following ethical approval from the university college london ethics of non - national health service human research committee , 531 families with children aged 7 - 9 years from five london schools were invited to take part in the physical exercise and appetite in children study ( peaches ) .
this is a longitudinal study of the associations between eating behaviours , physical activity and adiposity during childhood .
parents were sent a questionnaire that included measures of attitudes to their child s weight and their feeding practices . there was a 60% return rate ( n=244 ) , with the majority of respondents being mothers ( n=213 ) . because mothers have been reported to feed differently to fathers ( blissett et al . , 2006 ) , analyses were restricted to mothers for homogeneity of the sample .
parents were asked to indicate their highest level of education ( in the uk system ) using seven response options (  no qualifications ,  o - level / gcse / equivalent , 
ethnicity was reported using 11 response options based on 1991 uk census ( 1991 census , crown copyright , esrc purchase ) , but because of the diversity of the non - white groups , subdividing the sample into different ethnic sub - groups produced very small samples , and so ethnicity was dichotomised into 
maternal feeding practices were assessed with the child feeding questionnaire ( cfq ; birch et al .
restriction ( e.g.  i have to be sure that my child does not eat too many high fat foods ) , and  monitoring ( e.g.  how much do you keep track of the snack food ( e.g. crisps , cheesy crackers ) that your child eats? ) .
disagree ,  slightly disagree ,  neutral ,  slightly agree , and  agree for the restriction scale .
mean scale scores were computed if at least 70% of the items were completed ( tabachnick and fidell , 1996 ) .
each mother s perception of her child s weight was assessed using one item :  how would you describe your child s weight at the moment , with response options of :  very underweight, 
overweight and  very overweight. concern about overweight was assessed using the item :  how concerned are you about your child becoming or remaining overweight in the future , with response options on a 5-point scale : 
concerned ,  fairly concerned,  very concerned. both items have been used with parents of children of a similar age ( grimmett et al . , 2008 ; carnell et al . ,
children were weighed and measured in a private space at school by trained researchers using standardised procedures .
height was measured to the nearest millimetre using a freestanding stadiometer ( leicester height measure , seca , birmingham , uk ) , and weight ( kg ) to the nearest 0.01 kilogramme using the tanita tbf-300ma body composition analyser ( tanita corporation , japan ) .
inter - rater reliability in a sub - sample of 30 children was high for weight ( r=1.0 ) and height ( r=0.99 ) .
body mass index ( bmi : kg / m ) was calculated and converted into age- and sex - adjusted standard deviation scores ( bmi sd - score ) according to 1990 british reference data ( cole et al . , 1995 ) using the imsgrowth macro ( http://homepage.mac.com/tjcole ) .
bmi sd - scores were grouped into four weight categories based on the international obesity taskforce ( iotf ) criteria for healthy - weight , overweight and obesity ( cole et al . , 2000 ) , and the recently proposed criteria for underweight ( thinness grades 1 , 2 or 3 ) ( cole et al .
in addition , the healthy - weight group was subdivided into  lower - healthy - weight ( 50th centile ) and  higher - healthy - weight ( > 50th centile but not meeting criteria for overweight ) to create an additional sub - division of largest sub - group .
because of small numbers in the obese category , obese and overweight were combined into an  overweight / obese category .
very overweight , so just three categories of perceived weight ( underweight , normal weight , overweight ) were used in all analyses .
the patterning of each maternal feeding practice across weight groups was examined using trend analysis in spss one - way anova , both unadjusted and adjusted for demographic factors ( child sex and age , maternal ethnicity and education ) . because the weight distribution was similar to uk norms ( hse , 2006 , www.data.archive.co.uk ) , weighted rather than unweighted linear terms
similarly , the patterning of each feeding practice across weight perception groups and weight concern groups was examined using trend analysis both unadjusted and adjusted for socio - demographic factors ( child sex and age , maternal ethnicity and education ) to determine the suitability for correlation analyses .
pearson s bivariate correlations were run to test the first three ( of four ) steps in mediation analysis : ( a ) that the predictor ( bmi - sd - score ) is associated with the outcome ( feeding practices ) ( b ) that the predictor is associated with the mediators ( perceptions or concerns ) , and ( c ) that the mediator is associated with the outcome . to quantify the predictive value of bmi sd - score and perceptions and concerns on maternal feeding practices , and of bmi sd - score on perceptions and concerns , variables that were significantly correlated were entered into separate regression models . to test step four of the mediation analysis , child bmi sd - score ( the predictor variable )
must significantly predict maternal feeding style ( outcome variable ) in the absence of perceptions / concerns about child weight ( mediator variables ) and perceptions / concerns should be associated with both predictor and outcome variables .
