Influence of fathers on the feeding practices and behaviors of children: A systematic review

Appetite 147 (2020) 104558

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Influence of fathers on the feeding practices and behaviors of children: A systematic review

T

April Litchford, Mateja R. Savoie Roskos, Heidi Wengreen∗ Department of Nutrition, Dietetics, and Food Sciences, Utah State University, Logan, UT, USA, 84322

ARTICLE INFO

ABSTRACT

Keywords: Parenting strategies Father food practices Child feeding Child nutrition Child feeding behaviors

Introduction: This systematic review will identify and summarize current research concerning the influence of fathers on the feeding behaviors of their children. Outcomes specific to child health, development of eating habits, relationships between paternal weight and child weight, and paternal dietary habits and child dietary habits were specifically targeted. Methods: A systematic review was conducted based on protocols outlined by PRISMA. A database search produced 851 relevant articles to be screened based on pre-determined inclusion criteria. Twenty-three studies met inclusion criteria for full review including two papers based on a single randomized control trial, 3 longitudinal studies, and 18 cross-sectional studies. Results: The most consistent findings across studies include the following. Father's BMI was positively correlated with child's BMI, father's dietary intake was predictive of child's dietary intake, food availability in the home influenced child intake, father's food parenting style predicted their children's eating behaviors and congruent parenting by mothers and fathers produced the best child food choices. Conclusions: A growing body of research indicates that fathers play a key role in influencing child eating behaviors. Further research, including randomized control trials, will help strengthen current conclusions and better inform education and interventions designed for fathers.

1. Introduction Parents play a significant role in shaping food behaviors in children during infancy and early childhood (Blissett, 2011; Mallan, Daniels, Nothard, et al, 2014; Mallan, Nothard, Thorpe, et al, 2014). A range of parenting techniques and practices have been reported in the literature. For example, one recent publication describes a content map that highlights common parenting practices, defined as constructs, in order to guide future research in this area and define commonly used terminology (Vaughn et al., 2016). The three main constructs identified as being the most important influences in the development of child feeding practices are: coercive control, structure, and autonomy support (Vaughn et al., 2016). Other research supports the idea that various techniques used by parents and caregivers have direct effect on child feeding and eating behaviors (Adamson and Blight, 2014; Mallan et al., 2014; 2014). In addition, many of the behaviors developed in childhood are most easily altered within the family context (Khandpur, Blaine, Fisher, & Davison, 2014). Parenting feeding practices include a range of behaviors that can have both positive and negative consequences (Loth, MacLehose,

∗

Fulkerson, Crow, & Neumark-Sztainer, 2013). These parenting practices will often moderate specific outcomes in children (Davison et al., 2016). Some behaviors used by parents to influence the feeding behaviors of their child(ren) include encouraging/discouraging children to eat specific foods, expecting children to clean their plate at meals, rewarding certain behaviors with food, and controlling the amount of food eaten by their child (Loth et al., 2013). Two other important parenting feeding practices that have been widely studied are food restriction and pressure-to-eat (Larsen et al., 2015; Loth et al., 2013). Food restriction occurs when one or both parents restrict access to a child's highly desired foods or use these desired foods to encourage intake of less desired foods (Larsen et al., 2015; Loth et al., 2013). Pressure-to-eat occurs when parents pressure a child to eat certain types of foods they think are more nutritious or healthy (Larsen et al., 2015; Loth et al., 2013). In addition, children can be pressured to eat less of foods parents think are unhealthy and more of foods that are perceived as healthful (Larsen et al., 2015; Loth et al., 2013). Parenting styles are often predictive of child food intake (Blissett et al., 2008). Four categories of parenting styles are often used to classify parent/child feeding interactions (Blissett, 2011). An

Corresponding author. E-mail address: [email protected] (H. Wengreen).

https://doi.org/10.1016/j.appet.2019.104558 Received 15 August 2019; Received in revised form 13 December 2019; Accepted 13 December 2019 Available online 20 December 2019 0195-6663/ © 2019 Published by Elsevier Ltd.

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186 Scholarly (Peer Reviewed) Journals, 2008–2018, Academic Journals, English childhood OR kid OR kids AND eating OR feeding OR

119 2008–2018, Academic Journals, English childhood OR kid OR kids AND eating OR feeding OR

267 Journal article, 2008–2018, English childhood OR kid OR kids AND eating OR feeding AND

Article, Journal, 2018–2008, English language

Date searched

5/19/18

5/19/18

5/19/18

5/19/18

Scopus

PubMed

CINHAL

Academic Search Premier

Table 1 Literature review database search criteria.

