Early attachment and parental stress as predictors of obesity risk in middle adolescence: The role of self-regulation and food consumption

Pediatric obesity remains a public health concern in the U.S.(Ogden, Carroll, Kit, & Flegal, 2012) and worldwide (De Onis, Blössner, & Borghi, 2010) due to its prevalence and association to chronic illnesses in adulthood. The substantial number of null findings in intervention programs that focus primarily on eating and physical activity factors suggest that a more comprehensive understanding of early obesity risk is needed. The enduring relationship between stress and weight gain has been considered a promising area to examine in order to better understand the development of pediatric obesity. The inclusion of both interpersonal stressors (i.e., insecure parent-child relationship) and parental stressors may be especially salient, especially because developmental research has documented associations between poor parenting quality, low self-regulation ability, and unhealthy eating behaviors. Furthermore, a few findings reveal that early attachment insecurity increases obesity risk in early childhood and adolescence, but mechanistic models of and mechanisms accounting for these associations remain poorly understood. In response, this study aimed to examine whether attachment and parental stress in early childhood predict adolescent obesity risk, and whether child self-regulation and food consumption in middle childhood mediate these associations. Employing structural equation modeling (SEM), two theory-driven models were examined using a large sample (N = 1,237; 599 boys and 638 girls, ranging in age from 6 months to 15 years) drawn from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (1998). Attachment security was measured at 15, 24, 36 months using the Strange Situation Procedure (SSP) and Attachment Q-sort (AQS). Parental stress included a composite of maternal health, depression, and total life stress, which were measured across 36 months. Child self-regulation ability was assessed at 4.5 and 7 years of age by employing several observational and behavioral assessments including the snack delay task, parent-child interaction with challenging toys, and the Computer Performance Task (CPT). Healthy and unhealthy food consumption were obtained at age 11-12 from a self-report questionnaire. Height and weight measured in early/middle childhood and adolescence were used to compute BMI scores, and skinfold thickness was an additional anthropometric indicator of adolescent obesity risk. Income-to-needs ratio, maternal education, child’s negative temperament, and negative parenting practices assessed in early childhood were used as statistical controls in the analysis. Results revealed that both healthy and unhealthy food consumption models provided a good fit to the data (healthy model: χ2 = 122.610, df = 104, CFI = .994, RMSEA = .012 [.000 -.020] and unhealthy model: χ2 = 173.165, df = 117, CFI = .982, RMSEA = .020 [.013 -.026]). No direct associations between early attachment or parental stress and adolescent obesity risk were found in either model. However, child self-regulation was found to mediate the association between early attachment and both unhealthy food consumption and adolescent obesity risk. Moreover, early BMI was indirectly related to BMI z-score and obesity risk at age 15 via BMI in middle childhood. The significance of the mediated paths was confirmed with 10,000 bootstrap samples. This is the first study to document, using longitudinal data, the mediating role of child self-regulation in the associations between early attachment histories and subsequent dietary intake and obesity risk. The findings highlight how the nature of parent-child relationships impacts developing regulatory processes in children which, in turn, have implications for obesity-related outcomes. The discussion focuses on theory-driven explanations for these associations and implications for pediatric obesity prevention and intervention