mediation is assumed if the association between the predictor and the outcome is significantly reduced by inclusion of the mediator in the regression model ( baron and kenny , 1986 ) . in this case , if the association between child adiposity and maternal feeding style is reduced when maternal weight perception or concern is added into the regression model , perceptions and concerns are implicated as mediators . as a stronger test of mediation , the preacher and hayes ( 2004 ) bootstrapping approach to the sobel test ( sobel , 1982 ) was used to demonstrate the significance of an indirect effect of adiposity on maternal feeding styles via perceptions and concerns .
following ethical approval from the university college london ethics of non - national health service human research committee , 531 families with children aged 7 - 9 years from five london schools were invited to take part in the physical exercise and appetite in children study ( peaches ) .
this is a longitudinal study of the associations between eating behaviours , physical activity and adiposity during childhood .
parents were sent a questionnaire that included measures of attitudes to their child s weight and their feeding practices . there was a 60% return rate ( n=244 ) , with the majority of respondents being mothers ( n=213 ) . because mothers have been reported to feed differently to fathers ( blissett et al . , 2006 ) , analyses were restricted to mothers for homogeneity of the sample .
parents were asked to indicate their highest level of education ( in the uk system ) using seven response options (  no qualifications ,  o - level / gcse / equivalent , 
vocational , a - level / equivalent ,  bachelor degree / equivalent ,  higher degree and  other , please state ) . these were combined as 
ethnicity was reported using 11 response options based on 1991 uk census ( 1991 census , crown copyright , esrc purchase ) , but because of the diversity of the non - white groups , subdividing the sample into different ethnic sub - groups produced very small samples , and so ethnicity was dichotomised into 
maternal feeding practices were assessed with the child feeding questionnaire ( cfq ; birch et al . , 2001 ) , which has three subscales assessing 
i try to get him / her to eat anyway ) ,  restriction ( e.g.  i have to be sure that my child does not eat too many high fat foods ) , and  monitoring ( e.g.  how much do you keep track of the snack food ( e.g. crisps , cheesy crackers ) that your child eats? ) .
sometimes ,  often , and always for the pressure to eat and monitoring scales , and 
mean scale scores were computed if at least 70% of the items were completed ( tabachnick and fidell , 1996 ) .
each mother s perception of her child s weight was assessed using one item :  how would you describe your child s weight at the moment , with response options of :  very underweight, 
overweight and  very overweight. concern about overweight was assessed using the item :  how concerned are you about your child becoming or remaining overweight in the future , with response options on a 5-point scale : 
 very concerned. both items have been used with parents of children of a similar age ( grimmett et al . , 2008 ;
children were weighed and measured in a private space at school by trained researchers using standardised procedures .
height was measured to the nearest millimetre using a freestanding stadiometer ( leicester height measure , seca , birmingham , uk ) , and weight ( kg ) to the nearest 0.01 kilogramme using the tanita tbf-300ma body composition analyser ( tanita corporation , japan ) .
inter - rater reliability in a sub - sample of 30 children was high for weight ( r=1.0 ) and height ( r=0.99 ) .
parents were asked to indicate their highest level of education ( in the uk system ) using seven response options (  no qualifications ,  o - level / gcse / equivalent , 
vocational , a - level / equivalent ,  bachelor degree / equivalent ,  higher degree and  other , please state ) . these were combined as 
ethnicity was reported using 11 response options based on 1991 uk census ( 1991 census , crown copyright , esrc purchase ) , but because of the diversity of the non - white groups , subdividing the sample into different ethnic sub - groups produced very small samples , and so ethnicity was dichotomised into 
maternal feeding practices were assessed with the child feeding questionnaire ( cfq ; birch et al . , 2001 ) , which has three subscales assessing 
i try to get him / her to eat anyway ) ,  restriction ( e.g.  i have to be sure that my child does not eat too many high fat foods ) , and  monitoring ( e.g.  how much do you keep track of the snack food ( e.g. crisps , cheesy crackers ) that your child eats? )
disagree ,  slightly disagree ,  neutral ,  slightly agree , and  agree for the restriction scale .
