The influence of maternal modeling on body image concerns and eating disturbances in preadolescent girls

Behaviour Research and Therapy 100 (2018) 17–23

Contents lists available at ScienceDirect

Behaviour Research and Therapy journal homepage: www.elsevier.com/locate/brat

The influence of maternal modeling on body image concerns and eating disturbances in preadolescent girls

MARK

Charlotte M. Handford, Ronald M. Rapee, Jasmine Fardouly∗ Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, 2109, Australia

A R T I C L E I N F O

A B S T R A C T

Keywords: Maternal modeling Preadolescent girls Body image Eating pathology

Research suggests that mothers may influence the development of body image concerns and eating disturbances in their daughters by modeling negative body image beliefs and unhealthy eating behaviors. However, the causal nature of that mode of influence is yet to be established. This study implemented an experimental design to examine the impact of mothers' modeling of negative comments about their own appearance and diet on their daughters' body image concerns and eating behaviors. Participants were 8–12 year old girls and their mothers (N = 50). While viewing thin-ideal magazine advertisements with their daughter, mothers were instructed to make either negative comments about their own weight, shape, and diet or to make no appearance or diet related comments. Daughters' levels of body esteem, body satisfaction, and eating attitudes were assessed preand post-manipulation, and their actual eating habits were measured post-manipulation. Girls whose mothers had made self-critical comments about their own appearance and diet reported lower body esteem, lower body satisfaction, more problematic eating attitudes, and ate significantly fewer sweets than girls whose mothers had not made self-critical comments. These results have implications for disordered eating prevention programs, suggesting that greater emphasis be placed on discouraging negative modeling behaviors among mothers.

1.1. Introduction Although body dissatisfaction is most prevalent during adolescence (Gowers & Shore, 2001), there is considerable research suggesting that these concerns may arise from a much younger age (McLaughlin, Belon, Smith, & Erickson, 2015; Smolak & Levine, 2001). A number of studies using preadolescent samples have found that children as young as five are dissatisfied with their current weight and shape (Davison, Markey, & Birch, 2000; Flannery-Schroeder & Chrisler, 1996), hold fears about becoming fat (Feldman, Feldman, & Goodman, 1998), and express a desire to be thinner (Lowes & Tiggemann, 2003). Longitudinal research suggests that these concerns about weight and shape do not subside from childhood to early adulthood, but instead appear to intensify with age (Cash & Henry, 1995; Smolak & Levine, 2001). Body dissatisfaction has been described as one of the most robust risk factors in the development and maintenance of disordered eating (Stice, 2002). Among adolescent females, body dissatisfaction has been shown to have strong positive associations with the use of weight loss strategies including dieting, excessive exercise, and laxative abuse (Davis, Kennedy, Ravelski, & Dionne, 1994; Paxton et al., 1991; Stice & Shaw, 2002). Strategies such as these are widely believed to precede the onset of eating disorders. Given that body dissatisfaction has been identified in

∗

children well before they have reached adolescence, the need to help foster positive body image in children from a young age becomes even more apparent, because this may help to prevent the later onset of more serious physical and psychological problems. Extensive research has been dedicated to understanding the risk factors associated with body dissatisfaction and disordered eating (Stice, 2002; Striegel-Moore & Bulik, 2007), and researchers have examined both biological influences (e.g., Klump, McGue, & Iacono, 2000; Spanos, Burt, & Klump, 2010), as well as the influence of sociocultural factors such as the media, peers, and family (e.g., Keery, Van den Berg, & Thompson, 2004; Van den Berg, Thompson, Obremski-Brandon, & Coovert, 2002). During preadolescence, the parent-child relationship is the primary source of influence in development, and plays an important role in shaping children's attitudes and values about body image (Jones, 2011, chap. 13). By establishing lifestyle patterns of diet, exercise, and evaluation of others, parents express their expectations and beliefs about physical appearance and eating behavior to their children from a young age (Salvy, Elmo, Nitecki, Kluczynski, & Roemmich, 2011). Furthermore, while during adolescence female eating behaviors are more influenced by peers, younger children's food choices and eating behaviors are more strongly influenced by mothers than by friends (Salvy et al., 2011).

Corresponding author. E-mail addresses: [email protected] (C.M. Handford), [email protected] (R.M. Rapee), [email protected] (J. Fardouly).

https://doi.org/10.1016/j.brat.2017.11.001 Received 18 May 2017; Received in revised form 3 October 2017; Accepted 3 November 2017 Available online 06 November 2017 0005-7967/ © 2017 Elsevier Ltd. All rights reserved.

Behaviour Research and Therapy 100 (2018) 17–23

C.M. Handford et al.

shape concerns and the concerns of their daughters over time (Attie & Brooks-Gunn, 1989; Byely, Archibald, Graber, & Brooks-Gunn, 2000), more recent studies have demonstrated that mothers' self-reported weight and shape concerns predict body image and eating disturbances in their daughters years later (Jacobi, Agras, & Hammer, 2001; Stein et al., 2006; Van den Berg, Keery, Eisenberg, & Neumark-Sztainer, 2010).

