Association of maternal immigration status with emotional eating in Taiwanese children: The mediating roles of health literacy and feeding practices

Background: Emotional eating has been linked to childhood obesity. A variety of emotions often trigger this form of eating, which has been associated with stress-induced overeating, loss of control eating, and binge eating in children. However, research on how maternal immigration status and feeding practices influence emotional eating in children within Asian contexts is sparse. This study examines the association between maternal immigration status and emotional eating in children, exploring the mediating roles of health literacy and feeding practices. Method: The study focused on children aged 10-11 and their mothers in Taiwan, utilizing a sample of 2308 mother-child dyads. The Child Feeding Questionnaire (CFQ) was used to assess mothers' feeding practices, while emotional eating was measured using a subscale of the Three-Factor Eating Questionnaire-Revised 18 (TFEQR18). Health literacy was evaluated using the Health Literacy Survey Questionnaire (HLS-EU-Q12). Confirmatory factor analysis, Pearson's correlation, and Structural Equation Models (SEMs) were employed to explore the potential pathways leading to children's emotional eating. Results: Children of mothers with foreign nationality demonstrate higher emotional eating scores compared to those with native-born mothers (5.73 vs. 5.35, p = 0.04). These mothers also have significantly lower health literacy levels (35.21 vs. 38.52, p < 0.0001). They are more inclined to use rewarding and pressure-to-eat feeding practices while showing reduced tendencies toward monitoring and restriction. Serial mediation models suggest that maternal foreign nationality influences children's emotional eating primarily by increasing rewarding and pressure-to-eat practices alongside reduced health literacy, which ultimately lowers monitoring practices. Conclusions: Interventions should improve maternal health literacy and promote healthy feeding practices. Future research should investigate these pathways across various geographic regions and age groups to develop targeted interventions for immigrant families.