mean scale scores were computed if at least 70% of the items were completed ( tabachnick and fidell , 1996 ) .
each mother s perception of her child s weight was assessed using one item :  how would you describe your child s weight at the moment , with response options of :  very underweight, 
overweight and  very overweight. concern about overweight was assessed using the item :  how concerned are you about your child becoming or remaining overweight in the future , with response options on a 5-point scale : 
concerned ,  fairly concerned,  very concerned. both items have been used with parents of children of a similar age ( grimmett et al . , 2008 ; carnell et al . , 2005 )
children were weighed and measured in a private space at school by trained researchers using standardised procedures .
height was measured to the nearest millimetre using a freestanding stadiometer ( leicester height measure , seca , birmingham , uk ) , and weight ( kg ) to the nearest 0.01 kilogramme using the tanita tbf-300ma body composition analyser ( tanita corporation , japan ) .
inter - rater reliability in a sub - sample of 30 children was high for weight ( r=1.0 ) and height ( r=0.99 ) .
body mass index ( bmi : kg / m ) was calculated and converted into age- and sex - adjusted standard deviation scores ( bmi sd - score ) according to 1990 british reference data ( cole et al . , 1995 ) using the imsgrowth macro ( http://homepage.mac.com/tjcole ) .
bmi sd - scores were grouped into four weight categories based on the international obesity taskforce ( iotf ) criteria for healthy - weight , overweight and obesity ( cole et al . , 2000 ) , and the recently proposed criteria for underweight ( thinness grades 1 , 2 or 3 ) ( cole et al . , 2007 ) .
lower - healthy - weight ( 50th centile ) and  higher - healthy - weight ( > 50th centile but not meeting criteria for overweight ) to create an additional sub - division of largest sub - group .
because of small numbers in the obese category , obese and overweight were combined into an  overweight / obese category .
very overweight , so just three categories of perceived weight ( underweight , normal weight , overweight ) were used in all analyses .
concerned ,  fairly concerned or  very concerned about their child s weight , so these categories were combined to form a single category named 
the patterning of each maternal feeding practice across weight groups was examined using trend analysis in spss one - way anova , both unadjusted and adjusted for demographic factors ( child sex and age , maternal ethnicity and education ) . because the weight distribution was similar to uk norms ( hse , 2006 , www.data.archive.co.uk ) , weighted rather than unweighted linear terms
similarly , the patterning of each feeding practice across weight perception groups and weight concern groups was examined using trend analysis both unadjusted and adjusted for socio - demographic factors ( child sex and age , maternal ethnicity and education ) to determine the suitability for correlation analyses .
pearson s bivariate correlations were run to test the first three ( of four ) steps in mediation analysis : ( a ) that the predictor ( bmi - sd - score ) is associated with the outcome ( feeding practices ) ( b ) that the predictor is associated with the mediators ( perceptions or concerns ) , and ( c ) that the mediator is associated with the outcome . to quantify the predictive value of bmi sd - score and perceptions and concerns on maternal feeding practices , and of bmi sd - score on perceptions and concerns , variables that were significantly correlated were entered into separate regression models . to test step four of the mediation analysis , child bmi sd - score ( the predictor variable )
must significantly predict maternal feeding style ( outcome variable ) in the absence of perceptions / concerns about child weight ( mediator variables ) and perceptions / concerns should be associated with both predictor and outcome variables .
mediation is assumed if the association between the predictor and the outcome is significantly reduced by inclusion of the mediator in the regression model ( baron and kenny , 1986 ) . in this case , if the association between child adiposity and maternal feeding style is reduced when maternal weight perception or concern is added into the regression model , perceptions and concerns are implicated as mediators . as a stronger test of mediation , the preacher and hayes ( 2004 ) bootstrapping approach to the sobel test ( sobel , 1982 ) was used to demonstrate the significance of an indirect effect of adiposity on maternal feeding styles via perceptions and concerns .
maternal and child characteristics are shown in table 1 . as intended in the sampling procedure ,
there was high ethnic diversity with 38% of mothers classified as non - white ; compared with national statistics ( ons , 2005 , www.ons.gov.uk ) .
there were no significant differences in children s characteristics betwee those whose parents responded or did not respond to the parental questionnaire .
differences in bmi sd - scores between boys and girls approached significance ( t=(211)1.89 , p=.06 ) , with girls ( m=.07 , sd=1.29 ) being slightly thinner than boys ( m=.26 , sd=1.28 ) .
