Parental attitudes, body image disturbance and disordered eating amongst adolescents and young adults: A review

RESEARCH ARTICLE

Parental Attitudes, Body Image Disturbance andDisordered Eating Amongst Adolescents andYoung Adults: A ReviewRachel Rodgers* & H. Chabrol

Centre d’Etudes et de Recherche en Psychopathologie, Universite Toulouse-II Le Mirail, France

Abstract

Objective: The purpose of this paper was to review the existing literature regarding the contribution of parental

influences to the sociocultural pressures on body image disturbance and disordered eating so as to highlight

principal findings so that parents can be given practical information and identify areas that require further research.

Methods: Relevant articles were located through Pubmed, Sciencedirect and PsychInfo, as well as the screening of

bibliographies.

Results: The available data suggest that parents are strong communicators of sociocultural pressures. Parental

influences via verbal messages and active encouragement have been shown to have more impact on offspring’s body

concerns and eating behaviours than modelling effects. Both mothers and fathers are important sources of influence

for their offspring.

Conclusion: Considering the role of parents could help improve public health management. Futher exploration of

the way adolescents and young adults interpret and perceive parental attitudes and of potential protective factors is

necessary. Copyright # 2009 John Wiley & Sons, Ltd and Eating Disorders Association.

Keywords

eating disorders; body image; parental influences

*Correspondence

Rachel Rodgers, CERPP, Maison de la Recherche, Universite de Toulouse-Le Mirail, 5 Allees Antonio Machado, 31058 Toulouse Cedex,

France.

Email: [email protected]

Published online 7 January 2009 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/erv.907

Introduction

In recent years, much effort has been devoted to

understanding factors contributing to the development

of body image disturbance and disordered eating (Stice,

2002). High levels of body dissatisfaction and weight

concerns, linked to disordered eating, are widespread in

western societies, occurring at particularly high

frequencies during adolescence and early adulthood

(Neumark-Sztainer, Paxton, Hanna, Stat, Haines, &

Story, 2006). Although most research has focused on

negative body image and disordered eating patterns in

girls, there is growing recognition that these concerns

Eur. Eat. Disorders Rev. 17 (2009) 137–151 � 2009 John Wiley & Sons, Ltd and

are not gender-bound (Paxton, Eisenberg, & Neumark-

Sztainer, 2006). Body dissatisfaction, disordered eating

and extreme methods of weight control are strong risk

factors for developing eating disorders (Thompson,

Heinberg, Altabe, & Tantleff-Dunn, 1999), and are

costly disturbances in psychological, personal, inter-

personal and financial terms (Crow & Peterson, 2003;

Hay & Mond, 2005; Paxton, Neumark-Sztainer,

Hannan, & Eisenberg, 2006).

Sociocultural pressures to conform to the ‘thin-ideal’

that pervades western societies are considered to exert a

strong influence on body image, especially among

adolescents who are particularly vulnerable to these

Eating Disorders Association. 137

Parental Influence on Eating Disorder R. Rodgers and H. Chabrol

messages (Cafri, Yamamiya, Brannick, & Thompson,

2005). By creating a discrepancy between reality and the

unrealistic body-deals portrayed, these pressures are

thought to play an important role in body dissatisfac-

tion (Cafri et al., 2005). Body dissatisfaction has, in

turn, been found to be an important predictor for

weight-loss strategies (McCabe & Ricciardelli, 2001;

Neumark-Stzainer, Paxton, Hanna, Stat, Haines, &

Story, 2006), and restrictive eating and bulimic

symptomatology (Dunkley, Wertheim, & Paxton,

2001; Keery, van den Berg, & Thompson, 2004; van

den Berg, Thompson, Obremski-Brandon, & Coovert,

2002, Wertheim, Koerner, & Paxton, 2001).

Sources of sociocultural pressures are numerous, and

involve explicit and implicit messages that appear to be

conveyed by the media and by important-others such as

peers, siblings or parents. (Thompson et al., 1999).

During adolescence and young adulthood parents can

be considered to be primary targets for identification,

and gender-role models, in particular regarding

attitudes towards body shape and eating. Exploring

the part played by parents is of particular importance as

they can be presumed to be trying to act in their

children’s best interests. In view of prevention,

identifying parental attitudes and behaviours is

necessary in order to develop and deliver appropriate

interventions. Therefore there is much to be gained

from a better understanding of the behaviours and

attitudes that foster body shape concerns and eating

problems amongst their offspring.

A developing body of research has investigated the

role of the family factors involved in the appearance of

body image disturbance and disordered eating. How-

ever, there is, to our knowledge, no existing review of

this evidence. The aim of the present paper is therefore

to provide a review of the literature concerning

adolescents and young adults by considering in turn:

methodological issues identified in the research

literature, parent influences in the light of other sources

of influence, mechanisms of action and mediating

variables that may account for their influence on body

shape concerns and disordered eating amongst their

offspring, and lastly gender considerations.

Method

The studies to be reviewed were located by a

combination of methods. We first conducted a search

on PsychINFO, Medline and ScienceDirect using the

138 Eur. Eat. Disorders Rev. 17 (2009)

search terms eating disorders or disordered eating or

body dissatisfaction, parents or family, and adolescents

over the period from 1985 to the present. This was then

completed by a manual search of the reference tables of

relevant articles. Criteria for inclusion were that articles

had been published in English in peer-reviewed

journals; reported research conducted with adolescent

or young adult samples; and separated influence from

parents from other sources of sociocultural pressures in

their analysis. We further excluded studies using clinical

samples as family attitudes concerning weight and

eating might have been influenced by diagnosis and

treatment interventions.

