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Research Proposal – Influence of Eating Disordered Mothers on Their Daughters’ Eating Behavior

Introduction
Statement of the problem
This study seeks to examine the effect of mothers’ weight perceptions and eating behaviors on their daughters’ weight and eating behaviors, and the pathways through which such an effect is realized.
 
Background and significance of the problem
The number of women and girls suffering from eating disorders has been on a rapid increase in the recent past. According to the National Association of Anorexia Nervosa and Associated Disorders (2009), in the United States, it is estimated that approximately eight million people are affected by eating disorders. Of that number, seven million are women. A number of factors have been blamed for this trend and include: pop culture which depicts slim women as ideal, family relationships, parenting practices, and low self-esteem/self-confidence (Benninghoven, Tetsch, Kunzendorf, & Jantschek, 2007). However, none of these factors has attracted more attention than the effect of mothers’ weight perceptions and eating behaviors on their daughters. Research literature on mother-daughter weight and eating relationships abounds. A mother is one of the major socialization agents of children and their roles as socialization agents to increase as children grow up (Coulthard, Blissett, & Harris, 2003). This is especially true in the eating domain.
Research studies (Vincent and McCabe, 2000; Hill and Franklin, 1998) show that mothers play a key role in their daughters’ weight perception and eating habits. Girls who suffer from eating disorders are more likely than their counterparts who lack eating problems to have mothers who are preoccupied with their weight and eating habits. Such mothers are likely to have developed their obsession at an earlier age and are also likely to have suffered the similar eating disorders when they were younger. As the literature will show, this trend of weight and eating disorders can be a cycle in a family affecting many generations to come. It is therefore important to study the problem of the effect of mothers on girls’ weight and eating disorders so that the appropriate eating and health education can be established for both mothers and young girls.
 
Justification
The study of the effect of mothers’ weight and eating behaviors on their daughters is important for a number of reasons. First, the study will equip the researcher and readers with knowledge about the channels through which girls’ weight and eating problems are influenced by their mothers. Second, the study will reveal the gaps that exist in the literature which in turn would form the basis upon which future studies will be conducted. Lastly, the knowledge gained from the study will be used by health professionals to develop an effective program for girls suffering from eating disorders.
 
Statement of purpose for reviewing the literature
Reviewing the existing literature on the effect of mothers on girls’ weight perceptions and eating behaviors will enable the researcher and readers to know what has already been addressed by different researchers in different contexts. Most importantly, the literature review will enable the researcher to know the gaps that exist, that is, what has not been covered at all or what has been covered to a lesser extent. The literature review will therefore provide the platform upon which other future studies will be conducted to examine the phenomenon under investigation.
Possible questions to be answered from the literature review and for future research study

Is there a correlation between mothers’ body images and their daughters’ body images?
What is the role of family functioning on girls’ weight perceptions and eating behaviors?
Do mothers influence their daughters to lose weight?
Does the effect of mothers on girls’ weight and eating habits differ from one racial group to another or one demographic group to another?
Does the effect of mothers on their daughters’ weight and eating behaviors vary according to the daughters’ stage of development?

 
Review of the Literature
Introduction to the review of literature
The issues of women’s weight and eating problems have attracted the attention of scholars for a long time. Indeed, numerous studies have been carried out to examine the root causes and consequences of weight and eating disorders among women and girls (Coulthard et al., 2003). However, this paper will review only five studies. The studies were conducted between 1991 and 2007. The studies were conducted in different locations across the globe namely: Germany, Japan, and the United States. Samples consist of pairs of mothers and their adolescent daughters. In one of the studies (Sanftner, Crowther, Crawford and Watts, 1996), pre-adolescent girls were also studied. In addition, the study by Sanftner et al. is the only one that used a racially and demographically heterogeneous sample. The other four studies used homogeneous samples. All the studies examine the effect that mothers’ weight and eating habits have on their daughters’ weight perception and eating behaviors. Other factors that affect girls’ weight and eating behaviors have also been studied and include: family functioning, mother-daughter communication patterns, and the effect of the gender-stereotypical society on women’s weight perceptions and eating behaviors. It is hoped that the literature review will provide readers with additional information and deeper insight into the problem of weight and eating disorders that girls encounter as they grow up.
 
