Abstract
A host of factors, including family distress, may contribute to obesity. While weight gain happens over time, day-to-day interactions may explain how family interactions between one's romantic partner and one's children relate to weight (i.e., individuals may use food to compensate for poor relationships). The study aimed to examine the relationship between body mass index (BMI) and daily family distress (e.g., romantic partners and children) with couples experiencing pandemic-related stress. This diary method designed study sampled heterosexual couples with children (n = 59, N = 118) reporting pandemic stress. We conducted Actor-Partner Interdependence Models to test actor-partner effects between romantic partners. Results suggested, for men, more upsetting partner interactions were related to their own higher BMI. Women's BMI increased when their romantic partner reported upsetting interactions with them and when the women reported parenting distress.
Since 1980, American obesity rates have risen dramatically among adults (i.e., 13.4%–41.7%; Paulose-Ram et al., 2021). Most recently, we saw another rapid onset of weight gain during the pandemic. Lin et al. (2021) reported that nearly 40% of individuals gained weight since the start of the pandemic. Individuals, who are classified as obese, face higher risks for mental health concerns including weight discrimination, depression, and low self-esteem (Purnell, 2000). Despite numerous interventions, the United States has failed to make progress in preventing obesity (Ross et al., 2016). Obesity rates are continually increasing, making it difficult to differentiate the etiology of individual weight gain. Using pandemic weight gain as a model can provide a unique opportunity to identify factors linked to weight gain. If we can examine reasons related to higher weight during the pandemic period, we might be able to understand more about what concerns contribute to weight gain over time. Understanding micro-level concerns may be key to developing effective obesity prevention strategies.
While food practices and inactivity are most commonly cited as related to the progressive increase in weight gain (McAllister et al., 2010), a growing body of research suggests the environment may contribute to obesity rates (Hruby & Hu, 2015). Current literature indicates interpersonal distress may be linked to obesity in adults (Ames & Leadbeater, 2017). Since the onset of the pandemic, interpersonal distress has risen with Americans reporting factors such as family responsibilities, parenting stress, and romantic relationships as significant sources of stress (APA, 2021). Adding pressure to romantic and parental relationships, psychosocial stressors (e.g., mental health concerns, job and financial stress, and stressful family dynamics) have also increased during the pandemic (APA, 2021). Typically, it is difficult to predict how long stressors will last. The pandemic created a unique set of stressors that forced families into a state of chronic stress. Thus, it seems plausible to use pandemic stress as a chronic stress model to assess behaviors exhibited under enduring stress. Although research tends to focus on long-term outcomes of stress, studying daily interpersonal interactions may provide more details about how psychosocial concerns accumulate to contribute to chronic stress and weight changes.
Many people cope with periods of high stress by eating comfort food (i.e., fatty, calorically dense foods; Kiecolt-Glaser et al., 2015). Individuals who identified as the target of negative interpersonal interactions tended to increase their consumption of high-caloric foods (Oliver et al., 2000). Negative interpersonal interactions may be a regular occurrence in many families. Individuals may feel stuck and subject to regular harmful behaviors by family members. The pandemic forced many families to isolate together creating a predicament where individuals may have turned to emotional eating to cope with poor relationships (Meyer et al., 2024). The present study aimed to examine the associations between body mass index (BMI) and daily family-distressing interactions during the first year of the pandemic.
Family Distress Model
The Family Distress Model (Cornille & Boroto, 1992) was developed to explain family processes during times of change. Family Distress Model axioms note that families engage in predictable behaviors or stable patterns that may become disrupted when stressors are introduced. Stable patterns are expected and anticipated behaviors engaged in by family members and members of other interlocking systems (e.g., how family members communicate or comfort one another). Patterns include routines, roles, rituals, and rules that reflect the values and goals of the family, promote stability, and strengthen the family identity (e.g., family dinners, holiday rituals). When stressors are introduced, families may initially work to maintain their stable patterns until the stressor inhibits their natural behaviors. During the pandemic lockdown, family routines and rituals were disrupted, gender roles and expectations oftentimes became exaggerated, and rules changed as families learned to navigate new terrain. Many families tried to maintain a sense of normalcy, especially for the sake of the children in the home. Some stable family patterns were easier than others (e.g., family dinner) while other family norms were no longer possible (e.g., activities outside the home). Families experience distinct stages during times of stress, with the understanding that interactions with members of various systems may also impact problem management. Attempts to resolve the problem may occur unconsciously or through pre-established strategies, such as family conversations or changes in routine. Ideally, this will lead to problem relief and a return to stable behavioral patterns (Curtis et al., 2021).