A systematic review of 23 published studies was conducted. The review protocols were based on those outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Liberati et al., 2009). Databases used include the following: PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINHAL), and Academic Search Premier. The words and phrases used to search titles and abstracts within these databases are found in Table 1. Because of the nature of systematic reviews, data collected as part of a review becomes out-of-date almost as soon as the process of the review is completed (Barroso, Sandelowski, & Voils, 2006). In order to increase the relevance of the information included and to ensure that this work represented an expansion of the work published by Khandpur et al., a date range of 10 years was chosen as part of the inclusion criteria. Review inclusion criteria were as follows: printed between May 2008 and May 2018, published in the English language, quantitative

Database

Search terms

2. Methods

Father OR dad OR paternal AND child OR children OR mealtime AND practices OR strategies OR approaches Father OR dad OR paternal AND child OR children OR practices OR approaches OR strategies Father OR dad OR paternal AND child OR children OR mealtime AND practices OR strategies OR approaches Father OR dad OR paternal AND child OR children OR mealtime AND practices OR strategies OR approaches

childhood OR kid OR kids AND eating OR feeding OR

Filters

Paper results

authoritarian parenting style is characterized by high control and demanding expectations coupled with low warmth and responsiveness (Blissett, 2011). An authoritative parent is highly demanding, but also demonstrates a high level of warmth and responsiveness (Blissett, 2011). Indulgent permissive parenting is very high in warmth, but also very low in demandingness. This is in contrast to uninvolved/neglectful permissive parenting which is low in warmth and demandingness (Blissett, 2011). Extreme parenting styles such as; authoritative and uninvolved/neglectful permissive, have been found to hinder acceptance of foods in children (Blissett et al., 2008). Traditionally mothers have been seen as the main provider of food to children because they have been the primary caregivers (Fraser et al., 2011; Khandpur et al., 2014; Mallan et al., 2014; 2014). More recently, fathers have been taking on more child-care roles due to increasing employment for both parents outside of the home (Khandpur et al., 2014). Past research has focused primarily on how mothers influence child eating and dietary habits, while less is known about a father's role and influence on the dietary habits of their child(ren) (Khandpur et al., 2014). A review of 17 studies investigated how mothers influence eating habits among their children. The authors concluded that individual maternal characteristics are associated with specific child feeding practices, maternal parenting style is positively correlated with controlling feeding practices, and a mother's beliefs about eating led to more restriction of a child's food intake (McPhie, Skouteris, Daniels, & Jansen, 2014). Preliminary research suggests that fathers are taking more of a role in child feeding. Khandapur et al. found that, 50% of fathers reported being responsible for mealtimes at least half of the time (Khandpur et al., 2014). Other research suggests that a father's weight status, modeling of eating behaviors, parenting skills and feeding practices may all have direct effects on their child(ren)'s weight status and development of eating behaviors (Fraser et al., 2011). Because fathers have a unique perspective concerning child feeding, it is necessary to understand their influence on a child's development of eating and feeding behaviors (Adamson and Blight, 2014). Growing interest in the potential influence of fathers on child feeding behaviors have prompted new research in this area (Khandpur et al., 2014; Mallan et al., 2014; 2014). The present review seeks to expand the evidence reported in a literature review published by Khandpur et al., in 2014. The current review extends this previous work by including 11 studies published after the publication of the previous review. Also, the objective of the current review was to compile the evidence related to a father's influence on their children's feeding practices and related outcomes by reviewing current studies that examine associations between father's parenting practices and child risk of obesity, father's weight status and child's weight status, and father's dietary intake and risk of child becoming overweight or obese.

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Fig. 1. Systematic review exclusion process.

Thomas et al., 2004). Each area was rated according to a three point scale, (1 = strong, 2 = moderate, 3 = weak). Individual area scores were then analyzed to award a complete, or global, score for the study (Armijo-Olivo et al., 2012; Thomas et al., 2004). If two or more areas received a weak rating, the overall study was classified as weak. If one area received a weak rating, the overall study was classified as moderate (Armijo-Olivo et al., 2012; Thomas et al., 2004). An article was considered to be strong if it did not receive any weak ratings (ArmijoOlivo et al., 2012; Thomas et al., 2004). Both authors assigned the same initial rating to all articles except one. The authors compared ratings for the article and discussed the discrepancies until an agreement was reached. Two studies received a strong rating (Lloyd et al., 2014, 2015), two studies received a moderate rating (Freeman et al., 2012; Guerrero, 2016), and nineteen studies received a weak rating (Blissett et al., 2008; Gevers et al., 2015; Hall et al., 2011; Harris & Ramsey, 2015; Haycraft and Blissett, 2008, Haycraft and Blissett, 2012; Hebestreit et al., 2017; Kristjansdottir et al., 2009; Lloyd et al., 2014; Lora et al., 2016; Mallan et al., 2014, 2014; Matton et al., 2013; Parada et al., 2016; Penilla et al., 2017; Snethen et al., 2008; Tschann et al., 2015; Vollmer et al., 2015b; Watterworth et al., 2017; Zhang and McIntosh, 2011). A few common reasons for a weak rating included; lack of randomization and intervention, selection bias through the use of small convenience samples, poor data quality due to the use of non-validated survey instruments, and data collection bias based on self-reported information. Several of these studies used study designs that improved the validity of the results generated. For example, four of the 18 crosssectional studies used trained researchers to conduct one-on-one quantitative interviews with participants (Lora et al., 2016; Parada et al., 2016; Vollmer et al., 2015a, 2015b). Sixteen of the 18 crosssectional studies used one or more validated survey instruments to collect data. (Lora et al., 2016), (Gevers et al., 2015; Hall et al., 2011; Kristjansdottir et al., 2009; Snethen et al., 2008), (Harris & Ramsey, 2015; Hebestreit et al., 2017; Lloyd et al., 2014; Parada et al., 2016; Penilla et al., 2017), (Harris & Ramsey, 2015; Hebestreit et al., 2017; Lloyd et al., 2014; Parada et al., 2016; Penilla et al., 2017), (Harris & Ramsey, 2015; Hebestreit et al., 2017; Lloyd et al., 2014; Parada et al.,