We located 56 relevant publications, of which 38 were

conducted in North America, 14 in Australia and New

Zealand, and 4 in European countries. The sample size

varied between 51 and 98 758. Of these studies,

22 included data from daughters only, 2 from sons

only, 17 from daughters and sons, 9 from daughters and

mothers, 2 daughters and both parents, 2 mothers and

their sons and daughters, 2 children of both gender and

both parents. Of these, 3 were longitudinal in design

and 53 were cross-sectional (Table 1).

Methodological issues identifiedin the research literature

Constructs and methods of assessment

In the literature to be reviewed, both body dissatisfac-

tion and disordered eating are most frequently assessed

by means of self-report measures. In addition to the

general biases that can result from self-report assess-

ment tools such as tendencies to under-report socially

undesirable behaviours, these scales may affect data in

other ways. In particular, measures of body dissatisfac-

tion may be more or less gender-appropriate, thus

partially accounting for differences in the literature.

Body dissatisfaction can be defined in terms of

affective, cognitive and behavioural components that

together form a person’s subjective evaluation of their

body image (Thompson et al., 1999). As such, there

have been various methods developed to assess it: a first

means of assessment involves self-report measures of

dissatisfaction on Likert-like scales, the most frequently

used of which is the Eating Disorders Inventory-Body

Dissatisfaction subscale (Garner & Olmsted, 1984).

However, many items on scales such as these appear to

be very much aimed at assessing women’s dissatisfac-

137–151 � 2009 John Wiley & Sons, Ltd and Eating Disorders Association.

Table 1 Summary of the characteristics of the reviewed article

Author Year Country Sample characteristics Body image and disordered

eating outcomes

Ata, R.N. 2007 USA 100 females, age¼ 15.8 BD, DE (EAT-26)

77 males, age¼ 15.8

Attie, I. 1989 USA 193 daughter, (t1)age¼13.93,

(t2)age¼ 15.93 and mother dyads

BD, DE (EAT-26, DEBQ-R)

Baker, C.W. 2000 USA 47 daughters, age¼18.6� 1.2 with

46 mothers, and 36 fathers

DE (EAT-26)

44 sons, age¼ 19.1� 1.2 with

41 mother, and 30 fathers

Benedikt, R. 1998 Australia 89 daughter, age¼ 15.9� 0.76,

mother dyads

BD, UWLB, DR

Byely, L. 2000 USA 77 daughter, (t1) age¼ 12.3,

(t2) age¼ 13.3 and mother dyads

BD, DE (EAT-26)

Davis, C. 2004 Canada 158 female, age¼ 21.04� 2.74 Weight preoccupation: BD

(EDI-BD/DT/BU)

Dixon, R. 1996 NZ 232 female, age¼ 13.97� 0.75 Dieting beliefs

Dunkley, T.L. 2001 Australia 577 female, age¼ 15.5�0.40 BD (FRS), DR (DEBQ-R)

Edmunds, H. 1999 UK 200 female, age¼ 12.08 DR (DEBQ-R)

202 male, age¼ 12.08

Elfhag, K. 2005 Sweden 279 daughter, age¼16,8� 0.4

and mother dyads

BD (EDI-BD); DE (EDI-DT/BU), DR;

emotional and uncontrolled eating

202 sons, age¼ 16,9� 0.4 and

mother dyads

Field, A.E. 2001 USA 6770 female, age¼ 9–14 Weight concerns, constant dieting

5287 male, age¼ 9–14

Fulkerson, J.A. 2002 USA 429 female, age¼ 14.6�1.7 Weight concern

381 male, age¼ 14.6�1.7

Less and more extreme

weight control behaviours

2006 USA 49,620 female, age¼ 6th–12th grade Binge/purge behaviours,

excessive weight loss

49,138 male, age¼ 6th–12th grade

Fulkerson, J.A. 2007 USA 684 female, age¼ 7th–12th grade,

BMI�85th percentile

BD, UWCB

667 male, age¼ 7th–12th grade,

BMI�85th percentile

Griffiths, J.A. 2000 Australia 111 female, age¼ 12.46 BD (EDI-BD), importance of

appearance, DE

Gross, R.M. 2000 USA 221 female, undergraduates

Hanna, A.C. 2006 Australia 315 female, age 14–28 BD (EDI-BD), DE (EDI-DT/BU)

Kanakis, D.M. 1995 USA 112 female undergraduates,

age¼ 18.9� 2.48

BD, DE: BU, DR, emotional and

uncontrolled eating

Keel, P.K. 1997 USA 51 daughter, age¼ 14.8� 1.8,

father mother triads

Weight satisfaction, DR,

DSM-IV criteria

Keery, H. 2004 USA 325 female, age¼ 12.6�0.90 BD (EDI-BD), DE (EDI-DT /BU)

Keery, H. 2005 USA 372 female, age¼ 12.6�0.90 BD (EDI-BD), DE (EDI-DT/BU)

Keery, H. 2006 USA 429 daughter, age¼7th–12th grade,

and mother dyads

BD, weight concerns, UWCB

381 son, age¼ 7th–2th grade, and

mother dyads

Kichler, J.C. 2001 USA 148 daughter, age¼19.3� 4.2 and

mother diads

BD, DE (EAT-40)

Laliberte, M. 1999 Canada 324 daughter, age¼17–22, and

121 mothers

DSM-IV criteria

Levine, M.P. 1994 USA 385 female, age¼ 13.20� 0.92 BD, investment in thinness,

DE (ChEAT)

(Continues)

Eur. Eat. Disorders Rev. 17 (2009) 137–151 � 2009 John Wiley & Sons, Ltd and Eating Disorders Association. 139

