Parenting Culture and Child Obesity

Chapter 1: Introduction

The introduction is inclusive of the concept related to culture of parents and the ways it can influence nutrition among the children. Poor nutrition among the children is a leading cause of concern and may lead to issues such as obesity. For instance, Figueroaet al. (2019, p. 850), described obesity as a condition which occurs when a person carries excessive body fat that may affect their well being. A doctor usually suggests a person has a high body mass index a BMI of 30 or more than that suggests that a person is suffering from obesity (Brown and Perrin, 2018. p. 738). The research literature thus works on underpinning the influence of culture on the nutrition of children, The research further makes use of grounded theory to explore and establish the link the same and with obesity. The research makes use of grounded theory to understand the importance of nutrition and calories. The grounded theory is perceived as a systematic approach within the domain of social sciences that involves construction of methodological gathering and analysis of data. The chosen method uses inductive reasoning in contrast to the hypothetical deductive model (Ek et al. 2020, p. 104488). The introduction thus, provides a suitable set of objective and aim that helps in guiding the research further. The reason to conduct the research is additionally stated, supported with relevant statistics.

Topic: How parents contribute to childhood nutrition, for preventing obesity: Grounded theory model

Aim:

The study aims to investigate the role of low income parents in applying socio-cultural messages for reducing the chances of obesity

Background

Food consumption preferences are developed among the children during the initial stages. Understanding the pattern of food consumption choices are formed can invent the probable potential to influence individuals ‘health over the lifetime. Yackobovitch‐Gavan et al. (2018, p. 649), argued the fact that the leading cause of obesity is the consumption of sugar and parents are taking proactive measures to curb the consumption of sugar among their children. In spite of the preventive measures, children across the UK and other parts of the world are consuming food with high sugar levels. To compound the problem of sugar consumption, the consumption of healthy food is low across the world. In the UK, 62% of children do not consume enough fruits to meet the recommended nutrition guidelines and 93% of them do not consume the required portion of vegetables (Bupa, 2020). Parents are often observed as important agents of socialization playing the role of health promoters, educators and role models in the lives of their children. Termed as the systematic process where novice individuals are taught the behaviour pattern, motivation and values for suitable functioning, socialization is an evident component within the modern culture (Otterbach et al. 2018, p. 11). Thus, the culture of socialization within the concept of food consumption is inclusive of certain norms such as behaviour, attitude and knowledge. In regards to socialization, two broad concepts can be utilized to understand the influence of parental culture on child outcomes. Firstly, parental practices are context specific strategies, used by the parents to achieve social goals. Secondly, the parenting styles are different across different cultures and cuts across behavioural contexts (Hammersley et al. 2019, p. e11964). Currently, there is a lack of comprehensive, systematicreviews, surveying the influence of parental practices and styles on nutrition patterns of children. Existing reviews have either focused on broad arrays of determinants of nutrition without systematic examination of the role of parents or examining the possible influence of parenting practices, such as availability of role models. As per the reviews conducted by Howe, Alexanderand Stevenson(2017, p. 58), parental influences have examined the possibility of parental practices only in regards to specific food consumption. Similar studies have quantitatively summarized the effect size between food consumption outcome among the children and the culture followed by the parents (Swindle, Ward and Whiteside-Mansell, 2018, p. 9). However, there remains no meta-analytic study, supporting quantitative summary of the influence related to parenting and food behaviour among the children.

The current research thus sheds light on the possible gaps from comprehensive, systematic reviews to evaluate the cultural factor of parents (context specific parental practices, general style of parenting) and food consumption behaviour (O’Kane et al. 2017, p. 14). The research thus works on covering a wide spectrum of parental factors that can work on shaping the food consumption among the children, one preventive in nature (sugary foods) and other promotive in nature (healthy food consumption)

Rationale:

An increase in the rates of obesity has led to the designation of the global health epidemic. The prevalenceof obesity in 2015/2016, 40% of children in England within the most deprived areas are considered to be obese, compared to 27% within the affluent areas (rcpch.ac.uk, 2020). The deprivation increases and the number of children with health weight decreases. Thus, it can be clearly seen that there exists a role of socio-cultural context and weight gain. The increasing awareness pertaining to the complex aetiology related to increase in weight gain prevention programming is in immediate need (Bupa.co.uk, 2020). The prevention programming has adopted an ecological approach for targeting the children’s environment

Objective:

To understand the role of culture in influencing the nutritional needs of the child

To use grounded theory model of low income parents’ experiences with child health information

To evaluate the likely mode of action of the parents at the individual level (home) than social level

To evaluate the possible role of other characters such as physical and biological factors that can contribute towards childhood obesity

To explore the possible characteristics and definition pertaining to health to ensure better health intervention

Intended outcomes

The first section will foucus on the increasing obesity rates among the children. The possibility of gaining weight can be tremendous. However, the importance of parental role is evaluated and the ways it can regulate the nutrition intake among the children.

Identifying the possible gap between being informed about nutrition and the risks of unhealthy eating and the actual feelings of children targeted towards adhering to the potential warning.

Thematic influence of culture and parental guidance in the life of an obese child.

Health implication related to childhood obesity is discussed for spreading the needed awareness among the parents and children facing the threat of obesity.

The use of psychological models will be done and a positive body image needs to be encompassed for ensuring there is no stigma attached to obesity

Attention will be solely concentrated on young children, teenagers linking it with a series of possible eating disorders. The role of a parent during the child’s development is analysed to understand the efficacy of parental involvement in regulating child’s nutrition.