Review of the relevant articles
Benninghoven, Tetsch, Kunzendorf and Jantschek (2007) conducted a study to examine the body image of patients with eating disorders and their mothers as well as the role that family functioning plays in eating disorders. The researchers were motivated to conduct the study because of the literature gap that exists concerning the body images of eating disordered patients. On the other hand, the role of family functioning on eating disorders has been studied extensively (Laliberte, Boland and Leichner, 1999). The researchers used the notions of family functioning and body image distortion as the basis of their study. To conduct the study, Benninghoven et al. (2007) used a sample of twenty-nine patients treated at the Clinic for Psychosomatic Medicine at the University of Scheleswig-Holstein, Germany. Sixteen of the patients were diagnosed with anorexia nervosa while the remaining thirteen were diagnosed with bulimia nervosa. In addition, the patients’ mothers were also studied. Participation in the study was on a voluntary basis after informed consent had been given. All the participants of the study were female and the study was done within the first two weeks of participants’ treatment. The study was conducted using the somatomorphic matrix, a computer program that was created for the purpose of the study. The program presented the participants with different body images from which the participants were asked to choose the body image that best described them. In addition, SPSS for Windows, student t tests, Pearson correlations, and multivariate regression analysis were used for the data analysis. The results from the study were categorized into three classes: differences between the two groups of patients; correlations within each diagnostic group; and family functioning and body image.
The conclusion derived from this study is that family functioning – particularly mother-daughter relationship – plays an important role in the development of body image among young girls. The results from this study are consistent with prior studies that linked family environment with eating and dieting problems among clinical and non-clinical samples (Pike and Rodin, 1991). The major limitation of Benninghoven et al.’s (2007) study is the use of a small sample which did not permit the researchers to conduct separate multivariate analyses for the two groups of patients.
 
Hirokane, Tokumura, Nanri, Kimura and Saito (2005) carried out a study to examine the effect that mothers’ dieting habits have on their junior high school daughters. The significance of this study lies in its effort to address the literature gap that exists concerning the effect of mothers’ direct messages about eating and dieting behaviors on their daughters. The study was conducted using a sample of 221 pairs of mothers (aged between 34 and 57 years) and their junior high school daughters (aged between 12 and 15 years). Using random sampling, the participants were selected from a junior high school in Tokyo. Data were collected using questionnaires. The daughters filled in the questionnaire during class time with the help of trained teachers whereas the mothers’ questionnaires were mailed to them. Assessment of the participants’ dieting behaviors was done using a modified Dieting Behavior Scale that consists of 21 question items where each item is rated on a four-point Likert scale, from “0” (never) to “3” (always). Assessment of the desire to be slim was done using a direct close-ended question. Assessment of experience of conversations with daughters about diet was also done using a direct close-ended question. The data were analyzed using the Scheffe’s test one-way ANOVA, Mann-Whitney’s U test, Spearman’s rank correlation and the Kruskal-Wallis test (Hirokane et al., 2005).
The mothers were classified into three groups according to their dieting behaviors: Extraordinary Diet group (32%), Structured Diet group (15%), and Non-dieting group (54%). Hirokane et al. (2005) found that there was a significant correlation between the distribution of dieting behavior groups in the mothers and in their daughters. The scores for dieting behavior were significantly higher for the participants in the Ex-D group than for the participants in the N-D group for 8 of the 21 items of the Dieting Behavior Scale. A number of differences were found between mothers’ and daughters’ dieting behaviors. Mothers tended to focus more on the amount and caloric content of their foods, while daughters tended to focus more on the fat content of their foods and eating times. The scores of the mothers who had a desire to be slim were significantly lower than their counterparts. In addition, the correlation between mothers who had conversations with their daughters about food and the distribution of dieting behavior groups in the daughters was significant.
The conclusion derived from this study is that daughters’ dieting behaviors are highly influenced by their mothers’ dieting habits, eating consciousness, and experience of conversations with daughters concerning diets. This study is limited by the small sample used in the study and the fact that all the participants were selected from one junior high school.
 