R. Rodgers and H. Chabrol Parental Influence on Eating Disorder

Table 1. (Continued)


eating outcomes

Mccabe, M.P. 2001 Australia 644 female, age¼ 13.78� 1.09 BD, strategies to lose or increase

weight, binge eating

622 male, age¼ 13.94� 1.14

Mccabe, M.P. 2003 Australia 377 female, age¼ 13.69� 1.11 BD, body importance, strategies to

decrease/increase weight, increase

muscle-tone,

binge eating, food supplements

423 male, age¼ 13.92� 1.18

Mccabe, M.P. 2005 Australia 246 female, age¼ 14.22 BD, extreme weight-loss behaviours

344 male, age¼ 14.49

McKinley, N.M. 1999 USA 151 daughter, age¼ 18.41�0.73

and mother dyads

BD, Objectified Body Consciousness,

DR, dieting

Meesters, C. 2005 Netherlands 224 female, age¼ 12.5� 1.5 DE (ChEAT)

181 male, age¼ 12.5� 1.5

Nathanson, A.I. 2003 USA 160 students, age¼ 21, 220 parents,

149 siblings, age¼ 12–17

BD (EDI-BD), DE (EDI-DT/BU)

Neumark-Sztainer, D. 2004 USA 2363 female, 14.9�1.7 UWCB, Binge eating, Chronic Dieting

2383 male, 14.9�1.7

Ogden, J. 2000 UK 30 daughter, age¼17.13�0.78

and mother dyads

DR (DEBQ-R)

Paxton, S.J. 2006 USA 440 female, age¼ ,12.7� 0.74,

946 female age¼15.8� 0.81

BD

366 male age¼ 12.8� 0.76,

764 male age¼ 15.9� 0.78

Peterson, K.A. 2007 USA 191 female, age¼ 16.53 BD (EDI-BD), DE (EAT, EDI-DT)

142 male, age¼ 16.53

Pike, K.M. 1991 USA 77 mothers of daughters with

high levels of DE, age¼ 16

BD (EDI-BD), DE (EDI-DT, BU)

Pike, K.M. 1995 USA 410 female, age¼ 16� 1.2 BU (BULIT-R), dieting

Presnell, K. 2004 USA 293 female, age¼ 17 BD

238 male, age¼ 17

Ricciardelli, L.A. 2000 Australia 40 male, age¼ 12–15 BD, body change methods

Schwartz, D.J. 1999 USA 139 female, age¼ 20.26� 2.09 BD

114 male, age¼ 20.26� 2.09

Shisslak, C.M. 1998 USA 523 females, age¼9–15 BD (FRS), DE

Shroff, H. 2006 USA 391 female, age¼ 12.61� 0.85 BD (EDI-BD), DE (EDI-DT/ BU)

Smolak, L. 2006 USA 287 male, age¼ 12.9� 0.72 Drive for muscularity

Stice, E. 1996 USA 320 female high-school students BU (BULIT-R), DR (DEBQ-R)

117 female college students

Stice, E. 1998 USA 114 female students, age¼ 17–29 BD, BU (BULIT-R), DR (DEBQ-R)

218 female high-school students,

age¼16–18

Strong, K.G. 1998 Australia 141 female, age¼ 14.6 BD (EDI-BD), dieting

The McKnight Investigators 2003 USA 1103 female age¼6th–9th grade BD,DE

Twamley, E.W. 1999 USA 249 female age¼20� 2.4 BD, DE (EAT-26)

Usmiani, S. 1997 Canada 82 menstrual daughter, age¼13.42

and mother diads

BD

31 premenstrual daughter,

age¼12.5 and mother diads

Van den Berg, P. 2002 USA 196 female, age¼ 19.5 BD (EDI-BD), DE (EDI-BU/DT,

EAT-FP/ D), DR

(Continues)

140 Eur. Eat. Disorders Rev. 17 (2009) 137–151 � 2009 John Wiley & Sons, Ltd and Eating Disorders Association.


Table 1. (Continued)


eating outcomes

Vincent, M.A. 2000 Australia 306 female, age¼ 13.66� 1.12 DE (EDI-DT, DEBQ-R, BULIT-R)

297 male, age¼ 13.89� 1.13

Wade, T.D. 2002 USA 323 female, age¼ 14�0.7 BD, DE

Wertheim, E.H. 1997 Australia 30 female, age¼ 14–16 BD, dieting

Wertheim, E.H. 1999 Australia 369 daughter, age¼15.8,

mother, father triads

BD, DR (DEBQ-R)

Wertheim, E.H. 2002 Australia 619 female, age¼ 12.81� 0.23 BD (EDI-BD, FRS), DE (EDI-DT, BU)

587 male, age¼ 12.08� 0.2

Young, E.A. 2004 USA 193 female undergraduates, under30 BD, BU (BULIT-R)

BD, body dissatisfaction; BU, bulimic symptoms; ChEAT, Children’s Eating Attitudes Test (Maloney, McGuire, & Daniels, 1988); DE,disordered eating, DR, dietary restriction; EAT-26, Eating Attitudes test (Garner, Olmstead, Bohr, & Garfinkel, 1982); EAT-FP/ D, EatingAttitudes Test Bulimia and Food Preoccupation subscale/Dieting subscale (Garner & Garfinkel, 1979); FRS, Figure Rating Scales (Stunkard,Sorensen, & Schlusinger, 1983); EDI, Eating Disorders Inventory (Garner & Olmsted, 1984); EDI-BD, Eating disorders Inventory BodyDissatisfaction subscale; EDI-DT/BU, Eating Disorders Inventory Drive for Thinness subscale/Bulimia subscale (Garner et al., 1984); DEBQ-R,Dutch Eating Behaviours Questionnaire Restriction subscale (Van Strien, Frijters, Bergers, & Defares, 1986); Bulit-R, Bulimia Test-Revised(Thelen, Farmer, Wonderlich, & Smith, 1991).


tion with their figure, with items often phrased in terms

of body areas being ‘too big’, and an emphasis on lower-

body parts such as stomach and thighs. These measures

may therefore not be as relevant to young men who are

more concerned with a muscular figure, and perturb

investigations of gender differences. Other measures of

body dissatisfaction involve the use of silhouette figure

drawings, representing weights ranging from very thin

to obese. Participants are invited to indicate which

figure they regard themselves to be most close to, and

which figure they would most like to resemble. Body

dissatisfaction is then taken as the gap between both

body sizes. Frequently used figure-rating measures

include the Figure Rating Scale (Stunkard, Sorensen, &

Schlusinger, 1983). These figures can be gender and age

specific so as to control for population differences.