Given that mothers are often regarded as the most obvious role models of eating and weight issues for their developing daughters (Cooper & Stein, 2013), postulated mechanisms of parental influence have focused on qualities in the mother-daughter relationship (Cooley, Toray, Wang, & Valdez, 2008). Within the literature, two main modes of maternal influence have been proposed. One postulated mechanism is that mothers may directly influence the development of body image and eating disturbances in their daughters by making explicit negative comments about their daughter's shape and weight in the form of teasing, criticism, and encouragement to lose weight (Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). The second postulated mechanism is that mothers may indirectly influence their children's body image and eating habits by modeling their own negative body image related beliefs and dieting behaviors (Rodgers, Paxton, & Chabrol, 2009). Thus, whereas modes of direct influences are concerned with mother's explicit negative appraisals of their daughter's weight and shape, modes of maternal modeling are focused on mothers' negative appraisals of their own weight and shape and their engagement in various weight-loss strategies that may be vicariously learned by their daughters. Maternal modeling may, therefore, influence daughters' body image because the daughters may copy the behavior of their mother (e.g., making appearance comparisons or dieting) and/or because their mother's self-critical comments about their weight and shape, and weight loss behaviors may teach girls to place great value on the importance of being thin, both of which could result in girls becoming dissatisfied with their appearance. Although both direct and indirect maternal influences may be important predictors for girls' body image, the current study will focus on indirect influences to examine the immediate impact of maternal modeling on daughters' body image concerns and eating attitudes. Research investigating the role of maternal modeling has predominantly been correlational. Some studies have found significant positive correlations between daughters' body dissatisfaction and eating disturbances and the body image concerns and behaviors of their mothers in both adolescent (Field et al., 2005; Keery et al., 2004; Pike & Rodin, 1991) and preadolescent (Davison et al., 2000; Gonçalves, Silva, Gomes, & Machado, 2012; Hill, Weaver, & Blundell, 1990; Rüther & Richman, 1993) samples. There is also research suggesting that preadolescent girls' perception of their mother's body dissatisfaction may predict their own body dissatisfaction (Lowes & Tiggemann, 2003). While engagement in extreme weight loss strategies and actual dieting behavior is uncommon among children, studies of younger samples suggests that maternal modeling may influence the negative body image beliefs and concerns that precede these behaviors (Abramovitz & Birch, 2000). For example, research has shown that mothers' own dieting behaviors and levels of body dissatisfaction are positively correlated with preadolescent girls' body image concerns and conceptual understanding of dieting related concepts (Abramovitz & Birch, 2000; Davison et al., 2000). However, results examining the relationship between mothers' and daughters' weight related attitudes and behaviors are inconsistent, with other studies reporting either no significant correlation (Baker, Whisman, & Brownell, 2000; Fulkerson et al., 2002; Kanakis & Thelen, 1995; Moreno & Thelen, 1993) or mixed results (Abraczinskas, Fisakca, & Barnes, 2012; Hill & Franklin, 1998; Wertheim, Martin, Prior, Sanson, & Smart, 2002). This inconsistency may be, in part, due to methodological limitations. Research to date has been mostly correlational, and hence has been unable to reliably establish the direction of effect, or control for the influence of third variables such as media pressures (e.g., Thompson et al., 1999; Tiggemann & McGill, 2004) or anxiety and depressive symptoms (e.g., Chamay-Weber, Narring, & Michaud, 2005; Kostanski & Gullone, 1998; Santos, Richards, & Bleckley, 2007). Although limited in number, some studies have sought to overcome the limitations of simple correlational research by utilizing longitudinal designs, but again results have been inconsistent. Although some early research failed to show a significant prediction of mothers' weight and

1.1. The present study The aim of the present study was to investigate the immediate causal influence of maternal modeling on the body esteem, body satisfaction, eating attitudes, and eating behaviors of young girls by manipulating maternal comments about their own weight, shape, and diet and assessing the effects of this manipulation. It was hypothesized that girls whose mothers made self-critical comments about their own weight, shape, and diet would show lower body esteem, less body satisfaction, more problematic eating attitudes, and eat fewer sweets compared to girls whose mothers made no weight, shape, or diet related comments. These effects were predicted even after controlling for potential constructs previously associated with girls' body dissatisfaction (Abraczinskas et al., 2012; Davison et al., 2000; Kostanski & Gullone, 1998; Thompson et al., 1999), such as daughters' body mass index (BMI), daughters' age, daughters' anxiety and depressive symptoms, mothers' concerns about their daughter's weight and diet, mothers' concerns about their own weight and diet, and mothers' age and BMI. To our knowledge, this was the first experimental study to examine the immediate impact of maternal modeling on young girls' body image and eating behavior. The experimental and analogue nature of this study, however, only allows for the examination of the short-term influence of a single experience of maternal modeling on daughters body image and eating attitudes. 2. Method 2.1. Participants Participants were 50 girls, aged 8–12 years old (M = 10.30, SD = 1.68) and their mothers, who had a mean age of 41.46 years (SD = 3.29). The mean body mass index (BMI; kg/m2) of the girls was 20.64 (SD = 3.40; range = 14–29), and of the mothers was 24.27 (SD = 4.45; range = 18–35). The majority of mother-daughter pairs identified as Caucasian (n = 33, 66%), 8 (16%) identified as Asian, and 9 (18%) identified as ‘other’. All participants were English-speaking. Mother-daughter pairs were recruited from the local community using advertising flyers, disseminated within several local businesses. In return for their participation, all pairs went into a draw to win a family movie voucher. Mother-daughter pairs were randomly allocated to one of two conditions; maternal modeling (experimental condition, n = 25) or no modeling (control condition, n = 25). Independent samples t-tests revealed that there was no significant difference in the mean ages of girls, t(36.70) = 0.13, p = 0.90, or mothers, t(48) = −0.08, p = 0.93, or the mean BMI of girls, t(48) = 1.34, p = 0.19, or mothers, t (48) = 1.84, p = 0.07, in the experimental and control groups. Results from a chi-square test of contingencies indicated that mother and daughter ethnicity did not significantly differ between the experimental and control groups, χ2 (2) = 0.88, p = 0.64. 2.2. Outcome measures Daughters' body esteem. Daughters' body esteem was measured using the 24-item Body Esteem Scale (BES; Mendelson & White, 1982), which assesses levels of satisfaction with general appearance and overall body shape. Items are phrased as self-statements (e.g., “I like what I look like in pictures”), and respondents select either ‘yes’ (1) or ‘no’ (0) from a two-item forced choice response set. A total body esteem 18

Behaviour Research and Therapy 100 (2018) 17–23

C.M. Handford et al.

