A new study published in the December 26th online issue of the journal Pediatrics suggests that the extent of attachment security between mother and child when the child is aged between 15 and 36 months appears to be related to the risk for obesity in that child when it is 15 years old. The study was funded by the National Institutes of Health.
Sarah E. Anderson, from the Division of Epidemiology at the Ohio State University College of Public Health in Columbus, and colleagues, note in their study that attachment security to the mother influences the development of children's emotion regulation and stress response and “could influence adiposity through their effects on appetite, sleep, and activity.”
They looked at data from 977 of 1364 participants in the Study of Early Child Care and Youth Development, a prospective cohort study of children born in 1991 that was designed to examine the effect of non-maternal care on children's developmental outcomes.
The mother and child relationship of participants was scored on the basis of 2 measures. One measure was the extent of “secure attachment.” This evaluated the child's awareness that the mother can be used as a “secure base” from which to explore, and that returning to the mother after a stressful experience will be comforting. For this, the researchers evaluated the child's behavior during a standardized separation from and reunion in a laboratory setting (at 15 and 36 months), as well as observation in the home (at 24 months).
The other measure was maternal sensitivity, which assessed the mother's capacity to recognize the child's emotional state and to respond warmly and consistently. This quality was measured during a 15-minute play session between mother and child conducted either in the home (at 15 months) or a child development laboratory (24 and 36 months). Trained coders scored aspects such as sensitivity to non-distress, intrusiveness, and positive regard. Child attachment security and maternal sensitivity scores were then correlated with the presence of adolescent obesity, defined as a body mass index of the 95th percentile or higher at age 15 years.
According to Ohio State University maternal sensitivity refers to a mother’s ability to recognize her child’s emotional state and respond with comfort, consistency and warmth. Psychologists describe securely attached children as those who rely on their parents as a “safe haven,” which allows them to explore their environments freely, adapt easily to new people and be comforted in stressful situations. Toddlers who are insecurely attached tend to have experienced negative or unpredictable parenting, and may respond to stress with extreme anger, fear or anxiety, or avoid or refuse interactions with others.
A poor-quality maternal–child relationship, as indicated by a maternal–child relationship quality score of at least 3, was assigned to 24.7% of children, whereas a score of 0 (highest-quality relationship) was given to 22.0% of the children. Adolescent obesity was present in 26.1%, 15.5%, 12.1%, and 13.0% of those participants with risk scores of 3 or higher, 2, 1, and 0, respectively.
Researchers adjusted for sex and birth weight and found that adolescent obesity was 2.45 times higher in those with the worst relationship (score, ≥3) compared with those considered to have the highest-quality relationship (score, 0). Compared with insecure attachment, low maternal sensitivity was more strongly associated with obesity, the researchers found.
“Sensitive parenting increases the likelihood that a child will have a secure pattern of attachment and develop a healthy response to stress,” Anderson said in a statement. “A well-regulated stress response could in turn influence how well children sleep and whether they eat in response to emotional distress — just two factors that affect the likelihood for obesity.”
“Our results are suggestive of a cumulative effect of the poor quality of the early maternal–child relationship on a child's obesity risk,” the authors suggest. “Although maternal sensitivity was a stronger predictor than insecure attachment, the combination of both seemed to be a greater risk than either alone.” The researchers suggest that maternal sensitivity could protect against obesity by “improving children's ability to modulate their physiologic and behavioral responses to stress.” Those with a well-regulated response, they add, may eat less in response to emotional distress and may sleep more, which would reduce their risk for obesity.
“If future research confirms these mechanisms, obesity prevention interventions could incorporate more emphasis on the quality of maternal–child relationships,” Dr. Anderson and colleagues conclude.
“The sensitivity a mother displays in interacting with her child may be influenced by factors she can’t necessarily control. Societally, we need to think about how we can support better-quality maternal-child relationships, because that could have an impact on child health,” said Anderson.
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