Maternal restraint and external eating behaviour are associated with formula use or shorter breastfeeding duration

Appetite 76 (2014) 30–35

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Maternal restraint and external eating behaviour are associated with formula use or shorter breastfeeding duration q A. Brown Department of Public Health and Policy Studies, Swansea University, Swansea SA2 8PP, UK

a r t i c l e

i n f o

Article history: Received 27 August 2013 Received in revised form 19 October 2013 Accepted 19 December 2013 Available online 23 January 2014 Keywords: Maternal eating behaviour Breastfeeding Body image Maternal child-feeding style

a b s t r a c t Maternal eating behaviour (e.g. restraint, disinhibition) has been associated with maternal child-feeding style (e.g. pressure to eat, restricting intake, monitoring) for children over the age of two years. In particular, mothers high in restraint are significantly more likely to restrict and monitor their child’s intake of food. Research has not however examined the impact of maternal eating behaviour upon earlier infant feeding. A controlling maternal child-feeding style has been linked with shorter breastfeeding duration and earlier introduction of solid foods but the relationship between infant milk feeding and maternal eating behaviour has not been explored despite links between maternal weight, body image and breastfeeding duration. The aim of the current study was to explore associations between maternal restraint, emotional and external eating and breastfeeding initiation and duration. Seven hundred and fifty-six mothers with an infant aged 6–12 months completed a copy of the Dutch Eating Behaviour Questionnaire and reported breastfeeding duration and formula use up to six months postpartum. Mothers high in restraint and external eating were significantly more likely to formula feed from birth, to breastfeed for a shorter duration and to introduce formula milk sooner than those lower in these behaviours. Moreover these behaviours were associated with reporting greater control during milk feeding by feeding to a mother-led rather than baby-led routine. Maternal eating behaviour may therefore affect breastfeeding initiation and continuation and is an important element for discussion for those working to support new mothers. Ó 2014 Published by Elsevier Ltd.

Introduction Maternal eating behaviour and weight concerns have been associated with maternal child-feeding style and subsequently child diet and weight for children over the age of two years (Ventura & Birch, 2008). Mothers high in restraint are more likely to attempt to restrict their child’s intake of food (de LauzonGuillain, Musher-Eizenman, Leporc, Holub, & Charles, 2009; Fisher & Birch, 1999; Francis, Hofer, & Birch, 2001) and engage in higher monitoring behaviours (Tiggemann & Lowes, 2002). Both maternal body dissatisfaction and weight concerns (Birch & Fisher, 2000; Duke, Bryson, Lawrence, Hammer, & Agras, 2004; Francis et al., 2001; Wardle, Sanderson, Guthrie, Rapoport, & Plomin, 2002) have also been associated with restriction. Additionally, Wardle et al. (2002) found that maternal emotional eating was associated with child emotional feeding whilst external eating was associated with using food as a reward. q Acknowledgement: A.B. was supported by a postdoctoral fellowship from the ESRC. E-mail address: [email protected]

http://dx.doi.org/10.1016/j.appet.2013.12.022 0195-6663/Ó 2014 Published by Elsevier Ltd.

Mothers who hold personal concerns about their own weight often believe that restricting and monitoring their child’s intake of food will promote healthy eating habits (Benton, 2004). However, maternal restriction has been associated with child disinhibited eating (Joyce & Zimmer-Gembeck, 2009), eating in the absence of hunger (Birch, Fisher, & Davison, 2003) and in some studies overweight (Farrow & Blissett, 2006a, 2006b). Maternal disinhibited eating has also been associated with childhood overweight (Whitaker, Deeks, Baugchum, & Specker, 2000). Although the majority of research has explored the relationship between maternal eating behaviour and maternal child-feeding style for children over the age of two years (Ventura & Birch, 2008), limited research suggests that maternal eating behaviour may be important for their feeding choices and behaviours during the first year postpartum. For example, maternal eating behaviour is associated with her child-feeding style during the period infants are introduced to solid foods; mothers higher in restraint report higher levels of restriction and monitoring of their infants intake of food (Brown & Lee, 2011). However, there is a dearth of research examining any relationship between maternal eating behaviour and earlier infant milk