Chapter 2: Literature Review

Obesity and lifestyle

The epidemic nature related to obesity is disproportionately affecting children oflower socioeconomic status (Hildebrand, Betts and Gates, 2019, p. 499). Impoverished communities often face issues related to less access to healthy food and an environment to conduct a healthy physical activity for maintaining appropriate weight. These communities tend to be undeserved when it comes prevention related to weight problems. The term “weight related problems” encompasses concerns related to body image, obesity and eating disorders (Khadaee and Saeidi, 2016, p. 1505). The mentioned problems are thought to be fuelledby contemporary Euro-centric food environment, promoting the consumption of high fat content food. Due to increasing awareness related to the complicated aetiology of obesity, eating disorders and preventing the same has adopted the ecological approach, targeting children’s environment.

Within the prevention literature, there remains a specific need related to early intervention based studies for younger children (Rose et al. 2019, p. 294). As observed by Patsopoulou et al. (2016, p. 83), early childhood can be termed as a sensitive time when exposure to the environment and different kind of food can impact long term energy regulation and eating habits. Relationship based programming fuels positive relationship between families. The relationship between the families provides better care for the emotional and physical health of the children. However, individual dissemination of health information is not strong enough to promote healthy eating habits among the children.

Research conducted by Hatfield et al. (2017, p. 2017), suggest the fact that caregivers have an appropriate and accurate idea related to physical activity and healthy eating. However, it is the children, facing problem in implementing the words into actions. As supported by Miller et al. (2018, p. 124), parents are consumers of socio-cultural messages related to their children’s nutrition and food habits from relatives, friends, doctors and media. Nevertheless, the differing sources can provide competing messages that are yet to be explored. There is an evident lack of evidence, investigating perception of the parents of taking action at home or even within the community to influence food choices of the child. There needs to be an evidence basedunderstanding within the mentioned areas for designing interventions that can ensure better rates of obesity prevention. Parents are often criticised for not keeping a strong watch on their child’s eating habit (Francis et al.2016, p. 118). Children are programmed to respond to the energy content food that controls their intake and are highly responsive to the control attempts made by their parents. Research by Rahman et al. (2018, p. 311), shows that these attempts can refocus the child away from the possible responses to internal cues of satiety and external factors; presence of palatable food. Parents restricting their children'seating habits that they are doing the best. However, recent studies may challenge this assumption. As supported by Hildebrand, Betts and Gates(2018, p. 22), imposing strict controls on food can increase cravings for high fat content food, to regulate self hunger may become unbalanced.

Parental Roles during a Child’s Development

Parenting impacts the development of obesity in different stages of a child’s development. The discussion is structured around three time instances of a child, gestation, early infancy and childhood.

Gestation and infancy: Even before the birth of an infant, aspects of mother’s pregnancy can put the unborn foetus at risk of obesity. As influenced by Hall, Maynard and Hardaker,(2016, p. 1), the unfavourable intrauterine environment is a red flag for the development of adult metabolic malfunctions in later life. As supported by Suiraoka et al. (2017, p. 10), gestational diabetes can be passed on to the infant making it difficult for the child to maintain a healthy weight in later life. Parents have an important role to play during the stage of infancy when the child is establishing dietary habits. Thus, research suggests the way parents feed their children can contribute to individual differences. During the early years of development parents need to play proactive role in introducing children to better food choices that can fuel better food intake (Lim et al. 2017, p. 70)

Preschool children and toddlers: Preschoolers and toddlers develop habits related to physical and healthy eating habits. Parents can work on shapingthe environment of their children, which can further fuel eating habits of the child. As stated by Naess et al. (2017, p. 11), parents should be aware of the possible social context within which the food is consumed. The evidence based studyfound the fact that children develop preferences for certain food if provided in a positive context. On the contrary, children are likely to reject food offered in a negative context (Hughes et al. 2016, p. 16). Thus, offering healthy food in positive context can encourage youngsters to eat healthy

Childhood: Parents need to encourage early childhood activity to maintain healthy weight. The research found the fact that physical activity is responsible for keeping check on the weight among the preschool kids (Pluim and Gard, 2016, p. 75). Hence, it can be clearly stated that parents need to regulate the amount of physical exercise of their children to remove the potential chances of weight gain.

Culture and obesity among children

The work culture of the parents can have an evident impact on the obesity of children. As influenced by Suhaimi, Hussin and Hashim(2017, p. 3), income plays a significant impact on the eating and physical activity of people. A cohort study on adult population suggests the fact that, higher income women tend to be thinner as compared to lower income women. The reason for such disparity can be linked with money. As supported by Penilla et al. (2016, p. 148), money gives control over life and afford the needed resources such as healthy eating activities or gym memberships that can work on regulating weight control.

Just as personal culture affects attitude regarding eating, cultural norms help in regulating the perception about thinness. As stated by Davison et al. (2018, p. 715), some cultural groups are open towards higher body weights. On traditional basis, cultures have valued certain amount of heaviness; not obesity over extreme thinness. However, social ideas are subjective in nature and likely to change. Citing the example of UK’s obsession with a thin body, and dieting; thin bodies of children are considered a healthier option. However, a study conducted by Lydecker et al. (2017, p. 270), criticise the prevailing culture of supporting thinness. The prevailing culture of reducing weight affects the self esteem and can influence the perspective of an individual.

There remains a sought after debate among health experts in exploring the adverse effects of obesity on health. There is a lack of research on the general population of overweight people on general population to make statements and give advice to every obese child. As stated by Chomitz et al. (2018, p. 928), most studies have sought biological and psychological aspects of weight gain or related to clinical eating disorders. Relatively small number of representatives of the entire population of overweight individuals. There is a difference between being obese and overweight and the difference along with possible implications for health is yet to be explored.

