Modeling children's obesity based on the mediating role of child's emotional overeating in the relationship between mother's attachment style and child's body mass index

Subject Areas : Modeling research studies

Afrooz Satari ¹ , علیرضا حیدرئی ² , پرویز عسگری ³

1 - Department of Psychology, Ahwaz branch, , Azad Islamic University; Ahwaz, Iran, [e-mail]
2 - Department of psychology; Ahwaz Branch; Azad Islamic University; Ahwaz; Iran, (c0rresponding author), [e-mail], Tel: [phone]
3 - Full Professor, Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran [e-mail]

Received: 2023-09-24 Accepted : 2023-11-21 Published : 2024-05-21

Keywords: attachment styles, body mass index, child obesity, child's physical activity level, emotional overeating,

Abstract :

 

 

Original research Modeling children's obesity based on the mediating role of child's emotional overeating in the relationship between mother's attachment style and child's body mass index

 

Afrooz Sattari,[1] Alireza Heydari^*[2], Parviz Asgari[3]

 

 

[1] - Ph.D. student, Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran, [e-mail]

[2] - (Corresponding author) Professor of Psychology Department, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran, [e-mail], Tel: [phone]

 

[3] - Full Professor, Ahvaz Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran

Abstract

Introduction: The rapid increase in the prevalence of obesity, which is a multi-causal problem, in the past twenty years, in addition to genetic factors, has been attributed to cultural environmental factors, including family environment, eating and activity. . This research was conducted with the aim of predicting children's body mass index based on the mother's attachment style, taking into account the mediating role of emotional overeating in children.

 

Research method: The research method was applied and of the correlation type, which was done using structural equation modeling. 280 children aged 7-12 years (including 144 boys and 136 girls) along with their mothers were selected to participate in the research by using the purposeful sampling method, based on the referral of nutritionists. Research tools include body mass index (BMI), Hazen and Shaver attachment style questionnaire and emotional eating scale (EES).

 

Findings: The investigated model had a good fit and the results showed that mother's secure, avoidant and anxious attachment styles predict the child's body mass index both directly and indirectly through the mediation of the child's emotional overeating.

 

Conclusion: This research highlights the role of the child's early environment, especially the mother, in the development of childhood obesity.

 

Keywords: attachment styles, body mass index, child obesity, child's physical activity level, emotional overeating

 

Citation: Sattari A, Heydari A, Asgari P. Modeling children's obesity based on the mediating role of child's emotional overeating in the relationship between mother's attachment style and child's body mass index, Family and health, 2024; 14(1): 11-26

 

Received: 24/ September/ 2023               Accepted: 21/ November/ 2023

 

 

Introduction:

 

Obesity in children and adults is one of the most important public health problems in developed and developing countries. The prevalence of childhood obesity has greatly increased over the past 20 years and has caused concern about the future health and well-being of millions of children around the world (1). The 2017 World Nutrition Report found that 2 billion adults are overweight/obese and 41 million children are overweight worldwide (2). The results of various researches conducted in Iran have also shown that the prevalence of obesity in Iranian students was 11% based on body mass index and the prevalence of overweight was 12%. The rate of obesity in elementary school students is more than other levels reported (3).

 

According to the definition of the World Health Organization, the assessment of obesity in children is based on the percentile of the body mass index, so that children above the 85% percentile are considered overweight and children above the 95% percentile are considered obese. Obesity is assessed based on the child growth standards of the World Health Organization, in infants and children under 5 years of age, based on weight for height and for 5-19 years based on body mass index for age (4). During childhood, body fat levels change; therefore, obesity and overweight in children are defined by percentiles of body mass index using special charts. The World Health Organization and Centers for Disease Control and Prevention charts are recommended for all children.

 

In the growth and development of obesity, special attention is directed to the periods of childhood and adolescence as a time of risk for the development and maintenance of obesity, which can lead to consequences in adulthood. The negative effects of obesity and overweight on children's health and development can continue into adulthood and increase the risk of chronic diseases and disability. Childhood obesity is associated with a wide range of serious health complications and an increased risk of premature diseases, including diabetes and heart diseases (5). The psychosocial performance of obese children is also compromised and they are more prone to psychological problems such as depression, anxiety, low self-esteem and negative body image, which later affects their quality of life (6). Considering the vulnerability of children and the complex nature of their environment, strategies to help overcome what is called the "obesity epidemic" are still challenging, and very little research has been done on the psychological factors influencing childhood obesity; Therefore, identifying the factors that cause obesity in children is important for appropriate intervention in order to prevent and control obesity and its complications. In this regard, the family, which primarily forms the child's primary environment, is a suitable platform for examining these factors (7).

 

As the first place where a child grows, the family is important from various dimensions. Several studies that have been conducted in the field of factors related to obesity in children have indicated the important role of parents in the occurrence of obesity in children. Heredity on the one hand and behavioral and nutritional patterns on the other hand justify this relationship. Emotional and social aspects of parent-child interaction influence the risk of obesity in children, even when these interactions are not directly related to eating or physical activity (8). There is strong evidence that shows that the family lifestyle and eating habits formed in the family play an important role in the type of nutrition and the child's weight. Parents influence children's behaviors, habits, and attitudes through multiple socialization processes. It has been shown that such parental influences expand the development of children's weight problems (9) and understanding these influences can be an important way in prevention and interventions for children's nutritional problems and overweight (10).