A. Brown / Appetite 76 (2014) 30–35

feeding. Potentially, maternal eating behaviour may affect her decision to breast or formula feed. Firstly, formula feeding is associated with a maternal child-feeding style higher in control, both during milk feeding (Brown & Lee, 2013; Brown, Raynor, & Lee, 2011a, 2011b, 2011c) and during subsequent solid feeding (Brown & Lee, 2013; Blissett & Farrow, 2007; Farrow & Blissett, 2008). As maternal eating behaviour is linked to child-feeding style for older children, it is possible that this relationship appears earlier, during milk feeding. Secondly, maternal eating behaviour is also tied to overweight, body image and weight concerns. Restrained eating can be a consequence of poor body image and desire to lose weight (Herman & Mack, 1975) whereas emotional or external eating can lead to poorer body image and weight concerns due increased BMI (McGuire, Wing, Klem, Lang, & Hill, 1999). Mothers who are overweight are less likely to initiate or continue breastfeeding (Kitsantas & Pawloski, 2009; Hillson, Rasmussen, & Kjolhede, 2004), although not every study is conclusive (Bartok, Schaefer, Beiler, & Paul, 2012). A lack of body confidence (Hauff & Demerath, 2012) shyness or embarrassment at feeding in front of others (Brown et al., 2011a, 2011b, 2011c; Thulier & Mercer, 2009; Wambach & Cohen, 2009) or concerns relating to perceived changes in breast shape are also linked to formula use (Alexander, Dowling, & Furman, 2010; Haughton, Gregorio, & Pérez-Escamilla, 2010). Pregnant women who express higher concerns about the impact of breastfeeding upon their body are also less likely to breastfeed (Barnes, Stein, Smith, & Pollock, 1997). The aim of the current study was to explore associations between maternal eating behaviour (restraint, external and emotional eating) and breastfeeding initiation, duration and style. Methodology Design A cross sectional, self report questionnaire. Participants All aspects of the study have been performed in accordance with the ethical standards set out in the 1964 Declaration of Helsinki. Swansea University Department of Psychology Research Ethics Committee granted approval for this study. All participants gave informed consent prior to inclusion in the study. Mothers with an infant aged between six and twelve months completed a questionnaire examining their eating behaviour and infant feeding choices. Exclusion criteria included multiple birth, low birth weight or health complications with mother or infant. Procedure Data were collected between June 2011 and December 2011. Recruitment took place through local mother and baby groups based in South West Wales (UK) and through online parenting forums based in the UK. For the groups, contact was made with group leaders who distributed the information sheet and questionnaire to group members. Questionnaires were returned to the leader in a sealed envelope or via post to the researcher. Questionnaires had information letters attached with details of how to contact the researcher if further information was required. Groups were located in areas with varying degrees of social deprivation as measured by the Welsh Index of Multiple Deprivation. Study adverts were also placed on specific research request boards on online message boards on parenting forums based in the UK (e.g. http://www.mumsnet.com; http://www.bounty.com)

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with an online link to complete the questionnaire via survey monkey. All participants provided UK postcode to check UK residence. Participants could request a paper copy of the questionnaire if required. All participants received a written debrief at the end of the questionnaire. Both paper and online questionnaires contained researcher details to contact if they wanted further information. All participants were given instruction to contact their relevant health professional if completing the questionnaire had raised any questions or issues with regard to caring for their baby. Measures The questionnaire examined demographic background (age, education, marital status, occupation), breastfeeding duration up to six months postpartum, maternal weight and maternal eating style. Participants completed a copy of the Dutch Eating Behaviour Questionnaire (Van Strien, Fritges, Bergers & Defares, 1986). Respondents indicated the extent to which they eat for emotional reasons (e.g. in reaction to feeling sad), external reasons (e.g. smelling palatable foods) and restraint (attempt to restrict their intake of food). The DEBQ is a popular instrument used in eating behaviour research and is considered to have good internal consistency and factoral validity (Allison, Kalinsky, & Gorman, 1992; Van Strien et al., 1986; van Strien, Engels, van Staveren, & Herman, 2006) although there is continual debate in the area (e.g. Jansen et al., 2011; Williamson et al., 2007). Current weight and height were self-reported by participants from which Body Mass Index was computed. Participants also indicated whether they initiated breastfeeding at birth, breastfeeding duration, timing of introduction of any supplementary formula and timing of introduction of complementary foods. Finally, participants were asked whether they typically fed on infant demand or to a maternal-led routine. Data analysis Data analyses were carried out using SPSS v19, SPSS UK Ltd. Data were initially checked and cleaned, ensuring no outliers or missing data remained in the sample. Incomplete questionnaires were discarded from the sample (n = 33). The DEBQ was scored as per instructions to give the scales restraint, external eating and emotional eating (Van Strien et al., 1986). Data was tested and considered normally distributed for DEBQ scores. To examine breastfeeding duration, women were categorised as breastfeeding (fully or partially) or not at birth, two, six and twenty-six weeks. Breastfeeding duration was non-normally distributed due to typical patterns of relatively high levels of initiation followed by a steep drop in continuation rates (as shown in previous research e.g. McAndrew et al., 2012; Bolling, Grant, Hamlyn, & Thornton, 2007). However, as breastfeeding duration was to be used as categorical time point data (breastfeeding or not) and not as linear data, this was considered acceptable. One option was to compare three groups of women at each stage: formula, partial breastfeeding and exclusive breastfeeding. Data on timing of introduction of supplementary formula or solid foods was collected in order to calculate partial or exclusive breastfeeding. However, by six weeks postpartum only 133 (17.5%) of infants were still exclusively breastfed and no difference occurred in eating behaviour between partially and exclusive breastfeeders, thus the decision was made to combine the two groups for the analyses. This also follows typical measures of breastfeeding used by other large surveys in the field e.g. the UK Infant Feeding Survey, typically because levels of exclusive breastfeeding are so low in the UK (McAndrew et al., 2012; Bolling et al., 2007).