When stressors make maintaining stable family behavioral patterns or the family homeostasis challenging, the family navigates through the stressor by developing new patterns (Cornille & Boroto, 1992). During a crisis, attempts at resolution may only be successful if an identifiable strategy exists. Families may expand their boundaries to rely on other social networks for support (i.e., extended family). If the crisis continues, the family unit will either reshape their response to the problem or become overwhelmed. The distinction between these two outcomes is determined by the magnitude of the problem, available resources, and the family's social network support. For example, during the first year of the pandemic when many families were isolated, they often lacked access to resources that helped them to cope when under stress (e.g., working out at the gym, going out to dinner when they felt too tired to cook). Many families became overwhelmed. The combination of isolation and lack of access to coping strategies made many individuals depressed (APA, 2021). Tenets of the Family Distress Model suggest, eventually, the family will reach resolution either by returning to their previous stable routine, developing a new stable routine, or adopting the problem as part of their determinants of stability (Cornille & Boroto, 1992). For example, for many families, social distancing became a way of life or families extended their trusted circle to include others outside of their household.
The coronavirus disease 2019 (COVID-19) pandemic challenged stable family patterns as stay-at-home orders were implemented and daily routines were drastically altered (Curtis et al., 2021). Changes in family patterns often included poorer health habits (Meyer et al., 2024). A recent study by Zhu et al. (2021) examined how individuals in China coped with stay-at-home orders that disrupted their previously established stable patterns. Data indicated many individuals coped with the implementation of stay-at-home orders through increased food intake, especially snacking, a decrease in exercise, and an increase in sedentary time and sleep duration. The changes in health habits were consistent across gender, age, income, and education level.
Interpersonal distress, pandemic stress, and obesity
While weight loss and dietary changes are common options for managing obesity, an increase in stress can lead to disruptions in eating patterns and increase an individual's likelihood of weight gain (Hill et al., 2022; Zhu et al., 2021). Individuals under stress often eat foods higher in fat and calories (Lu et al., 2018). Higher stress and anxiety levels are correlated with an increase in eating foods higher in sugar, fat, and calories (Cotter & Kelly, 2018). During the COVID-19 pandemic, snacking was used to help some individuals cope with increased anxiety (Bennett et al., 2021). During the pandemic lockdown, 40% of participants in an Italian study reported an increased consumption of comfort foods (e.g., desserts; Mattioli et al., 2020).
While many individuals experienced daily stressors across multiple sectors, the initial period of the COVID-19 pandemic saw an increase in interpersonal concerns. Marital conflicts, parental stress, and psychosocial stress multiplied as many families transitioned to extended lockdown periods (Calvano et al., 2022). Weight gain and psychological stress often accompany one another (Knapp et al., 2011), with women being particularly sensitive to familial relationship stress (Block et al., 2009). When looking at romantic relationships, Burke et al. (2012) found individuals in mixed-gender partnerships reported more marital conflict when the woman had a higher weight status than her male partner. Skoyen et al. (2018) expanded on these findings and linked partners’ BMI to their relationship conflict and the couple's utilization of unhealthy behaviors (e.g., drinking alcohol, eating junk food, etc.). They found that women's BMI increased by 1.63 (∼9 pounds) for each unit increase in relationship conflict. Increased BMI was associated with higher utilization of unhealthy behaviors by women (Skoyen et al., 2018). Across genders, parents gain weight at a higher rate than their childless peers (Umberson et al., 2011), perhaps related to the additional stress of parenting. Further, the transition to parenthood is linked to declines in physical activity (Corder et al., 2020). Across all familial relationships, emotional eating may correspond with family challenges (Meyer et al., 2024), demonstrating weight gain may be related to changes in food choices (Lu et al., 2018).
While exercise may be a mechanism to compensate for poor diet, the stay-at-home orders during the pandemic lockdown limited opportunities for many individuals to exercise. Pandemic weight gain may be due, in part, to the closure of exercise facilities and, consequently, a decrease in physical activity coupled with dietary changes (Knapp et al., 2022). International research indicates approximately 44% of adults reported reduced physical activity during the pandemic lockdown, which was often combined with changes in diet and increased levels of stress (Curtis et al., 2021; Mattioli et al., 2020). Finally, poor diet choices may also be related to economic strain. Lower quality and higher caloric foods are often less expensive than healthier foods (Knapp et al., 2022). Unfortunately, the pandemic has been financially hard for families; thus, families may not have the option to eat healthier food due to economic stress.