prevalence of overweight and obesity ( 16% ) was lower than the general population ( 33% ) ( www.dh.gov.uk ) , which may be due to families with heavier children choosing not to participate in the study .
linear trend analysis demonstrated a significant negative trend across child weight groups for  pressure to eat in the adjusted ( f(3,190)=3.78 , p=.012 ) and unadjusted models ( f(1,208)=6.93 , p=.003 ) , and a significant positive trend across weight groups for  restriction in the adjusted ( f(3,189)=2.95 , p=.034 ) and unadjusted models ( f(1,206)=6.25 , p=.01 ) .
normal weight. only 41% of underweight children were perceived as underweight , and only 44% of overweight or obese children were perceived as overweight . for concern about overweight ,
50% of mothers of children classified as overweight / obese were concerned or very concerned about their child staying or becoming overweight in the future .
there was a significant linear trend for perceived weight across child weight groups in unadjusted ( f(1,209)=76.69 , p<.001 ) and adjusted ( f(3,188)=28.51 , p<.001 ) analyses , indicating that although mothers perception of their child s weight was often incorrect , relative perception was correct .
concern about overweight showed a significant linear trend across child weight groups in the unadjusted ( f(1,209)=33.48 , p<.001 ) and adjusted models ( f(3,202)=17.49 , p<.001 ) .
mean cfq subscale scores across categories of perceived weight and concern for overweight are illustrated in table 3 .
there was a significant linear trend for  pressure to eat across perceived weight categories in the adjusted ( f(2,188)=4.79 , p= .009 ) and unadjusted models ( f(1,208)=11.15 , p=.001 ) , with lower use of pressure for children who were perceived to be more overweight .
restriction across categories of concern about overweight in both unadjusted ( f(1,206)=21.24 , p<.001 ) and adjusted models ( f(2,188)=9.60 , p<.001 ) , with restriction increasing among mothers who were more concerned about overweight .
table 4 illustrates the bivariate correlations between bmi sd - score , perceptions , concerns and maternal feeding practices .
bmi sd - score , perception of child weight and maternal pressure to eat were intercorrelated , as was bmi sd - score , concern and restriction ; fulfilling the criteria to test mediation and were taken forward into two separate mediation analyses .
monitoring was not included , because it was not associated with bmi sd - score or mediators .
linear regression analysis showed that bmi sd - score significantly predicted  pressure to eat ( =0.23 , p=.001 ) , restriction ( =.16 , p=.02 ) , concern about weight ( =.39 , p<.001 ) , and perception of weight ( =.56 , p<.001 ) .
perception of weight significantly predicted  pressure to eat ( =.023 , p=.001 ) , and concern about overweight significantly predicted 
following baron and kenny s criteria ( baron and kenny , 1986 ) , mediation analysis was appropriate for  pressure to eat and 
restriction was the only feeding practice significantly associated with both child weight group and maternal concern about overweight , and 
pressure was the only feeding practice associated with both child weight group and perception of child weight .
table 5 presents results of change in associations between bmi sd - score , and maternal feeding practices upon the addition of maternal perceptions or concerns .
when concern for child overweight was added into the regression model , the association between child bmi sd - score and  restriction became non - significant ( =.04 , p=.44 ) , but concern remained a significant predictor ( =.30 , p<.001 ) , with the full model explaining 9.9% of the variance . using bootstrapping ,
the sobel test confirmed the significance of an indirect effect of the association between child adiposity and restriction ( z=3.29 , p=.001 ) , indicating that maternal concern about child overweight mediates the relationship between the child s actual weight and parental use of restrictive feeding . when perception of child weight was added to the model to predict  pressure to eat ,
the effect was reduced , but the association between child bmi sd - score and pressure remained significant ( =.17 , p=.04 ) with the full model explaining 7.1% of the variance .
linear trend analysis demonstrated a significant negative trend across child weight groups for  pressure to eat in the adjusted ( f(3,190)=3.78 , p=.012 ) and unadjusted models ( f(1,208)=6.93 , p=.003 ) , and a significant positive trend across weight groups for  restriction in the adjusted ( f(3,189)=2.95 , p=.034 ) and unadjusted models ( f(1,206)=6.25 , p=.01 ) .
normal weight. only 41% of underweight children were perceived as underweight , and only 44% of overweight or obese children were perceived as overweight . for concern about overweight ,
50% of mothers of children classified as overweight / obese were concerned or very concerned about their child staying or becoming overweight in the future .
