Date of Graduation

2018

Document Type

Dissertation

Degree Type

PhD

College

School of Public Health

Department

Epidemiology

Committee Chair

Keith J Zullig

Committee Co-Chair

Lesley Cottrell

Committee Member

Danielle M Davidov

Committee Member

Christa L Lilly

Committee Member

Stephanie C Zerwas

Abstract

PURPOSE: There is a paucity of research exploring individuals' recall of parental dieting behavior, engagement in "fat talk", or criticism of weight or eating behavior in childhood. This dearth of literature exists in both community samples and in clinical populations of eating disorder patients. There is also limited information on women with a history of eating disorders and their pregnancy experience or anticipation of their pregnancy experience. This dissertation focuses on the aforementioned areas in order to develop the research literature further to understand whether parental feedback (such as parental comments or parental dieting) is associated with health outcomes such as BMI or eating pathology in community or clinical cohorts respectively. Secondly, there is also research provided to fill the gap on intergenerational transmission of eating disorders and dieting behavior between mother and child in a population of child-bearing women with current or past eating disorders. Together, the research presented aims to provide a framework to both understand and prevent intergenerational transmission of eating disorders and dieting behavior in both community and clinical samples. METHODS: This dissertation explores the topic of intergenerational transmission of eating disorders and dieting behavior in three aims, two quantitative aims, and one qualitative aim. The first quantitative aim comprised a total of 507 participants (78.1% female; 20.7% male; and 1.2% transgender) who participated in an online, self-administered survey. The qualitative study included 15 women -- 9 of whom were mothers and 6 of whom were nulliparous -- who had either a current or past eating disorder and were recruited through purposive sampling. The last aim used convenience sampling to recruit 60 participants, 93.3% of whom were female. RESULTS: The primary finding from the first aim showed that participants who recalled maternal encouragement to diet reported a significantly higher adult BMI (beta = 1.31, SE = 0.32, p<.0001). In the second aim, one of the prevailing major themes that arose from both mothers and nulliparous participants was intergenerational transmission, especially the concern that their children would develop an eating disorder or pick up on some of their behaviors. The primary finding in the last aim showed a significant relationship between parental feedback and eating pathology (beta = 14.1, SD = 7.0, p=.05). CONCLUSION: Despite the known genetic risk factors for EDs, there remain malleable environmental factors that warrant further study to improve prevention efforts for these serious illnesses. In particular, the family context can be extremely effective in ED recovery for children, but they can also play a role in the development of body dissatisfaction, feeling pressure to diet, and have an association with children having a higher BMI as adults. With this understanding, parents are not to be blamed, but rather can contribute to the solution by reinforcing positive over negative behaviors and focusing on health rather than weight. More research is needed to both confirm and expand some of the findings in these studies. However, the research presented can help to guide interventions with the hope that parents can create environments for children to foster a positive relationship with food and their bodies.

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