 

In the early years, a significant part of the relationship between the child and the mother is formed through eating. For example, parents provide a family eating environment where the child learns how to eat and forms healthy and unhealthy eating habits. Exposure to food variety, quantity and quality of foods, physical and emotional environments in which eating takes place, formation of the child's food preferences and the ability to regulate food consumption are among the things that are taught in the early years of the child in the family (11). These experiences affect a person's eating habits and final weight in the future (12).

 

Another influential factor regarding parents is that in communicating effectively with the child, the mother plays an essential role that can affect the child's social adaptations and emotion regulation (13). Children learn these skills through interaction with their caregivers and important people in their lives (14). It is clear that through different levels and types of parent-child interactions, children learn overtly and unobtrusively about emotional reactions and how to manage them (15). Emotional eating is defined as a tendency to eat in response to a series of negative emotions such as anxiety, depression, anger and loneliness, in order to overcome the negative emotion (16). According to some views, emotional eating is a coping mechanism to reduce negative emotions that are called by stressful events. Other theories have also argued that people who suffer from emotional eating actually confuse arousal with hunger, when these people experience sadness and anxiety, their inhibitions are disrupted and lead to overeating (17). In the research of Babakhanlou et al. (18), it has been shown that emotional processing is damaged in obese people. There is evidence that eating disorders including anorexia,

 

Body mass index of the child

 

 

 

 

                                                                                                     

Attachment Styles: Secure attachment avoidant attachment دلبستگی اضطرابی

 

 

 

 

Figure 1. Proposed research model

 

 

 

Research Method:

 

The research method is based on the objective, practical, and in terms of the method of data collection, it is a descriptive correlation type, which was done by using structural equation modeling method. The statistical population of the present study was made up of clients aged 7 to 12 years of nutrition and health centers in Tehran in 2017 and 2018. Among these, 280 subjects (including 144 boys and 136 girls) were selected using the purposeful sampling method, based on the referral of nutritionists and according to the entry criteria. Entry criteria include: not having a specific physical disease that causes obesity; including glandular or hormonal problems; Not taking drugs that lead to side effects of obesity, being between 7-12 years old for children, being diagnosed with obesity or overweight based on the chart of the Center for Disease Control and Prevention. At this stage, after obtaining informed consent, the child's body mass index was evaluated and the research tools, which are attachment styles and emotional eating questionnaires, were completed by the mothers.

 

Body mass index (BMI), the percentile table of body mass index, is known as the best measurement tool for diagnosing obesity and overweight in childhood (39). Body mass index 1 provides a guide to weight in relation to height and is equal to body weight (in kilograms) divided by the square of height (in meters). Body mass index changes during childhood and is also different between girls and boys; therefore, in this research, the reference data of the Center for Disease Control and Prevention was used according to age and gender.

 

The attachment style questionnaire was created by Hazen and Shaver in 1987 and has 15 items, 5 items are assigned to each of the three attachment styles: secure, ambivalent and avoidant. Scoring is done on a Likert scale from never (score 0) to always (score 4). Hazen and Shaver obtained the total test-retest reliability of this questionnaire as 0.81 and the reliability with Cronbach's alpha as 0.78. Collins and Reid (40) also obtained high reliability with Cronbach's alpha of 0.78. Cronbach's alpha validity of this questionnaire in the research of Rahimianboger et al. (41) for the whole test, ambivalent, avoidant and secure attachment style was obtained as 0.75, 0.83, 0.81 and 0.77, respectively, which shows good reliability. Gives. Cronbach's alpha coefficient was estimated at 0.85 in this research.

 

The Emotional Eating Scale (EES) was developed by Arno, Kenardy and Agras (42). This 25-item parent-report questionnaire is scored on a 5-point Likert scale (from no desire to irresistible desire to eat) that assesses the extent to which a person eats in response to emotions. The emotional eating scale consists of three subscales that reflect the tendency to eat in response to: anger/frustration, anxiety, and depression. In addition to the parent-report form of this questionnaire, this scale was modified in 2007 by Tanfski-Kraf et al. for the use of children aged 8-17. The subscales of this scale show internal consistency (alpha: 0.83 to 0.95), convergent validity and adequate temporal stability (43). In this study, Cronbach's alpha coefficient was calculated as 0.79.

 

Data analysis was done using descriptive statistical indicators such as frequency distribution table and using SPSS software to check for independence, normality and multicollinearity and to test research hypotheses, structural equation modeling method was used using AMOS software. .

 

Findings:

 

In this section, first the descriptive findings of the research variables and then the results of the path analysis which were carried out in order to investigate the research hypotheses are presented. Descriptive information including mean and standard deviation of research variables as well as correlation coefficients of research variables are presented in Table 1.