However they only provide information regarding

overall appearance, and may not be as sensitive.

Reported versus perceived measures

There has been much debate over the use of measures of

attitudes towards body shape and eating reported by

parents versus those perceived by their offspring, and

the role of perception in the transmission of concerns in

these areas. A number of studies have discovered

daughters’ reports of encouragement to be thin, and

criticism to be more predictive of body dissatisfaction

and disordered eating outcomes than parents’ (Baker,

Whisman, & Brownell, 2000; Kanakis & Thelen, 1995;


Keel, Heatherton, Harden, & Hornig, 1997; Wertheim,

Mee, & Paxton, 1999). Perception of maternal dieting

has been more strongly associated with their offspring’s

weight concerns and weight control behaviours

than maternal self-reports of dieting (Keery, Eisen-

berg, Boutelle, Neumark-Sztainer, & Story, 2006).

Interestingly, the frequencies perceived by sons and

daughters were higher than those reported by the

mothers.

However, focussing on perceived criticisms and

encouragments could bias the assessment of inter-

generational transmission of body shape and eating

concerns (Baker et al., 2000). It may be the case that

participants with higher levels of concern are more

sensitive to parental encouragement to diet or body

criticism, and tend to exagerate reports of these

behaviours. Similarly parents may be uncomfortable

reporting overt criticism of their offspring (Baker et al.,

2000). Thus, both parents’ and their offpring’s

perception and reports of the levels of family criticism

may be inaccurate, and measures of parental influences

unreliable. However, accurate measures of these

behaviours appear extremely difficult to obtain.These

results highlight the role of perception and interpret-

ation of parental attitudes and behaviours in the

shaping of their offspring’s own attitudes. Future

research should concentrate on perception when

investigating associations with disordered eating and

body shape disturbances, but could also benefit from

exploring the origin of the discrepancy between

perceived and self-reported data.



Study design

As mentioned above, only 3 of the 56 articles to be

reviewed are of longitudinal design. This somewhat

limits the possibility of concluding as to the prospective

effects of parent influences on body image disturbance

and disordered eating. The majority of studies are

cross-sectional with relatively small sample-size, there-

fore the significance of their results might be considered

with a degree of caution when interpreting predictive

relationships.

Furthermore, only two of the studies to be reviewed

includes a mixed-gender sample and both parents. This

is particularly relevant when considering the relative

influence of each parent, or attempting to explore

gender differences.

Parent influences in the contextof multiple independentsociocultural agents

Three main sources of pressure have typically been

identified, namely parents, peers and the media. It has

been proposed that these sources of influence,

combined, are stronger predictors of body shape and

weight concerns than any single one (Dunkley,

Wertheim, & Paxton, 2001; Levine, Smolak, & Hayden,

1994; Peterson, Paulson, & Williams, 2007). This

conception has led to the suggestion of the existence of a

‘Subculture of dieting’ (Levine et al., 1994), in which

media, parents and peers combine to convey the

importance of slenderness. Attempts to determine the

relative importance of different sources of influence

have not led to conclusive findings.

In order to gain a better understanding of the

relationships between parent, peer and media influ-

ences and body shape and eating concerns, a number of

studies have chosen to consider sociocultural factors as

independent agents. In one of the first studies to explore

sources of influence seperately (Levine et al., 1994),

parental teasing and criticism was found to be

associated with body shape and eating concerns,

although media influences emerged as the strongest

predictor. Prospective studies have also supported the

theory that sociocultural sources of influence act as

seperate agents. One such study involving a large

sample of adolescent girls and boys (Field, Camargo,

Barr, Berkey, Roberts, & Colditz, 2001), indicated that

parental influences were an important source of


pressure, independently of media or peer influence,

in the prediction of the appearance of weight concerns

or constant dieting. These findings reveal that the

patterns of sociocultural influences on body shape and

eating disturbances are intricate, with no single agent

emerging as a principal source of influence. However,

an important limitation of these studies resides in their

failure to assess pressure from the three sources of

influence using comparable measures.

In order to address this issue, parallel measures of

parent, media and peer influence have been developed.

These self-report scales are designed to examine the

three sources of social influence concurrently and better

assess their relative contribution.

The ‘Family, Peers and Media Influence Scale’,

expanded from a scale first used by Levine et al. (1994),

contains three parallel scales assessing the participant’s

recollections of family, friends and the medias’ attitudes

towards dieting behaviours, weight and general

appearance. As such, it does not directly assess percep-

tion of influence, but can be used to explore the

association between the attitudes and values of others

and the participants’ own responses. Research using

this measure, in conjunction with other scales to obtain

a global view of family influences as part of the tripartite

model, have shown an association with body dis-

satisfaction and measures of disordered eating (Keery

et al., 2004; van den Berg et al., 2002). A replication of

this model has suggested that influences from peers and

the media may be better predictors than those from

parents (Shroff & Thompson, 2006).

