.31)
Pressure to -0.69** 0.50 0.31 0.81 -0.83** 0.44 0.26 0.75
eat (0.26) (0.28)
Monitoring 0.34 1.40 0.67 2.94 0.12 1.13 0.53 2.37
(0.38) (0.38)
Parenting Styles
Authoritarian 1.55* 4.71 1.23 18.10
(0.69)
Authoritative 0.41 1.51 0.30 7.70
(0.83)

Nagelkere R2 0.11 0.11 0.24 0.30

Notes. OB/OW ¼ Obese-overweight; NW ¼ Normal weight; BMI ¼ Body Mass Index.

**p < 0.01; *p < 0.05; þ p < 0.10.

previous findings showing the link between authoritarian to OB/OW problems.

parenting and less healthy eating and higher OB/OW problems or
BMI in children (Kakinami et al., 2015; Kim et al., 2008; Lohaus
et al., 2009; Rhee et al., 2006; also see Enten & Golan, 2008 for a
review). But it is also noteworthy that our results further revealed
the role of authoritarian parenting in child OB/OW problems over
and above maternal child-feeding behaviours.
Previous studies suggested that authoritarian parenting limits
child's self-control (Grolnick & Farkas, 2002) which increases their
risk of being OB/OW (Francis & Susman, 2009). It was also argued
that highly controlling parenting practices might create a general
stressful home environment for the child and increase emotional
and excessive eating instead of eating as a response to internal
satiety cues, intensifying the risks for being OB/OW (Rhee et al.,
2006). Turkish mothers in general display high levels of warmth
towards their children (Sen, Yavuz, & Yagmurlu, 2013). Hence,
Turkish children who receive lower levels of warmth and higher
levels of strict control from their authoritarian mothers might
particularly feel rejected emotionally, which can increase their
emotional overeating behaviours and which may predispose them
Among maternal child feeding behaviours, only maternal pres-
sure for eating was found to be significant and it was related with
lower BMI in pre-schoolers. In line with earlier findings (Blissett &
Haycraft, 2008), our results revealed that mothers who pressured
their children to eat had children with lower risk for OB/OW,
although the effect was low. It can be speculated that mothers
pressure their children more for the consumption of healthier foods
(e.g., fruits and vegetables) which might relate to child's increased
consumption of these foods and retain a healthier weight; hence,
having a lower risk of being OB/OW. Such an explanation is also in
line with studies (e.g., Bourcier et al., 2003) which showed that
children consumed more fruits and vegetables upon pressure; as
well as the studies conducted with Turkish children (e.g., Camci
et al., 2014). However, current results may also be suggesting that
children who have higher BMI do not receive pressure from their
mothers for further eating. For instance, Webber, Cooke, Hill, and
Wardle (2010) found that children with higher BMI at the ages of
7e9 received less pressure from their mothers for eating 3 years
later. Therefore, for the role of pressure to eat, it is more likely that
 H. Melis Yavuz, B. Selcuk / Appetite 120 (2018) 491e499
there can be a reciprocal relation between maternal pressure and
child weight status, each influencing the other over time.
Another important risk factor for childhood OB/OW problems in
Turkish pre-schoolers was maternal BMI, with children being under
higher risk for OB/OW when mothers had higher BMI. This asso-
ciation is again found in many studies (Gibson et al., 2007; Strauss
& Knight, 1999). When mothers have weight problems, the children
might be under double risk for developing OB/OW: They might
receive both the genetic susceptibility for OB/OW from their
mothers, and they might be more likely to experience obesogenic
environmental factors influencing both maternal and child weight
negatively (Strauss & Knight, 1999).
Contrary to our expectations, authoritative parenting style as
well as restrictive feeding behaviours and monitoring child's eating
were not related to child weight status. Although some studies
investigating these links suggested that children with parents who
displayed high levels of authoritative parenting and who used less
restriction and more monitoring in their feeding behaviours were
at a healthier weight, others did not find such associations in
Western and non-Western samples (Carnell & Wardle, 2007;
Johannsen, Johannsen, & Specker, 2006; Spruijt-Metz, Lindquist,
Birch, Fisher, & Goran, 2002; also see Sleddens et al., 2011 for a
review on parenting styles). Possible reasons for this inconsistency
in the literature and the current non-significant results might be
about the varying demographic characteristics of the samples such
as child's age and baseline BMI as well as about the differences in
measurement tools, control variables, sample sizes, the outcome
that is examined (e.g., child BMI, child obesity/overweight status,
child fruit and vegetable consumption), and the culture in which
the study was conducted. Therefore, the heterogeneity in the
methods of previous research can be one of the reasons for the
reported inconsistencies about the role of different aspects of
parenting.