research design, and peer reviewed. In addition, articles were only included if they measured father influence on child behaviors and/or some type of nutritional intake/level. Outcomes included: measurements of children's BMI z score and waist to height ratio (WHtR), intake of vegetables/whole grains, “junk” food intake, father influence on feeding, father's perception of role in child feeding and the effect these perceptions had on child. Studies were excluded for the following reasons: qualitative research design, focus on specific medical conditions or diseases, no specific focus on father feeding, focus on feeding problems related to traumatic experiences, food insecurity, focus on child overweight or obesity as the main outcome without assessing the influence of fathers’ feeding practices, breastfeeding, outcome measure did not allow for comparison between subjects, weight-related outcomes for child(ren) were not measured, outcomes were not related to nutrition, and outside of developed countries. See Fig. 1 for specific exclusion reasoning during full text article review. The article search criteria described above produced 838 abstracts eligible for review. An additional 13 abstracts were identified through reference lists for a total of 851 articles. There were 97 articles identified as duplicates, these were removed from the screening list. Of the remaining 754 articles, 702 were excluded after applying inclusion/ exclusion criteria. Full text review of the remaining 52 articles resulted in 29 articles being excluded based on the inclusion and exclusion criteria listed above. Database searches and review of inclusion/exclusion criteria were conducted by one independent reviewer. Specific data was collected from the articles based on the selection criteria mentioned earlier. Extracted data from each of the studies can be found in Table 2. Two authors (AL and MSR) conducted a quality assessment of the articles included in the review using the Effective Public Health Practice Project Tool (EPHPP) (Armijo-Olivo, Stiles, Hagen, Biondo, & Cummings, 2012; Thomas, Ciliska, Dobbins, & Micucci, 2004). The EPHPP focus on several specific areas of a study to determine overall quality. These areas include the following; selection bias, study design, confounders, blinding, data collection methods, withdrawal/dropouts, intervention integrity, and analysis methods (Armijo-Olivo et al., 2012; 3

4 N = 329 children, 12–14 years of age n = 51 fathers of 8–12 year old children

Cross sectional

Cross sectional

n = 48 Families n = 19 Male children n = 29 Female children Father-child dyads n = 150

Gevers et al., 2015 (Gevers, van Assema, Sleddens, de Vries, & Kremers, 2015) Snethen et al., 2008 (Snethen et al., 2008)

Hispanic fathers (n = 61) Black fathers (n = 49)

Self-reported questionnaire Self-reported questionnaire

FEAQj

One-on-one interview

CFQh CFSQi CEBQf 24 h food recall

Shortened CFQ about food parenting methods.

Self-reported survey

One-on-one interviews

32-item questionnaire

CFPQd PFQe CEBQf BEVQ-PSg

Parent interview Direct child assessment

No specified tool

n = 2441 fatherchild dyads

Cross sectional

Longitudinal: birthabt. 5 years

Guerrero, 2016 (Guerrero, 2016)

Baseline home visit, self-reported questionnaire

PFPQc

Self-reported questionnaire

PEASa

n = 322 children n = 182 fathers

Vollmer, Adamsons, Foster, & Mobley, 2015 (Vollmer et al., 2015a)

Longitudinal: 3 time points

Tschann et al., 2015 (Tschann et al., 2015)

Self-reported: questionnaire

PEASa ACAESb

Self-reported/trained researcher

Data collection method

Measurement tool(s)

No specific tool

Fathers n = 3285 Child n = 3285

Cross sectional

Longitudinal: 2 time points

Freeman et al., 2012 (Freeman et al., 2012)

n = 87 children n = 87 fathers

Blissett & Haycraft, 2008 (Blissett et al., 2008)

RCT: 7 week duration

Lloyd, Lubans, Plotnikoff, Collins, & Morgan, 2014 (Lloyd, Lubans, Plotnikoff, Morgan, 2014)

n = 87 children n = 87 fathers

Cross sectional

RCT: 7 week duration

Lloyd et al., 2015 (Lloyd, Lubans, Plotnikoff, & Morgan, 2015)

Participants

Lora, Hubbs-Tait, Ferris, & Wakefield, 2016 (Lora et al., 2016)

Study Design

Author, year

Table 2 Systematic review article details and key findings.