The theoretical approach to obesity among children

Parental characteristic that has impacted interpretation of information is inclusive of critical thinking about social messages regarding child’s nutrition and health (Pedersen et al. 2019, p. 233). Relationship with trust and support can be termed as an emerging factor that can influence receptivity of parents towards information. The findings are in alignment to Flórez et al. (2019, p. 12525), with the conceptualization of self determinationtheory; which describes desire of a person to engage in a behaviour influenced by people they trust. Furthermore, parents discussed the fact that social learning theory plays an important role in influencing the eating behaviour of the children. For instance, a study conducted by Mena et al. (2020, p. 15), collected perception of the parents; wherein the research participants discussed the possible link between emotional and physical health of the children. The chosen holistic view is in line with the current trends integrated with paediatric care.

Thus, future research should evaluate the effectiveness and utility of nutrition related education and the associated psychological process; while engaging in prevention of obesity. Citing the example of social learning theory, parents complained that television is one of the prime reasons of unhealthy weight gain among the children. A randomised controlled trial by Gu et al. (2017, p. 400), suggested the fact that watching a few hours of television can reduce the risk of obesity. Thus, viewing television for a few hourscan cause childhood obesity and parents can control it by controlling the television watching time. TV viewing increases weight by limiting the level of physical activity and by encouraging poor eating habits among the children. The cultural exposure to television encourage poor eating habits through the use of poor commercial for unhealthy food. The use of television commercials advertises food such as sugary food that contributes to weight gain.

The current model of family food decision making (FFDM), as outlined by McIsaac et al. (2017, p. 215), discusses the role of family in maintaining healthy weight among the young children. The FFDM is inclusive of eating routines and family interaction and communication. Ochoa and Berge (2017, p. 435), outlined a model illustrating the points of illustration related to family food decision making. However, the chosen model is inclusive of personal food choices and how the choices of an individual are influencedby the course of life and further influenced through a series of social and cultural factors. Research based study provides a clear understanding to the fact that children are often seen in memory the behaviour exhibited by their parents. Studies by Kelley (2016) suggests a father from that parent engaging in eating healthy food are more likely to bring up children dealing with proper weight. Hence, in order to develop a healthy eating habit among the children parents’ worth first engage themselves in the mentioned behaviour. Parents can take a proactive approach to save the child's eating preferences by making show that the healthy food options are readily available (Heerman et al. 2018, p. 6). For instance removing all the cookies and chips from the cabinet and replacing them with freshly cut vegetables and fruits can help the child to enhance the habit of a healthy eating where healthy snack is the only option. However, parents should approach where they a need to motivate children to eat healthy but not overburden never the responsibility for doing so. For instance, asking the child to clean the plate and finishing of all the food, even if it is healthy can contribute to overeating. In other words, such behaviour with parents of foster the risk of gaining weight

A theoretical exploration of children’s eating behaviour

As per the ecological model of developing food choices one should consider the pioneering theory put forward by Bronfenbrenner, as it harbours the probable potential to influence new development within Child and Youth Care (Mech et al. 2016, p. 605). The ecological systems theory proposes the fact that behaviour of human is influenced by set of interaction of different environmental factors and personal characteristics such as age, genetics and gender. The ecological niche of a child includes peers and family, both of which is influenced by society. The complexity and the associated variety of children’s milieu changes throughout their life. Parents are seen to provide experiences with food and required environment and idea regarding body image (Hitti et al. 2019, p. 624).

Dietary habits are formed at a young age and maintained through later stages of life. As stated by Mindell, Leichman and Walters(2017, p. 5), eating behaviour among the children persists with implications such as high responsiveness to food cues and risks towards obesity. However, eating behaviour is difficult to modify among children, parenting practices can be termed as a good target for preventing unhealthy mode of eating that contributes to excessive weight gain. Studies in the domains of human eating behaviours have explored separate elements with the risk of not understanding the real contribution of each factor. The narrative review of the current research works on improving the probable strategies for introducing better eating habits among the children (Bushaw, 2019, p. 13).

Changing the cultural context of obesity

Obesity can be difficult to spot even though it is all around. For instanceHeerman et al. (2017, p. 1157), argued the fact, parents thinking about the child’s right weight, even if the child is obese. As per the survey conducted by the Health Survey for England one out of four parents are worried about the health of their child (Fenton, 2020). With similar regards, high rates of obesity prevalence compared to earlier decades may lead to insidious effect. If enough children are overweight, things may start looking normal. Researchers have mapped the fact that obesity could spread through social networks and further influenced by a series of health behaviour. The fact related to obesity is linked with several characteristics, narrowing down to one point, eating more and exercising less. Thus, it becomes important to understand the fact changing cultural context of obesity can help in managing the problems associated with overeating (Fenton, 2020). Citing the example of culture, Lydecker et al. (2019, p. 15), observed the fact, high rates of obesity is evident among the minority groups such as Roma, one of the largest nomadic groups in the European Union. Additional studies designed by researchers to monitor the health status of the chosen nomadic group shows that despite the proactive measures of the governments across the European continent, they suffer from poor health care services. Renzaho et al. (2018, p. 867), discovered a potential link between unhealthy lifestyle and the prevalence of obesity. Roma individuals suffer from high degrees of obesity as compared to the rest of the population. In this case, the possible genetic predisposition of susceptible individuals is supported by unhealthy lifestyles. Coupled with the external possible determinants and continuous cultural characteristics of Roma can have a notable influence on public health intervention. Due to an encounter with the dominant culture of life there have been modifications in their way of traditional lifestyle; however, particularities do exist. The series of particularities are evident in their way of life and socio-economic status (Ejtahed et al. 2018, p. 13). However, argued the fact that prevention programs can work on sorting out the issues related to obesity among the targeted population. Nevertheless, obesity prevention programs need to be diverse, considering the possible cultural determinants and keeping in mind the needs of the individual target group (Demir and Bektas, 2017, p. 140). In the similar vein, the level of nutritional acculturation of the population group as per the difference in culture. The preventive programs implemented at present with a focus on obesity are developed for people all over the European continent. However, the efficacy of the preventive programs appears to be lower among the Roma population due to possible differences in culture.