Our results also revealed that temperamental negative affec-
tivity was not related to the weight status of Turkish pre-schoolers.
Previous studies (e.g., Anzman-Frasca et al., 2012) suggested that
temperamental negative affectivity would influence maternal
feeding with the aim of soothing and this would influence child's
later eating patterns, increasing child's eating based on emotional
rather than satiety cues, and increasing the risk for obesity. On the
other hand, some studies (e.g., Haycraft, Farrow, Meyer, Powell, &
Blissett, 2011) did not find a significant relation between temper-
ament and obesity in preschool years and onwards. It is plausible
that contrary to initial suggestions, the association between
temperament and maternal feeding to soothe in infancy does not
lead to problematic eating patterns in later years, when children
gain more control over their own eating.
The results should be interpreted in light of some limitations.
First, the study had a cross-sectional design examining concurrent
relations and not allowing for the investigation of the directionality
of the effects. Although, based on the previous literature, child
weight status (as OB/OW vs NW) was selected as the ultimate
outcome of parenting styles and feeding practices; and although
some previous longitudinal studies have shown that parenting
longitudinally influences child weight (e.g., Birch et al., 2003; Faith
et al., 2004a, 2004b; Fisher & Birch, 1999); child weight status also
has an important influence on parenting, especially parental
feeding behaviours. It is very likely that parents change their
feeding behaviours based on the OB/OW status of their child,
therefore, for the current results, the direction of the effect might
also be from child OB/OW to parental pressuring. Longitudinal
studies with more than two time points of assessment might be
beneficial in understanding the intertwined associations between
parenting and childhood OB/OW problems, and might be infor-
mative as to which factor precedes the other in preschool years and
497
onwards. Another limitation of the current study was that the
sample of OB/OW group was composed of more overweight chil-
dren than obese children, limiting the generalizability of the results
to obese pre-schoolers. Moreover, this study was conducted with
mothers with middle-to-high education levels limiting the gener-
alizability of the results to populations with lower education. Yet,
the studies conducted in Turkey indicate that obesity in early
childhood years is a more pertinent issue in middle to high income
groups, since the prevalence of obesity is lower in children of low
SES families (Atamtürk, 2009). Therefore, the results might be
informative for the group that would need interventions for child
weight problems the most. Finally, although the post-hoc power
analyses revealed adequate power for authoritarian parenting and
pressure to eat variables, the sample size of the current study was
not large enough to have adequate power to detect the influence of
maternal BMI on child OB/OW problem, correcting for the role of
other variables in the logistic regression analysis. Even though
maternal BMI is a widely cited contributor for child BMI, future
studies with larger sample sizes might be necessary to alienate the
influence of maternal BMI among other factors.
Despite these limitations, this study has important contribu-
tions. To the best of our knowledge, it was the first to investigate the
relative contributions of maternal parenting styles and specific
feeding practices in children's weight status, controlling for the role
of a less widely investigated factor, child temperamental negative
affectivity, in preschool years. In the literature, most of the early
childhood obesity intervention programs target child's diet and
physical activity related behaviours, rather than parenting styles,
and show limited effectiveness, especially in the long term (Yavuz,
van IJzendoorn, Mesman, & van der Veek, 2015). Current results
were important in revealing the importance of authoritarian
parenting, and in indicating that not only specific feeding behav-
iours but also general authoritarian parenting style should be tar-
geted to decrease childhood OB/OW.
Since obesity-related habits develop in preschool years (Certain
& Kahn, 2002), addressing the problem of OB/OW in these years is
highly important, and would be beneficial to avoid future psycho-
logical and physiological problems. Considering the higher rate of
OB/OW problem in Turkish pre-schoolers, it is especially important
to understand the factors related to higher risk. The knowledge on
which aspects of parenting is more related to higher risks for OB/OW
in early childhood years are specifically necessary for effective and
cost-effective interventions (Heckman, 2006). This study suggests
that guiding parents about the risks of their authoritarian parenting,
specifically about the role of high control that is presented with low
levels of warmth on child weight gain and OB/OW problems might
be an important step in future prevention and intervention studies.