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A. Brown / Appetite 76 (2014) 30–35

The main data analysis aims of the study were thus to 1. Examine differences in eating behaviour for mothers who initiated breastfeeding (or not) at birth or who were breastfeeding at all (or not) at two, six and twenty-six weeks postpartum. 2. Explore the potential confounding role of maternal weight and demographic background in this relationship. Spearman’s correlations, chi square and MANOVA were used to examine the relationship between maternal demographic background, BMI, Eating behaviour and breastfeeding duration. MANCOVA were used to explore differences in eating behaviour for infant feeding mode at birth (breast/formula) and infant feeding at two, six and twenty-six weeks postpartum (any breast/formula). Maternal age, education, marital status, occupation and BMI were used as covariates where appropriate. Pearson’s correlations were used to explore relationship between timing of introduction of formula and eating behaviour. Chi Square was used to examine association between feeding method at birth and use of infant routine. Finally, MANCOVA explored differences in eating behaviour between mothers who followed an infant or parent led routine. Results Seven hundred and fifty-six mothers completed the questionnaire. Mean age of the respondents was 29.01 (SD: 5.33) [Range 18–45] with a mean number of 13.82 (SD: 3.09) years in education. 538 (71.2%) were primiparous and 218 (28.8%) multiparous. In terms of BMI, 46 (6.1%) were classified as underweight, 485 (64.2%) normal weight, 161 (21.3%) were overweight and 64 obese (8.5%). Further demographic details can be found in Table 1. No difference in breastfeeding duration, demographic background, BMI or eating behaviour was found between the mothers recruited online or face-to-face. No association was found between maternal demographic background (age, education, marital status, occupation and parity) and eating behaviour. Maternal BMI was significantly correlated with eating behaviour. Mothers who were higher in emotional eating (Pearson’s r = .222, p = .000) and external eating (Pearson’s r .077, p = .024) had significantly higher BMIs whilst those higher in restraint had significantly lower BMIs (Pearson’s r = .635, p = .000). 650 (88.9%) mothers breastfed at birth whilst 81 (11.1%) formula fed. Breastfeeding rates dropped over time. At two weeks, 521 (68.9%) of infants were breastfed even partially, at six weeks 410 (54.2%) and by twenty-six weeks 201 (26.5%). Few infants Table 1 Sample distribution by demographic factors. Indicator