 

Table 1: Correlation matrix, Mean and standard deviation of variables Research

 

	Average	The standard deviation	1	2	3	4	5
1- Safe attachment _	-7/53	-958/1	1
2-attachment _ _ Avoidance	--8.05	-825.1	-0.291     **--	1
3-attachment _ _ anxiety	--7.8	-436.1	-0.431 **--	447.0**	1
4- Child's emotional overeating	--32.55	-401.4	-0.371 **--	466.0**	717.0**	1
5- child's body mass index	-22.19	-992.3	-476.0**	495/0**	733.0**	749.0**	1

 

 

 

As shown in Table 1, the correlation coefficients of the model's dependent variable (child's body mass index) with other variables are significant at the P<0.1 level. The significance of coefficients provides the prerequisite for path analysis. In order to test the research model, path analysis using Amos software was used. Before using path analysis, univariate outlier data were checked using box plot and multivariate outlier data were checked using Mahalanobis statistic and excluded from the data set. The skewness and skewness of the variable scores distribution were calculated using SPSS software and the results showed that none of the skewness and skewness values were greater than ±1 range. The normality of the data was checked using the Kalmogorov-Smirnov test. The results showed that the distribution of scores of all 4 model variables is normal (P<0.5). The assumption of independence of errors was investigated with Durbin-Watson's statistic to calculate the regression equations of the research model, and the obtained value indicates the establishment of this assumption. The assumption of collinearity between variables was investigated using Pearson correlation between pairs of variables. Considering that the correlation of 2 variables of 0.8 and above indicates collinearity, this problem was not observed in the data of this research. In addition, the tolerance statistic and variance inflation factor were calculated in order to investigate multiple collinearity. The results showed that none of the values of the tolerance statistic are smaller than the permissible limit of 0.1 and none of the values of the variance inflation factor are larger than the permissible limit of 10; therefore, based on the 2 mentioned indicators, the existence of multiple collinearity was not observed in the data. After examining the assumptions and making sure that they are established, path analysis was used to evaluate the investigated model. The results of the standard coefficients of the proposed model in order to investigate the mediating role of child's emotional overeating in the relationship between attachment styles and the child's body mass index are presented in Figure 2.

 

 

 

 

 

Figure 2: Standard coefficients of the role model Mediator of overeating emotional Child at Relation among Attachment styles _ With Indicator mass physical Child

 

Table 2: Model fit indices

 

Fit index	fitness index (GFI)	NFI	root mean square error (RMSEA)	Comparative fitness index  (CFI)	Increased fitness (IFI)	Standard Root Mean Square Residual (SRMR)
Accepted domain	0.9>	0.9>	<8.0	0.9>	0.9>	<08.0
observed value	-0.957	-0.958	-0.71	-0.959	-0.959	0.66

 

 

 

In Table 2, the fit indices of the model are presented. The root mean square error of approximation (RMSEA) is equal to 0.71 and the square root of the residual mean square (SRMR) is equal to 0.66, which is smaller than the criterion value (0.8) and as a result, it confirms the fit of the model. IFI, CFI, GFI and NFI indices are also greater than the desired criterion (0.9). The obtained coefficients indicate the optimal fit of the model. The relationships between the variables in the model include the direct, indirect and total effects of the variables as shown in Table 3.

 

Table 3: Effects direct, Indirect and the whole door Model the final

 

direct effect	Indirect effect	total effect	Variance explained	to the variable	from the variable
-0.185** --	-45.0**	-0.230** --	682.0	Indicator mass physical Child	Secure attachment
108.0**	0.61** --	169.0**			affection _ Avoidance
351.0**	228.0*	579.0**			affection _ anxiety
378.0**	-	378.0**			Child emotional overeating
-119.0**	-	-441.0*	--0.552	gluttony emotional Child	Secure attachment
0.162**	-	132.0*			affection _ Avoidance
0.604** --	-	93.0*			affection _ anxiety

 

* Significance at the 0.5 level ** Significance at 0.1 level _

 

According to the information contained in the tested model and Table 4, all research hypotheses were confirmed. Based on the results of path analysis, secure attachment styles (β=0.185, P<0.1), avoidant attachment (β=0.108, P<0.1), anxious attachment (β=0.351, 1 P < 0.001) and emotional overeating of the child (β = 0.378, P < 0.1) directly predicts the body mass index of the child.

 

To investigate the mediating role of child's emotional overeating in the relationship between attachment styles and the child's body mass index, Boytstrap method was used. The obtained results showed that attachment styles indirectly predict the child's body mass index. Indirect standardized coefficients for secure attachment styles (β=0.45, P<0.5), avoidant attachment (β=0.61, P<0.5) and anxious attachment (β=0.228, P<0.5) >P) is significant. Also, the results of the model showed that 68.2% of the variance of the child's body mass index and 55.2% of the variance of the child's emotional overeating are explained using the variables in the model.

 

Discussion and conclusion:

 

The significant increase in the prevalence of childhood obesity during the last few decades has changed the existing attitudes about childhood obesity, and this issue has been considered as one of the ten most important problems related to health at the global level today (44). Obesity in childhood and adolescence, especially during the second decade of life, is proposed as a strong predictor of adult obesity (45). Without intervention, babies and children who are overweight during childhood, adolescence and adulthood will increase their weight (46). Researches have repeatedly shown that the onset of obesity in childhood leads to a wide range of serious health complications as well as psycho-social problems, and this issue adds to the importance of further investigating the problem of childhood obesity. In this regard, the aim of this research was to investigate the prediction model of body mass index based on mother's attachment style, taking into account the mediating role of emotional binge eating in primary school children of Tehran city, using structural equation modeling, and the results of statistical tests showed that the investigated model was appropriate. It has been favorable.