These results are especially important in countries like Turkey, in
which parents display highly controlling and obedience demanding
behaviours on their children (Sen et al., 2013). Especially in such
countries, informing parents about the negative influences of
authoritarian parenting would be beneficial in decreasing weight
problems as well as concurrent and longitudinal physiological and
psychological problems related to OB/OW. Even if, there are some
intervention studies targeting parenting styles in order to decrease
the risk for childhood OB/OW (e.g., Brotman et al., 2012), these are
few in number, and have generally targeted Western populations.
These results advocate for the increase of such intervention pro-
grams for young children and extend previous results obtained in
Western studies in a non-Western culture.
Funding
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
498 H. Melis Yavuz, B. Selcuk / Appetite 120 (2018) 491e499

References obese children: Evidence for parent behavior change strategies and research
gaps: A scientific statement from the american heart association. Circulation,
125, 1186e1207.
Agras, W. S., Hammer, L. D., McNicholas, F., & Kraemer, H. C. (2004). Risk factors for
Farrow, C. V., & Blissett, J. (2008). Controlling feeding practices: Cause or conse-
childhood overweight: A prospective study from birth to 9.5 years. The Journal
quence of early child weight? Pediatrics, 121, 164e169.
of Pediatrics, 145, 20e25.
Fisher, J. O., & Birch, L. L. (1999). Restricting access to palatable foods affects chil-
Allison, P. D. (1991). Multiple regression: A premier. Thousand Oaks, CA: Pine Forge
dren's behavioral response, food selection, and intake. The American Journal of
Press.
Clinical Nutrition, 69, 1264e1272.
Anzman-Frasca, S., Stifter, C. A., & Birch, L. L. (2012). Temperament and childhood
Francis, L., & Susman, E. (2009). Self-regulation and rapid weight gain in children
obesity risk: A review of the literature. Journal of Developmental & Behavioral
from age 3 to 12 years. Archives of Pediatrics & Adolescent Medicine, 163,
Pediatrics, 33, 732e745.

un 297e302.
Atamtürk, D. (2009). Alt sosyoekonomik düzeyde yer alan çocuklarda aşın kilolug

ı [The prevalence of obesity and overweight among Galloway, T. A., Fiorito, L. M., Francis, L. A., & Birch, L. L. (2006). ‘Finish your soup’:
ve obezitenin yaygınlıg
Counterproductive effects of pressuring children to eat on intake and affect.
children from lower socioeconomic status]. Gaziantep Medical Journal, 15,
Appetite, 46, 318e323.
10e14.
Gibson, L. Y., Byrne, S. M., Davis, E., Blair, E., Jacoby, P., & Zubrick, P. (2007). The role
Batsell, W., Brown, A. S., Ansfield, M. E., & Paschall, G. Y. (2002). “You will eat all of
of family and maternal factors in childhood obesity. Medicine and the Commu-
that!”: A retrospective analysis of forced consumption episodes. Appetite, 38,
nity, 186, 591e595.
211e219.
Grolnick, W., & Farkas, M. (2002). Parenting and the development of children's self-
Batum, P., & Yagmurlu, B. (2007). What counts in externalizing behaviors? The
regulation. In M. H. Bornstein (Ed.), Vol. 5. Handbook of parenting (pp. 89e110).
contributions of emotion and behavior regulation. Current Psychology, 25,
London: Lawrence Erlbaum Associates.
272e294.
Gunduz, G., Yagmurlu, B., & Harma, M. (2015). Self-regulation mediates the link
Birch, L. L., Fisher, J. O., & Davison, K. K. (2003). Learning to overeat: Maternal use of
between family context and socioemotional competence in Turkish pre-
restrictive feeding practices promotes girls' eating in the absence of hunger. The
schoolers. Early Education and Development, 26, 729e748.
American Journal of Clinical Nutrition, 78, 215e220.
Haycraft, E., Farrow, C., Meyer, C., Powell, F., & Blissett, J. (2011). Relationships be-
Birch, L. L., Fisher, J., K.Grimm-Thomas, K., Markey, C., Sawyer, R., & Johnson, S.
tween temperament and eating behaviours in young children. Appetite, 56,
(2001). Confirmatory factor analysis of the child feeding questionnaire: A
689e692.
measure of parental attitudes, beliefs and practices about child feeding and
Heckman, J. (2006). Skill formation and the economics of investing in disadvan-
obesity proneness. Appetite, 36, 201e210.
taged children. Science, 312, 1900e1902.
Blissett, J. (2011). Relationships between parenting style, feeding style and feeding
Johannsen, D. L., Johannsen, N. M., & Specker, B. L. (2006). Influence of parents'
practices and fruit and vegetable consumption in early childhood. Appetite, 57,
eating behaviors and child feeding practices on children's weight status.