Role of healthcare professionals

The challenge to a dietician or healthcare providers is to be culturally adaptable for displaying culturally adaptable behaviour and display cross cultural communication skills for exhibiting awareness related to non-verbal cues that act as a cultural motive and move towards trusting interpersonal relationship. Mojica et al. (2019, p. 2018), found the fact that it is possible to derive possible guiding principles indicating the importance of culturein designing effective health programs. Healthcare workers should have detailed knowledge about people’s beliefs before introducing new innovation. The second principle is difficult to apply and the social functions need to be evaluated. As stated by Kiraly et al. (2017, p. 135), it is relatively easier to perceive that others harbour different beliefs due to difference in culture. It is in the area of determining the system which these beliefs fit those social scientists and can make the greatest contribution to health programs. The knowledge pertaining to the mentioned field can help in understanding the reason for certain nutritional practices influenced by cultural norms practised by the parents. A third principle should be emphasised and the possible sub cultural group needs to be carefully defined, as intervention for one group may not hold true for the others (Zoellner et al. 2017, p. 87)

Thus, as stated by Smith et al. (2017, p. 427), while dealing with the influence of culture on food habits, healthcare workers need some training in regards to the principles of education and anthropology. Cultural variation may play an evident role in human nutrition. Nutritional assessment may be further complicated due to variation within the culture. As supported by Ordwayet al. (2018, p. 20171076), the link between nutrition and ethnicity may harbour an evolutionary importance. Similarly, food beliefs may exhibit detrimental or beneficial effect on health status. The study of the chosen population may help in understanding the pathogenesis of nutrition related diseases, such as obesity. Appreciation of interaction of nutrition and culture may yield better rates of disease prevention. Several research report concludes that overconsumption of dietary components is a major concern among the children. Several food factors are involved, chief amongst them are good with complex carbohydrates and high fat that may be conducive to health. Thus, as influenced by Chi,Luuand Chu(2017, p. 25), two widely recommended strategies for incorporating better nutrition related education directed to resolve obesity problems among the children. School based nutrition education intervention is targeted to improve the nutrition among children. Minute changes in the attitude of healthcare providers can provide a strong context to routine health care.

Further study conducted by Liszewska et al. (2018, p. 195), on cultural perception of dietary practices among culturally diverse groups. Factor analysis found the fact parents’ behaviour in controlling the children’s dietary intake. Attitudes were highly different among families from non-deprived and deprived backgrounds. The perception of parents to control their child‘s nutrition is a significant predictor of obesity. The study currently supporting the hypothesis that parental attitudes have clear impact on the nutrition.

Literature gap

The gap in literature is considered as the possible missing pieces within the research literature, especially the pieces that are yet to be explored. This could be sampled or population, research method and mode of collecting data. In regards to the current research literature, it would be fair enough to mention the fact that there remains no strong evidence that supports the link of parental culture with the nutrition of the child. The research concentrated on a diverse nomadic culture and the ways culture can influence the nutrition among the children. However, the research failed to understand the extent of impact created by the paternal cultures on the eating behaviour of children.

Conceptual framework

Summary

The research in the mentioned context provides a clear understanding to the fact that food habits are one of the complex aspects within the human behaviour and determined by several motives. Food acceptance is a critical reaction, influenced by a series of social, cultural and psychological factors. Metabolic conditions are seen to play an evident role. People differ in terms of sensory responses to food. The dislike and like of an individual with respect to food is an outcome of race, economic status, environmental conditions and framework of race. Linking culture with food gave a streamlined direction to the research acquired by learning starts from the earliest experiences of childhood and not taught by anyone. Food habits are the deeply entrenched aspects in various cultures and cannot be changed easily or through the use of force. Food habits are a basic part of the culture and serve as a focus of emotional association and usually bears a symbolic reference.

Chapter 3: Research Method

The review was conducted in two phases. Firstly, an extensive systematic review of the literature review was carried out to identify the possible parental factors in relation to childhood food consumption behaviour. Then a meta-analysis was carried out after the following classification, with studies containing the required statistical information

Literature search

In order to find the suitable studies in regards to parenting effect on childhood food cognitions choice, the intake of suitable search was conducted on series of databases such as PsycINFO, ERIC, Google Scholar and Pubmed. The search strategy was carried out, through the use of suitable keywords on studies based on parenting effects on food cognition among the children. The parental factor keywords were matched with keywords for food consumption. The parental factors were “parenting”, “parent* feed* strategy*” and so on. The keywords for childhood consumption of food were as follows “eating”, “food consumption”, “soft drink*”, “sweetened beverage*”. In order to ensure that the comprehensiveness is rightly maintained there was an initial search and a second round of final search

Inclusion and exclusion criteria

Following are the criteria to be considered while choosing the research journals. Most importantly, the study participants under the mentioned research journals need to be under the age of 18 years

The studies had to utilize quantitative methods of data collection, such as interview or survey, or both, with the presence of statistical significance

There needs to be a presence of an independent variable on the basis of parent’s culture such as parenting style

The dependent variable needs to be cognition related to food

The series of articles was meticulously selected for streamlining the research. Articles were excluded on the following basis:

The articles not published in English

Studies involving children and parents who are obese

The studies with stratified analyses as per the BMI without the provision of overall effect size

Studies examining the dependent variable of eating disorders

Analytical approach

In the initial stages a three step systematic process was used to identify the relevant study for review. Firstly, the retrieved papers were shortlisted and screened using their titles. The abstracts were used to shortlist the papers further. The shortlisted articles were read and analysed for better understanding. Finally, entire articles were obtained from the database and screened with the correct information being retained for review. The link between culture of the parent and nutrition among the children is represented with “+” to indicate a positive association and “-” was used to denote the inverse association. Thus, the use of PRISMA association can be termed as a suitable way of providing clear understanding of the ways the research journals were selected for the study.