Current literature identifies aspects of daily life that can influence weight gain and obesity. One such factor is the modern lifestyle, classified as being increasingly sedentary, overconsumption of refined foods, and poor sleep quality (Seaman, 2013). Other daily concerns include lack of regular exercise, idle recreational activities, smoking, and alcohol use (Mozaffarian et al., 2011). Mozaffarian and colleagues examined the correlation between lifestyle habits, dietary factors, and weight change in a large, adult sample in the United States. At the onset of the study, the participants were healthy and not obese. Lifestyle and weight were measured every 4 years over 20 years. Results indicated consumption of refined foods and sugary beverages, low levels of physical activity, alcohol use, high television consumption, and smoking were all associated with higher levels of long-term weight gain. Of these factors, diet and physical activity accounted for the largest weight gain.
Current study
A host of research shows interpersonal stress may be detrimental to healthy eating choices. Interpersonal stress combined with unique challenges linked to the pandemic (e.g., fear of contracting the virus in public spaces, economic strain) may have created an environment where individuals did not have the options to make healthier choices. Additionally, the COVID-19 pandemic introduced novel changes to daily routines. Changes included decreased physical activity, increased stress and familial conflict, and increased consumption of refined foods. While previous research has linked daily health habits to weight gain, little research has investigated the contribution of family stress (Meyer et al., 2024). Thus, we sought to examine the unique contribution of interpersonal interactions to weight by assessing the associations between BMI and daily family-distressing interactions. We specifically examined distressing interactions with romantic partners and children, amongst a sample of cohabitating couples during the first year of the COVID-19 pandemic. As the research demonstrates stress is related to weight gain (van der Valk et al., 2018), to reduce the unique contribution of stress in our model, our sample mean indicated nearly all the sample experiencing pandemic stress.
Methods
Data from this diary methods study was collected during the 2020–2021 Fall/Winter COVID-19 pandemic peak. The study was conducted in a naturalistic setting. We collected four daily surveys within a two-week period. Couples could choose what days they completed the daily surveys as long as two weekdays and two weekend days were selected to create variety in sampling times. Data from the study is available upon request.
Procedures
This study was approved by the principal investigator's university institutional review board. Participants were recruited from paid advertisements on social media and elementary school-based resources (e.g., peach jar), online groups for parents (mothers of preschoolers, moms’ groups), and flyers placed around the community (e.g., universities, restaurants, community centers, medical centers, and churches). To participate all couples needed: To cohabitate with their romantic partner, both romantic partners needed to agree to participate, they needed to be aged 21 and older, respond to surveys in English, and be living in the United States. If individuals were interested in participating, the potential participants contacted the PI through email, phone calls, or a Facebook research page. All potential participants were vetted (i.e., to ensure they were a real person and in a romantic relationship) via email or phone call by the PI before a research team member called the couple to determine eligibility, describe the study, and enroll couples in the study. The couple and research team member also determined what days the couple would like to complete the four surveys. All couples were emailed the survey links for four days. On each survey day, couples completed their survey at bedtime responding to questions as they reflected on their entire day. Surveys took approximately 10–15 min to complete. Couples were thanked with gift card for their participation.
Participants
A total of 59 couples (N = 118; married couples n = 55, cohabitating couples n = 4) participated in this portion of the study. All couples identified as being in mixed-gender relationships (n = 59 women, n = 58 men, 1 person did not respond) and had been together an average of 13.92 years (SD = 6.51). Participants were middle-aged and ranged in age from 34 to 62 years (M = 40.95 years; women M = 39.92, SD = 5.02; men M = 41.97, SD = 5.86). The sample was mostly white (n = 73, 62%), Black/African American (n = 19, 16%), Asian (n = 13, 11%), Latinx (n = 3, 3%), Multiracial (n = 7, 6%), and three individuals did not respond. The majority of the sample identified as heterosexual (n = 112, 95%) with few individuals identifying as bisexual, pansexual, or queer (n = 3, 3%), and three individuals did not respond. Almost all of the couples had children (n = 55) and had between one to six children, (mode = 2, n = 49 individuals). It appeared only four couples had children with other partners other than their current partner. Children ranged in age from newborns to adult children. Few couples had children aged 19 and older (n = 6), 18 couples had teenage children, 44 couples had elementary-aged children, and 67 couples had babies and toddlers. Most couples reported their income was over 100,000 per year (n = 43) with only 15 couples reporting an income less than 100,000 (n = 15, 1 did not respond). The majority of the sample held a Bachelor's degree or higher (n = 81, 69%), 35 (30%) individuals held less than a Bachelor's degree, and two individuals did not respond.