measures of both anxiety (α = 0.86) and depression (α = 0.72). Mothers' concerns regarding daughter's weight and diet. To assess mothers' attitudes and behaviors in relation to their daughter's weight and eating habits, the Concerns about Child Weight subscale and Restriction Subscale from the Child Feeding Questionnaire (CFQ; Birch et al., 2001) were used. The Concerns about Child Weight subscale consists of three items assessing the extent to which mothers worry about their daughter becoming overweight, and their belief that their daughter needs to diet in order maintain a healthy weight (e.g., “How concerned are you about your child eating too much when you are not around her?”). Items were rated on a 4-point Likert scale, ranging from ‘not at all concerned’ (0) to ‘very concerned’ (3), with higher scores indicating greater maternal concern regarding daughter's weight status. This subscale demonstrated excellent internal consistency for the current sample (α = 0.93). The Restriction Subscale is comprised of eight questions assessing the extent to which parents' control their child's diet (e.g., “I have to be sure that my child does not eat too many sweets”). Mothers' are instructed to rate the extent to which they agree with the statement on a 5-point Likert scale ranging from ‘disagree’ (0) to ‘agree’ (4). Higher scores indicate that mothers are more restrictive of their daughter's food intake. Internal consistency of the Restriction Subscale for the current sample was adequate (α = 0.63). Mothers' concerns about own weight and diet. The five-item Weight Concerns Scale (WCS; Killen et al., 1994) was used to assess mothers' preoccupations with weight and shape, fear of gaining weight, dieting history, and perceived fatness (e.g., “How much more or less do you feel you worry about your weight and body shape than other women your age?”). Items 1, 2 and 5 were rated on a 5-point response scale, item 3 had six response options and item 4 had four response options. Scores for each item were calculated using the formula 100*(response-1)/(number of response options-1). For example, if a mother chose option “4” for question 1 (“I worry a little more than other women”), their score for that question would be 75 (4 minus 1, multiplied by 100, divided by 4). A total score is then created by summing and averaging the five scores. In the current sample, the internal consistency for the Weight Concerns Scale was good (α = 0.84).

score was calculated by summing responses for the 24 items (after reverse scoring negative items). Scores ranged from 0 to 24, with higher scores indicating higher levels of body esteem. Internal consistency of this scale for the current sample was good (pre-manipulation α = 0.93, post-manipulation α = 0.94). Note that although the BES was originally designed as a trait measure, it was used as a state measure in the present study consistent with previous experimental research (e.g., Dittmar, Halliwell, & Ive, 2006). Daughters' body satisfaction. Collins' Figure Ratings (CFR; Collins, 1991) were used to collaborate with results obtained for the BES as both measures assess level of body satisfaction. The CFR is a pictorial instrument that consists of drawings of seven preadolescent bodies, ranging from very thin (1) to obese (7). Participants were asked to select the figure that they believed looked like their current self and also the figure that they would most like to have. A body satisfaction score was calculated by subtracting the current self-score from the ideal self-score. Scores closer to 0 indicated greater satisfaction with current body shape; negative scores indicated body dissatisfaction with a preference for a thinner figure, while positive scores indicted body dissatisfaction with a preference for a larger figure. Similar to the BES, the CFR was originally designed as a trait measure but has been found to be sensitive to state-like changes in previous research (e.g., Anschutz & Engels, 2010) and thus was used as a state measure in the present study. Daughters' eating attitudes. In order to measure daughters' attitudes towards eating, an amended version of the Children's Eating Attitude Test (ChEAT) was used (Maloney, McGuire, & Daniels, 1988). The original ChEAT consists of 26 self-statement items rated on a 6point Likert scale ranging from ‘always’ to ‘never’. In the current study, only 12 of the original items were retained to reduce response fatigue and also because a number of the items were not deemed appropriate, given the non-clinical sample in this study. Items removed were those that did not apply to state-based tendencies (e.g., “I have gone on binges where I feel that I might not be able to stop”) and those pertaining to purging behaviors. The wording of some of the items in the current study was also slightly changed, in order to measure state-based rather than trait-based behaviors. For example, the item “I think about food a lot of the time”, was changed to “I am currently thinking about food”. Items were rated on a 4-point Likert scale, where “very much so” was given a score of 2, “a little bit” was given a score of 1, and “not very much” and “not at all” were given a score of 0. Scores could range from 0 to 24, with higher scores indicating more maladaptive and problematic eating attitudes. Internal consistency of this modified scale for the current sample was good (pre-manipulation α = 0.80, post-manipulation α = 0.83). Daughters' actual eating habits. Girls' actual eating behavior was measured in addition to their attitudes towards eating. While daughters were filling out the final set of questionnaires a bowl of exactly 50 sweets (jelly snakes) was left beside them and the experimenter informed the girls that they were free to eat as many as they pleased. A total food intake score was then calculated by counting how many sweets were consumed. Previous studies have effectively used actual food intake as an outcome measure (e.g., Anschutz, Engels, Becker, & Van Strien, 2009; Seddon & Berry, 1996).

2.4. Manipulation check As a check on the experimental manipulation, girls responded to four items assessing the extent to which they perceived their mother to be unhappy with her appearance (e.g., “my mother thinks she needs to lose weight”). Girls selected either ‘yes’ (1) or ‘no’ (0) from a forced choice response set. Scores were summed with higher scores indicating higher perceived mother body dissatisfaction. 2.5. Procedure Prior to conducting the research, approval was gained from the university ethical review board. Participants were informed that the study investigated the effect of media advertisements on the motherdaughter relationship. Upon arrival at the laboratory, mothers provided written consent for their own participation in the research, and the participation of their daughters. To begin, height and weight measurements were taken for both mothers and daughters to calculate BMI. Mothers and daughters were then taken to separate rooms where they completed the first set of questionnaires (pre-manipulation body esteem, body satisfaction, and eating attitudes, and potential covariate measures). Mothers were also asked to indicate both their own and their daughter's age, ethnicity, and language spoken at home. While mothers were alone, the experimenter explained the true aims of the research (i.e., to examine the influence of maternal modeling) and allocated them to either the control or experimental condition as determined by a computer generated randomization program. Written re-consent was obtained from mothers according to the true aims of the experiment.