Associations with father weight and eating patterns and child weight and eating patterns

Relationships between paternal weight, feeding practices, and feeding styles and child eating behaviors, child diet quality, and child weight status Difference between father general parenting practices and snack intake among adolescents

Association between parenting style and feeding practices and child BMI

Association between paternal feeding practices and child desire to drink sugar sweetened beverages (SSB)

Association of father's involvement in child nutrition and feeding practices and child outcomes (child weight status and dietary behaviors)

Correlation between father feeding practices and child weight status

BMI of father and child pairs measured at two time points four years apart

Association between father use of limit setting and reinforcement on child adiposity

Association between change in father nutrition beliefs and percent of child energy intake from core foods (nutrient dense foods)

Outcome Measure

Weak

Weak

Weak

Weak

Weak

Moderate

Weak

Moderate

Strong

Strong

Quality Rating

(continued on next page)

Changes in a father's nutrition beliefs significantly increased the percent of energy their child took from core foods (p = 0.026) the mediation effect explained 72.9% of the intervention effects on energy intake. Changes in father's use of limit setting (medium effect size d = .4) and reinforcement (large effect size d = .8) of healthy foods significantly changed the tendency for child adiposity. (P = 0.048, p= < 0.01) Overweight or obese father increased odds of child being obese by 318% and 1388% respectively (p = 0.046, p = 0.02) and odds ratio (4.18) Significant correlations reported for this study included: Higher father BMI associated with higher child BMI (p = 0.001), use of food restriction associated with higher BMI in boys and girls (p= < 0.001), and use of pressure to eat resulted higher BMI in boys (p= < 0.01) Father report of eating out with child multiple times a week had 2 times the odds of eating fast food at least once per week (OR 2.89) and of consuming sugar sweetened beverages (OR 1.67). Every day father ate breakfast with child increased odds of child being overweight by 9% and a 7% decrease in drinking sugar sweetened beverages. Fathers that had a difficult time feeding their child was associated with a 33% increase in child SSB intake (p < 0.05), and father's use of food to calm was associated with an 83% increase in SSB intake (p < 0.001), and father's use of food as reward was associated with a 44% increase (p < 0.001) in child SSB intake. Father use of pressure to eat was associated with lower child BMI (p < 0.05), no significant interactions were found between parenting style and child BMI. Significant associations included father BMI positively associated with child BMI-z score (p = 0.05) and overall diet quality of father associated with overall quality level of child diet (p < 0.0001). Use of structure by father was negatively related to number of snacks consumed (p < 0.05) and use of restrictive snacking rules was negatively related to number of snacks consumed (< 0.01). Fathers who had children that were overweight or obese reported that their children were more likely to eat fast food (p = 0.009), more likely to eat when bored (p = 0.011), and less likely to eat dinner together as a family (p = 0.040).

Results and Key Findings

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Cross sectional

Cross sectional

Cross sectional

Cross sectional

Cross sectional

Cross sectional (based on Healthy kids RCT)

Cross sectional

Cross sectional

Matton, Goossens, Braet, Durme, 2013; (Matton et al., 2013)

Hebestreit et al., 2017 (Hebestreit et al., 2017)

Penilla et al., 2017 (Penilla et al., 2017)

Parada et al., 2016 (Parada, Ayala, Horton, Ibarra, & Arredondo, 2016)

Lloyd et al., 2014 (Lloyd et al., 2014)

5

Harris & Ramsey, 2015 (Harris & Ramsey, 2015)

Haycraft and Blissett, 2012 (Haycraft and Blissett, 2012)

n = 48 mothersfather pairs n = 48 children

n = 102 father and child dyad

n = 93 fathers-child dyads

n = 81 fathers and child

n = 174 mother, fathers, and child combinations

n = 789 father-child dyads

n = 688 children n = 714 parents

n = 312 children n = 247 fathers n = 320 mothers

n = 71 fathers and children

Cross sectional

Zhang and McIntosh, 2011 (Zhang and McIntosh, 2011)

n = 963 parent-child couples

Cross sectional

Kristjansdottir, De Bourdeaudhuij, Klepp, & Thorsdottir, 2009 (Kristjansdottir et al., 2009) Hall et al., 2011 (Hall et al., 2011)

Participants

Study Design

Author, year

Table 2 (continued)

Self-reported questionnaire Self-reported questionnaire (24 h recall) Self-reported questionnaire

One-on-one interview

Self-reported questionnaire

Self-reported questionnaire

Self-reported questionnaire

CEDEQl CFQh SACANAm

Fruit and vegetable 2cup instrument PEASa CLASSo PEASa Australian eating survey

CFPQe

CFQh CEBQf eating inventory-2 BSIp

PFPn

Phone interviews and self-reported questionnaire

Parent-reported questionnaire

FFQk (Australian version)

No specific tool

Self-reported questionnaire

Data collection method

Fruit and vegetableFFQ

Measurement tool(s)

Associations between father feeding practices and child food intake and behaviors

Association between father food intake and feeding practices and child food consumption