Other questionnaires focus more specifically on a

particular outcome. The Perceived Sociocultural Pres-

sure Scale (Stice, Ziemba, Margolis, & Flick, 1996) is a

6-item scale assessing pressure to be thin from parents,

peers and media. The Bulimic Modelling Scale (Stice,

1998) assesses awareness of bulimic behaviours in

family members, friends or the media. Using these

measures, family and peer influences were shown to

prospectively predict bulimic symptomatology,

whereas media influence was not found to be significant

(Stice, 1998).

The Perceived Sociocultural Influences on Body

Image and Body Change Questionnaire (McCabe &

Ricciardelli, 2003) uses parallel measures to investigate

pressures in relation to weight change, and muscle-tone

increase strategies. It consists of five scales assessing

feedback from father, mother, best male friend, best

female friend and media influences. The four feedback



scales each assess general feedback and encouragement,

teasing and behavioural example to gain weight and

increase muscle tone, or lose weight and increase

muscle tone. One of the strong points of this scale lies in

its relevance to both girls and boys, as a result of its

focus not only on weight loss and slenderness but also

muscle tone. Consistent with previous findings, the

authors reported effects of parental pressure on body

dissatisfaction. Although the complexity of the study

design, which involved a large number of sources of

influence and of outcome variables, made it difficult to

draw general conclusions, they reported that

parents were the most important source of social

influence.

Dunkley et al. (2001) assessed pressures to be thin

using other parallel measures. Social sources of

influence were further subdivided with family listed

as mother, father and siblings, peers as friends, other

girls, popular girls and boys, and media as fashion,

advertising, magazines and TV. With the sociocultural

agents thus decomposed, pressure from the media was

reported to be stronger than that from peers, itself

stronger than that from parents. The overall authors’

findings again confirmed parental pressures to be a

predictor of body image disturbance and disordered

eating.

Attempts to evaluate the relative importance of

different sources of sociocultural pressures on body

image disturbance and disordered eating have therefore

met with moderate success. Adolescent and young adult

reports show that parents do have an influence on body

shape and weight concerns, but their relative import-

ance with respect to other agents remains unclear.

Mechanisms of influence

Two main modes of influence have been proposed to

account for the association between parents and their

offspring regarding body shape and eating attitudes and

behaviours. The first theory suggests that children’s

body image and eating behaviours are modelled by

those of their parents. The second theory places

emphasis on parental attitudes towards their offspring’s

shape, weight and eating behaviours, conveyed by

verbal messages in the form of teasing, criticism, and

encouragement to lose or control weight (Thompson

et al., 1999). Both of these theories have received

support from the literature and led to the exploration of

possible mediating variables.


The modelling theory

Several studies have lent support to the modelling

theory. Amongst daughters there has been evidence of a

relation between levels of body dissatisfaction and levels

of maternal body dissatisfaction (Elfhag & Linne, 2005;

Fulkerson, McGuire, Neumark-Sztainer, Story, French,

& Peery, 2002; Keery et al., 2006; Kichler & Crowther,

2001, McKinley, 1999; Usmiani & Daniluk, 1993), and

paternal body dissatisfaction (Keel et al., 1997).

Regarding the modelling effects of dieting amongst

daughters, there has been little support. Keery et al.

(2006) and Dixon, Adair, & O’Connor (1996) reported

no evidence of an association between mother and

daughter reports of dieting. Only Fulkerson et al. (2002)

described a positive correlation regrading these

behaviours, which was no longer significant after

controlling for BMI. One study, however, reported a

positive relationship between fathers’ and daughters’

dieting (Dixon et al., 1996).

None of the studies exploring the link between

mothers’ and sons’ self-reported body dissatisfaction,

have provided any evidence of a relationship (Elfhag &

Linne, 2005; Fulkerson et al., 2002; Keery et al., 2006;

Wertheim, Martin, Prior, Sanson, & Smart, 2002), nor

was there any evidence of an association between

maternal body dissatisfaction and dieting amongst sons

(Fulkerson et al., 2002; Keery et al., 2006). However,

Keery et al. (2006) explored the relationship between

perception of maternal dieting and offsprings’ eating

behaviours and reported an association with dieting

and weight concerns in sons, and extreme weight-loss

methods in both sons and daughters.

Restriction and abstention behaviours amongst

daughters have been reported to be associated with

the dieting, abstention and restrictive behaviours of

their mothers (Vincent & Mccabe, 2000) and fathers

(Wertheim et al., 1999). Drive for thinness has shown a

positive correlation with maternal dieting amongst

daughters (Strong & Huon, 1998; Wertheim et al.,

2002) and sons (Wertheim et al., 2002). A similar

relationship has been reported regarding extreme

weight-loss amongst mothers and daughters (Benedikt,

Wertheim, & Love, 1998). These findings provide

further support for the theory that daughters’ restictive

behaviours appear shaped by those of their mothers.

There has been evidence of a modelling effect

regarding maternal disordered eating amongst sons

(Keery et al., 2006; Vincent & McCabe, 2000), and



daughters (Attie & Brooks-Gunn, 1989, Elfhag & Linne,

2005; Pike & Rodin, 1991). Regarding bulimic

symptoms in particular, there is evidence to support

the modelling effect amongst girls (Pike, 1995; Stice

et al., 1996; Wertheim et al., 1999).

Similarly, the offspring of parents who place high-

importance on the regularity of family meals appear to

display less disordered eating (Fulkerson, Story, Mellin,

Leffert, Neumark-Sztainer, & French, 2006), even after

controlling for parental weight pressures such as

encouragement to diet (Neumark-Sztainer, Wall, Story,

& Fulkerson, 2004) suggesting a modelling effect might

also exist for positive eating behaviours.