2.3. Potential covariates Daughters' anxiety and depression. Girls' symptoms of anxiety and depression were measured using the short version of the Revised Children's Anxiety and Depression scale (RCAD; Ebesutani et al., 2012). The measure consists of 15 self-statements that measure broad anxiety and depressive symptoms in children (e.g., “I feel sad or empty”, “I suddenly start to tremble or shake for no reason”). Items are rated on a 4-point Likert scale ranging from ‘never’ (0) to ‘always’ (3). Total scores were calculated separately for anxiety and depression by summing the relevant items, with higher scores indicating more severe symptomology. For the current sample, internal consistency was good for 19

Behaviour Research and Therapy 100 (2018) 17–23

C.M. Handford et al.

modeling, Wilks' λ = 0.92, F(2, 38) = 1.73, p = 0.19, η2p = 0.08. However there was a significant multivariate interaction between time and maternal modeling, Wilks' λ = 0.68, F(2, 38) = 8.80, p = 0.001, η2p = 0.32. Given this significant multivariate interaction, univariate main effects were examined. To control family wise error rate for multiple tests, alpha was set at a Bonferroni adjusted level of 0.017 (0.05/3). An inspection of the univariate effects indicated a significant time by group interaction on body esteem, F(1, 39) = 18.68, p < 0.001, η2p = 0.33, body satisfaction, F(1, 39) = 10.45, p = 0.002, η2p = 0.21, and eating attitudes F(1, 39) = 11.49, p = 0.002, η2p = 0.23. As seen in Table 2, girls in the experimental condition reported less body esteem, less body satisfaction, and more eating pathology than girls in the control condition.

Mothers and daughters were then taken into the same room, where they completed an advertisement rating task. Mothers and daughters were shown six fashion advertisements and were instructed to make a mutual decision about how effective they believed the image was at advertising the clothes being worn. Mothers assigned to the control condition were instructed to talk only about the clothes, and to make no comments about the models themselves, for example, about their body or appearance. Mothers assigned to the experimental condition were instructed to make negative comments about their own appearance in relation to the images being viewed. Specifically, mothers in the experimental condition were instructed to make two weight related comments (e.g., “looking at these pictures makes me feel like I need to lose a bit of weight”), two shape related comments (e.g., “she has nice thin legs doesn't she? I wish I had legs like that”), and two diet related comments (e.g., “I think I am going to have to go on a diet. I am going to need to start eating less if I want to look as good as these girls”). While a list of example comments was provided, mothers were instructed to make their comments as natural and non-contrived as possible. Daughters were not informed of the experimental manipulation. Mothers were then asked to leave the room, and daughters were left alone to complete the second set of questionnaires (post-manipulation body esteem, body satisfaction, and eating attitudes, and the manipulation check). While completing the questionnaires, a bowl of sweets was placed beside each girl, and they were informed that they could eat as many as they pleased. Mothers and daughters were fully debriefed by the experimenter at the end of the study.

3.3. Impact of maternal modeling on eating behaviors A one-way ANCOVA was conducted to determine whether the number of sweets that daughters' consumed differed between the control group and experimental group. After controlling for mother age, daughter age, mother BMI, daughter BMI, daughter depression, daughter anxiety, mothers' concerns about their daughter's weight and diet, and mothers' concerns about their own weight and diet, there was a significant main effect of maternal modeling, F(1, 39) = 9.12, p = 0.004, η2p = 0.19. As seen in Table 2, girls in the experimental condition ate fewer sweets than girls in the control condition. 4. Discussion

3. Results This study investigated the immediate influence of maternal modeling on preadolescent girls' levels of body esteem, body satisfaction, eating attitudes, and actual eating behaviors. As hypothesized, after controlling for a range of covariates (mothers' age, daughters' age, mothers' BMI, daughters' BMI, daughters' depression, daughters' anxiety, mothers' concerns about their daughter's weight and diet, and mothers' concerns about their own weight and diet), girls whose mothers made more self-critical comments about their own weight, shape, and diet had lower levels of body esteem, were more dissatisfied with their body shape, had more problematic eating attitudes, and demonstrated more restrained eating habits than girls whose mothers made no appearance or diet related comments. By experimentally manipulating maternal behavior, these findings extend the results of correlational data (Davison et al., 2000; Gonçalves et al., 2012; Hill et al., 1990; Rüther & Richman, 1993), by demonstrating that maternal modeling can have an immediate causal influence on body dissatisfaction and eating disturbance in girls. The findings of the current study have important theoretical implications, contributing to and extending current knowledge about the causes and risk factors of poor body image. It is possible, that if mothers frequently express preoccupations with their weight, shape, and diet in the form of self-critical comments, or by engaging in various weightloss behaviors, their daughters may also learn to place great value on the importance of being thin. That is, by regularly criticizing their own body shape, and by making consistent efforts to change it, mothers may foster an ideal of beauty that is both highly desirable (Hesse-Biber, Leavy, Quinn, & Zoino, 2006), yet also highly unattainable (Brownell, 1991; Flegal, Carroll, Kit, & Ogden, 2012), in turn contributing to their daughter's body dissatisfaction. The results of the current study also have important implications for body image and disordered eating prevention programs, suggesting that in addition to fostering positive body image in young girls, greater emphasis should be placed on discouraging negative modeling behaviors among mothers. Previous research suggests that body image interventions involving mothers can be effective at reducing daughters' appearance-related concerns and behaviors (e.g., Diedrichs et al., 2016; Hart, Cornell, Damiano, & Paxton, 2015). Interventions that discourage mothers from making self-critical comments, and encourage them to

3.1. Preliminary analyses There were no missing values for any of the study variables. An independent samples t-test revealed that girls in the experimental condition (M = 3.28; SD = 1.31) believed their mothers were more unhappy about their weight, shape, and diet than girls in the control condition (M = 0.12; SD = 0.33), t(48) = −11.71, p < 0.001, d = 3.31. Thus, the experimental manipulation was successful. Correlations were calculated between all of the study variables and the outcome variables (see Table 1). Although mothers' BMI, mothers' concerns about their daughter's weight and diet, and mothers' concerns about their own weight and diet were not correlated with the outcome variables, they have been linked with girls' body dissatisfaction in previous research (Abraczinskas et al., 2012; Davison et al., 2000; Gonçalves et al., 2012; Kostanski & Gullone, 1998; Thompson et al., 1999). Therefore, all of the potential covariates measured in the present study were controlled for in further analyses. [Note that daughters also completed the Media Pressures subscale of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4; Thompson et al., 2011). However, scores on the Media Pressure subscale had a large positive skew and 94% of the participants reported a score of 0 (potential range = 0–16), indicating that the majority of the sample did not feel any pressure from the media to improve their appearance. Therefore, this variable was not included in any analyses.] 3.2. Impact of maternal modeling on body esteem, body satisfaction, and eating attitudes To assess whether maternal modeling of negative weight, shape, and diet related comments influenced changes in daughters' body esteem, body satisfaction, and eating attitudes a Repeated Measures MANCOVA was conducted, with mother age, daughter age, mother BMI, daughter BMI, daughter depression, daughter anxiety, mothers' concerns about their daughter's weight and diet, and mothers' concerns about their own weight and diet included as covariates. Results indicated that there was no significant multivariate effect of time, Wilks' λ = 0.93, F(2, 38) = 1.35, p = 0.27, η2p = 0.07; or maternal 20