there was a significant linear trend for perceived weight across child weight groups in unadjusted ( f(1,209)=76.69 , p<.001 ) and adjusted ( f(3,188)=28.51 , p<.001 ) analyses , indicating that although mothers perception of their child s weight was often incorrect , relative perception was correct .
concern about overweight showed a significant linear trend across child weight groups in the unadjusted ( f(1,209)=33.48 , p<.001 ) and adjusted models ( f(3,202)=17.49 , p<.001 ) .
mean cfq subscale scores across categories of perceived weight and concern for overweight are illustrated in table 3 . there was a significant linear trend for  pressure to eat across perceived weight categories in the adjusted ( f(2,188)=4.79 , p= .009 ) and unadjusted models ( f(1,208)=11.15 , p=.001 ) , with lower use of pressure for children who were perceived to be more overweight .
no significant trends were found for restriction or monitoring across perceived weight groups . there was a significant linear trend for 
restriction across categories of concern about overweight in both unadjusted ( f(1,206)=21.24 , p<.001 ) and adjusted models ( f(2,188)=9.60 , p<.001 ) , with restriction increasing among mothers who were more concerned about overweight .
table 4 illustrates the bivariate correlations between bmi sd - score , perceptions , concerns and maternal feeding practices .
bmi sd - score , perception of child weight and maternal pressure to eat were intercorrelated , as was bmi sd - score , concern and restriction ; fulfilling the criteria to test mediation and were taken forward into two separate mediation analyses .
monitoring was not included , because it was not associated with bmi sd - score or mediators .
linear regression analysis showed that bmi sd - score significantly predicted  pressure to eat ( =0.23 , p=.001 ) , restriction ( =.16 , p=.02 ) , concern about weight ( =.39 , p<.001 ) , and perception of weight ( =.56 , p<.001 ) .
perception of weight significantly predicted  pressure to eat ( =.023 , p=.001 ) , and concern about overweight significantly predicted 
following baron and kenny s criteria ( baron and kenny , 1986 ) , mediation analysis was appropriate for  pressure to eat and 
restriction was the only feeding practice significantly associated with both child weight group and maternal concern about overweight , and 
pressure was the only feeding practice associated with both child weight group and perception of child weight .
table 5 presents results of change in associations between bmi sd - score , and maternal feeding practices upon the addition of maternal perceptions or concerns .
when concern for child overweight was added into the regression model , the association between child bmi sd - score and  restriction became non - significant ( =.04 , p=.44 ) , but concern remained a significant predictor ( =.30 , p<.001 ) , with the full model explaining 9.9% of the variance . using bootstrapping ,
the sobel test confirmed the significance of an indirect effect of the association between child adiposity and restriction ( z=3.29 , p=.001 ) , indicating that maternal concern about child overweight mediates the relationship between the child s actual weight and parental use of restrictive feeding . when perception of child weight was added to the model to predict  pressure to eat ,
the effect was reduced , but the association between child bmi sd - score and pressure remained significant ( =.17 , p=.04 ) with the full model explaining 7.1% of the variance .
this study demonstrated that mothers concern about their child s weight significantly mediated the association between their use of restrictive feeding practices and their child s adiposity .
this supports our hypothesis that restriction is more likely to be a response to maternal concern about overweight than a cause of weight gain .
, 2006 ; carnell and wardle , 2007 ; spruijt - metz et al , 2002 ) , child adiposity was inversely associated with the  pressure to eat feeding style , but neither maternal perception of the child s weight , nor their concern about their child being overweight in the future mediated this effect . that maternal concern about child overweight mediates the association between child adiposity and
 restriction suggests a plausible causal relationship : mothers who are not concerned about their child staying or becoming overweight in the future see no need to restrict their child s intake of unhealthy foods , while concerned mothers limit their child s intake in an attempt to control weight gain .
restriction may therefore be a result of maternal concern rather than a cause of weight gain .
the cross - sectional nature of our study means causality is only implicated , not confirmed , but some support comes from a longitudinal study of 7 - 14 yr old african- and white - american children in which maternal concern about child weight was associated with lower increase in fat mass 3 years later ( spruijt - metz et al . , 2006 ) .
if maternal concern results in greater control in child feeding , this may be protective against childhood weight gain .
perceptions of child weight did not fully mediate the association between child adiposity and pressure to eat , but there was little variation in mother s perception of their child s weight with most mothers perceiving their child as normal - weight .