Several studies have reported findings that do not, or

only partially lend support the modelling theory (Byely,

Archibald, Graber, & Brooks-Gunn, 2000; Kanakis &

Thelen, 1995; Keel et al., 1997; McKinley, 1999; Ogden

& Steward, 2000; Usmiani & Daniluk, 1993, Wertheim

et al., 2002). These failures to replicate the relationship

between attitudes towards weight and eating behaviours

in parents and offspring could be in part due to sample

size, and age: the studies conducted by Byely et al.

(2000), Kanakis and Thelen (1995), Keel et al. (1997),

Ogden and Stward (2000) all involving fewer than 115

participants, and mean age in the samples used by

Usmiani and Daniluk (1993) and Wertheim et al.

(2002), being of 12.5 and 12.81 years old, respectively.

As the modelling of behaviours is a gradual process, it

might be that these relations are visible only in slighlty

older samples, who have been more exposed to these

behaviours from their parents. Similarly, these relations

may not be visible among smaller samples, lacking in

statistical power.

Although the findings in this area are not unanimous,

parents’ attitudes towards eating and body shape have

been shown to have a modelling effect on attitudes

amongst adolescents and young adults.

Active influences

The impact of perceived parental pressures on body

image and disordered eating has been repeatedly

demonstrated. Amongst girls, parental teasing and

encouragement to diet has been associated with body

dissatisfaction (Ata, Ludden, & Lally, 2007; Fulkerson,

Strauss, Neumark-Sztainer, Story, & Boutelle, 2007;

Hanna & Bond, 2006; Keel et al., 1997; Keery, Boutelle,

Berg, & Thompson, 2005; Schwartz, Phares, Tantleff-

Dunn, & Thompson, 1999), dieting (Dixon et al., 1996;


Keel et al., 1997; Ricciardelli, McCabe, & Banfield, 2000;

Wertheim et al., 2002), restriction and weight-loss

attempts (Benedikt et al., 1998; Dunkley et al., 2001,

Keel et al., 1997), disordered and high-risk eating

behaviours (Ata et al., 2007; Dixon et al., 1996; Hanna &

Bond, 2006; Kanakis & Thelen, 1995; Young, Clopton,

& Bleckley, 2004), and eating disorders (Keery et al.,

2005; The McKnight Investigators, 2003).

Although fewer studies have included male partici-

pants, similar patterns have been suggested in boys.

Amongst boys, parental encouragement to lose weight

has been reported to be associated with body

dissatisfaction (Wertheim et al., 2002), strategies to

lose weight (McCabe & Ricciardelli, 2005, Ricciardelli

et al., 2000), extreme weight-loss (Vincent & McCabe,

2000), drive for muscularity (Smolak & Stein, 2006),

drive for thinness (Vincent & McCabe, 2000; Wertheim

et al., 2002), dieting and eating and weight concerns

(Fulkerson et al., 2002; Meesters, Muris, Hoefnagels, &

van Gemert, 2007), and binging (Fulkerson et al., 2002).

However parental teasing has not been found to be

associated with body dissatisfaction in boys (Schwartz

et al., 1999).

Prospectively, amongst both adolescent boys and

girls, family pressures to be thin have not been shown to

predict any increase in body dissatisfaction over time

(Presnell, Bearman, & Stice, 2004), and although

correlated with body dissatisfaction, parental dieting

and encouragement to diet were not significant

longitudinal predictors when considered amongst other

influences, in particular from peers (Paxton et al., 2006).

Regarding critisim of present body shape and weight

rather than encouragement to lose weight, negative

comments from parents about body shape have been

found to be linked to body dissatisfaction (Vincent &

McCabe, 2000). Disordered eating has been reported to

be associated with criticism regarding shape and weight

from both parents among girls, and from fathers among

boys (Baker et al., 2000). Furthermore, it has been

proposed that perceived parental criticism, was more

predictive of offspring’s disordered eating than parent’s

own levels of disordered eating behaviours (Baker et al.,

2000; Benedikt et al., 1998; Wertheim et al., 1999).

However, Griffiths and McCabe (2000) found no

association between adolescent girl’s perception of their

parents’ view of their body and disordered eating,

suggesting that perhaps the association is to be found

only when parents directly communicate their opinion

regarding their offspring’s shape and weight.



In order to explore the exact nature of parental verbal

messages, Gross and Nelson (2000) designed a

questionnaire exploring the perceived frequency of

15 messages regarding weight and shape. The results

showed that young women with low body dissatisfac-

tion perceived negative parental messages. This finding

was replicated and extended to reveal that the

perception of negative messages predicted disordered

eating (Hanna & Bond, 2006). Gross and Nelson (2000)

also reported that participants with higher body

satisfaction perceived higher frequencies of positive

messages. It has been proposed that among boys,

positive messages were also associated with body

satisfaction, suggesting that positive messages might

act as a protective factor for body shape concerns.

(Ricciardelli et al., 2000).

It would appear that the relationship between body

image disturbance and disordered eating and active

influences such as parental criticism, verbal encourage-

ment to lose weight and teasing is stronger than the

modelling effect. However, these studies take into

account only a limited spectrum of parental messages,

mainly direct and explicit references their own off-

spings’ weight and eating behaviours. Although useful,

these do not explore more indirect messages, or

comments directed at other individuals as part of an

increased appearance orientated context. Furthermore,

few studies have explored the potential protective effect

of positive comments concerning weight and body

shape.

Mediating variables

Parental influences on body image disturbance and

disordered eating have been reported to be mediated by

a number of psychological variables that illustrate the

close-knit nature of the various factors involved in

appearance and eating concerns and the necessity of

considering parent-child interections in their light.