Group

N

%

Age in years

619 20–24 25–29 30–34 35P

28 107 271 211 97

3.7 14.2 41.1 45.8 11.1

Education

School College Higher Postgraduate

132 189 314 121

17.4 25.0 41.5 16.0

Marital status

Married Cohabiting Single

524 199 30

69.3 26.3 3.9

Maternal occupation

Professional/managerial Skilled Unskilled No occupation

319 264 73 52

45.1 37.3 10.3 7.3

were breastfed exclusively for six months postpartum (n = 16, 2.1%). 602 mothers introduced formula milk before six months postpartum, mean age 14.2 days (SD: 11.09). Mean age of introducing solids was 19.56 weeks (SD: 5.172) with a range from 6 to 32 weeks. Mothers who breastfed at birth were significantly older [t (730) = 2.667, p = .008) and had more years in education [t (730) = 2.343, p = .019) compared to mothers who formula fed. Married mothers were also significantly more likely to breastfeed at birth [X (1, 753) = 4.596, p = .023] as were those with a professional/ managerial occupation [X (1, 719) = 5.204, p = .014]. Mothers who breastfed had a significantly lower BMI (t (692) = 2.612, p = .015] compared to mothers who formula fed. No significant difference was seen in breastfeeding initiation between primiparous and multiparous mothers. A MANCOVA (controlling for maternal age, education, marital status, occupation and BMI) found that mothers who breastfed at birth had significantly lower levels of external and restrained eating compared to mothers who formula fed. Similarly, mothers who were breastfeeding at all at two, six and twenty-six weeks had lower levels of external and restrained eating compared to those who were formula feeding. No significant differences were found for emotional eating (Table 2). Six hundred and two mothers had introduced formula milk before six months postpartum. A significant association was seen between external eating (Pearson’s r = .217, p = .000) and restraint (Pearson’s r = .480, p = .000) and timing of introduction to formula milk. Mothers higher in external eating and restraint introduced formula at an earlier date. Four hundred and seventy-six mothers reported generally feeding their infant to an infant led routine whilst two hundred and sixteen followed a mother led routine, feeding on infant demand. Mothers who breastfed were significantly more likely to use an infant led routine [X (1, 726) = 5.649, p = .010]. Mothers who reported feeding their infant to a maternal-led routine were significantly higher in restraint [F (690) = 7.946, p = .000] and external eating [F (690) = 3.733, p = .000] compared to those who fed on infant demand. This finding was independent of breastfeeding initiation and continuation.

Discussion This study explored the association between maternal eating behaviour and breastfeeding duration during the first six months postpartum. It showed that mothers who were higher in restrained or external eating were both less likely to initiate breastfeeding or to continue if started. No association was found between breastfeeding and emotional eating. The results will be applicable to those working to support mothers during the postnatal period to understand how wider eating behaviour influences can affect breastfeeding duration. Considerable research has highlighted the association between eating behaviour, weight and body image in the general population. Evidence also suggests that maternal body image can affect not only their own weight and eating behaviour but that of their children. Mothers with high weight and eating concerns are more likely to try and control their child’s diet; restricting and monitoring intake of food (Fisher & Birch, 1999; Tiggemann & Lowes, 2002). This however is the first study to suggest that maternal eating behaviour is associated with breastfeeding duration, independently of maternal weight. Reasons for this relationship may be attributed to maternal body image, differences in the nature of breast and formula feeding and underlying psycho-social factors. Mothers who are overweight are also less likely to breastfeed (Kitsantas & Pawloski, 2009; Li, Jewell, & Grummer-Strawn,

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A. Brown / Appetite 76 (2014) 30–35 Table 2 Differences in eating behaviour by milk feeding. Restraint

External

Emotional

Breast

Formula

Breast

Formula

Breast

Formula

Birth 3.14 (.76) F (3, 601) = 27.886, p = .000

3.39 (1.14)

2.24 (.75) F (3, 601) = 7.563, p = .006

2.89 (1.09)

2.55 (.84) F (3, 601) = .481, p = .498

2.65 (1.1)

Two 3.13 (.75) F (3, 601) = 23.933, p = .000

4.41 (3.54)

2.22 (.74) F (3, 601) = 24.363, p = .000

2.64 (.94)

2.53 (.85) F (3, 601) = .196, p = .658

2.57 (.97)

Six 3.14 (.77) F (3, 601) = 13.366, p = .005

4.11 (3.19)

2.24 (.77) F (3, 601) = 27.905, p = .000

2.51 (.88)

2.53 (.86) F (3, 601) = .114, p = .736

2.56 (.93)

Twenty-six 3.15 (.79) F (3, 601) = 8.140, p = .005

3.9 (2.89)

2.25 (.76) F (3, 601) = 15.376, p = .000

2.45 (.88)

2.53 (.87) F (3, 601) = .200, p = .655

2.56 (.91)

Table shows mean (SD) and significance (MANCOVA) controlling for maternal age, education, occupation, marital status and BMI.

