Poverty, Parenting, and Obesity Prevention: Examining Pathways of Family Mealtime Quality

Background

Poverty-related disparities in childhood obesity rates are pervasive. We urgently need to identify mechanisms of obesity prevention for children growing up in poverty. Family meals are hypothesized to play an important role through different pathways, including promoting better quality diets, healthier eating habits, structured routines, and opportunities to engage in positive family interactions. Because parents shape the mealtime environment, it is important to understand how the constraints and stressors of being low-income affect parents, and how parenting shapes mealtimes. Yet, research on the effect of poverty on both parenting and mealtimes is scarce.

To address this gap, we assess how financial stress (income-to-needs ratio) associates with parent mental health (depression) and parenting practices (laxness/overreactivity), and whether these factors are linked to family mealtime quality (mealtime structure and family functioning) among low-income families. We hypothesize: 1)higher poverty will be associated with poorer mealtime quality and 2)greater depression and negative parenting practices will mediate the relationship between poverty and mealtime quality.

Methods

Participants were 175 children/families from Head Start programs in Michigan followed longitudinally from early (3-4-years-old; T1) to middle childhood (6-8-years-old; T2). Parents reported demographics (race, education, income-to-needs ratio [1.0=100% of federal poverty line]), depression symptoms (none/mild vs. moderate/severe; CES-D), and parenting style (Parenting Scale; higher scores reflect more laxness/overreactivity). Mealtime quality was measured as: parent-reported mealtime structure (16 items; higher scores reflect practices associated with higher mealtime quality, e.g., family-style meals, TV off), and observed family functioning (videorecorded naturalistic home-based meal; reliably coded by independent raters, Kappa>.70; range 1-7; higher scores reflect more engaged, harmonious family mealtime interactions). Path models were conducted in MPLUS V.8 to test: a) longitudinal associations between income-to-needs (T1, T2) and mealtime structure (T2), mediated by depression (T2) and laxness/overreactivity (T2); (b) cross-sectional associations (T1 only) between income-to-needs ratio and family functioning during meals, mediated by depression and laxness/overreactivity.

Results

The sample was primarily white (68%); 46% of parents had less than a highschool degree. Average income-to-needs ratio was .98 (T1) and 1.16 (T2); 30% (T1) and 29% (T2) of parents had moderate/severe depression symptoms. Average scores for parent-reported mealtime structure were 35.8 (T1; range 21-47) and 35.2 (T2; range 18-48). Mean score for family functioning at mealtimes (T2) was 5.08 (range: 1-7).

In all models, higher income-to-needs was linked to higher depression symptoms, which in turn associated with poorer parenting practices (laxness, overreactivity), which significantly lowered the quality of family mealtimes (mealtime structure and family functioning).

There were no direct effects of income-to-needs on mealtime structure. Models yielded trend-level indirect effects for mediation of the association through depression and parenting style (laxness: p=.05; overreactivity p=.049).

Family functioning models showed significant direct effects of income-to-needs on family functioning (β=.14, p=.01) in addition to indirect effects (trending) of income-to-needs through depression and parenting style on family functioning (laxness: p=.08, overreactivity: p=.09).

Conclusions

Social workers, public health and medical professionals should participate in intervention development to prevent obesity in high-poverty populations including components that will best support parents in their efforts to achieve high-quality family mealtimes under stressful conditions.