 

Based on the findings of this research, mother's secure, avoidant and anxious attachment styles as well as child's emotional overeating directly predict the child's body mass index. Research on childhood obesity shows the important role of parents' attachment styles and their influence on the growth and development of obesity in children. Parents of normal weight children have more secure attachment style compared to parents of overweight and obese children (47). Studies have shown that insecure attachment in both mothers and fathers predicts child obesity. As has been repeatedly pointed out in the research background, an unhealthy attachment relationship can contribute to the development of overweight and obesity in children. Children who have insecurely attached mothers show more obesity. Likewise, fathers' insecure attachment is associated with greater severity of the problem. It has also been shown that insecure and unresolved/disturbed parental attachment are risk factors for higher levels of food consumption in children (48). In Fraley and Roizman (49), the prevalence of insecure attachment style in the group of mothers with obese children was (66.6%) compared to the control group of mothers with normal weight children (38.5%). In the research of Hepworth, Berlin, Martocchio and Jones Harden (50), a significant direct effect of mother's attachment style on the weight-height score of babies was found. Babies of mothers who classified themselves as secure had lower weight-height scores than babies of insecure mothers (avoidant or anxious). The sensitivity of the mother did not mediate this relationship, but it had a positive relationship with the weight-height score of the baby. Faber and Dobbie (2015) showed that parental insecure attachment, both actual (Study 1, children) and recalled (Study 2, adults), significantly and positively related to high-calorie food intake in both samples predicts. The findings of this research also emphasize the importance of parental attachment and its relationship with unhealthy eating patterns in children and adults. In the research of Bahrami, Keli Shadi, Jafari et al. (51), the relationship between children's obesity and parental attachment has been shown. The quality of attachment has a direct effect on obesity, and attachment has a direct effect on self-control and impulsivity.

 

The obtained results also showed that attachment styles indirectly predict the child's body mass index through the mediation of emotional overeating. In explaining this finding, the effect of attachment style on psychological health and emotional control can be considered. Anxious attachment (fear of abandonment) is associated with unrestrained eating in adults, and this unrestrained mother eating is related to emotional eating in children (52). Research results show that disturbances in food control, diet quality, planning and organization of eating behaviors occur mainly in people with insecure attachment (53). A number of previous studies, for example Raku-Bogdan (54); Maishi et al. (55); Mikulincer and Shaver (56); Cichanowski et al. (56) point out that people with insecure attachment apply negative regulatory strategies in stressful situations and regulate their emotions through eating. Emotional states resulting from parent-child interactions can affect eating behaviors. Parents' secure attachment is a source of availability and emotional support for children. Secure attachment enables the child to express and experience his feelings. Parents in secure relationships are consistent in their behavior and are sensitive to the stimuli coming from their children, they have a set of adaptive and flexible strategies to deal with new and stressful situations; Therefore, there is no need to use food to regulate the emotional states of parents and children (57). Parents with an emotionally insecure attachment style neglect their child and in fact do not manage his feelings and emotions, as a result, the child also does not learn to manage his emotions, which results in the failure to develop adaptive strategies to regulate emotions, which can lead to emotional overeating in the relationship. Occur with negative emotions in obese or overweight children. If the mother is not in harmony with the baby and does not respond to the child's needs continuously and appropriately, the child may develop a confusing concept of hunger and satiety and, as a result, irregular eating behaviors. In addition, since a healthy infant-mother relationship promotes the development of healthy regulatory behaviors, the absence of a responsive mother may lead to permanent changes in the child's behavior and physiology, resulting in disordered eating (58). Various types of self-regulation skills that are developed in the context of attachment, such as emotional regulation (59), feeding and eating regulation, low inhibitory control (60) and high sensitivity to reward (61), have been identified as risk factors for obesity in children and adolescents. In line with this finding of Har Deman, Christiansen and Wilkinson (62) showed in their research that anxious attachment of mothers has a direct effect on children's emotional overeating. These findings highlight the influence of mothers' anxious attachment on parents' reports of maladaptive eating behaviors in children. While this effect may be due in part to the use of emotional feeding methods, there is stronger evidence for the "responsive infant" model, according to which anxiously attached mothers use these feeding methods in response to emotional overeating in the child. In the research of Goossens, Bratt, Van Durme, Decalvo, Bozemans (63), father's insecure attachment was a predictor of children's emotional binge eating. This provided evidence of a longitudinal association between attachment and eating pathology and adolescent weight gain. In addition, it appears that mother's attachment and father's attachment are differentially related to children's disordered eating attitudes and their body mass index. Research also shows that insecure attachment causes parents to be at risk of using negative emotion regulation strategies in response to their child's distress, which may have important consequences for the interpersonal environment related to food and the development of the child's early eating behaviors (64). In this regard, Mazshi et al. (65) also showed that insecurely attached parents may use negative emotional regulation strategies in response to the child's distress, which has important consequences in interpersonal fields including food and the development of eating behaviors, including children's emotional overeating. The results of this research are also in agreement with the researches of Hepworth et al. (66), Pastek-Olpica et al. (67), Bergmayer et al. ), Lo et al.