A similar study by regarding mother’s eating habits by Francis and Birch (2005) was conducted to examine: “the effect of mothers who are highly preoccupied with weight and diets on their daughters’ weight and diets; the correlation between mothers’ attempts to influence their daughters’ weight and eating and daughters’ eating behavior; and whether the correlation is mediated by daughters’ perceptions of their mothers’ weight pressure,” (p. 549). The study was conducted using 173 pairs of non-Hispanic White mothers and daughters living in central Pennsylvania. The measures for the study were derived from the Three-Factor Eating Questionnaire which consists of “51 true-false items that determine dietary restraints, dietary disinhibition, and susceptibility to hunger,” (Francis and Birch, 2005, p. 549). The measures were obtained from the participants when the daughters were aged 5, 7, 9, and 11.
The analysis of the data collected was done using different techniques. The Spearman correlations were used to test whether there were any correlations among the girls’ eating habits. On the other hand, the SAS statistical package was used to statistically measure mothers’ and daughters’ features, while the path analysis was used “to test whether mothers who were obsessed with their weight and eating made attempts to influence their daughters’ weight and eating habits, and whether such attempts were associated with daughters’ problematic eating,” (Francis and Birch, 2005, p. 550). The researchers found that mothers who were highly obsessed with their weight and eating also influenced their daughter’s weight and eating by restricting their intake of energy-rich snack foods and encouraging them to maintain low weight. The mothers’ encouragement of their daughters to cut down weight was significantly related to the girls’ controlled eating habits from the age of 9 to the age of 11. However, this link was somewhat minimized by the girls’ perceptions about their mothers’ determination to lose weight over the passage of time.
The conclusion derived from this study is that mothers’ weight and eating habits influence their daughters’ restrained eating habits. The results from this study can assist health professionals to prevent the development of problematic eating habits among young girls by changing their family environments. The limitation of this study is that it uses a sample of participants from one racial group and one demographic group. As a result, the results from the study cannot be used to make inferences about women and girls suffering the similar problem but belonging to different racial and demographic groups.
 
Majority of the studies that examine the influences of mothers’ weight and eating habits on their daughters use samples of pubertal and ethnically homogenous girls. Sanftner, Crowther, Crawford and Watts (1996) studied the relationships between the eating disorders of younger pre-pubertal girls and their mothers. The researchers also examined whether such relationships vary according to the stage of daughter’s pubertal development.
The study was done using a sample of 382 pairs of fourth-grade to eighth-grade girls and their mothers. The participants were selected from two suburban public elementary schools, two suburban parochial elementary schools and four suburban public middle schools in northeastern Ohio. The daughters and mothers respectively belonged to different ethnic groups: Caucasian (72%, 73%), African American (21%, 22%) and Asian, Hispanic or other (5%, 2%). Measures for the study were derived from: the Eating Disorder Inventory (EDI), the Eating Disorder Inventory for Children (EDI-C), the Tanner Stages Questionnaire, the Maternal Life History Questionnaire-Revised (MLHQ-R), and the Child Life History Questionnaire-Revised (CLHQ-R). The EDI was completed by sixth- through eighth-grade girls and their mothers, while the EDI-C was completed by fourth- and fifth-grade girls and their mothers. In addition, mothers of sixth- through eighth-grade girls completed the Tanner Stages Questionnaire. Girls were considered to be pre-pubertal if they belonged to stage 1 and 2, while post-pubertal girls were those who belonged to stage 3, 4 and 5.
Sanftner et al. (1996) found that during the pre-pubertal stage of development, there is no significant correlation between mothers’ and daughters’ eating habits. However, as girls approach and progress through puberty, there develops some correlations between mothers’ weight obsession and dieting behaviors and their daughters’ weight obsession and dieting habits. However, the researchers do not interpret their findings to mean that mothers are to blame for their daughters’ weight and dieting habits. Instead, the researchers assert that many socio-cultural factors such as gender stereotype in the society significantly contribute to both mothers’ and daughters’ weight and eating habits. They argue that eating disorders and weight preoccupation are strategies used by women to survive the gender inequalities that they encounter in their societies. The difference found between the pre-pubertal and post-pubertal girls in the study lies in the fact that gender inequalities become a reality when girls reach their adolescent years. The strength of this study is that it has used a sample of girls from different stages of development and different ethnic groups. The study is limited in two ways: it fails to consider the role of family functionality; and it does not include women with diagnosable eating disorders (Sanftner et al., 1996).
 