Chapter 4: Finding And Analysis

The section under the mentioned context is inclusive of understanding previous research literature and theway it has worked on understanding the food pattern in children with parental influence. The finding was based on clear understanding the ways children can be influenced as per their eating habits. The finding thus works on understanding the role of parents in influencing the nutrition among the children. For instance, the journals are read and the relevant keywords are filtered and the suitable journals were added and the following results were obtained.

Context-specific parental practices and childhood nutrition

Restrictive guidance

As stated by Lim et al. (2019, p. 155), restrictive guidance is defined as the number of times, parents set rules regarding the consumption of food. A close link with the domain of parental mediation dimension of restrictive mediation inclusive of a range of overt parental control and rule making. Among the series of studies included, 33 examined the link between restrictive guidance of parents and healthy food intake among the children. Amongst these, 13 indicated a positive relationship of healthy eating, while three yielded negative relationship and 17 provided non-significant results. In case of unhealthy consumption of food, restrictive guidance reported reduction of unhealthy food consumption. Eight studies suggest the fact that parental restrictive guidance is linked with higher consumption of unhealthy food among children. This suggests a large amount of heterogeneity in the terms of the relationship between healthy and unhealthy food consumption among children in relation to restrictive guidance.

Modelling

Modelling was measured in two ways across the current research literature. The first modelling was evaluated as a parental intake on the basis of a target food item. In such case, a positive link between child intake and parental relationship was an evident indication of modelling effect. The second modelling was measured as frequency within which parents eat healthy food in front of their children (Ross et al. 2018, p. 977). In both cases, modelling was found to be consistently linked with eating behaviour among the children. Roughly 13 studies showed a significant positive link between modelling and eating behaviour among the children. This suggests the possible effects of parental modelling on consumption behaviour among the children are significant and homogenous.

Availability of parental control

Availability of parental control simply indicates whether a particular food is available at home. As influenced by Chatham and Mixer(2020), children develop preferences for certain kinds of food through consistent exposure to food. The availability of food is important in determining whether children develop a preference for healthy food, rather than food which are dense in energy. Among the studies, 19 studies indicated a positive link. Thus, it can be conclusively stated availability of healthy food or the non availability of unhealthy food, coupled with the right amount of parental control were linked with decreased unhealthy eating. Thus, the results suggest that a right control on the food availability can be termed as a consistent predictor of nutrition among children

Pressure to eat

Parents are often seen to pressurize kids for eating more. This practice can be termed as parents exercising the power of verbal communication to convince kids to eat more. Pressure can manifest in a parent asking their child to clean the plate even if the child is not hungry. The ever increasing parental pressure to eat is often an outcome of fear harboured by the parents that their child is not consuming enough nutrition. However, Rieder et al. (2018, p. 15), argued the fact that the intention of the parents were utilizing the pressure to encourage the consumption of sufficient nutrition. Six studies found an evident negative association where pressure was linked with limited healthy food consumption.

Food as reward

Parenting culture often makes use of food as a reward, provided children exhibit desirable behaviour. On the basis of the studies, there was a negative association between healthy food consumption and using food as rewards (Eldridge et al. 2016, p. 145). However, unhealthy foods which are high in sugar content are often used as a reward. The practice of using food as reward tends to increase the preference for unhealthy food. Nevertheless, there remains limited knowledge about the use of healthy food items as rewards for influencing the food habits among the children.

Rewarding food consumption materially

Rather than using food as a form of reward, parents can reward the kids using playtime reward. As per the self determination theory, the use of extrinsic rewards can potentially decrease the motivation to perform a certain activity. As supported by Ledford and Gast(2018), certain parenting cultures are seen to reward the child for eating certain kinds of food. This act carried out by the parents may devalue the activity performed to receive the reward. In simple words, eating healthy food is the only way of getting playtime. The child may see as a chore and keep a negative mental association and cognition about food. The studies in the mentioned context found no significant relationship between healthy eating among children and the food reward system. However, three studies found a positive association. The study conducted by Lim et al. (2019, p. 155), states that positive association could be due to single entity may be due to composite measure of food rewarding method, for instance the use of dessert is contingent upon eating something that the child does not prefer eating.

Rewarding with praise

Parents can make use of praise rather than hedonic rewards. Some research suggested the fact that praise is qualitatively different from other kinds of rewards Ross et al. (2018, p. 977). Praise is seen to foster the intrinsic need of relatedness, autonomy and competence as compared to the possible extrinsic rewards. Among several studies examining the relationship between healthy food consumption and praise, four studies provided positive relationship. Hence, it can be clearly stated rewarding with praise can ensure healthy eating habits among the children as they are refraining from consuming snacks.