21

3.56 (3.39)

3.76 (3.81)

−0.52 (0.65)

−0.40 (0.65)

17.52 (6.30)

17.12 (7.01)

−0.60 (0.87) 9.40 (6.05)

6.76 (3.01)

4.52 (2.90)

1

12.60 (5.44)

−0.15

−0.50***

1

−1.12 (0.93)

−0.14

0.16

0.50***

−0.67***

1

12.64 (6.53)

0.27

−0.18

0.63***

−0.68***

0.84***

4.60 (2.89)

5.04 (2.78)

−0.22

7.96 (5.54)

9.32 (5.36)

−0.13

−0.18

0.52***

1

0.48***

−0.35*

−0.42**

−0.25

Anxiety

0.33*

−0.44**

−0.29*

Depression

−0.29*

0.41**

0.58***

Number of sweets consumed

0.36*

1

−0.47**

Post eating attitudes

−0.44**

0.74***

−0.59***

1

0.68***

Post body satisfaction

0.72***

0.89***

−0.54***

0.81***

16.00 (6.05)

1

Post body esteem

Pre eating attitudes

Pre body satisfaction

Note. *p < 0.05, **p < 0.01, ***p < 0.001. N = 50 for all analyses.

Pre Body Esteem Pre Body Satisfaction Pre Eating Attitudes Post Body Esteem Post Body Satisfaction Post Eating Attitudes Number of Sweets Consumed Maternal Modeling Mean (SD) No Maternal Modeling Mean (SD)

Pre body esteem

10.28 (1.72)

10.32 (1.68)

−0.42**

0.41**

−0.24

−0.30*

0.26

−0.19

−0.30*

Daughter age

Table 1 Correlations between all study variables and outcome variables pre and post manipulation, and mean (standard deviation) scores per condition.

41.52 (4.14)

41.40 (2.22)

−0.13

0.33*

−0.07

−0.10

0.28

−0.12

−0.09

Mother age

21.28 (2.69)

20.00 (3.94)

0.28*

0.03

−0.23

−0.04

−0.23

−0.04

0.05

Daughter BMI

25.40 (4.86)

23.14 (3.77)

−0.02

0.28

−0.10

−0.09

−0.03

−0.06

−0.06

Mother BMI

36.36 (22.10)

34.75 (23.38)

−0.16

0.06

−0.19

−0.15

0.25

−0.18

−0.22

Mother concerns for daughter weight

12.04 (3.40)

12.20 (4.17)

−0.08

−0.06

−0.02

0.02

−0.03

0.08

0.00

Mother restraint on daughter diet

2.12 (2.47)

2.48 (2.04)

−0.20

−0.10

−0.20

−0.21

0.07

−0.21

−0.21

Mother weight concerns

C.M. Handford et al.

Behaviour Research and Therapy 100 (2018) 17–23

Behaviour Research and Therapy 100 (2018) 17–23

C.M. Handford et al.

direct influences are far more adverse (Baker et al., 2000; Smolak, Levine, & Schermer, 1999). Furthermore, it is possible that mothers' modeling of unhealthy eating habits and weight-loss behaviors and their modeling of self-critical comments may produce additive or interactional effects in daughters. Investigation of these more complex relationships remains a topic for future research. Notwithstanding the aforementioned limitations, to our knowledge, this is the first study to investigate the causal influence of maternal modeling on daughters' body image by experimentally manipulating maternal behavior. The results provided evidence that mothers' modeling of self-critical comments about their own weight, shape, and diet may cause at least short-term body dissatisfaction, problematic eating attitudes, and restrictive eating habits in young girls. It is possible, that just as the modeling of maladaptive body image related attitudes and behaviors could cause harmful outcomes in daughters, maternal modeling of healthy attitudes and behaviors could cause favorable outcomes. If this hypothesis is supported by future experimental studies, there are important implications for prevention programs.

Table 2 Adjusted means (standard error) for body esteem, body satisfaction, eating attitudes and number of sweets consumed by girls in each group. Maternal modeling (n = 25)

Body Esteem Body Satisfaction Eating Attitudes Number of Sweets Consumed

No maternal modeling (n = 25)

Pre

Post

d

Pre

Post

d

16.11 (1.17) −0.51 (0.12) 3.15 (0.63)

12.35 (1.30) −1.18 (0.17) 13.00 (1.02) 4.55 (0.49)

3.04

17.41 (1.17) −0.41 (0.12) 4.17 (0.63)

17.41 (1.30) −0.54 (0.17) 8.99 (1.02) 6.72 (0.49)

0.00

4.62 −11.94

0.90 −5.84

Note. Number of sweets consumed was only measured post manipulation. Cohen's d effect sizes are reported per condition for changes in the outcome measures pre- and postmanipulation. Means for body esteem, body satisfaction, eating attitudes, and the number of sweets consumed are adjusted for daughter anxiety, daughter depression, daughter age, daughter BMI, mother age, and mother BMI, mothers' concerns about their daughter's weight and diet, and mothers' concerns about their own weight and diet.