The influence of mothers’ weight and eating attitudes and behaviors has also been studied by Pike and Rodin (1991). In their study, Pike and Rodin (1991) aimed at addressing three major questions: “to what extent do mothers and daughters share similar attitudes and behaviors about diet and weight?; to what extent do mothers serve as role models for their daughters; and is it possible that mothers become society’s messengers? (p. 198). The researchers used 350 high school girls who were classified into two subgroups: the disordered eating group and the comparison group. The measures for the disordered eating were derived from three subscales of the Eating Disorders Inventory (EDI) namely: Drive for Thinness, Bulimia, and Body Dissatisfaction. Girls classified into the disordered eating group are those who scored in the 75th percentile or higher on the Disordered Eating Index, while those classified into the comparison group are those who scored in the 10th-35th percentiles in the same index. The mothers who participated in the study were 77 who were selected based on their daughters’ classification into either of the two groups. The mothers were all white, middle-class urban and suburban women. In addition to the EDI, the Family Adaptability and Cohesion Evaluation Scale III (FACES-III) was also used as a measure.
Pike and Rodin (1991) found that family functionality plays an important role in the weight and eating behaviors of daughters. In this study, mothers of daughters with eating disorders reported lower family cohesion although the difference between the two groups was not statistically significant. Unlike their mothers, the girls in the disordered eating group viewed their family as less cohesive than girls in the comparison group. In addition, mothers of daughters in the disordered eating group had a longer history of dieting and were preoccupation with their weight than their counterparts in the comparison group. This therefore proves that there is a link between mothers’ weight and dieting behaviors and their daughters’ weight and dieting behaviors. Mothers therefore serve as strong role models for their daughters particularly in the weight and eating domains. The major limitation of this study is that it uses a racially homogenous sample and hence the results from the study cannot be generalized to other population groups.
Summary
All the articles reviewed above address the effect of mothers on their daughters’ weight preoccupation and eating behaviors. Mothers serve as key role models when it comes to girls’ weight and eating habits. Mothers who are preoccupied with their weight and eating issues are highly likely to communicate the same issues to their daughters. Such mothers are also likely to have started dieting at an earlier age than mothers who are less obsessed with their weight and eating habits. With the exception of the study by Sanftner et al. (1996), the other four studies argue that girls’ weight and eating problems are as a result of their mothers’ weight and eating disorders. Sanftner et al. (1996) argue that both mothers and their adolescent daughters are victims of gender-stereotypical societies and therefore their obsession with weight and diet is a coping strategy used by women. The role of family functioning on girls’ weight and eating habits has also been explored in majority of the above studies. The general agreement is that the state of family affects girls’ body images. Families which are cohesive and where communication among members is regular are likely to bring up girls with healthy body images. On the other hand, girls with eating disorders and distorted body images are likely to belong to dysfunctional families. A number of literature gaps exist in the literature dealing with effect of mothers on daughters’ weight and eating habits. The first gap is the body image of girls suffering from eating disorders and the correlation between the girls’ body images and their mothers’ body images. The second gap is the effect of mothers’ direct messages about weight and dieting on their daughters. The third gap is the difference in weight and eating habits between pre-pubertal and pubertal girls.
 
Possible research question

How do mothers with eating disorders influence their daughters’ eating behaviors?

Conclusion
Mothers who are preoccupied with their weight and eating behaviors influence their daughters’ weight and eating habits in various ways: role modeling and direct communication. Role modeling occurs when young girls pick up eating habits from their mothers by observing what their mothers eat, the frequency with which they eat and their engagement in weight loss activities. Through such observation, girls become socialized into believing that they should maintain their weight. As a result, if a mother suffers from a particular eating disorder, her daughter is also likely to develop it. Direct communication between mothers and daughters has the greatest effect on girls’ weight and eating habits. Mothers with eating disorders are more likely than their counterparts to tell their daughters over and over again to lose weight. They are also more likely to tell their daughters to avoid eating certain foods such as foods that have high content of fat and energy. However, influencing their daughters’ weight and eating habits may be a strategy that mothers use to protect their daughters from the cruelty of their gender-stereotypical society in which women are mostly judged based on how thin they are and how they look physically.
 


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