826e831.
Obesity, 14, 431e439.
Blissett, J., & Haycraft, E. (2008). Are parenting style and controlling feeding prac-
Johnson, S., & Birch, L. (1994). Parents' and children's adiposity and eating style.
tices related? Appetite, 50, 477e485.
Pediatrics, 94, 653e661.
Bocca, G., Corpeleijn, E., Stolk, P., & Sauer, P. R. (2012). Results of a multidisciplinary
Kagitcibasi, C. (2010). Self, family, and human development: Cultural psychology.
treatment program in 3-year-old to 5-year-old overweight or obese children a
Istanbul: Koc University Press.
randomized controlled clinical trial. Archives of Pediatrics & Adolescent Medicine,
Kakinami, L., Barnett, T. A., Se guin, L., & Paradis, G. (2015). Parenting style and
166, 1109e1115.
obesity risk in children. Preventive Medicine, 75, 18e22.
Bourcier, E. J., Bowen, D., Meischke, H., & Moinpour, C. (2003). Evaluation of stra-
Kim, M., McIntosh, W. A., Anding, J. M., Kubena, K. S., Reed, D. B., & Moon, G. (2008).
tegies used by family food preparers to influence healthy eating. Appetite, 41,
Perceived parenting behaviours predict young adolescents' nutritional intake
265e272.
and body fatness. Maternal & Child Nutrition, 4, 287e303.
Brotman, L. M., Dawson-McClure, S., Huang, K. Y., Theise, R., Kamboukos, D.,
Klesges, R., Stein, R., Eck, L., Isbell, T., & Klesges, L. (1991). Parental influence on food
Wang, J., et al. (2012). Early childhood family intervention and long-term
selection in young children and its relationships to childhood obesity. The
obesity prevention among high-risk minority youth. Pediatrics, 129, 621e628.
€ gele, C., & Gibson, E. L. (2008). The role of parental control American Journal of Clinical Nutrition, 53, 859e864.
Brown, K. A., Ogden, J., Vo
Kremers, S. P., Brug, J., de Vries, H., & Engels, R. C. M. E. (2003). Parenting style and
practices in explaining children's diet and BMI. Appetite, 50, 252e259.
adolescent fruit consumption. Appetite, 41, 43e50.
Camci, N., Bas, M., & Buyukkaragoz, A. H. (2014). The psychometric properties of the
Lee, Y., Mitchell, D. C., Smiciklas-Wright, H., & Birch, L. L. (2001). Diet quality,
child Feeding Questionnaire (CFQ) in Turkey. Appetite, 78, 49e54.
nutrient intake, weight status, and feeding environments of girls meeting or
Carnell, S., & Wardle, J. (2007). Associations between multiple measures of parental
exceeding recommendations for total dietary fat of the American Academy of
feeding and children's adiposity in United Kingdom preschoolers. Obesity, 15,
Pediatrics. Pediatrics, 107, 95e110.
137e144.
Lohaus, A., Vierhaus, M., & Ball, J. (2009). Parenting styles and health-related
Cebeci, N., & Guven, A. (2014). Does maternal obesity have an influence on feeding
behavior in childhood and early adolescence results of a longitudinal study.
behavior of obese children? Minerva Pediatr, 67(6), 481e487.
The Journal of Early Adolescence, 29, 449e475.
Certain, L. K., & Kahn, R. S. (2002). Prevalence, correlates, and trajectory of television
Lundahl, A., Kidwell, K. M., & Nelson, T. D. (2014). Parental underestimates of child
viewing among infants and toddlers. Pediatrics, 109, 634e642.
weight: A meta-analysis. Pediatrics, 133(3), 1e15.
Chen, J., & Kennedy, C. (2004). Family functioning, parenting style, and Chinese
Magarey, A., Daniels, L., Boulton, T., & Cockington, R. (2003). Predicting obesity in
children's weight status. Journal of Family Nursing, 10, 262e279.
early adulthood from childhood and parental obesity. International Journal of
Clark, H. O., Goyder, E., Bissell, P., Blank, L., & Peters, J. (2007). How do parents' child-
Obesity, 27, 505e513.
feeding behaviours influence child weight? Implications for childhood obesity
Nacak, M., Yagmurlu, B., Durgel, E., & van de Vijver, F. (2011). Parenting in
policy. Journal of Public Health, 29, 132e141.
metropolis and Anatolian samples: The role of residence and education in be-
Cole, T., Bellizzi, M. C., Flegal, K. M., & Dietz, W. H. (2000). Establishing a standard
liefs and behaviors. Turkish Journal of Psychology, 26, 85e100.
definition for child overweight and obesity worldwide: International survey.
