Cultural influences

Understanding how feeding beliefs and practices differ among various cultural and socio-demographic groups can be helpful. For example, African American mothers report more frequent monitoring, restricting, pressuring, and controlling their children’s eating than Caucasian mothers of similar socio-economic status (SES). When low-income Hispanic mothers are compared to low-income African American mothers, the feeding styles the Hispanic mothers describe are both more controlling (demanding, threatening, bribing) and more indulgent (reasoning, encouraging) than the African American styles.

Mothers of lower SES, regardless of ethnicity, seem to prompt their children to eat more than mothers with higher SES, a difference that may be due to their concerns about inconsistent or inadequate food supplies. Studies like these are, of necessity, over-generalized. Pediatricians will need to assess for themselves whether they apply to particular families in their care. But observations like these do provide some insight into how cultural and socioeconomic differences affect maternal feeding behavior. They can offer a launching point for a discussion with a particular mother about her feeding beliefs and practices.

Evaluation of a child’s weight status is often in the eye of the beholder. When the beholder is the child’s mother, the perception is often inaccurate. Maternal accuracy in evaluating a child’s weight status has ranged, in various studies, from 15% to 68%. The inability to recognize overweight in one’s child transcends SES, race, nationality, and the mother’s own weight status.36-42 Mothers have a particularly difficult time recognizing overweight in younger children, and generally speaking, the younger the child, the less concerned the mother. Why is this so? Several factors seem to be involved: community norms for children’s weight, the naturally shifting range of adiposity over the course of childhood, and the body type that seems ideal to a particular mother.

Let’s start with community norms. Mothers are likely to judge their child’s weight status in comparison with the child’s peers. Given the rapidly rising prevalence of overweight among children, particularly in low-income and minority populations, a BMI in the 95th percentile or above may be the norm among the child’s classmates and neighbors (see “The other kids on the block”).

The other kids on the block

The issue: “My mother says he’s thinner than most other boys in the neighborhood.”

Why it matters: In some communities, half the children are overweight or at risk of overweight. That’s been the case for the last decade. When families live in an environment like that, their frame of reference for what constitutes a normal body type has very likely shifted to accommodate this new norm.

Starting the conversation: “Sometimes when parents look back at their own childhood, they remember only one or two kids who were really overweight. When you look at your child’s classroom or neighborhood today, do you see more overweight kids than when you were growing up? Sometimes it’s hard to tell what a normal weight is any more, since so many grownups and children are overweight. Do you think it’s hard to tell if a child is overweight?”

What not to say: Don’t ask a mother to compare her child’s weight to other children in the same class. Children may find that kind of comparison very distressing.

A second factor that may skew a mother’s assessment is the way adiposity shifts over the course of childhood. Babies have a lot of body fat, which they shed as they grow older. Somewhere between the ages of 4 and 6, this process reaches its nadir and children are at their skinniest (see “Losing the baby fat”). Because of this phenomenon, any 5-year-old tends to look skinnier (have less body fat) than a 3-year-old or an 11-year-old. But when that 5-year-old—the one who looks “too skinny” to his mother—is compared with children his own age, he may actually be overweight.