Parental pressure on child body image, BMI, body image dissatisfaction associated with eating disorders: A path analysis

Children's eating behaviors, body shape and body image cognition may be more susceptible to the influence of their parents, but these influences may be weakened with age. There may be different association pathways between parental pressure on children’s body image (PPCBI), body mass index (BMI), body image dissatisfaction (BID) and eating disorders (EDs) among children and adolescents at different developmental stages. This study aims to analyze the association pathways between PPCBI, BMI, BID and EDs among children and adolescents at different developmental stages. The stratified cluster sampling method was used to select 486 students aged 8–15 years in two 9-year schools. Children’s body height, weight, testicular volume and breast development were measured. PPCBI, BID, and EDs were investigated using the Appearance-related Social Stress Questionnaire, Body Size Questionnaire (BID-14), and EDI-1 scale, respectively. The boys with testicular volume <4 ml had significantly higher EDs score than girls with breast development <Tanner II ( P <0.05). There were significant association pathways of PPCBI→BMI→BID→EDs and PPCBI→BID→EDs in boys with testicular volume <4 ml ( β =0.035, P <0.01; β =0.059, P <0.01), boys with testicular volume ≥4 ml ( β =0.032, P <0.01; β =0.175, P <0.001), and girls with breast development ≥Tanner II ( β =0.026, P <0.01; β =0.172, P <0.001). There was a positive association pathway of PPCBI→EDs in boys with testicular volume <4 ml ( β =0.30, P <0.001) and PPCBI→BID→EDs in girls with breast development <Tanner II ( β =0.176, P <0.01). Parental pressure on children’s body image may positively predict children's eating disorders through BMI and body image dissatisfaction in boys and girls after puberty initiation and directly predict eating disorders in boys before puberty initiation; however, it indirectly predicts eating disorders only through BID in girls before puberty initiation.