 

Limitations of the research:

 

The use of available sampling and the completion of the sample only from nutrition and health centers in Tehran caused the sample to be limited to those children who have referred for treatment, which has limited the generalization of the research results; Therefore, it is recommended to use a more comprehensive sample with a wider range of children with obesity and overweight, as well as the participation of fathers in future research.

 

Application of research:

 

The findings of this research highlighted the importance and necessity of paying attention to variables such as mother's attachment style and child's emotional overeating as influencing factors on body mass index in children. By identifying these psychological structures as intermediate variables in children, an effective step can be taken in preventing the adverse consequences of childhood obesity. Based on the findings of this research, knowing the importance of role modeling by parents and especially mothers in children's body mass, it is possible to develop preventive programs based on changing and modifying environmental variables, especially those related to parents. More researches are recommended to accurately identify factors related to childhood obesity in order to design appropriate interventions to prevent childhood obesity. In addition, the findings of this research can be used for intervention research. In addition, it is suggested that the results of the above researches be used in the parent education program to intervene in children's obesity and overweight.

 

The ethical considerations

 

The ethical considerations of the research were to submit a written letter of introduction and obtain permission from the authorities in order to conduct the research, introduce yourself to the research units and explain the objectives and nature of the research, assure the research units about the confidentiality of the studies and obtain consent from the people under investigation and comply Trustworthiness and honesty in the review of texts and analysis of studies and the lack of registration and surnames of the people under investigation were among the important aspects of observing ethical considerations in this research.

 

Acknowledgments:

 

The authors of the article know their duty to thank and appreciate all the colleagues and participants who helped us in conducting the research.

 

References:

 

 

 

 

References:

1. World Health Organization. Global strategy on diet, physical activity and health, 2014 https://doi.org/10.1177/156482650402500310
2. Hawkes C, Fanzo J. Nourishing the SDGs: Global nutrition report 2017. Retrieved from: https://openaccess.city.ac.uk/id/eprint/19322/
3. Sarokhani D, Sarokhani M, Hasanpour Dehkordi A, Ghanei Gheshlagh R, Fakhri M. Prevalence of obesity and overweight in Iranian students: a systematic review and meta-analysis. Journal of Pediatric Endocrinology and Metabolism. 2020 Apr 28; 33(4): 453-68. doi.org/10.1515/jpem-2019-0474
4. Guo Y, Yin X, Wu H, Chai X, Yang X. Trends in overweight and obesity among children and adolescents in China from 1991 to 2015: a meta-analysis. International journal of environmental research and public health. 2019 Dec; 16(23): 4656. doi.org/10.3390/ijerph16234656
5. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. The lancet. 2014 Aug 30; 384(9945): 766-81. doi: 10.1016/S0140-6736(14)60460-8
6. Sagar R, Gupta T. Psychological aspects of obesity in children and adolescents. The Indian Journal of Pediatrics. 2018 Jul; 85: 554-9. doi.org/10.1007/s12098-017-2539-2
7. Danford CA, Schultz CM, Marvicsin D. Parental roles in the development of obesity in children: Challenges and opportunities. Research and Reports in Biology. 2015 Apr 13: 39-53. doi.org/10.2147/RRB.S75369
8. Whitaker RC, Phillips SM, Orzol SM, Burdette HL. The association between maltreatment and obesity among preschool children. Child abuse & neglect. 2007 Nov 1; 31(11-12): 1187-99. doi.org/10.1016/j.chiabu.2007.04.008
9. Krebs NF, Jacobson MS. Prevention of pediatric overweight and obesity. Pediatrics. 2003 Aug 1; 112(2): 424-30. doi.org/10.1542/peds.112.2.424
10. Joyce JL, Zimmer-Gembeck MJ. Parent feeding restriction and child weight. The mediating role of child disinhibited eating and the moderating role of the parenting context. Appetite. 2009 Jun 1; 52(3): 726-34. doi.org/10.1016/j.appet.2009.03.015
11. Jansen PW, Roza SJ, Jaddoe VW, Mackenbach JD, Raat H, Hofman A, Verhulst FC, Tiemeier H. Children's eating behavior, feeding practices of parents and weight problems in early childhood: results from the population-based Generation R Study. International Journal of Behavioral Nutrition and Physical Activity. 2012 Dec; 9(1): 1-1. doi.org/10.1186/1479-5868-9-130
12. Musher-Eizenman D, Holub S. Comprehensive feeding practices questionnaire: validation of a new measure of parental feeding practices. Journal of pediatric psychology. 2007 Sep 1; 32(8): 960-72. doi.org/10.1093/jpepsy/jsm037
13. Kochanska G, Kim S. Early attachment organization with both parents and future behavior problems: From infancy to middle childhood. Child development. 2013 Jan; 84(1): 283-96. doi.org/10.1111/j.1467-8624.2012.01852.x
14. Perry NB, Calkins SD, Nelson JA, Leerkes EM, Marcovitch S. Mothers' responses to children's negative emotions and child emotion regulation: The moderating role of vagal suppression. Developmental psychobiology. 2012 Jul; 54(5): 503-13. doi.org/10.1111/j.1467-8624.2012.01852.x
15. Norona AN, Baker BL. The transactional relationship between parenting and emotion regulation in children with or without developmental delays. Research in Developmental Disabilities. 2014 Dec 1; 35(12): 3209-16. doi.org/10.1016/j.ridd.2014.07.048
16. Ricca V, Castellini G, Fioravanti G, Sauro CL, Rotella F, Ravaldi C, Lazzeretti L, Faravelli C. Emotional eating in anorexia nervosa and bulimia nervosa. Comprehensive psychiatry. 2012 Apr 1; 53(3): 245-51. doi.org/10.1016/j.comppsych.2011.04.062
17. Raspopow K, Matheson K, Abizaid A, Anisman H. Unsupportive social interactions influence emotional eating behaviors. The role of coping styles as mediators. Appetite. 2013 Mar 1; 62: 143-9. doi.org/10.1016/j.appet.2012.11.031
18. Babakhanloo A, Haghayegh SA, Moradi Manesh F, Dehghani A. Emotional Eating and Self-Compassion in People with Obesity: The Mediating Role of Emotional Processing. https://jip.stb.iau.ir/article_679813_bd674288fa65a45907a7562abae38ef3.pdf?lang=en
19. Fischer S, Munsch S. Self-regulation in eating disorders and obesity–implications for treatment. Verhaltenstherapie. 2012 Jan 1;22(3):158-64. DOI: 10.1159/000341540
20. Khademi Z. The Effect of Positive Psychology on the Human Beings from the Viewpoint of Seligman. Preventive Counseling. 2021 Apr 1; 2(1): 58-70. https://jpc.uma.ac.ir/article_1219_0238644cd2851dda7530d1bc5947f91b.pdf
21. Alexander KE, Siegel HI. Perceived hunger mediates the relationship between attachment anxiety and emotional eating. Eating behaviors. 2013 Aug 1; 14(3): 374-7. doi.org/10.1016/j.eatbeh.2013.02.005
22. Mikulincer M, Shaver PR. Attachment processes and emotion regulation. Attachment in adulthood: Structure, dynamics, and change. 2007: 188-218. https://scholar.google.com/scholar?hl=fa&as_sdt=0%2C5&q
23. Harrison A, Sullivan S, Tchanturia K, Treasure J. Emotional functioning in eating disorders: attentional bias, emotion recognition and emotion regulation. Psychological medicine. 2010 Nov; 40(11): 1887-97. doi.org/10.1016/j.biopsych.2010.04.037
24. Mikulincer M, Florian V. The relationship between adult attachment styles and emotional and cognitive reactions to stressful events, 1998 https://psycnet.apa.org/record/1997-36873-005