Acknowledgements The authors received no funding from an external source. The authors declare no conflict of interest.

model healthful eating and positive body esteem may be effective in preventing the onset of body dissatisfaction and eating disturbances during adolescence. However, the current research focused specifically on the influence of mothers' self-critical comments, and thus the causal impacts of mothers' modeling of positive weight and food related attitudes and behaviors might be a productive topic to pursue in future experimental studies. There are several limitations to the present study that should be noted. First, findings from this study are limited in that they are based on a convenience sample of girls and mothers, predominantly recruited from a local family medical practice located in an affluent area. Future investigations would benefit from using a more heterogeneous sample that better represents the general population. Second, although experimental designs such as the current one have the benefit of increasing internal validity, this is usually at the expense of external validity. The contrived scenarios used in this study may not accurately reflect typical mother-daughter interactions and so the degree to which the obtained results can be applied in the real world may be limited. Third, the number of appearance and diet related comments made by mothers in both conditions during the advertisement rating task were not recorded. Thus, although girls in the maternal modeling condition reported that their mothers were more concerned about their own appearance than girls in the control condition, we cannot be certain that mothers in each condition complied with the study instructions. Fourth, girls in the present study were not asked if they were aware of the true nature of the study and it is possible that their responses may have been influenced by social desirability. Fifth, it is possible that measuring mothers' and daughters' height and weight at the beginning of the study may have primed weight concerns. However, because height and weight were measured at the same time in both the experimental and control conditions, it is unlikely to explain any differences found between conditions. Sixth, the experimental nature of the current study tested short-term (state) effects of maternal modeling on girls' body dissatisfaction and eating disturbance. Future research using ecological momentary assessments (EMA) could test the impact of maternal modeling in girls' natural environment to determine whether the effects of maternal modeling cumulate over time, and to test how long those effect last. Finally, by seeking to isolate the causal effect of mothers' negative comments about their own weight, shape, and diet, other important dimensions of maternal influence, such as direct maternal criticism, or the modeling of unhealthy eating behaviors, were not considered in the current study. Previous research has suggested that in the presence of direct maternal criticism and maternal modeling, the consequences of

References Abraczinskas, M., Fisakca, B., & Barnes, R. D. (2012). The relation between parental influence, body image, and eating behaviors in a nonclinical female sample. Body Image, 9, 93–100. http://dx.doi.org/10.1016/j.bodyim.2011.10.005. Abramovitz, B. A., & Birch, L. L. (2000). Five year old girls' ideas about dieting are predicted by their mother's dieting. Journal of the American Dietetic Association, 100, 1157–1163. http://dx.doi.org/10.1016/S0002-8223(00)00339-4. Anschutz, D. J., & Engels, R. C. M. E. (2010). The effects of playing with thin dolls on body image and food intake in young girls. Sex Roles, 63, 621–630. http://doi.org/10. 1007/s11199-010-9871-6. Anschutz, D. J., Engels, R. C., Becker, E. S., & Van Strien, T. (2009). The effects of TV commercials using less thin models on young women's mood, body image and actual food intake. Body Image, 6, 270–276. http://dx.doi.org/10.1016/j.bodyim.2009.07. 007. Attie, I., & Brooks-Gunn, J. (1989). Development of eating problems in adolescent girls: A longitudinal study. Developmental Psychology, 25, 70–79. http://dx.doi.org/10.1037/ 0012-1649.25.1.70. Baker, C. W., Whisman, M. A., & Brownell, K. D. (2000). Studying intergenerational transmission of eating attitudes and behaviors: Methodological and conceptual questions. Health Psychology, 19, 376–381. http://dx.doi.org/10.1037/0278-6133. 19.4.376. Birch, L. L., Fisher, J. O., Grimm, T. K., Markey, C. N., Sawyer, R., & Johnson, S. L. (2001). Confirmatory factor analysis of the child feeding questionnaire: A measure of parental attitudes, beliefs, and practices about feeding and obesity proneness. Appetite, 36, 201–210. http://dx.doi.org/10.1006/appe.2001.0398. Brownell, K. D. (1991). Dieting and the search for the perfect body: Where physiology and culture collide. Behavior Therapy, 22, 1–12. http://dx.doi.org/10.1016/s00057894(05)80239-4. Byely, L., Archibald, A. B., Graber, J., & Brooks-Gunn, J. (2000). A prospective study of familial and social influences on girls' body image and dieting. International Journal of Eating Disorders, 28, 155–164 doi: 0.1002/1098-108X(200009)28:2 < 155::AIDEAT4 > 3.0.CO;2-K. Cash, T. F., & Henry, P. E. (1995). Women's body images: The results of a national survey in the USA. Sex Roles, 33, 19–28. http://dx.doi.org/10.1007/BF01547933. Chamay-Weber, C., Narring, F., & Michaud, P. A. (2005). Partial eating disorders among adolescents: A review. Journal of Adolescent Health, 37, 416–426. http://dx.doi.org/ 10.1016/j.jadohealth.2004.09.014. Collins, E. M. (1991). Body figure perceptions and preferences among preadolescent children. International Journal of Eating Disorders, 10, 199–208 doi: 10.1002/1098108X(199103)10:2 < 199::AID-EAT2260100209 > 3.0.CO;2-D. Cooley, E., Toray, T., Wang, M. C., & Valdez, N. N. (2008). Maternal effects on daughters' eating pathology and body image. Eating Behaviours, 9, 52–61. http://dx.doi.org/10. 1016/j.eatbeh.2007.03.001. Cooper, P. J., & Stein, A. (2013). Childhood feeding problems and Adolescent eating disorders. New York, NY: Routledge. Davis, C., Kennedy, S. H., Ravelski, E., & Dionne, M. (1994). The role of physical activity in the development and maintenance of eating disorders. Psychological Medicine, 24, 957–967. http://dx.doi.org/10.1017/S0033291700029044. Davison, K. K., Markey, C. N., & Birch, L. L. (2000). Aetiology of body dissatisfaction and weight concerns among 5-year-old girls. Appetite, 35, 143–151. http://dx.doi.org/10. 1006/appe.2000.0349. Diedrichs, P. C., Atkinson, M. J., Garbett, K. M., Williamson, H., Halliwell, E., Rumsey, N., ... Barlow, F. K. (2016). Randomized controlled trial of an online mother-daughter

22

Behaviour Research and Therapy 100 (2018) 17–23

C.M. Handford et al.