Correlation of father parenting strategies related to feeding and child eating behaviors and weight status

Correlation of father feeding-related parenting strategies and child food intake

Associations between father feeding practices and child BMI z-score

Association of father feeding strategies and child's self-regulation capacity Associations between father dietary patterns (DP) and child DP

Correlation between father fruit and vegetable (FV) intake and child FV intake Relationship between father-child intakes of fruits, vegetables, energy dense foods, macronutrients, % energy from macronutrients, and micronutrients Influence of father feeding practices on child weight status

Outcome Measure

Weak

Weak

Weak

Weak

Weak

Weak

Weak

Weak

Weak

Weak

Quality Rating

(continued on next page)

Children were more likely to have a DP high in sweets and fat if father DP was high in sweets and fat. (OR 2.30 and 3.18) Father use of pressure to get child to eat was significantly associated with lower child BMI-z score, p < 0.04 and greater control over child food intake predicted lower child BMI-z score, p < 0.001. Also, father use of food restriction predicted higher child BMI z-score, p < 0.01. More use of food control by fathers resulted in less fruit and vegetable (FV) intake (p = 0.05) and more use of reinforcement for healthy eating associated with greater FV intake (p = 0.05) Use of control by father was associated with lower child BMI (p < 0.01). Use of control was associated with lower child fruit and vegetable intake (p = 0.05) where reinforcement of healthy eating was associated with higher child fruit and vegetable intake (p = 0.05). Also, father use of low reinforcement of healthy eating associated with daughters eating more fast food where sons ate less fast food (p = 0.02). Amount of fruit and vegetables consumed by child was predicted by the amount the father ate (p < 0.001, r2 42%). Also, when fathers drank more sugar sweetened beverages and made these beverages available in the home, child consumption increased (p < 0.05, r2 39%). Use of food monitoring by father predicted a low level of child emotional undereating (p ≤ 0.01) and father pressure to eat predicted child slowness in eating (p ≤ 0.01). Father use of restriction predicted child slowness in eating, p ≤ 0.05

Father use of pressure to eat reduced odds of child being overweight by 31% and emphasizing healthy eating habits increased odds of child being overweight by 40%. Father use of food was predictive of a decrease in child overeating. (p < 0.01)

Positive effect (p < 0.01) of father modeling eating fruit and negative effect (p < 0.01) of father's active encouragement to eat vegetables. Significant positive linear relationships noted for father-child intakes of fruit (p < 0.01), fruit juice (p < 0.05) potato chips (p < 0.05), and cookies (p < 0.0001).

Results and Key Findings

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s

r

q

Cross-sectional

Cross-sectional

Cross-sectional

Watterworth et al., 2017 (Watterworth et al., 2017)

Mallan et al., 2014; 2014, (Mallan et al., 2014; 2014)

Haycraft & Blissett, 2008 (Blissett et al., 2008)

n = 23 fathers

n = 436 fathers

n = 40 children n = 31 fathers

Participants

Parenting Style and Dimensions Survey. Based on CFPQ, s Using Food as a Reward for Children's Behavior Sub-scale. Healthy Food Availability Subscale. a Parenting Strategies for Eating and Activity Scale. b Australian Child and Adolescent Eating Survey. c Parental feeding practices questionnaire. d Comprehensive Feeding Practices Questionnaire. e Pre-school Feeding Questionnaire. f Child Eating Behavior Questionnaire. g Beverage Intake Questionnaire for Preschoolers. h Child Feeding Questionnaire. i Care-giver Feeding Style Questionnaire. j Family Eating and Activity Habits Questionnaire-Revised. k Food Frequency Questionnaire. l Children's Eating Disorder Examination Questionnaire. m Self-Administered Children, Adolescents and Adult Nutrition Assessment. n Parental Feeding Practices Questionnaire. o Children's Leisure Activities Study Survey. p Brief Symptom Inventory.

Study Design

Author, year

Table 2 (continued) Data collection method Self-reported questionnaire

Self-reported questionnaire

Self-reported questionnaire Meal observation

Measurement tool(s) Shortened CFPQd NutriSTEP

CFQh

CFQh Association between father feeding practices and child feeding patterns

Associations between father's characteristics and perceived responsibility for child feeding and use of controlling feeding practices

Associations between paternal food parenting practices and nutrition risk

Outcome Measure Children were associated with lower nutrition risk if their father was involved during meal preparation (p = 0.01), modeled healthy eating behaviors (p = 0.01), and created a healthy home environment (p = 0.04). Children were found to be at higher nutrition risk if their father pressured them to eat in general (p < 0.001) or pressured them to eat for health purposes (p = 0.03). Fathers who were more concerned about their child becoming overweight had higher perceived responsibility for child feeding (p = 0.007) and used more controlling feeding practices (p ≤ 0.002). Fathers with younger children and greater time commitments to work reported less perceived responsibility for child feeding (p ≤ 0.002). Father BMI and sex of the child were not associated with perceived responsibility or feeding practices. Fathers that reported more use of pressure to eat gave more verbal prompts (p = ≤0.05) and more use of incentives to eat (p = ≤ 0.05) to their children. Great use of restriction among fathers led to significant use of pressure to eat (p = ≤ 0.05) and use of incentives to eat (p = ≤ 0.05). Fathers with higher BMI, reported greater use of pressure to eat with children (p = ≤ 0.001)