The effect of sociocultural influences on body shape

concerns and disordered eating has been explored in

relation to the internalisation of social norms, as well as

individual tendencies to engage in social comparison,

which have been described as mediators (Halliwell &

Harvey, 2006). The tripartite model (Thompson et al.,

1999) proposes a pathway for the influence of family,

peer and media pressure on body image disturbance

and disordered eating, including both internalisation of

social norms and social comparison tendencies as


mediational variables. The exploration of the role of

social comparison provided support for its role as a

mediator of the effects of parental pressures on body

dissatisfaction and disordered eating (van den Berg

et al., 2002). A re-appraisal of this model (Keery et al.,

2004) brought further evidence to suggest that parental

influence was fully mediated by internalisation and

social comparison. Another replication, however, did

not support the full-mediation hypothesis and

described a direct pathway leading to restrictive

behaviours in addition to the previous findings (Shroff

et al., 2006). It is important to note that all of these

studies were conducted amongst adolescent girls, and

therefore did not explore potential differences amongst

adolescent boys.

Comments about shape and weight have been

proposed to lead to the overvaluation of the personal

implications of physical appearance, leading in turn to

disordered eating (Wade & Lowes, 2002). Kichler and

Crowther (2001) suggested that negative comments

from family members moderated the effects of maternal

modelling of their daughters’ body satisfaction and

eating attitudes. In their sample, they reported high

levels of modelling effects only in conjunction with high

levels of negative communications. Parental pressures

to control weight have also been suggested to moderate

the relationship between the awareness of sociocultural

norms and their internalization (Twamley & Davis,

1999). These authors proposed family pressures to be a

risk factor for high levels of internalisation only when

initial levels of awareness were low. Again, these studies

included all-female samples. These findings suggest that

negative comments are associated with increased

disordered eating not only through their content but

also by facilitating other phenomenon.

A study investigating the mediating effect of parents

on media pressures (Nathanson & Botta, 2003)

reported that parental mediation of media messages

concerning sociocultural ideals led to body image and

eating disturbance. Nathanson and Botta (2003) found

that the extent to which parents commented on the

physical appearance of TV characters was associated

with disordered eating, with social comparison acting as

a mediating variable. Interestingly, this association was

similar in strength regardless of the complimentary or

critical nature of the comments, suggesting that the

effect was due to the focus on appearance, rather

than the appreciation or criticism of media beauty-

standards.



Finally, Davis, Shuster, Blackmore, and Fox (2005),

investigated ‘proneness to anxiety’ as a moderating

variable of family orientation towards appearance and

disordered eating. Their results revealed that partici-

pants who claimed to be easily made anxious, showed

more vulnerability to family influences.

The existing literature describes complex relation-

ships between sociocultural pressures and body image

disturbance and disordered eating, involving several

mediating variables. Findings suggest that parental

influences are, entirely or partially, mediated by

personal factors such as internalisation of social ideals,

comparison tendencies or anxiety. The results of the

previous studies are interesting to consider together as

they suggest that parents play a role by intentionally

encouraging their offspring to strive for the socially

valued body shape, but may also perhaps unintention-

ally increase their offspring’s’ body shape and weight

concerns with potentially well-meant comments.

Regardless of the specific pathway or mode of action,

it would appear that some families provide a climate

more conducive to the appearance of disorder eating,

displaying high levels of family body shape dissatisfac-

tion and placing importance on appearance (Laliberte,

Boland, & Leichner, 1999).

Gender considerations

Gender differences in outcomes

There are significant gender differences in frequency of

body dissatisfaction and disordered eating. Some research

has suggested that body image and weight concerns are

less frequent among boys (Ericksen, Markey, & Tinsley,

2003; Field et al., 2001; Phares, Steinberg, & Thompson,

2004; Thelen & Cormier, 1995). However, a detailed

review of the literature argued that this finding could be

explained by the frequent use of wish for weight-loss as

and indicator of body dissatisfaction. This is problematic

as body dissatisfaction amongst boys is expressed in equal

proportions as a wish for weight-loss and weight-gain

(McCabe & Ricciardelli, 2004). Studies have revealed that

girls diet more frequently than boys, and exhibit more

dietary restraint and disordered eating (Edmunds & Hill,

1997; Halliwell & Harvey, 2006). Consistent with their

respective gender body-ideals, although girls appear

more likely to adopt strategies to lose weight, boys

appear more likely to adopt strategies to increase

muscle (McCabe & Ricciardelli, 2005). Furthermore, in

boys, perceived pressure has been reported to be the


strongest predictor of body dissatisfaction whilst in girls

the strongest predictor was internalisation (Knauss,

Paxton, & Alsaker, 2007). These initial differences

render the investigation of the differences in impact and

action of sociocultural pressures in function of gender

all the more challenging.

There has been some evidence of gender differences

regarding the amount of pressure perceived from

parents. Girls have tended to report higher levels of

weight-related teasing (Ata et al., 2007), maternal

criticism (Baker et al., 2000), weight-loss discussions

with mothers (Vincent & McCabe, 2000), and general

feedback concerning appearance from their fathers

(Schwartz et al., 1999) than their male counterparts.

These differences could stem from a gender-linked

cultural context that tends to place more emphasis on

appearance and body shape in female than in males.

Interestingly however, gender comparisons of active

pressure to be thin and to lose weight have shown

conflicting findings. Some authors have reported girls

to receive more pressure (Ata et al., 2007; Peterson et al.,

2007; Presnell et al., 2004), whereas others have

reported no gender differences in encouragement to

diet and lose weight (Meesters et al., 2007; Vincent &

McCabe, 2000; Wertheim et al., 2002). These seemingly

contradictory findings could be the reflection of several

phenomena. It would appear that gender differences

become apparent in the more recent studies, suggesting

they may firstly be attributable to a general trend over

time for parents to engage more actively in encouraging

their daughters to achieve social standards of thinness,

but other gender-appropriate stereotypes for their sons.