25. Maunder RG, Hunter JJ. A prototype-based model of adult attachment for clinicians. Psychodynamic psychiatry. 2012 Dec; 40(4): 549-73. doi.org/10.1521/pdps.2012.40.4.549
26. Wilkinson LL, Rowe AC, Bishop RJ, Brunstrom JM. Attachment anxiety, disinhibited eating, and body mass index in adulthood. International Journal of Obesity. 2010 Sep; 34(9): 1442-5. doi.org/10.1038/ijo.2010.72
27.Ganji, M. Psychopathology based on DSM-5. Tehran: Savalan Publication; 2019 https://intjmi.com/article-1-998-en.html
28. Carper JL, Fisher JO, Birch LL. Young girls' emerging dietary restraint and disinhibition are related to parental control in child feeding. Appetite. 2000 Oct 1; 35(2): 121-9. doi.org/10.1006/appe.2000.0343
29. Braet C, Van Strien T. Assessment of emotional, externally induced and restrained eating behaviour in nine to twelve-year-old obese and non-obese children. Behaviour research and therapy. 1997 Sep 1; 35(9): 863-73. doi.org/10.1016/S0005-7967(97)00045-4
30. Zocca JM, Shomaker LB, Tanofsky-Kraff M, Columbo KM, Raciti GR, Brady SM, Crocker MK, Ali AH, Matheson BE, Yanovski SZ, Yanovski JA. Links between mothers’ and children's disinhibited eating and children's adiposity. Appetite. 2011 Apr 1; 56(2): 324- doi.org/10.1016/j.appet.2010.12.014
31. Rodgers RF, Paxton SJ, Massey R, Campbell KJ, Wertheim EH, Skouteris H, Gibbons K. Maternal feeding practices predict weight gain and obesogenic eating behaviors in young children: a prospective study. International Journal of Behavioral Nutrition and Physical Activity. 2013 Dec; 10: 1-0. doi.org/10.1186/1479-5868-10-24
32. Hamburg ME, Finkenauer C, Schuengel C. Food for love: the role of food offering in empathic emotion regulation. Frontiers in psychology. 2014 Jan 31; 5: 32. doi.org/10.3389/fpsyg.2014.00032
33. Tan CC, Holub SC. Emotion regulation feeding practices link parents’ emotional eating to children’s emotional eating: A moderated mediation study. Journal of Pediatric Psychology. 2015 Aug 1; 40(7) :657-63. doi.org/10.1093/jpepsy/jsv015
34. Orzolek-Kronner C. The effect of attachment theory in the development of eating disorders: can symptoms be proximity-seeking?. Child and adolescent social work journal. 2002 Dec; 19: 421-35. doi.org/10.1023/A:1021141612634
35. Anderson SE, Whitaker RC. Attachment security and obesity in US preschool-aged children. Archives of pediatrics & adolescent medicine. 2011 Mar 7; 165(3): 235-42. doi: 10.1001/archpediatrics.2010.292. PMID: 21383273; PMCID: PMC3086349
36. Anderson SE, Gooze RA, Lemeshow S, Whitaker RC. Quality of early maternal–child relationship and risk of adolescent obesity. Pediatrics. 2012 Jan 1; 129(1): 132-40. doi.org/10.1542/peds.2011-0972
37. Bost KK, Wiley AR, Fiese B, Hammons A, McBride B, Strong Kids Team. Associations between adult attachment style, emotion regulation, and preschool children's food consumption. Journal of Developmental & Behavioral Pediatrics. 2014 Jan 1; 35(1): 50-61. DOI: 10.1097/01.DBP.0000439103.29889.18
38. Mazzeschi C, Pazzagli C, Laghezza L, De Giorgi G, Reboldi G, De Feo P. Parental alliance and family functioning in pediatric obesity from both parents' perspectives. Journal of Developmental & Behavioral Pediatrics. 2013 Oct 1; 34(8): 583-8. DOI: 10.1097/DBP.0b013e3182a50a89
39. Tyson N, Frank M. Childhood and adolescent obesity definitions as related to BMI, evaluation and management options. Best practice & research Clinical obstetrics & gynaecology, 2018 Apr 1; 48: 158-64. doi.org/10.1016/j.bpobgyn.2017.06.003
40. Hazan C, Shaver P. Romantic love conceptualized as an attachment process. InInterpersonal development 2017; 30: 283-296. Routledge. Doi:10.4324/9781351153683-17
41. Collins NL, Read SJ. Adult attachment, working models, and relationship quality in dating couples. Journal of personality and social psychology. 1990 Apr; 58(4): 644. doi.org/10.1037/0022-3514.58.4.644
42. Mashayekhi N, Mashayekhi S, Ninggal MB. The relationship of youngs primary inconsistent schemas on attachment styles in females students in Isfahan university. InICERI2011 Proceedings; 2011: 6042-6048. IATED. https://library.iated.org/view/MASHAYEKHI2011REL
43. Arnow B, Kenardy J, Agras WS. The Emotional Eating Scale: The development of a measure to assess coping with negative affect by eating. International journal of eating disorders. 1995 Jul; 18(1): 79-90. https://doi.org/10.1002/1098-108X(199507)
44. Tanofsky‐Kraff M, Theim KR, Yanovski SZ, Bassett AM, Burns NP, Ranzenhofer LM, Glasofer DR, Yanovski JA. Validation of the emotional eating scale adapted for use in children and adolescents (EES‐C). International Journal of Eating Disorders. 2007 Apr; 40(3): 232-40. https://doi.org/10.1002/eat.20362
45. Khadaee GH, Saeidi M. Increases of obesity and overweight in children: an alarm for parents and policymakers. Int J Pediatr. 2016 Apr 28; 4(4): 1591-601. https://www.researchgate.net/profile/Masumeh-Saeidi/publication/301287536
46. Strauss RS, Pollack HA. Epidemic increase in childhood overweight, 1986-1998. Jama. 2001 Dec 12; 286(22): 2845-8. doi:10.1001/jama.286.22.2845
47. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. The lancet. 2014 Aug 30; 384(9945): 766-81. doi.org/10.2147/RRB.S75369