Results and Key Findings

Weak

Weak

Weak

Quality Rating

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2016; Penilla et al., 2017), (Harris & Ramsey, 2015; Hebestreit et al., 2017; Lloyd et al., 2014; Parada et al., 2016; Penilla et al., 2017), (Harris & Ramsey, 2015; Hebestreit et al., 2017; Lloyd et al., 2014; Parada et al., 2016; Penilla et al., 2017), (Harris & Ramsey, 2015; Hebestreit et al., 2017; Lloyd et al., 2014; Parada et al., 2016; Penilla et al., 2017),42

(Hebestreit et al., 2017). Reported results indicated that children were clustered in the sweet and fat group if their father was also allocated to the sweet and fat cluster (Hebestreit et al., 2017). In addition, the father's dietary pattern for sweet and fat, refined cereals, and animal products was strongly associated with their child(ren)'s dietary pattern (Hebestreit et al., 2017). Use of paternal restriction and control over child food choices was reported to have a negative impact on child eating behavior (Lloyd et al., 2014; Mallan et al., 2014, 2014; Parada et al., 2016; Tschann et al., 2013; Vollmer et al., 2015a, 2015b; Watterworth et al., 2017). Paternal restriction was correlated with child avoidant food behaviors, emotional over and undereating, and a stronger desire to drink instead of eat (Lloyd et al., 2014; Vollmer et al., 2015a). Additionally, father control over what foods and how much of the foods they expected a child to eat was associated with lower intakes of fruits and vegetables in children (Parada et al., 2016). In contrast to the previous negative findings, setting rules restricting the number of allowed daily snacks reduced overall child snack consumption (Gevers et al., 2015). Paternal pressure to eat, another common parenting technique used by fathers, was associated with food avoidant behaviors, slowness in eating, nutritional risk, and less enjoyment of food by children in three studies (Haycraft and Blissett, 2012; Lora et al., 2016; Vollmer et al., 2015a; Watterworth et al., 2017). Reinforcement of healthy foods or eating habits by fathers, predicted higher intakes of fruits and vegetables in all children in another study (Parada et al., 2016). A different study found that a child's ability to enjoy an adaptable diet and selfregulate food choices was associated with a father's use of permissive parenting techniques (Blissett et al., 2008). A study of parenting styles in both fathers and mothers, found that fathers used more authoritarianism than mothers did, including use of coercion to get child to eat desired types and amounts of food (Pratt, Hoffmann, Taylor, & Musher-Eizenman, 2017). Use of permissive parenting by fathers resulted in lower monitoring of unhealthy foods and greater pressure to eat healthy foods (Pratt et al., 2017). Another study found that a child's ability to enjoy an adaptable diet and self-regulate food choices was associated with a father's use of permissive parenting (Blissett et al., 2008). Furthermore, one study reported that parenting style and parenting practices were associated with child-weight outcomes, but not child BMI-z score (Taylor et al., 2011). Three research studies analyzed the congruency of rules and expectations between both parents (mother and father). One of the three studies determined that rule congruency reduced the incidence of snacking among adolescents (Gevers et al., 2015). Further study concluded that demanding family rules about eating fruits and vegetables, increased child intake of these foods (Kristjansdottir et al., 2009). However, these findings seem to contradict the conclusion of another article that mothers and fathers who focused on building healthy child eating habits through rules and expectations, increased the risk of child becoming overweight or obese by 26% (Zhang and McIntosh, 2011). Conversely, further study reported that fathers were less likely to use reinforcement for healthy eating when they felt their child was overweight or obese (Parada et al., 2016). Also, if a father was more concerned about child overweight they felt more responsible for child feeding and used more controlling feeding practices with children (Haycraft & Blissett, 2008; Mallan et al., 2014, 2014). This finding contrasts with reported conclusions of another study that suggested a father is often more restrictive or controlling of feeding practices when they feel their child is overweight (Haycraft & Blissett, 2008; Lora et al., 2016).