Analysis of the finding:

The role of parents and their associated culture on children’s eating habits. On the basis of above finding it can be clearly stated that a parent plays an important role in shaping the eating behaviour of the child. A study conducted by Davis et al. (2018, p. 123), states the fact that parents act as a big influence over the family environment within which the meals are cooked, served and eaten. Positive experience about food during the initial stages of life may help the child to develop healthy eating habits. For instance, several studies in the mentioned research suggested the fact that creating a positive environment for eating. Family meals take place in a home environment that can have either positive or negative impact on the eating habits of the children. Following are the ways that can be found to hold true for the statement that parental culture creates a significant impact on the children’s nutrition (Ward et al. 2016, p. 132) A grounded theory model directed for parental movement towards action was formed. The overarching theme of cultural context represents the perception of researchers how the UK culture impacted the message received by the parents on body shape, nutrition and health. Within the overarching theme the messages received by the parents through selective sources, such as television or education, were interpreted and understood on the basis of parenting cultures, coupled with engagement (Avis et al. 2016. 389). The latter topic of engagement appears to influence the constructs of (A) motivation of parents grouped by hope and realisation, and (B) taking the needed action on individual or social basis to curb the growing rates of obesity. The process of moving to action from motivation is regulated by two regulating factors such as limited resources and family system barriers. As per the study conducted by Agaronov et al. (2018, p. 489), cultural factor play an evident role in why some cultural groups are likely to suffer from issues related to obesity. To understand the importance of cultural factors play an evident role in obesity one has to understand that culture is comprised of set of experiences and rules. A group of people sharing the same culture and values also share the same kind of experiences. The way that group defines the actual acceptable way of eating may seem a bit unusual to others. How one group describes the acceptable way of consuming food may make them unique. As influenced by Zacharova(2018. p. 106), few cultures perceive obesity as a sign pertaining to affluence due to the existing shortage of food. People sharing similar cultural background reside in same place. An example of this would be fit enough to understand through the perspective of the immigrants from different parts of the world and countries, these population tend to eat food that are familiar to them. There remains no doubt that certain cultural backgrounds prefer food choices that are highly comforting but when eaten in excessive quantity may lead to obesity. The place where people live and what possible food choices can effect their nutrition is explored. On basis of the mentioned context Lydecker and Grilo(2017, p. 656), observed that people are seen to eat lost of fat food due to that low cost consumotion which are high in fat and sugar contributing to long term obesity. Fresh vegetables and fruits are beneficial for overall weight control. People residing in economically developed societies tend to be more obese due to availability of highly processed food

Cultural context

The data collected from secondary sources expressed different levels of awareness in relation to cultural influences on health information. In certain cases research participants noticed socio-economic status acting as a major cultural influence on the eating habits of the parents (Howard-Drakeand Halliday, 2016, p. 52). The data collected through the secondary sources revealed the fact that parents were not just passive recipients of information related to their child’s health. The values and level of engagement expressed by the parents in relation to the socio-cultural messages created evident impact when the information revealed was personally important. The category related to parental values, included aspects of parental identities that can impact feelings and thoughts of the parents about the information regarding nutrition.

Parent motivation

The particular set of data provided an understanding that knowledge is not strong enough to exercise action over the parents. Two types of experiences are seen to bolster motivation of the participants to take up the aspect of change for instance the first thing is the moment of realisation, followed by the parental hope for the future. As influenced by Miller et al. (2016. p. 170), the moment of realisation was identified and included the events that can cause shifts in the thoughts related to health and nutrition. Feelings related to the child’s future ignites motivation among the parents. For instance Elinder et al. (2018, p. 459) described perception of the parents who were bullied as children due to obesity. The same parents wish their children not to undergo similar experiences. Thus, it can be conclusively stated motivation among the parents to apply health and nutrition related information seemed to have impacted by the use of pivotal movement of change in perspective as well as a deep desire to improve their child’s health and future.

Family barriers and systems

Family barriers, such as changes in lifestyle and attitude of the caregiver are a major hindrance in controlling the nutrition of the child. The picky eating behaviour impacted parental implementation of healthy eating habits in the home. A research study conducted by Hussein(2017, p. 15), found the fact that parents were unwilling to leave food with high sugar content. Care giver’s attitude indicated a clear resistance to change emerged in the domain of self description such as being strong minded. Inconsistencies of caregiver are often inclusive of instances where the parents often struggle to keep children’s eating habits which are often undermined by the friends or close relatives. The caregiver’s inconsistencies were evident within the inconsistent eating habits of the children, evidently due to lack of follow through the pre-determined food rules. The category relates to power struggles as the parents often fail to win over their kid’s tantrums. It thus appeared that there exists a plethora of barriers existing within the parents to make positive changes among the research participants.

Action by parents at social and individual level

A unique goal addressed through the mentioned study was to identify the ways parents implemented at the individual and social level. An evidence based study conducted by Lydecker and Grilo(2016, p. 1126), provided a clear understanding that the use of certain individual factors such as promoting resilience, or the use of parental monitoring can be termed as one of the greatest ways of ensuring better eating practises among the children. In a similar vein Morgan et al. (2017, p. e20162635), argued the fact, implementation of parental responsibility demonstrated in monitoring the children’s behaviour for eating. The parents often emerge out to a perfect role model, which further influences the children to maintain a check on their weight. Parents emphasis on emotional health discovered ways to find quality time and promote their child’s resilience, self esteem and literacy about nutrition and related topics. On the social levelsparents are likely to exhibit challenges that go into the domain of community involvement. The finding suggested the fact, changes within the media and education program tend to have a positive effect. As supported by Elinder et al. (2018, p. 459), parents are highly involved within the advocacy of meals and suggest the fact that healthy meals can be used for changing the eating behaviour of the children. Some researchers additionally discussed the use of healthy meals in the school for reducing the chances of obesity.