48. Liberska H, Boniecka K. Attitudes of obese and overweight children’s parents. Journal of Health Sciences. 2013; 3(13): 396-409. https://www.elibrary.ru/item.asp?id=21417725
49. Mazzeschi C, Pazzagli C, Laghezza L, Radi G, Battistini D, De Feo P. The role of both parents’ attachment pattern in understanding childhood obesity. Frontiers in psychology. 2014 Jul 28; 5: 791. doi.org/10.3389/fpsyg.2014.00791
50. Fraley RC, Roisman GI. The development of adult attachment styles: Four lessons. Current opinion in psychology. 2019 Feb 1; 25: 26-30. doi.org/10.1016/j.copsyc.2018.02.008
51. Hepworth AD, Berlin LJ, Martoccio TL, Jones Harden B. Maternal attachment style, sensitivity, and infant obesity risk in low-income, Latino families. Attachment & Human Development. 2021 Jan 2; 23(1): 75-89. doi.org/10.1080/14616734.2020.1729214
52. Faber A, Dubé L. Parental attachment insecurity predicts child and adult high-caloric food consumption. Journal of Health Psychology. 2015 May; 20(5): 511-24. https://doi.org/10.1177/1359105315573437
53. Bahrami F, Kelishadi R, Jafari N, Kaveh Z, Isanejad O. Association of children's obesity with the quality of parental–child attachment and psychological variables. Acta Paediatrica. 2013 Jul; 102(7): e321-4. doi.org/10.1111/apa.12253
54. Hardman CA, Christiansen P, Wilkinson LL. Using food to soothe: Maternal attachment anxiety is associated with child emotional eating. Appetite. 2016 Apr 1; 99: 91-6. doi.org/10.1016/j.appet.2016.01.017
55. Cichecka-Wilk M. Eating behaviors in children with simple obesity in relation to the results of own research. Lubelski Rocznik Pedagogiczny. 2013; 32: 243-75. https://scholar.google.com/scholar
56. Raque-Bogdan TL, Ericson SK, Jackson J, Martin HM, Bryan NA. Attachment and mental and physical health: self-compassion and mattering as mediators. Journal of counseling psychology. 2011 Apr; 58(2): 272. doi.org/10.1037/a0023041
57. Mikulincer M, Florian V. The relationship between adult attachment styles and emotional and cognitive reactions to stressful events. 1997 https://psycnet.apa.org/record/1997-36873-005
58. Ciechanowski P, Russo J, Katon W, Von Korff M, Ludman E, Lin E, Simon G, Bush T. Influence of patient attachment style on self-care and outcomes in diabetes. Psychosomatic medicine. 2004 Sep 1; 66(5): 720-8. DOI: 10.1097/01.psy.0000138125.59122.23
59Pasztak-Opiłka A, de Jonge R, Zachurzok A, Górnik-Durose ME. Adult attachment styles and mothers’ life satisfaction in relation to eating behaviors in the families with overweight and obese children. Plos one. 2020 Dec 3; 15(12): e0243448. doi.org/10.1371/journal.pone.0243448
60. Tan CC, Holub SC. Emotion regulation feeding practices link parents’ emotional eating to children’s emotional eating: A moderated mediation study. Journal of Pediatric Psychology. 2015 Aug 1; 40(7): 657-63. doi.org/10.1093/jpepsy/jsv015
61. Graziano PA, Calkins SD, Keane SP. Toddler self-regulation skills predict risk for pediatric obesity. International journal of obesity. 2010 Apr; 34(4): 633-41. doi.org/10.1038/ijo.2009.288
62. Francis LA, Susman EJ. Self-regulation and rapid weight gain in children from age 3 to 12 years. Archives of pediatrics & adolescent medicine. 2009 Apr 6; 163(4): 297-302. doi:10.1001/archpediatrics.2008.579
63. Hardman CA, Christiansen P, Wilkinson LL. Using food to soothe: Maternal attachment anxiety is associated with child emotional eating. Appetite. 2016 Apr 1; 99: 91-6. doi.org/10.1016/j.appet.2016.01.017
64. Goossens L, Braet C, Van Durme K, Decaluwé V, Bosmans G. The parent–child relationship as predictor of eating pathology and weight gain in preadolescents. Journal of Clinical Child & Adolescent Psychology. 2012 Jul 1; 41(4): 445-57. doi.org/10.1080/15374416.2012.660690
65. Bost KK, Wiley AR, Fiese B, Hammons A, McBride B, Strong Kids Team. Associations between adult attachment style, emotion regulation, and preschool children's food consumption. Journal of Developmental & Behavioral Pediatrics. 2014 Jan 1; 35(1): 50-61. DOI: 10.1097/01.DBP.0000439103.29889.18
67. Mazzeschi C, Pazzagli C, Laghezza L, Radi G, Battistini D, De Feo P. The role of both parents’ attachment pattern in understanding childhood obesity. Frontiers in psychology. 2014 Jul 28; 5: 791. doi.org/10.3389/fpsyg.2014.00791
68. Hepworth AD, Berlin LJ, Martoccio TL, Jones Harden B. Maternal attachment style, sensitivity, and infant obesity risk in low-income, Latino families. Attachment & Human Development. 2021 Jan 2; 23(1): 75-89. doi.org/10.1080/14616734.2020.1729214
69. Pasztak-Opiłka A, de Jonge R, Zachurzok A, Górnik-Durose ME. Adult attachment styles and mothers’ life satisfaction in relation to eating behaviors in the families with overweight and obese children. Plos one. 2020 Dec 3; 15(12): e0243448. doi.org/10.1371/journal.pone.0243448
70. Bergmeier H, Paxton SJ, Milgrom J, Anderson SE, Baur L, Hill B, Lim S, Green R, Skouteris H. Early mother-child dyadic pathways to childhood obesity risk: A conceptual model. Appetite. 2020 Jan 1; 144: 104459. doi.org/10.1016/j.appet.2019.104459
71. Power TG, Hidalgo-Mendez J, Fisher JO, O'Connor TM, Micheli N, Hughes SO. Obesity risk in Hispanic children: bidirectional associations between child eating behavior and child weight status over time. Eating behaviors. 2020 Jan 1; 36: 101366. doi.org/10.1016/j.eatbeh.2020.101366