Onder, A., & Gulay, H. (2009). Reliability and validity of parenting styles & di-
BMJ, 320, 1240.
mensions questionnaire. Procedia-Social and Behavioral Sciences, 1, 508e514.
Darling, N., & Steinberg, L. (1993). Parenting style as context: An integrative model.
Patrick, H., & Nicklas, T. A. (2005). A review of family and social determinants of
Psychological Bulletin, 113, 487e496.
children's eating patterns and diet quality. Journal of the American College of
De Bourdeaudhuij, I., Te Velde, S. J., Maes, L., Perez-Rodrigo, C., De Almeida, M., &
Nutrition, 24, 83e92.
Brug, J. (2009). General parenting styles are not strongly associated with fruit
Peker, E., Topaloglu, N., Sahin, E. M., Essizoglu, E., Uludag, A., Gungor, S., et al. (2014).
and vegetable intake and socialeenvironmental correlates among 11-year-old
The comparison of parent's perception on weight, appearance and appetite of
children in four countries in Europe. Public Health Nutrition, 12, 259e266.
€ssner, M., & Borghi, E. (2010). Global prevalence and trends of their children with objective criteria. Turkish Journal of Family Practice, 18,
De Onis, M., Blo
142e148.
overweight and obesity among preschool children. The American Journal of
Putnam, S. P., & Rothbart, M. R. (2006). Development of short and very short forms
Clinical Nutrition, 92, 1257e1264.
of the children's behavior questionnaire. Journal of Personality Assessment, 87,
Enten, R. S., & Golan, M. (2008). Parenting styles and weight-related symptoms and
102e112.
behaviors with recommendations for practice. Nutrition Reviews, 66, 65e75.
Quattrin, T., Roemmich, J. N., Paluch, R., Yu, J., Epstein, L. H., & Ecker, M. (2012).
Eschenbeck, H., Kohlmann, C. W., Dudey, S., & Schürholz, T. (2009). Physician-
Efficacy of family-based weight control program for preschool children in pri-
diagnosed obesity in German 6-to-14-year-olds: Prevalence and comorbidity of
mary care. Pediatrics, 130, 660e666.
internalising disorders, externalising disorders, and sleep disorders. Obesity
Reilly, J., Armstrong, J., Dorosty, A., Emmett, P., Ness, A., Rogers, I., … Sherriff, A.
Facts, 2, 67e73.
(2005). Early life risk factors for obesity in childhood: Cohort study. BMJ, 330,
Faith, M., Berkowitz, R., Stallings, V., Kerns, J., Storey, M., & Stunkard, A. (2004a).
1357e1363.
Parental feeding attitudes and styles and child body mass index: Prospective
Reilly, J., & Kelly, J. (2011). Long-term impact of overweight and obesity in childhood
analysis of a gene-environment interaction. Pediatrics, 114, 429e436.
and adolescence on morbidity and premature mortality in adulthood: Sys-
Faith, M. S., Scanlon, K. S., Birch, L. L., Francis, L. A., & Sherry, B. (2004b). Parent-child
tematic review. International Journal of Obesity, 35, 891e898.
feeding strategies and their relationships to child eating and weight status.
Reilly, J., Methven, E., McDowell, Z., Hacking, B., Alexander, D., Stewart, L., et al.
Obesity Research, 12, 1711e1722.
(2003). Archives of Disease in Childhood, 88, 748e752.
Faith, M. S., van Horn, L., Appel, L. J., Burke, L. E., Carson, J. A., Franch, H. A., et al.
Rhee, K. (2008). Childhood overweight and the relationship between parent be-
(2012). Evaluating parent and adult caregivers as “agents of change” for treating
haviors, parenting style, and family functioning. The ANNALS of the American
 H. Melis Yavuz, B. Selcuk / Appetite 120 (2018) 491e499
Academy of Political and Social Science, 615, 11e37.
Rhee, K., Lumeng, J., Appugliese, D., Kaciroti, N., & Bradley, R. (2006). Parenting
styles and overweight status in first grade. Pediatrics, 117, 2047e2054.
Robinson, C. C., Mandleco, B., Olsen, S. F., & Hart, C. (1995). Authoritative, authori-
tarian, and permissive parenting practices: Development of a new measure.