2003). In turn, BMI is linked to eating behaviour; Individuals who are high in emotional (Geliebter & Aversa, 2003) and external (McGuire et al., 1999) eating are more likely to be overweight as they eat for cues other than hunger. Restrained eating can also be associated with higher body weight (Elfhag & Lime, 2005) as although it may initially lead to weight loss (Boschi, Iorio, Margiotta, D’Orsi, & Falconi, 2001), weight gain can increase over time as high levels of restraint can lead to cravings and overeating (Stunkard & Messick, 1985). However, eating behaviour and breastfeeding duration were associated independently of maternal BMI suggesting the relationship must be explained by something more than simple weight dissatisfaction. Eating behaviour is also associated with body image dissatisfaction, either as a driver for restrained eating (Boschi, Iorio, Margiotta, D’Orsi, & Falconi, 2001) or as a consequence of emotional/ external eating, weight gain and perceived loss of control (Kaplan & Kaplan, 1957; Lowe & Fisher, 1983). Issues related to body image such as lack of confidence, embarrassment at feeding in front of others or concerns about impact of feeding upon breast shape can discourage a woman from breastfeeding (Brown et al., 2011a, 2011b, 2011c; Khoury, Moazzem, JarJoura, Carothers, & Hinton, 2005; Wambach & Cohen, 2009). Women who have poorer body image feel more self conscious of how they appear to others (Grogan, 2007) which might make feeding in public more difficult or make them feel more critical about any general changes they perceive to their postnatal body or impact on the breast. It is also possible that the relationship arises due to maternal desire to diet. Women high in restraint are naturally likely to wish to control their calorie intake whilst women who have gained weight due to uninhibited eating (potentially increased during pregnancy) may also wish to diet. The misperception that a breastfeeding woman must not diet is common (Li, Fein, Chen, & Grummer-Strawn, 2008). Despite sensible weight loss of up to two pounds per week not impacting upon infant growth (Lovelady, Garner, Moreno, & Williams, 2000), desire to diet is still a common reason for breastfeeding cessation (Brown et al., 2011a, 2011b, 2011c; Li et al., 2008; Thulier & Mercer, 2009). Women report increasing pressure to lose weight postnatally (Riley, 2011) and it is likely that women high in restraint feel this pressure more. They may choose to formula feed so that they can lose the weight they have gained. Another explanation for the findings is the difference in feeding approaches often associated with breast and formula feeding. Research with older children shows that mothers who are higher in restraint report a more controlling child-feeding style; restricting and monitoring intake (Fisher & Birch, 1999; Francis et al., 2001; Tiggemann & Lowes, 2002). Differences in maternal child-feeding

style also apply to milk feeding. Formula feeding is associated with a milk feeding style that is more controlling, in terms of routine and monitoring of intake (Brown & Lee, 2013). Formula milk typically allows greater maternal control over feeding patterns and intake as the amount consumed is measurable and visible whereas breastfed infants need to be fed on demand to establish milk supply (Brown et al., 2011a, 2011b, 2011c). Mothers high in restraint are more likely to restrict and monitor their child’s intake of food, thus formula feeding may be a potential precursor to this, allowing them greater routine and control. More generally, restraint has been associated with a higher desire for order and routine (Elfhag & Morey, 2008), which formula milk may allow, especially amongst the many demands of new motherhood. Related to this, anxiety may play a role. Maternal anxiety is often linked to desire to formula feed as milk intake can be measured and consumption viewed (Brown et al., 2011a, 2011b, 2011c) and infants often gain weight more quickly which can be seen as a positive sign (Sachs, Dykes, & Carter, 2006). Mothers high in restraint and external eating (Goldberg, 1999) report higher levels of anxiety. Restraint has also been associated with poorer confidence, a factor known to be associated with using formula (Forster, McLachlan, & Lumley, 2006). External eating is also associated with the personality trait of neuroticism (Heaven, Mulligan, Merrilees, Woods, & Fairooz, 2001) which again is associated with formula use (Brown, 2013). Indeed, a range of psychological factors may play a role. Depression (Goldberg, 1999) and stress (Conner, Fitter, & Fletcher, 1999) have been associated with external eating and restraint, both of which have been implicated in breastfeeding cessation through mechanisms such as postnatal depression (Field, 2010). Further research is needed to explore causal pathways. The research does have its limitations. Participants were selfselecting. Although a range of responses both in terms of infant feeding and body image were seen, a higher proportion of mothers breastfed for at least six months compared to population norms (McAndrew et al., 2012). A demographic spread was also seen in participant background but mothers were typically older and more educated than average (Office for National Statistics, 2010). Care should be taken in generalising the findings to a wider population. Further research should explore the issue in a wider population based sample. Recruitment also relied on online participation through advertising on targeted online message forum. Internet recruitment is growing in popularity in health research (e.g. Alcalde & Cristina, 2011; Ferguson & Hansen, 2012; Hamilton, White, & Cuddihy, 2012) as it allows access access to a targeted sample in a cheap and effective way (Koo & Skinner, 2005). It is particularly useful in recruiting pregnant and new mothers due to high use of internet

