Behavioral Intervention for Mothers with Eating Disorders
1
Eating Disorder Behavioral Intervention for
First-Time Mothers
Overview
This overview provides information regarding mothers with eating disorders and their common behavior towards
their children. Reputable sources show a high correlation between certain behaviors exhibited by mothers with eating
disorders towards their children. Studies reported from 2002 until 2005 show a consistent pattern of mothers
behaving negatively towards their children when they are diagnosed with an eating disorder. Trials from studies
show that mothers are less likely to breast feed their children, more likely to engage in negative talk at mealtimes,
punish their children when it comes to food and are more likely to feed their children irregularly.
Citation: Coulthard, H., Blissett, J., Harris, G. (2003). The Relationship between parental eating problems and
children’s feeding behavior: A selective review of the literature. International Journal of Eating Disorders 5 (2), pp
103-115.
Objective
Design
Primary Objective: To determine the short and long-term
effects of a behavioral intervention for first-time mothers
with eating disorders who have a daughter three years of
age or younger.
A randomized, pretest-posttest nonequivalent groups
design was conducted for two months during the study
and for ten years following completion of the study.
Women who met study requirements were divided
randomly into an experimental (those receiving
behavioral intervention) and control group.
Treatments
Prior to the duration of the study there were random
sampling methods to determine participants. Women
who were diagnosed with an eating disorder and had a
daughter aged three or younger were considered for
the study. The control group consisted of women who
fit the criteria for the study but were not selected
during random sampling.
The intervention included behavioral modification for
the experimental group, including:
 Breast feeding for six months
 Positive conversation at mealtimes
 Regular mealtimes
 Avoid using food as a rewards/punishment
system
 Eating with children
Some flexibility was allowed as participants adjusted to
the changes in behavior during the intervention.
Follow-up visit occurred every 3 months for the first
year, every 6 months for the second and third years, and
every year for the remaining seven years. In-clinic visits
were mandatory and interviews, evaluations and
discussion with both mother and daughter were
required.
Trial Design
854,688 Women Screened
44,231 Women Randomized
22,118
Behavioral
Intervention
22,113 Control
Behavioral Intervention for Mothers with Eating Disorders
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Population
Female woman with eating disorders
Eligibility Criteria for study participation:
 Woman aged 20 to 35 at the time of study
 First-time mothers with a single daughter aged
three years or younger
 At least a high school degree
 Must be a United State citizen
 Women with eating disorders, defined by:
o Currently undergoing treatment at a
hospital or clinic after being diagnosed
o Treatment must not have exceeded
three consecutive months in hospital or
clinic
o Had a pattern of disordered eating for
at least five years prior to and during
participation of study
 Written informed Consent
Exclusion Criteria:
 Those who did not meet study requirements
 Those who have a history of an eating disorder
but have recovered since diagnosis
 Admitted to a hospital or clinic for more than
three consecutive months
 Those not selected by systematic random
sampling during study participation selection
(random sampling)
Endpoints
Primary Endpoint:
 Mothers who participated in the study created
a more wholesome environment for their
daughter, including:
o positive communication
o better social skills at mealtimes
o regular eating patterns
o eating with children
o developing normal eating behaviors
instead of using food as a
rewards/punishment system
Results
Primary Endpoint:
Early detections in behavioral modification did not go
unnoticed, but it wasn’t until later in the study that true
effects could be seen. The combination of different
treatments led to a successful change in behaviour
exhibited by mothers who previously had eating
disorders. In addition to radically changing the effect
they had on their young daughter, they also benefited
from the intervention by overall decreasing their own
eating disorders. This created happier and more
motivated mothers, both at the end of the study and
throughout the ten years of follow-up.
Secondary Endpoints:
Mothers who excelled at behavioral modification
provided a healthier atmosphere for their daughter;
however, some participants exhibited frustration and a
more stressful environment due to the difficulty of
changing their disordered eating behaviors so
drastically. Throughout the study some mothers never
overcame their frustration, but they did level out over
the course of follow-up and fell in with the rest of the
statistically significant study population.
The independent t-tests in Table 1 suggest that the
groups are not statistically different from zero at pretest
t(49) = .55, p = .85 (two-tailed).
However,
independent samples t-test are significantly different at
post-test t(49) = 3.24, p = .01 (two tailed). Finally,
paired t-tests suggest that behavioural modification
symptoms significantly increased in the experimental
group, but the control group remained the same.
Comparison
Secondary Endpoints:
 Daughters grow up with a more positive selfesteem
 Daughters grow up with a better body-image
 Daughters have a lower risk of developing
t
df
p
Behavioral Intervention for Mothers with Eating Disorders
Paired t-test for Behavioral Modification with Mothers
who have Eating Disorders
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Table 1
80
75
70
65
60
C o mp ar iso n
55
Pr o g r am
50
45
40
35
30
Pr et est
Po st t est
Independent Samples
T-Test
Pretest
Posttest
0.55
3.24
49
49
.85
0.01
Paired t-tests
Control
Program
0.25
3.33
49
49
.95
.01
Authors Conclusions




The overall benefits of the behavioral intervention outweighed monitoring the control group who received no
treatment
At the end of the study, the intervention proved beneficial to eating disordered mothers participating as
volunteers willing to change their behavior
Behavioral interventions should be implemented when woman diagnosed with eating disorders have children,
especially a daughter
Interventions should be monitored due to adverse affects that may occur as mothers undergo behavior changes,
including frustration and difficulty overcoming the harms from the eating disorder
Take–Away Message
Women with eating disorders treated with behavioral therapy including positive talk at mealtimes, regular eating
intervals, breast feeding for six months, and developing normal eating habits demonstrated:
 Decrease risk of daughter developing eating disorder
 More positive conversation between mother and daughter
 Increase level of communication and trust between mother and daughter
 Higher risk of healthier and normal eating patterns in both mother and daughter
The behavioral intervention for mothers with eating disorders has greatly influenced the relationship between mother
and daughter and created a healthier environment for both parties. Additionally, daughter has the opportunity to
develop normal eating behaviors due to the good influence that mother is providing.