Measures
Demographics. Demographics (e.g., age, gender, race, ethnicity, parental status, relationship status, income, education) were collected via self-reported on day one of data collection. Pandemic stress was measured through one item: “How distressing have you found the situation with COVID-19?”. Participants responded on a 5-point Likert scale ranging from (1) little to no distress to (5) extremely distressing. Participants frequently reported pandemic changes to be distressing (total sample M = 3.35, women M = 3.7; men M = 3.0). For women, the most frequent response to the item was the situation with COVID-19 was very distressing and for men, the most frequent response to the situation with COVID-19 was distressing.
Body Mass Index
Parenting Distress. Parenting distress was measured using the question, “Did you experience any distress or irritability in your role as a parent today?” Participants responded on a five-point Likert scale ranging from 1 indicating little to no distress to 5 indicating extremely. Higher scores indicated more parenting distress. We calculated a mean for parenting distress scores using all four days of data. Parenting distress for the sample, overall, was relatively minor (women M = 1.55, SD = .59; men M = 1.40, SD = .41).
Partner Distress
Correlations for study variables.
*p < .05, ** p < .001
Analytic plan
The Actor-Partner Interdependence Model (APIM; Kenny et al., 2006) was conducted to assess how individual men's and women's BMI (actor) as well as partner BMI were related to parenting and partner distress means across the four days. Using the APIM statistic, we could calculate partner influence on the outcome variable. Specifically, we could test if one's own parenting and partner distress was related to their own BMI as well as if one's partner's responses on parenting and partner distress were related to one's BMI. Dyads were distinguishable by gender and a two-intercept model was used to determine actor–partner effects per level of the distinguishable variables. All couples identified as having different gender partners and, thus, all 59 couples were included in the partner distress on BMI APIM and only the couples with children (n = 55) were included in the parenting distress on BMI APIM. To confirm the assumption of independence (Cook & Kenny, 2005), using SPSS 28, we calculated Pearson product-moment correlations for all variables. We set the correlation limit at 0.69 consistent with Ratner's (2009) definition of a strong correlation. We used the Lavaan program for R to conduct APIMs via structural equation with bootstrapping using a Monte Carlo simulation approach (Rosseel, 2012). We accounted for missing data using the full maximum likelihood estimation. All analyses were conducted using an online web-based program (Stas et al., 2018). No outliers (SD > 4) were found across analyses. Partner and actor effects were calculated simultaneously, controlling for non-independence. Partial correlation effects were provided in these models including (1) Woman intercept; (2) Man intercept; (3) Woman actor effect (BMI on partner and parenting distress) (4) Woman partner effect (BMI on partner and partnering distress) (5) Man actor effect (BMI on partner and partnering distress), and (6) Man partner effect (BMI on partner and partnering distress). Beta coefficients are Z tests, standard errors were calculated to measure the relationship of actor and partner effects on BMI, and all alphas were set at 0.05 (Stas et al., 2018).
Results
Correlations
Pearson produce-moment correlations were calculated. See Table 1. Inter-partner independent variables were correlated; however, no variables were strongly correlated.
Actor partner interdependence models
Results summarize analysis calculated with the Stas et al. (2018) application. We conducted an exploratory analysis to examine if BMI was significantly related to partner and parenting distress and exhibited actor/partner effects. The model (BMI = 0.312, 95% CI [0.02, 0.52], p = .038), was converged after 102 iterations. Gender differences were observed (χ2 (10) = 36.50, p < .001). Actor-partner effects explained 20.6% of the variance for women's BMI and 15.2% of the variance for men's BMI.
Table 2 shows results from the APIM model examining the relationship between BMI and parenting and partner distress. Results demonstrated, for men, only partner distress actor effects were significantly related to their BMI. For women, parenting distress actor effects and partner distress partner effects were significantly related to their BMI. For men, the more distress they experienced with their romantic partner, the higher their BMI. For women, the more distress their romantic partner experienced with them as well as the more distress women experienced while parenting, the higher their BMI.
APIM analysis.
CI = confidence interval; LL = lower limit; UL = upper limit; APIM = Actor-Partner Interdependence Model.