however , concern for overweight also did not mediate the association between child adiposity and pressure to eat .
previous research in a sample of mothers and their infants ( n=634 ) showed that maternal concern about their child being underweight was associated with pressure to eat ( baughcum et al . , 2001 ) ; suggesting that mothers who perceive their child as underweight use more pressuring strategies . a similar trend across perceived weight groups was found in the present study . a more sensitive measure of concern for underweight might help test whether  pressure to eat is , like  restriction , also a child - responsive parental feeding practice , rather than accepting the more unlikely hypothesis that pressure to eat is protective against weight gain .
however , pressure is more likely to be related to diet quality generally than weight specifically because it is often exerted to ensure that healthy foods are consumed .
mothers who are worried about the quality of their child s diet might also be expected to exert more pressure , but perceptions of diet quality were not assessed in this study .
one limitation of this study is that the measurement of maternal concerns was limited to a single question asking about both current and future weight concerns .
it is therefore not possible to know whether the concern was about either current or future overweight or a combination of the two .
furthermore , maternal concerns are likely to extend beyond weight to include the child s eating and activity patterns .
studies assessing the influence of such concerns on controlling feeding practices and their future consequences on children s weight are needed .
there was limited variance in the measure of maternal perceptions and concerns , making it necessary to combine response options into three categories , and thereby lose detail .
another limitation is the cross - sectional nature of this study , precluding causal inference . in these analyses , the child s body size ( bmi sd - score )
was treated as the independent variable rather than outcome , but the alternative model in which concern causes restriction and thereby weight gain can not be ruled out .
other possible interpretations , such as overlap of the concern and restriction categories , or that another untapped variable is relevant to how parents feed their children , may account for the findings .
importantly , the current study has identified a significant mediating factor in the relationship between child adiposity and parental feeding practices proving the need for further research . because peaches is a longitudinal study , future work will be able to assess longitudinal associations between child weight , maternal concern and maternal feeding practices , allowing more explicit testing of causal relationships .
another weakness is that the sample was lean relative to the wider population ; which we believe to be due to heavier children electing not to participate .
however , a greater spread across the weight trajectory should strengthen rather than weaken the associations observed here .
the socio - economic and ethnic diversity of the sample is a strength , allowing greater generalisability of the findings .
our results indicate that attributing overweight to excessive maternal control in feeding , in particular to mothers use of restriction , is unjustified .
mothers appear to adopt specific restrictive feeding strategies in response to their concerns about their child s weight .
instead of blaming parents for influencing childhood weight through detrimental feeding practices , future work should explore maternal concerns and beliefs about feeding in more detail , and identify the type and degree of control that is effective for optimal diet and growth .
 objectiveto determine whether controlling parental feeding practices are associated with children s adiposity and test the hypothesis that any associations are mediated by maternal perception of their child s weight.methodchildren aged 7 - 9 yrs ( n=405 ) were weighed and measured at school as part of the physical exercise and appetite in children study ( peaches ) . 
 adiposity was indexed with bmi sd - scores . 
 the child feeding questionnaire ( cfq ) was completed by 53% of mothers of participating children ( n=213 ) . 
 mothers reported whether they thought their child was overweight , normal weight or underweight , and rated their concern about future overweight on a 5-point scale.resultshigher child adiposity was associated with lower  pressure to eat and higher  restriction scores . 
 restriction increased linearly with maternal concern about overweight , and maternal concern about overweight fully mediated the association between child adiposity and restriction . 
 use of pressure increased as mothers perceived their child to be thinner , but perceived weight did not mediate the association between child weight status and maternal pressure to eat . 
 monitoring was not associated with child adiposity , maternal perception of weight or concern about overweight.conclusionrestriction appears to be a consequence of mothers concern about their child becoming overweight rather than a cause of children s weight gain . 
 pressure may be a more complex response that is influenced by the desire to encourage consumption of healthy foods as well as ensure adequate energy intake and appropriate weight gain . 
Methods
Participants
Measures
Maternal socio-demographic information
Maternal feeding practices
Maternal perception of weight and concern about overweight
Childrens anthropometry
Data treatment and statistical analysis
Results
Trend analysis: Maternal feeding practices across child weight groups
Trend analysis: Maternal perceptions and concerns across child weight groups
Trend analysis: Maternal feeding practices across child weight perception and concern groups
Mediation analysis
Discussion