Discussion

The research helped in understanding the ways, parenting, culture can influence the nutritional intake of children. Analysis of the results revealed the idea, how parents’ engagement can influence behaviour of the parents at home and within the community, notwithstanding the destructive intervening conditions. The study model followed in the current research study was based on the participant data collected through previous research. However, there was a later review in behavioural change models and a number of similarities was found in the present model with the health belief model (HBM). Particularly, Beck et al. (2018, p. 387), proposed a change for HBM focusing on the health promotion for culturally diverse young families. Furthermore, Ashraf, Shamsi and Ashraf(2017, p. 214) stressed the relation between physical health of the children and their emotional health for gaining a holistic view, as per the trends towards integrated paediatric care. Further research should work on evaluating the efficacy of psychological process and nutrition related education while engaging in integrated primary care for reducing the chances of obesity. Some parents felt content with their strategies and see no need to change.Salvy et al. (2017, p. 157), supported the fact parents expressing motivation were fuelled by the hope for their child’s future. The current model is aligned with several models, one of which is family food decision making (FFDM). As influenced by Okour et al. (2019, p. 34), FFDM is inclusive of the interaction of families with food and suitable communication patterns. The researchers additionally, outlined the possible models illustrating the similar areas of intervention in the process of decision making related to food. The study mentioned in the current context works on understanding the possible ways that can be implemented to engage parents in social activism. The result indicated, social and individual activism to address obesity related issues. The results indicated that parents belonging from poor financial background found that actions at individual levels are manageable. The type of action undertaken by the parents is highly dependent on the culture and values parents placed on the definition of health (Ling, Robbins and Wen, 2016, p. 275). Thus, it is recommended that educators and healthcare service providers need to form goals that are aligned with the parental cultures.

Nourishment utilization inclinations are created among the youngsters during the underlying stages. Understanding the example of nourishment utilization decisions are framed can concoct the likely potential to impact people 'wellbeing over the lifetime. Yackobovitch‐Gavan et al. (2018, p. 649), contended the way that the main source of stoutness is the utilization of sugar and guardians are taking proactive measures to control the utilization of sugar among their kids. Notwithstanding the preventive measures, youngsters over the UK and different pieces of the world are devouring nourishment with high sugar levels. To intensify the issue of sugar utilization, the utilization of sound nourishment is low over the world. In the UK, 62% of kids don't devour enough organic products to meet the prescribed sustenance rules and 93% of them don't expend the necessary segment of vegetables (Bupa, 2020). Guardians are frequently seen as significant operators of socialization assuming the job of wellbeing advertisers, teachers and good examples in the lives of their youngsters. Named as the deliberate procedure where beginner people are encouraged the standard of conduct, inspiration and qualities for appropriate working, socialization is a clear segment inside the cutting edge culture (Otterbach et al. 2018, p. 11). Along these lines, the way of life of socialization inside the idea of nourishment utilization is comprehensive of specific standards, for example, conduct, frame of mind and information. Concerning socialization, two wide ideas can be used to comprehend the impact of parental culture on kid results. Right off the bat, parental practices are setting explicit methodologies, utilized by the guardians to accomplish social objectives. Furthermore, the child rearing styles are diverse across various societies and cuts across conduct settings (Hammersley et al. 2019, p. e11964). At present, there is an absence of exhaustive, efficient audits, looking over the impact of parental practices and styles on nourishment examples of youngsters. Existing audits have either centered around expansive varieties of determinants of nourishment without orderly assessment of the job of guardians or analyzing the conceivable impact of child rearing practices, for example, accessibility of good examples. According to the surveys directed by Howe, Alexander and Stevenson (2017, p. 58), parental impacts have analyzed the probability of parental practices just concerning explicit nourishment utilization. Comparative investigations have quantitatively condensed the impact size between nourishment utilization result among the youngsters and the way of life followed by the guardians (Swindle, Ward and Whiteside-Mansell, 2018, p. 9). In any case, there remains no meta-scientific investigation, supporting quantitative synopsis of the impact identified with child rearing and nourishment conduct among the youngsters.

The ebb and flow look into along these lines reveals insight into the potential holes from complete, methodical audits to assess the social factor of guardians (setting explicit parental practices, general style of child rearing) and nourishment utilization conduct (O'Kane et al. 2017, p. 14). The examination accordingly chips away at covering a wide range of parental components that can take a shot at forming the nourishment utilization among the kids, one preventive in nature (sugary food sources) and other promotive in nature (sound nourishment utilization) Systematic review on involvement of the family suggests better weight loss intervention. The studies simultaneously indicate the fact that behavioural changes related to weight loss. In similar terms, involvement of atleast one parent in weight loss process involvement related to weight loss and reducing the chances of obesity. For families with different members are battling with issues related to weight. As stated by Karmali et al. (2019, p. 345), family treatment can further reduce the per person related costs of obesity treatment and the parents can achieve similar percentage related to changes in weight.

Clinical implication

Early childhood programs and health programs at schools can work on presenting the model to inform suitable interactions with the family. First, it appears important to explore the cultural context of obesity and the health information system. Healthcare providers should work on providing the relevant information and how the parents are viewed in the case of each family. As influenced by Lee et al. (2019, 117), nutrition experts should work in close collaboration with the parents and explore their cultural beliefs to ensure that the nutrition related advice is directed as per the cultural expectations of the parents. Early childhood programs directed to child care and nutrition are available from parents belonging from all cultures. Thus, the intervention effort, in relation to primary paediatric care may be able to reach to a large population of parents. In addition to that, the mentioned research provides relevant information about the parent’s past experiences, such as being subjected to bullying due to excessive body weight. Thus, the research can work addressing the needs of the targeted population in preventing excessive related issues. A similar research conducted by Suarez-Balcazar et al. (2018, p. 70), puts out the fact that the involvement of parental cultures in monitoring the nutritional intake of children can open modes of communication and associated social activism. The parents need to ask and understand the food preferred by their children. Using that as a tool, parents can influence the eating behaviour followed by their children. Thus, the healthcare providers should explore the motivation of parents and also work with the parents to understand the scope of food preferences (Heerman et al. 2018, p. 110). Thus, it can be conclusively stated the nutritionists should take into considerations of all the possible factors, considering that the intervention can be tailored as per the needs of the targeted population.

