We found that among this diverse group of mothers, the majority are categorized into a high demanding/low responsive or low demanding/high responsive feeding style. Feeding styles differed by child weight status, ethnicity and perceived stress. In multivariate analysis, we found that a low demanding/high responsive feeding style was significantly and positively associated with child weight status.
Our finding that a large number of mothers were categorized as high demanding/low responsive and low demanding/high responsive adds to the growing literature of what others have found in studies with diverse, low-income parents. Ventura and colleagues found that among a small sample of diverse parents, only 15% were categorized into the high demanding/high responsive style  whereby parents may negotiate or praise their child. This finding is consistent with findings in our population, where only 17% of mothers were categorized into high demanding/high responsive style. Similarly the majority of African American/Hispanic mothers reported from a study of Head Start parents were classified into the same two feeding styles: high demanding/low responsive and low demanding/high responsive . Olvera and colleagues also found a small percentage of Mexican American mothers who were categorized as high demanding/high responsive in their general parenting style . Because parents’ attitudes toward child-rearing are influenced by cultural norms and other contextual factors, we expected to identify ethnic differences across feeding styles. These differences have also been observed in the general parenting style literature [38, 40, 41].
Although there has been some investigation into how maternal mental health, including stress and depression, can interfere with responsive parenting [42–45], few studies have explored associations between maternal mental health and feeding styles. In our bivariate analysis, we found that mothers with higher stress scores were also more likely to express high demanding/low responsive feeding style. Hurley and colleagues conducted a study of 702 diverse mother-infant dyads and found that maternal stress and depression was significantly associated with both a forceful and an uninvolved feeding style in mothers of African-American children . Although our finding that a higher demanding/less responsive style appears to be operating in the same direction, the population in this study was different than ours (African American infants), and the feeding styles were assessed with a different measure, thus limiting comparisons. Future studies should further explore how mental health may influence feeding dynamics in diverse populations of parents.
Our finding that a low demanding/high responsive feeding style is predictive of higher child weight is consistent with our hypothesis and is supported by prior literature with diverse populations. Hennessy and colleagues found this style was significantly associated with both higher child weight status and consumption of low-nutrient dense foods among a rural population of mostly African-American and Hispanic mothers [26, 47]. Similarly, Hughes and colleagues found that among 718 Head Start parents, predominantly African American and Hispanic, a low demanding/high responsive feeding style was significantly associated with a high child body mass index controlling for parent affect, child temperament and other covariates . In this sample, a low demanding/high responsive style was also associated with low consumption of fruits and vegetables . Together, these results suggest that that parents with a low demanding/high responsive style try to control the emotional climate of specific feeding occasions by being nice, supportive, and non-directive, which may result in a child overeating and gaining unnecessary weight.
In the context of Live Well, it is possible that these immigrant mothers may be transitioning from under resourced countries where they often had to say “no” to their child’s requests and that moving into an “obesogenic” food environment where high energy dense food is more readily available and less costly they feel this is an area where they can say “yes” to their child more often. This would help explain how a low demanding/high responsive feeding style would be associated with a higher child weight status in our study population. Moreover, it is likely that immigrant mothers have other life stressors that take a higher priority in their lives than feeding situations, and that this, in turn may influence the feeding environment . Given this high level of stress associated with the acculturative process, mothers may find it easier to say “yes” to food requests. In our study, we did not identify associations between acculturation (time of residence in the U.S., and food and physical activity changes) and feeding styles; however, these proxies do not capture specific aspects of the transition from one country to another, such as attitudes towards certain feeding environments (e.g., fast food restaurants) or types of foods (e.g., chips or soda), which may have influenced feeding interactions. Future research is needed to help understand the larger socio-cultural context, its effects on the mental health of our participants and its influence on feeding interactions among immigrant families. It is also important to note that our study took place during a time of strong anti-immigrant feelings in general and actions against undocumented immigrants in particular. Simultaneously, social upheaval in the country of origin and the January 2010 Haitian earthquake added considerable situational stress for that community.
Our findings should be interpreted within the context of the study limitations. Although our sample represents a diverse group of mother–child dyads, generalizability may still be limited given the focus on families from Brazil, Haiti and Latin America (predominately Central and South America). As a cross-sectional study, one cannot discern the direction of influence, nor look at change over time. For example, we do not know if these children were overweight or obese before coming to the US and whether feeding styles changed based on their location. Further, mothers are not parenting in isolation, but in response to several factors including child traits . Thus, the parent–child relationship is bi-directional and additional studies are needed to understand causal pathways between parenting behaviors (from both mothers and fathers) and child weight status that also include measures of specific child behaviors (e.g., food intake). Although our measures captured some aspects of acculturation, we did not gather specific information on how the acculturative process may influence the feeding dynamics or other aspects of socio-cultural norms.