Boldface indicates significant findings.
Discussion
The purpose of our study was to assess the associations between BMI and daily family distressing interactions, focusing on distressing interactions with romantic partners and children, amongst a sample of stressed cohabitating couples during the COVID-19 pandemic. Our findings show that men's BMI is more likely to be impacted by their relationship with their romantic partner. Thus, for men, their BMI increased when they are upset by interactions with their partner. Whereas women's relationships with others (e.g., their partner upset with them or upset by interactions with their children) were linked to higher BMI. When men report more upsetting interactions with their romantic partner, women (as the romantic partner) have a higher BMI. Additionally, when women report they had more distressing interactions with their children, they report higher BMIs. Our results align with previous studies linking the family environment with an individual's BMI, and thus, support the call for greater use of family-based intervention models for weight loss (Novak et al., 2023).
The results of this study highlight the role of daily life stressors, specifically interpersonal relationships, in contributing to a higher weight in both men and women. Previous studies have similarly demonstrated that more psychosocial stressors, such as one's career, finances, and social interactions, can lead to significant weight gain in both men and women (Block et al., 2009). Interpersonal conflict plays a significant role in weight gain (Jaremka et al., 2015). This may be explained biologically. A previous study demonstrated women who experienced higher amounts of interpersonal stress also had higher levels of hormones involved in appetite regulation, i.e., leptin and ghrelin (Jaremka et al., 2015). However, food may be used to cope with interpersonal stress. The aforementioned women also reported consumption of more food than those who experienced fewer interpersonal stressors. Although this study primarily examined women, this suggests a link between increased interpersonal stress and weight gain (Jaremka et al., 2015). The findings by Jaremka and colleagues could also reflect our work showing women's BMI was impacted by multiple types of relationships, suggesting the presence of more interpersonal stress. Our findings reveal, regardless of gender, that partner dynamics of cohabitating couples are key factors in relation to weight changes. Yet, we may be attributing weight to family relationship distress when other factors may be the culprit. Weight gain is common early in relationships (The & Gordon-Larsen, 2009). Timing may be paramount to weight gain. One study examining the effects of cohabitation on BMI found that living with a partner led to significant weight gain in both men and women after four years, with BMI after separation being similar to what it was prior to cohabitation (Mata et al., 2018).
Our findings show women may be more sensitive to interpersonal distress. The average rating of parenting and partner distress was higher for women compared to men. Both types of family relationships, i.e., women's partner perceived distressing interactions and the woman's perception of their parenting distress, were linked to BMI. This is consistent with previous research showing women tend to report higher stress levels than men (APA, 2012) and women experience higher stress levels associated with distress from relationships with their partner or children at home (APA, 2010). Studies have shown that men and women perceive social stress differently and women are more reactive to interactions with their partners or children (Bouchard & Shih, 2013). In addition to higher perceived or rated stress levels in women, men and women respond to stress differently. Women are more likely than men to eat to manage stress (APA, 2012). Research shows stress is negatively associated with diet quality in women (Khaled et al., 2020). The women in our study may similarly respond to social stress from interpersonal relationships through eating and poor diet quality. Thus, the women who reported more stress may be more likely to gain weight, as reflected in higher BMI. These findings are consistent with previous research that shows parenting or partner distress is correlated with weight gain in women but not men (Block et al., 2009). This is puzzling, though, as men, on average, in our study fell into the obese BMI category and women were categorized, on average, as overweight. While these categories are different, numerically, the BMI score differences were 0.64 and this may not be meaningful from a health standard. Thus, for women, relationship distress may manifest in other areas (e.g., depression; Liu & Alloy, 2010).
The results appear to indicate BMI and social relationships are interconnected, a notion supported by the Family Distress Model. Our results, and those of previous studies, support the Family Distress Model's assumption of a bidirectional association between the family and the individuals within it (Cornille & Boroto, 1992). The stress experienced in the family unit (e.g., negative interactions with partners and children), leads to adaptations within the individual (e.g., higher BMI). This could create a cyclical pattern by which the higher the stress, the higher the BMI, the higher the stress within the family (e.g., less energy to support one another, more health complications), the higher the BMI, and on it goes. Diet and exercise habits may be strategies used to cope with family distress. This suggests that there is a need to understand an individual's BMI not solely from the context of height and weight, but also the social and psychological factors surrounding and within the individual. Our results suggest a need to incorporate the family into treatment models of weight gain and its comorbidities (e.g., Type 2 diabetes, cardiovascular diseases, etc.). Without addressing the family stress, individuals seeking to lose weight may struggle to overcome the family processes contributing to their higher BMI.