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A. Brown / Appetite 76 (2014) 30–35

forums amongst this sample (Hall & Irvine, 2008; Plantin & Danebeck, 2009). Such forums are now typically used by a wide spread of demographic groups (Quan-Haase, Wellman, Witte, & Hampton, 2002; Sarkadi & Bremberg, 2005). However it has been criticised for increasing sample bias; internet users may be a well educated and proactive group (Drentea & Moren-Cross, 2005). This is a common limitation of many research studies however. There is also the question of reliability of the DEBQ and changes in eating behaviour in the first year postpartum. Research exploring maternal eating behaviour (apart from dieting) during this time is sparse. Although eating behaviour is relatively stable (Cain, Epler, Steinley, & Sher, 2010) and possibly genetically driven (Sung, Lee, Song, Lee, & Lee, 2010), maternal eating behaviour during this time could be different e.g. increased motivation for restraint or emotional or external eating in response to the new stressors of motherhood. Weight during this period may also not be indicative of stable weight. One study suggested that prior to six months postpartum mothers are reluctant to engage in dieting behaviour but that they become more motivated to regain their pre pregnancy weight as they return to work (Price et al., 2012). Linked to this it could be that decision to breastfeed affects eating behaviour. Mothers may decide not to restrict their calorie intake because they are breastfeeding, or believe that they need to eat more to produce enough milk (Durham, Lovelady, Brouwer, Krause, & Østbye, 2011). Moreover they may make a concerted effort to eat more healthily during breastfeeding, deliberately not allowing themselves to eat sugary and high fat items in response to food cues as they believe it might affect the quality of their breast milk, despite limited evidence that average variations in a normal diet have any impact (Schreiber, 2001). Research may wish to explore how eating behaviour changes during pregnancy, the postnatal period and later over time. Limitations aside, this study shows a novel relationship between maternal eating behaviour and breastfeeding duration. The findings extend a body of research showing that maternal eating behaviour can impact upon maternal child-feeding style, illustrating that mothers high in restraint or external eating are less likely to initiate or continue breastfeeding. This relationship may be explained by increased body image concerns, differences in attitudes towards the baby-led nature of breastfeeding or wider underlying psychosocial factors. Importantly, the findings are important for those working to support new mothers during the postnatal period and to understand the influences on what drives and affects breastfeeding duration. References Alcalde & Cristina, M. (2011). To make it through each day still pregnant. Pregnancy bed rest and the disciplining of the maternal body. Journal of Gender Studies, 20(3), 209–221. Alexander, A., Dowling, D., & Furman, L. (2010). What do pregnant low-income women say about breastfeeding? Breastfeeding Medicine, 5(1), 17–23. Allison, D. B., Kalinsky, L. B., & Gorman, B. S. (1992). A comparison of the psychometric properties of three measures of dietary restraint. Psychological Assessment, 4(3), 391. Barnes, J., Stein, A., Smith, T., & Pollock, J. I. (1997). ALSPAC Study Team. Extreme attitudes to body shape, social and psychological factors and a reluctance to breast feed. Journal of the Royal Society of Medicine, 90, 551–559. Bartok, C. J., Schaefer, E. W., Beiler, J. S., & Paul, I. M. (2012). Role of body mass index and gestational weight gain in breastfeeding outcomes. Breastfeeding Medicine, 7(6), 448–456. Benton, D. (2004). Role of parents in the determination of the food preferences of children and the development of obesity. International Journal of Obesity, 28, 858–869. Birch, L. L., & Fisher, J. O. (2000). Mothers’ child-feeding practices influence daughters’ eating and weight. American Journal of Clinical Nutrition, 71, 1054–1061. Birch, L. L., Fisher, J. O., & Davison, K. (2003). Learning to overeat. Maternal use of restrictive feeding practices promotes girls eating in the absence of hunger. American Journal of Clinical Nutrition, 78, 215–220.

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