Psychological Reports, 77, 819e830.
Sanson, A., Hemphill, S., Yagmurlu, B., & McClowry, S. G. (2011). Temperament and
social development. In P. K. Smith, & C. H. Hart (Eds.), Wiley-Blackwell handbook
of childhood social development (2nd ed., pp. 227e245). West Sussex, UK: Wiley-
Blackwell.
Savashan, C., Sarı, O., Aydogan, U., & Erdal, M. (2015). Obesity frequency in school
children and related risk factors. Turkish Journal of Family Practice, 19, 2e9.
Sen, H., Yavuz, H. M., & Yagmurlu, B. (2013). Parenting: The Turkish context. In
H. Selin (Ed.), Parenting across cultures: Childrearing, motherhood and fatherhood
in non-western cultures. Netherlands: Springer Publishers.
Sleddens, S. F. C., Gerards, S. M. P. L., Thijs, C., De Vries, N., & Kremers, S. (2011).
General parenting, childhood overweight and obesity-inducing behaviors: A
review. International Journal of Pediatric Obesity, 6, 12e27.
Snyder, E., Walts, B., Perusse, L., Chagnon, Y., Weisnagel, J., Rankinen, T., et al. (2004).
The human obesity gene map: The 2003 update. Obesity Research, 12, 369e439.
Speiser, P., Rudolf, M., Anhalt, H., Camacho-Hubner, C., Chiarelli, F. A.,
Eliakim, A., … Hocheberg, Z. (2005). Consensus statement: Childhood obesity.
The Journal of Clinical Endocrinology & Metabolism, 90, 1871e1887.
Spruijt-Metz, D., Lindquist, C., Birch, L., Fisher, J., & Goran, M. (2002). Relation be-
tween mothers' child-feeding practices and children's adiposity. The American
Journal of Clinical Nutrition, 75, 581e586.
Stark, L., Spear, S., Boles, R., Kuhl, E., Ratcliff, M., Scharf, C., … Rausch, J. (2011).
A pilot randomized controlled trial of a clinic and home-based behavioral
intervention to decrease obesity in preschoolers. Obesity, 19, 134e141.
Stifter, C. A., Anzman-Frasca, S., Birch, L. L., & Voegtline, K. (2011). Parent use of food
to soothe infant/toddler distress and child weight status. An exploratory study.
499
Appetite, 57, 693e699.
Strauss, R. S., & Knight, J. (1999). Influence of the home environment on the
development of obesity in children. Pediatrics, 103, 1e8.
Taylor, A., Wilson, C., Slater, A., & Mohr, P. (2011). Parent-and child-reported
parenting. Associations with child weight-related outcomes. Appetite, 57,
700e706.
The Nutrition and Health Survey of Turkey. (2014). Beslenme durumu ve

erlendirilmesi sonuç raporu [The final report of the eval-
alışkanlıklarının deg
uation of nourishment and dietary habits]. Retrieved from http://www.sagem.
gov.tr/TBSA_Beslenme_Yayini.pdf .
The Statistical Institute of Turkey. (2013). Ulusal eg
itim istatistikleri [National sta-
tistics of education]. Retrieved from https://biruni.tuik.gov.tr/medas/?
kn¼130&locale¼tr .
Ventura, A., & Birch, L. (2008). Does parenting affect children's eating and weight
status? International Journal of Behavioral Nutrition and Physical Activity, 5,
15e27.
Wang, Y., & Lobstein, T. (2006). Worldwide trends in childhood overweight and
obesity. International Journal of Pediatric Obesity, 1, 11e25.
Webber, L., Cooke, L., Hill, C., & Wardle, J. (2010). Child adiposity and maternal
feeding practices: A longitudinal analysis. The American Journal of Clinical
Nutrition, 92, 1423e1428.
Yavuz, H. M., van IJzendoorn, M. H., Mesman, J., & van der Veek, S. (2015). In-
terventions aimed at reducing obesity in early childhood: A meta-analysis of
programs that involve parents. Journal of Child Psychology and Psychiatry, 56,
677e69.
Yilmaz, R., Erkorkmaz, U., Ozcetin, M., & Karaaslan, E. (2013). How does paren-
ts’visual perception of their child's weight status affect their feeding style?
Nutricion Hospitalaria, 28, 741e746.
Yilmaz, R., & Osaz, M. B. (2009). Parental perception on body weight and growth of
children with low appetite. Medical Journal of Bakirkoy, 5, 11e17.