Study: Tantrums Lead to Obese Children

July 9, 2004 -- A new study finds that using food to calm a child's temper tantrums might lead to childhood obesity.

Published in the latest Journal of Pediatrics, the 9 ½ year study followed 150 children from birth, looking for factors that may contribute to childhood obesity. Fully 25 percent of the kids studied were overweight by age 9, with 9 percent considered to be severely overweight.

While overweight parents were most likely to have overweight children, researchers also found a link between frequent temper tantrums and childhood obesity. That is, children who threw persistent tantrums over food from ages 2-5 were three times more likely to be overweight than kids who did not often throw tantrums.

Researchers speculate that parents use food bribes to calm upset kids. "Parents aren't doing their kids any justice" by doing so, says lead study author Dr. W. Stewart Agras, professor emeritus of psychiatry and behavioral sciences at Stanford University.

Additionally, the authors determined children who took shorter or fewer daytime naps from the ages of 2-5 years were also more likely to be overweight, possibly due to less energy to burn off calories.

"It's no secret that food is an emotional soother," says Dr. Madelyn Fernstrom, founder and director of the University of Pittsburgh Medical Center's Weight Management Center. "The problem with [emotional feeding] is that this is the same [problem] for most parents as well as children."

She adds: "We submit to 'head hungers' and food is considered a reward or a mollifier. The problem isn't just genetic or parental, it's also environmental and social."

Parents whose kids throw occasional tantrums need not be as concerned. The study found while 82 percent of the children in the study threw an occasional "food fit", only 19 percent had regular food tantrums. The infrequent tantrum throwers did not show a relationship between tantrums and childhood obesity.

The next highest risk factors included child temperament, parental concerns about weight, food interest, and weight gain during the first six months after birth. Other risk factors for childhood weight problems include parental obesity, socioeconomic status, weight at birth, physical activity, and diet.

Nature Versus Nurture

Not surprisingly, those children whose parents were overweight were at the greatest risk to be overweight by age 9. Sixty-four percent of children with overweight parents were obese by the end of the study, compared to only 16 percent of those children whose parents were of normal weight.

"We've always known that children whose parents are overweight are more likely to be overweight," notes Fernstom. "You almost never see a child who is overweight with thin parents."

But whether the additional risk is due to the parental attitude toward food or to a genetic predisposition, Fernstrom and the study authors could not determine.

"It's probably both," Fernstom speculates. "But it's important to remember that no one is genetically doomed to be obese — You might be predisposed to being overweight, but you can usually keep your weight under control with careful diet and exercise."

Agras says parental attitudes about thinness may also contribute to childhood obesity. "Some parents are overly concerned about a child's weight, prompting some parents to overfeed their children," Agras explains.

Parents should not micro-manage everything a child eats, he adds. "Over-controlling food intake disrupts the child's self-control of food. Putting a child who cannot judge his or her food intake into a very food-friendly environment certainly puts them at risk for high caloric intake."

Dr. Francine Kaufman, head of the Center for Diabetes and Endocrinology at the Children's Hospital of Los Angeles believes there should be a complete separation of food and parenting. "If we want to end the problem of childhood obesity, we need to use a more holistic approach to parenting. We need to keep food out of the paradigm of parenting."

Does Study Hold Up?

Dr. David Fassler, clinical associate professor of psychiatry and child development specialist at the University of Vermont's College of Medicine, notes the study "helps us identify kids at particular risk, which is central to the design of effective prevention and early intervention programs."

Yet, Fassler adds, "as with most interesting studies, it raises more questions than it answers. … Do the temper tantrums and reduced sleep really cause obesity, or are they correlated with other genetic or environmental factors, such as parenting style or the child's temperament?"

He, like Fernstrom, believes study's major shortcoming is its small size. The study's 150 participants are from the surrounding San Francisco Bay area, and did not represent every race and ethnic group in the region or in the country.

"Perhaps this is premature," Fernstrom notes. "The study was small, and as the authors suggest, it was not very diverse, and a significant number of participants dropped out by age 9."

But Agras believes the study is timely and important, given the rise of childhood obesity. "Kids have been rapidly gaining weight. The number of kids who are overweight now has doubled in the past 20 years," he notes. "That's really very worrying for the future of this country."

Kaufman says she saw the long-term study as "a great achievement — not many studies of that length have embarked looking at obesity." She adds: "They were under tremendous limitations with this kind of subjective study, but they did it as clinically as possible."

In the end, Argas suggests, parents should not obsess over these results but should learn from them. "Mainly, parents should try not to over-control their child's eating — it's not a good thing for anyone."

Adds Fernstrom: "It's hard if parenting becomes 'Do as I say, not as I do.' But there should be some accountability for parents and children; parents should try to make positive health changes for themselves as well as their kids."

Finally, she warns, "As hard as it is, don't reward your children with food. It only temporarily fixes behavioral problems, and it brings [your children] into a bio-risk environmental factor for obesity."