198809000-00004. McLaughlin, E. A., Belon, K. E., Smith, J. E., & Erickson, S. J. (2015). Mothers' and daughters' beliefs about factors affecting preadolescent girls' body satisfaction. Body Image, 13, 9–17. http://dx.doi.org/10.1016/j.bodyim.2014.11.002. Mendelson, B. K., & White, D. R. (1982). Relation between body-esteem and self-esteem of obese and normal children. Perceptual and Motor Skills, 54, 899–905. http://dx.doi. org/10.2466/pms.1982.54.3.899. Moreno, A. B., & Thelen, M. H. (1993). A preliminary prevention program for eating disorders in a junior high school population. Journal of Youth and Adolescence, 22, 109–124. http://dx.doi.org/10.1007/BF01536647. Paxton, S. J., Wertheim, E. H., Gibbons, K., Szmukler, G. I., Hillier, L., & Petrovich, J. L. (1991). Body image satisfaction, dieting beliefs, and weight loss behaviors in adolescent girls and boys. Journal of Youth and Adolescence, 20, 361–379. http://dx.doi. org/10.1007/BF01537402. Pike, K. M., & Rodin, J. (1991). Mothers, daughters, and disordered eating. Journal of Abnormal Psychology, 100, 198. http://dx.doi.org/10.1037/0021-843X.100.2.198. Rodgers, R. F., Paxton, S. J., & Chabrol, H. (2009). Effects of parental comments on body dissatisfaction and eating disturbance in young adults: A sociocultural model. Body Image, 6, 171–177. http://dx.doi.org/10.1016/j.bodyim.2009.04.004. Rüther, N. M., & Richman, C. L. (1993). The relationship between mothers' eating restraint and their children's attitudes and behaviors. Bulletin of the Psychonomic Society, 31, 217–220. http://dx.doi.org/10.3758/BF03337328. Salvy, S., Elmo, A., Nitecki, L. A., Kluczynski, M. A., & Roemmich, J. N. (2011). Influence of parents and friends on children's’ and adolescents' food intake and food selection. American Journal of Clinical Nutrition, 93, 87–92. http://dx.doi.org/10.3945/ajcn. 110.002097. Santos, M., Richards, C. S., & Bleckley, M. K. (2007). Comorbidity between depression and disordered eating in adolescents. Eating Behaviors, 8, 440–449. http://dx.doi.org/ 10.1016/j.eatbeh.2007.03.005. Seddon, L., & Berry, N. (1996). Media-induced disinhibition of dietary restraint. British Journal of Health Psychology, 1, 27–33. http://dx.doi.org/10.1111/j.2044-8287.1996. tb00489.x. Smolak, L., & Levine, M. P. (2001). Body image in children. In J. K. Thompson, & Smolak (Eds.). Body image, eating disorders and obesity in Youth: Assessment, prevention and treatment (pp. 41–67). Washington, DC: Taylor and Francis. Smolak, L., Levine, M. P., & Schermer, F. (1999). Parental input and weight concerns among elementary school children. International Journal of Eating Disorders, 25, 263–271 doi: 10.1002/(SICI)1098-108X(199904)25:3 < 263::AIDEAT3 > 3.0.CO;2-V. Spanos, A., Burt, S. A., & Klump, K. L. (2010). Do weight and shape concerns exhibit genetic effects? Investigating discrepant findings. International Journal of Eating Disorders, 43, 29–34. http://dx.doi.org/10.1002/eat.20666. Stein, A., Woolley, H., Cooper, S., Winterbottom, J., Fairburn, C. G., & Cortina-Borja, M. (2006). Eating habits and attitudes among 10-year-old children of mothers with eating disorders longitudinal study. The British Journal of Psychiatry, 189, 324–329. http://dx.doi.org/10.1192/bjp.bp.105.014316. Stice, E. (2002). Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128, 825–848. http://dx.doi.org/10.1037/0033-2909. 128.5.825. Stice, E., & Shaw, H. E. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: A synthesis of research findings. Journal of Psychosomatic Research, 53, 985–993. http://dx.doi.org/10.1016/S0022-3999(02)00488-9. Striegel-Moore, R. H., & Bulik, C. M. (2007). Risk factors for eating disorders. American Psychologist, 62, 181–198. http://dx.doi.org/10.1037/0003-066x.62.3.181. Thompson, J. K., Heinberg, L. J., Altabe, M., & Tantleff-Dunn, S. (1999). Exacting beauty: Theory, assessment, and treatment of body image disturbance. Washington, DC: American Psychological Association. Thompson, J. K., Schaefer, L. M., Burke, N. L., Heinberg, L. J., Calogero, R. M., BardoneCone, A. M., ... Vercellone, A. C. (2011, September). Development and validation of the 4th version of the sociocultural attitudes towards appearance questionnaire (SATAQ-4). Poster presented at the annual eating disorder research society meeting, Edinburgh, scotland. Tiggemann, M., & McGill, B. (2004). The role of social comparison in the effect of magazine advertisements on women's mood and body dissatisfaction. Journal of Social and Clinical Psychology, 23, 23–44. http://dx.doi.org/10.1521/jscp.23.1.23.26991. Van den Berg, P. A., Keery, H., Eisenberg, M., & Neumark-Sztainer, D. (2010). Maternal and adolescent report of mothers' weight related concerns and behaviors: Longitudinal associations with adolescent body dissatisfaction and weight control practices. Journal of Pediatric Psychology, 35, 1093–1102. http://dx.doi.org/10.1093/ jpepsy/jsq042. Van den Berg, P., Thompson, J. K., Obremski-Brandon, K., & Coovert, M. (2002). The tripartite influence model of body image and eating disturbance: A covariance structure modeling investigation testing the meditational role of appearance comparison. Journal of Psychosomatic Research, 53, 1007–1020. http://dx.doi.org/10. 1016/j.bodyim.2012.12.006. Wertheim, E. H., Martin, G., Prior, M., Sanson, A., & Smart, D. (2002). Parent influences in the transmission of eating and weight related values and behaviors. Eating Disorders, 10, 321–334. http://dx.doi.org/10.1080/10640260214507.