Another possibility, however, regarding conflicting

reports of the presence of gender differences, might

pertain to the phrasing of the items assessing parental

influence. Participants could interpret differently items

exploring parental ‘encouragement’ to diet and lose

weight and parental ‘pressure’ to do so. If this were the

case, participants might understand items phrased in

terms of ‘encouragement’ to be exploring positive,

supportive and helpful attitudes in relation to their own

weight-loss attempts, whilst items phrased in terms of

‘pressure’ might assume more coercive and manip-

ulative connotations. In this light, female adolescents

and young adults might report perceiving more

pressure, and messages pushing them to lose weight

than their male counterparts, but reports of perceived

support and encouragement regarding weight-loss

would produce no gender differences.



Further gender differences have been investigated

regarding the strength of the association between

parental influences and body shape concerns and

disordered eating amongst adolescents and young

adults. Although Schwartz et al. (1999) reported

stronger associations between perceived teasing and

feedback and body shape satisfaction amongst female

participants, there has been little evidence for this

regarding eating outcomes. No gender interaction was

found in the extent to which family criticism contributed

to disordered eating by Baker et al. (2000), and Fulkerson

et al. (2002) reported stronger associations between

maternal encouragement to diet and body shape and

eating outcomes amongst boys. Encouragement to lose

weight and develop muscle were also reported to be more

strongly associated with disordered eating in boys by

Meester et al. (2007). Vincent &McCabe (2000) suggested

that in boys, encouragement to lose weight was an

important predictor of disordered eating, whereas other

forms of influences such as weight-discussions, criticism

and modelling were not. The authors proposed that boys

could be less exposed to weight-loss discussions, an

important predictor amongst girls, and therefore

attribute significance to active encouragement.

In summary, although findings are unclear as to

whether there are gender differences regarding amounts

of messages perceived regarding shape and weight, it

would appear that these messages are more strongly

associated with behavioural outcomes in girls. This

may, in part, be a reflection of the differences in body

shape ideals.

Gender of parent

While both mothers and fathers have been alternately

highlighted as primary souces of influence, there would

appear to be emerging evidence of the importance of

both parents. Mothers have been described as exerting

greater influence over boys’ body image than any other

source of sociocultural pressure (Ricciardelli et al.,

2000). However, in both girls and boys, constant dieting

was predicted by the perception of the importance of

thinness to their fathers but not their mothers (Field

et al., 2001), and pressures to be thin from fathers but

not mothers prospectively predited weight control

behaviours in middle school girls, although only when

parents were separated/divorced (Shisslak et al., 1998).

Other research has tended to disagree with this

theory, and proposed that both mothers and fathers


exert an influence on body and eating concerns

(McCabe & Ricciardelli, 2003, Vincent & McCabe, 2000).

A gender-linked transmission model of parent influ-

ences would suggest that mothers are more influential

for daughters, and fathers for sons. This model has been

supported by the findings of several studies (Wertheim,

Paxton, Schutz, & Muir, 1997; Wertheim et al., 1999).

However, it has been pointed out that findings that

could be attributable to this gender-link may be due to

the higher rates of body and eating concerns amongst

girls, as well as their increased vulnerability to parent

influences (Elfhag & Linne, 2005).

A cumulative sociocultual model would propose that

the combination of messages from both parents

regarding body shape and eating would be more

strongly associated with those factors in their offspring

than values transmitted by either parent alone.

However, studies that have explicitly examined this

model have found little support for it (Wertheim et al.,

1999, 2002).In order to continue to explore the

respective roles of both parents in the transmission

of body shape and eating attitudes further research on

mixed-gender samples, seperating influences from both

parents is necessary to provide evidence of their

respective roles.

Conclusion

The aim of this paper was to review the literature

concerning parental influences on body image disturb-

ance and disordered eating. The studies included clearly

point to parents as important sociocultural influences

in the development of these concerns. This review

demonstrates the importance of family attitudes, and in

particular of direct verbal messages concerning body

shape and eating habits. It also however, highlights the

small number of studies that consider these effects

amongst male adolescents and young adults, despite

increasing evidence of the relevance of these issues to

young men.

From a practical point of view, there is evidence that

focussing on appearance and weight in a number of

ways is conducive to increasing body shape and weight

concerns amongst offspring. This effect would appear

to be particularly strong regarding active encouragment

and criticism, but also present in relation to parental

behaviour. Parents could be made aware of the impact

of the importance they attribute to appearance in

general.



Future research might contribute to current under-

standing in several ways. The large majority of the

research reviewed here involves cross-sectional designs.

More longitudinal work is necessary to better determine

prospective effects of parental influences. Secondly,

further investigation of the exact nature of parents’

messages and comments concerning body shape, weight

and eating behaviours, and the way in which they are

perceived and interpreted by their offspring, also appear

necessary. Given both the discrepancy reported between

parental self-report data and their perceived attitudes,

and the stronger association between perceived attitudes

and behaviours and body shape and eating outcomes, it

would appear important to explore the meaning

attributed to parental pressures and encouragements.

Furthermore, research should increasingly aim to

incorporate a wide variety of attitudes and behaviours

in their measures so as assess the entire spectrum of

parent influences. This is particularly important in view

of the suggestion that negative comments might interact

with modelling effects. Finally, gender differences require

more thorough examination, through the design and

implementation of gender-appropriate instruments.

Understanding the extent of family influences and

their contributions to the development of body shape

concerns and disordered eating is particularly import-

ant as, unlike the media, parents are able to deliberately

adapt their communication with their children. Greater

knowledge of the manner in which family attitudes can

act as protective or risk factors will enable future

prevention programs to better target their action and be

increasingly effective.

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Documents

Parental attitudes, body image disturbance and disordered eating amongst adolescents and young adults: A review