3. Results The type of study design varied for the included articles, two studies used randomized controlled trials (RCT), three studies were of longitudinal design, and eighteen studies were of cross-sectional design. The sample sizes in these studies ranged from 23 to 3285 participants. Six of the studies reported sample sizes > 200 participants (Gevers et al., 2015; Hebestreit et al., 2017; Kristjansdottir et al., 2009; Mallan et al., 2014, 2014; Matton et al., 2013; Zhang and McIntosh, 2011). The studies included in this paper were conducted in developed countries including the United States (Guerrero, 2016; Harris & Ramsey, 2015; Lloyd et al., 2014; Lora et al., 2016; Parada et al., 2016; Penilla et al., 2017; Snethen et al., 2008; Tschann et al., 2015; Vollmer et al., 2015a; Zhang and McIntosh, 2011), Australia (Freeman et al., 2012; Hall et al., 2011; Lloyd et al., 2014, 2015; Mallan et al., 2014, 2014), Canada (Watterworth et al., 2017), Belgium (Matton et al., 2013), Netherlands (Gevers et al., 2015), Iceland (Kristjansdottir et al., 2009), the United Kingdom (Blissett et al., 2008; Haycraft and Blissett, 2008, Haycraft and Blissett, 2012), and other European countries (Hebestreit et al., 2017). Participants included fathers of varying ages and children ranging in age from birth to 18 years of age. Results of each study were organized by outcome and are discussed below, for specific numeric results and study particulars refer to Table 2. Six of the twenty-four studies analyzed, determined that father BMI was significantly and positively correlated with child BMI-z score (Lloyd et al., 2014; Matton et al., 2013; Penilla et al., 2017; Vollmer et al., 2015a, 2015b; Zhang and McIntosh, 2011). One study reported that having an obese father and an overweight mother was predictive of the development of child obesity (Freeman et al., 2012). However, it was more likely (odds ratio 4.18) that children would become overweight or obese if the mother was at a healthy weight and the father was overweight or obese (Freeman et al., 2012). Several studies reported correlations between father feeding and parenting practices and child weight status. One study reported that parenting style and parenting practices were associated with childweight outcomes, but not child BMI-z score (Taylor, Wilson, Slater, & Mohr, 2011). Two other studies indicated that food restriction by fathers predicted a higher child weight status (Lloyd et al., 2014; Tschann et al., 2013). Also, a similar relationship between father's control and restriction of food and higher weight status in children was a major finding of three additional studies (Lloyd et al., 2014; Tschann et al., 2013; Vollmer et al., 2015b). Another study reported that father feeding practices were correlated with their child's waist height ratio (WHtR) or BMI and change in WhtR and BMI over a two year period (Tschann et al., 2015). Use of food restriction by the father at base-line predicted higher weight status and WHtR in the child, including both boys and girls, measured one year later (Tschann et al., 2015). Results of the RCTs reported that when a father increased their use of limit setting and reinforcement of healthier eating with their children, the children ate more nutrient dense foods (medium effect size) (Lloyd et al., 2014). Additionally, five studies reported a positive relationship between the extent of diet quality eaten by fathers and overall child food intake (Harris & Ramsey, 2015; Penilla et al., 2017; Vollmer et al., 2015a, 2015b; Watterworth et al., 2017). However, two of these studies reported that paternal modeling of food behavior did not predict child dietary intake (Harris & Ramsey, 2015; Penilla et al., 2017). Another study reported similar results concerning parent/child food intake pattern similarity. Researchers in this study used K-means clustering to group participants into specific categories of food intake

4. Discussion This review expands on the work of Khandpur et al., and increases our understanding of the influence fathers have on overall development of child eating behaviors and risk for obesity and disease later in life (Khandpur et al., 2014). The previous review focused specifically on 1) 7

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the characteristics of studies used to asses father feeding practices, 2) general patterns in father feeding practices, 3) similarities between the feeding practices of mothers and fathers. The current review extends the information provided by Khandpur et al. by focusing on the evidence regarding associations between father's parenting practices and child risk of obesity, father's weight status and child's weight status, and father's dietary intake and risk of child becoming overweight or obese (Khandpur et al., 2014). Risk for obesity has been associated with parenting strategies commonly used by parents when addressing expectations for food intake (Tschann et al., 2015). Use of pressure to eat by fathers resulted in a lower body weight and WHtR in their children (Mallan et al., 2014, 2014; Matton et al., 2013; Penilla et al., 2017; Tschann et al., 2015). Four other studies provide evidence that when a father used greater control and restriction on child food intake, child BMI-z was lower (Lloyd et al., 2014; Penilla et al., 2017; Tschann et al., 2015; Vollmer et al., 2015a). The observed effects reported by some studies appear to be modified by the biological sex of the child as a father appears to have more influence on sons than on daughters (Mallan et al., 2014, 2014; Matton et al., 2013; Penilla et al., 2017; Tschann et al., 2015). However, three studies provide evidence that higher dietary restriction by a fathes predicted higher BMI-z or weight in both boys and girls (Penilla et al., 2017; Tschann et al., 2015; Vollmer et al., 2015b). Correlations of parental weight status and child weight status was a common theme through many of the studies included in this review. Findings of five studies suggest that a higher BMI in a father is associated with a higher BMI-z among his child(ren) (Haycraft & Blissett, 2008; Lloyd et al., 2014; Matton et al., 2013; Penilla et al., 2017; Zhang and McIntosh, 2011). These conclusions are only based on associations; however, this information could be beneficial in helping develop programs designed to reduce the risk of overweight/obesity in children by promoting healthy weight in fathers. The personal eating habits and weight status of fathers may have a direct and predictive effect on child eating habits and weight status as well. Three studies provided evidence to suggest that a father's dietary intake could predict child dietary intake (Harris & Ramsey, 2015; Hebestreit et al., 2017; Kristjansdottir et al., 2009). Results of a RCT indicate that as fathers changed their eating habits to include more fruits and vegetables and other healthy food choices there was a notable change in child eating habits as well (Lloyd et al., 2015). This evidence supports the hypothesis that fathers at a healthy weight, with better dietary habits, could make a positive impact on the future health and wellness of their child. Another finding discussed in the included research was the need for congruent parenting to produce the best outcomes in child behavior and health Vollmer et al., 2015 (Gevers et al., 2015) (Adamson and Blight, 2014) When the same information was gathered from fathers and mothers, there was little variation in the responses when analyzed by comparison. Fathers and mothers tended to have the same types of parenting style and similar rules about food and what was considered healthy. Children in these studies made better food choices when the rules concerning foods were reinforced by both parents. (Vollmer et al., 2015a), (Gevers et al., 2015), (Adamson and Blight, 2014) The concept of congruent parenting may also be a good target for family education in attempting to develop healthy eating habits that are reinforced for the whole family. Food parenting styles and their effectiveness in teaching children healthy behaviors were studied in three articles reviewed (Freeman et al., 2012; Lloyd et al., 2014, 2015). One notable conclusion stated that increased knowledge on how to use an authoritative parenting style improved the amount and type of limit setting and reinforcement for healthy food choices in children (Lloyd et al., 2015). Another conclusion was that a child's energy intake was positively associated with the level of paternal limit setting and paternal energy intake (Lloyd et al., 2014) These results suggest that the actions of a father are noticed and internalized by their children.