Limitations and future research
The current study has limitations. First, the study occurred over a short time period, limiting our study's ability to assess BMI changes over time. We did not collect data about BMI prior to the pandemic. We do not know how BMI may or may not have changed in relation to interpersonal relationship stress. Thus, we cannot make causal conclusions regarding family interactions’ impact on the development or progression of obesity. We are also unsure if are findings related to weight are specific to the pandemic. Secondly, we relied on self-reported height and weight, which can be biased towards lower weights and higher heights among adults (Shiely et al., 2013). Ideally, research team members would have measured participants using standardized scales and stadiometers; however, this was not possible at the time of the data collection due to COVID restrictions. Lastly, our items and rating scales for partner distress and parenting distress varied. There was more variability in responses to partner distress interactions compared to parenting. A more refined scale for parenting distress may have altered findings.
Future research should seek to replicate our results using more standardized measures of BMIs. Future research should also correct our biases in our sample. Our sample was somewhat homogenous in demographics, including protective factors against the development of obesity (i.e., high socioeconomic indicators, etc.), limiting the study's generalizability regarding high-risk populations (e.g., Black and Latinx adults, those of lower socioeconomic status, etc.). Couples were all in mixed-gender relationships. Individuals who identify as lesbian or bisexual are more likely to be overweight (Deputy & Boehmer, 2014). Additionally, certain cultural practices may mediate the relationship between family interactions and BMI, such as using spiritual practices to cope with negative interactions or having an extensive social support network outside of the family of procreation. Future studies should recruit a more diverse sample (e.g., racial identity, sexual orientation) and consider cultural mediators.
Therapeutic implications
Counselors address underlying concerns related to mental health distress. However, when a physical health condition is the primary concern, counselors may feel ill-equipped to help couples. Some practical reasons for the lack of attempting a psychological intervention when working with a client with obesity may be related to topic discomfort, scope of practice concerns, or fear of client shaming. Research supports mental health is vital to physical health. Empirical research examining the body-mind connection has grown rapidly in recent years (Li et al., 2022), providing robust evidence for the need for psychological intervention (Brennan et al., 2018). A review of psychological interventions for obesity shows interventions are designed to utilize an individual approach (Brennan et al., 2018). While physical health concerns lie within the client, exploring the reason for weight gain may need a systemic approach. Our findings suggest daily family interactions may be related to weight. Dietary habits often reflect life stress (e.g., poor relationships; Lu et al., 2018). Food can be used to cope with relationship distress or the emotions arising from negative interactions (Meyer et al., 2024). Furthermore, if other family members have poor quality eating habits, family members trying to make healthier choices may be challenged by the addictive nature of unhealthy foods (i.e., ultra-processed foods; Lustig, 2020).
If counselors deem interpersonal distress may be related to weight, the counselor may choose to utilize a host of systemic interventions. Interventions could target health habits and relationship functioning, specifically using a two-pronged approach focused on accountability and mindfulness. First, counselors could explore with the family eating and exercise habits and work with the family to learn how to utilize each other for support in making healthy choices. Group-based approaches to weight loss demonstrate success (Murakami et al., 2020). Counselors could work with family members to motivate one another and hold each other accountable for their diet and exercise choices (Dailey et al., 2018). Counselors could also work with the family to understand factors that lead to unhealthy food choices and lack of exercise. During this exploration phase, learning more about family functioning may be key. For example, counselors could assess if behavioral interactions are related to diet habits (e.g., if parents are frustrated when their children do not listen, are the parents likely to turn to food to emotionally cope with the interaction). Counselors could teach parents how to be mindful during these interactions, to accept their emotional state, and to question if they are eating due to emotions or hunger (Olson & Emery, 2015). Using a two-pronged approach where families learn how to keep one another healthy and mindful of emotional eating may be key in systemic approaches.
Conclusion
Our results emphasize the need to understand the familial context of adults who have elevated BMIs and research needs to continue to investigate the contribution family interactions have on obesity development. Our current study highlights adults are not immune to familial influence in relation to their weight. The results point to a need for assessment of family dynamics and interaction patterns within weight loss treatment settings and further expansion of family-based weight loss interventions into the adult patient population. Counselors can work with families to intervene using accountability and mindfulness-based systemic approaches.
Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) and Saint Louis University.