body image and well-being intervention. Health Psychology, 35, 996–1006. http://dx. doi.org/10.1037/hea0000361. Dittmar, H., Halliwell, E., & Ive, S. (2006). Does Barbie make girls want to be thin? The effect of experimental exposure to images of dolls on the body image of 5- to 8-yearold girls. Developmental Psychology, 42, 283–292. http://dx.doi.org/10.1037/00121649.42.2.283. Ebesutani, C., Reise, S. P., Chorpita, B. F., Ale, C., Regan, J., Young, J., ... Weisz, J. R. (2012). The Revised Child Anxiety and Depression Scale-Short Version: Scale reduction via exploratory bifactor modeling of the broad anxiety factor. Psychological Assessment, 24, 833. https://doi.org/10.1037/a0027283. Feldman, W., Feldman, E., & Goodman, J. T. (1998). Culture vs. biology: Children's attitude toward thinness and fatness. Pediatrics, 81, 190–194. Field, A. E., Austin, S. B., Striegel-Moore, R., Taylor, C. B., Camargo, C. A., Laird, N., et al. (2005). Weight concerns and weight control behaviors of adolescents and their mothers. Archives of Pediatrics & Adolescent Medicine, 159, 1121–1126. http://dx.doi. org/10.1001/archpedi.159.12.1121. Flannery-Schroeder, E. C., & Chrisler, J. C. (1996). Body esteem, eating attitudes, and gender-role orientation in three age groups of children. Current Psychology, 15, 235–248. http://dx.doi.org/10.1007/BF02686880. Flegal, K. M., Carroll, M. D., Kit, B. K., & Ogden, C. L. (2012). Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. Journal of the American Medical Association, 307, 491–497. http://dx.doi.org/10.1001/jama. 2012.40. Fulkerson, J. A., McGuire, M. T., Neumark-Sztainer, D., Story, M., French, S. A., & Perry, C. L. (2002). Weight-related attitudes and behaviors of adolescent boys and girls who are encouraged to diet by their mothers. International Journal of Obesity, 26, 1579–1587. http://dx.doi.org/10.1038/sj.ijo.0802157. Gonçalves, S., Silva, M., Gomes, A. R., & Machado, P. P. (2012). Disordered eating among preadolescent boys and girls: The relationship with child and maternal variables. Nutrients, 4, 273–285. http://dx.doi.org/10.3390/nu4040273. Gowers, S. G., & Shore, A. (2001). Development of weight and shape concerns in the aetiology of eating disorders. British Journal of Psychiatry, 179, 236–242. http://dx. doi.org/10.1192/bjp.179.3.236. Hart, L. M., Cornell, C., Damiano, S. R., & Paxton, S. J. (2015). Parents and prevention: A systematic review of interventions involving parents that aim to prevent body dissatisfaction or eating disorders. International Journal of Eating Disorders, 48, 157–169. http://dx.doi.org/10.1002/eat.22284. Hesse-Biber, S., Leavy, P., Quinn, C. E., & Zoino, J. (2006). The mass marketing of disordered eating and eating disorders: The social psychology of women, thinness and culture. Women's Studies International Forum, 29, 208–224. http://dx.doi.org/10. 1016/j.wsif.2006.03.007. Hill, A. J., & Franklin, J. A. (1998). Mothers, daughters and dieting: Investigating the transmission of weight control. British Journal of Clinical Psychology, 37, 3–13. http:// dx.doi.org/10.1111/j.2044-8260.1998.tb01275.x. Hill, A. J., Weaver, C., & Blundell, J. E. (1990). Dieting concerns of 10-year-old girls and their mothers. British Journal of Clinical Psychology, 29, 346–348. http://dx.doi.org/ 10.1111/j.2044-8260.1990.tb00894.x. Jacobi, C., Agras, S. W., & Hammer, L. (2001). Predicting children's reported eating disturbances at 8 years old. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 364–372. http://dx.doi.org/10.1097/00004583-200103000-00017. Jones, D. C. (2011). Interpersonal and familial influences on the development of body image. In T. F. Cash, & L. Smolak (Eds.). Body image: A handbook of science, practice, and prevention (pp. 110–118). (2nd ed.). New York, NY: The Guilford Press. Kanakis, D. M., & Thelen, M. H. (1995). Parental variables associated with bulimia nervosa. Addictive Behaviours, 20, 491–500. http://dx.doi.org/10.1016/0306-4603(95) 00007-Y. Keery, H., Van den Berg, P., & Thompson, J. K. (2004). An evaluation of the tripartite influence model of body dissatisfaction and eating disturbance with adolescent girls. Body Image, 1, 237–251. http://dx.doi.org/10.1016/j.bodyim.2004.03.001. Killen, J. D., Taylor, C. B., Hayward, C., Wilson, D. M., Haydel, K. F., Hammer, L. D., ... Kraemer, H. (1994). Pursuit of thinness and onset of eating disorder symptoms in a community sample of adolescent girls: A three-year prospective analysis. International Journal of Eating Disorders, 16, 227–238 doi: 10.1002/1098-108X(199411) 16:3 < 227::AID-EAT2260160303 > 3.0.CO;2-L. Klump, K. L., McGue, M., & Iacono, W. G. (2000). Age differences in genetic and environmental influences on eating attitudes and behaviors in preadolescent and adolescent female twins. Journal of Abnormal Psychology, 109, 239–251. http://dx.doi. org/10.1037/0021-843X.109.2.239. Kostanski, M., & Gullone, E. (1998). Adolescent body image dissatisfaction: Relationships with self-esteem, anxiety, and depression controlling for body mass. Journal of Child Psychology and Psychiatry, 39, 255–262. http://dx.doi.org/10.1111/1469-7610. 00319. Lowes, J., & Tiggemann, M. (2003). Body dissatisfaction, dieting awareness and the impact of parental influence in young children. British Journal of Health Psychology, 8, 135–147. http://dx.doi.org/10.1348/135910703321649123. Maloney, M. J., McGuire, J. B., & Daniels, S. R. (1988). Reliability testing of a children's version of the eating attitude test. Journal of the American Academy of Child & Adolescent Psychiatry, 27, 541–543. http://dx.doi.org/10.1097/00004583-

23