The test to a dietician or medicinal services suppliers is to be socially versatile for showing socially versatile conduct and show multifaceted relational abilities for displaying mindfulness identified with non-verbal signals that go about as a social rationale and move towards confiding in relational relationship. Mojica et al. (2019, p. 2018), found the way that it is conceivable to determine conceivable core values showing the significance of culture in structuring powerful wellbeing programs. Medicinal services laborers ought to have point by point information about individuals' convictions before presenting new development. The subsequent standard is hard to apply and the social capacities should be assessed. As expressed by Kiraly et al. (2017, p. 135), it is moderately simpler to see that others harbor various convictions because of contrast in culture. It is in the zone of deciding the framework which these convictions fit those social researchers and can make the best commitment to wellbeing programs. The information relating to the referenced field can help in understanding the purpose behind certain wholesome practices impacted by social standards rehearsed by the guardians. A third standard ought to be stressed and the conceivable sub social gathering should be deliberately characterized, as mediation for one gathering may not remain constant for the others (Zoellner et al. 2017, p. 87) In this manner, as expressed by Smith et al. (2017, p. 427), while managing the impact of culture on nourishment propensities, human services laborers need some preparation with respect to the standards of instruction and human studies. Social variety may assume an apparent job in human nourishment. Healthful evaluation might be additionally confounded because of variety inside the way of life. As upheld by Ordway et al. (2018, p. 20171076), the connection among sustenance and ethnicity may harbor a developmental significance. Also, nourishment convictions may show unfavorable or gainful impact on wellbeing status. The investigation of the picked populace may help in understanding the pathogenesis of sustenance related illnesses, for example, corpulence. Energy about connection of nourishment and culture may yield better paces of malady anticipation. A few research report presumes that overconsumption of dietary segments is a significant worry among the youngsters. A few nourishment factors are included, boss among them are acceptable with complex starches and high fat that might be helpful for wellbeing. Along these lines, as impacted by Chi,Luu and Chu (2017, p. 25), two generally prescribed techniques for joining better nourishment related instruction coordinated to determine weight issues among the kids. School based nourishment instruction mediation is focused to improve the sustenance among kids. Minute changes in the frame of mind of human services suppliers can give a solid setting to routine medicinal services.

Further investigation led by Liszewska et al. (2018, p. 195), on social impression of dietary practices among socially differing gatherings. Factor investigation found the reality guardians' conduct in controlling the youngsters' dietary admission. Frames of mind were exceptionally extraordinary among families from non-denied and denied foundations. The impression of guardians to control their youngster 's nourishment is a critical indicator of stoutness. The investigation presently supporting the theory that parental dispositions have clear effect on the sustenance.

Limitations and strengths

The present study makes use of grounded theory approach. The use of research triangulation coupled with audit trial were used to establish the reliability of the accessed journals. The themes were derived after rigorousanalysis from series of journals that discussed similar topics. Social validity was gained by analysing the research journals which perceived obesity and nutrition related concerns as a major social concern. These results can be further implemented in the broader discourse of nutrition and psychology related education (JaKa et al. 2017, p. 357). The model use to explain the core theory of the mentioned topic is a clear way of interpreting experiences of the target population. Information in regards to the process of analysis is rightly supported by evidence, for ensuring that transferability is maintained. However, the prime limitation to the chosen research study is the selection of homogenous population; the journals were strictly concentrated on the cultural limitations. There remains no data or evidence, concentrating on the economic background of the parents. Further research with topics including educational level, caregiver status, ethnic background could provide rich knowledge. One more potential limitation of the chosen study is the aspect of time. There remains no lack of research journal within the chosen domain; however, the lack of time made it difficult for reviewing all the journals.

Chapter 5: Conclusion

The theoretical model in relation to parental movement towards action is typical in such a way that it provides clear insight about the parental actions based on culture. The results provided a clear indication that the parents’ experiences related to culture are greatly influenced by levels of engagement. In similar regards, motivation among the parents can be negatively impacted due to prevailing issues in family or due to limited resources. The result obtained through the current research suggests, effective programs targeted for prevention can nutrition related health information. The resultof the present study provides an idea about the early intervention related to weight control among the young children. More research is directed to focus on early prevention of obesity among the young population, by using the parental culture as a key instrument for controlling the eating disorders among the children. At present, there is an absence of complete, precise audits, looking over the impact of parental practices and styles on nourishment examples of youngsters. Existing surveys have either centered around expansive varieties of determinants of sustenance without methodical assessment of the job of guardians or looking at the conceivable impact of child rearing practices, for example, accessibility of good examples. According to audits, parental impacts have analyzed the probability of parental practices just with respect to explicit nourishment utilization. Comparable examinations have quantitatively outlined the impact size between nourishment utilization result among the kids and the way of life followed by the guardians. In any case, there remains no meta-systematic examination, supporting quantitative rundown of the impact identified with child rearing and nourishment conduct among the kids.

The ebb and flow investigate therefore reveals insight into the potential holes from far reaching, precise surveys to assess the social factor of guardians (setting explicit parental practices, general style of child rearing) and nourishment utilization conduct. The exploration in this manner deals with covering a wide range of parental variables that can take a shot at molding the nourishment utilization among the youngsters, one preventive in nature (sugary nourishments) and other promotive in nature (sound nourishment utilization)

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