These research conclusions are promising and helpful in determining the overall impact and needs of fathers in becoming more effective in feeing their child(ren). However, there are several limitations that restrict the formation of strong conclusions from the research cited in this review. Perhaps the largest limitation is the quality of the reviewed studies. Because the bulk of the studies used weak methodologies to gather data, the findings of these studies are limited in scope and applicability. One such limitation is that most of the data gathered in these studies were done through self-report of questions that could be subject to a wide variety of interpretations. As a result of self-reporting, conditions of bias exist in the data gathered from these surveys. In addition, most of the data collected was done using convenience samples, limiting the ability of data to be generalized to all people and populations. Eighteen of the studies included in this review used a cross-sectional design that relied heavily on self-reported answers to questionnaires or surveys. Moreover, methods of data collection can strengthen or weaken conclusions drawn from cross sectional studies. Nineteen of the 23 studies used validated methods and instruments to collect data which improved the reliability and quality of the information these studies gathered (Blissett et al., 2008; Freeman et al., 2012; Gevers et al., 2015; Hall et al., 2011; Harris & Ramsey, 2015; Haycraft and Blissett, 2012; Hebestreit et al., 2017; Kristjansdottir et al., 2009; Lloyd et al., 2014, 2014, 2014; Lloyd et al., 2014; Mallan et al., 2014, 2014; Matton et al., 2013; Penilla et al., 2017; Snethen et al., 2008; Tschann et al., 2015; Watterworth et al., 2017; Zhang and McIntosh, 2011). Four of the 23 studies included in this review used one-on-one interviews conducted by trained researchers to gather quantitative information from participants (Lora et al., 2016; Parada et al., 2016; Vollmer et al., 2015a, 2015b). This method of data acquisition is known to generate higher quality data than self-reported survey responses. Large study populations also add strength and credibility to studies, eight of the eighteen cross sectional studies included in this review reported participant responses > 200 participants (Gevers et al., 2015; Hebestreit et al., 2017; Kristjansdottir et al., 2009; Matton et al., 2013; Zhang and McIntosh, 2011). Overall the information presented in this review adds new insight into what is known about the effect a father has on child eating/feeding outcomes. This information could better inform education classes or interventions targeted at fathers. Observational studies suggest that a father's eating habits, weight status, and parenting techniques influence the dietary behaviors of their children. Programs, education, and interventions designed to help fathers change their personal eating habits and parenting practices could work to improve health outcomes among children in general. While the information reported in this review helps to inform professionals of potential parent influence, future research is needed to strengthen these conclusions. Research concerning the effect of father weight loss on child weight status would contribute valuable information concerning effective interventions in this population. Also, research to determine specific areas of influence by fathers on child dietary intake would help alleviate some of the confusion surrounding this topic caused by contradicting study results. Lastly, strong research designs that include RCTs are needed to demonstrate cause and effect of the many associations reported in this review. Appendix A. Supplementary data Supplementary data to this article can be found online at https:// doi.org/10.1016/j.appet.2019.104558. References Adamson, M., & Blight, E. J. (2014). Bringing dads to the table: Comparing mother and father reports of child behaviour and parenting at mealtimes. Journal of Family Studies, 20(2), 118–127. https://doi.org/10.1080/13229400.2014.11082001. Armijo-Olivo, S., Stiles, C. R., Hagen, N. A., Biondo, P. D., & Cummings, G. G. (2012).

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