What can families gain from the family meal? A mixed-papers systematic review

Abstract

The family meal has been associated with numerous health and wellbeing benefits for both adults and children. However, the majority of the research in this area is correlational, unable to prove a causal relationship between family meals and health and wellbeing outcomes. The objectives of this systematic review were to determine the causal relationship between family meals and health and wellbeing and explore family members’ perceptions of the family meal. A systematic search across five databases was undertaken to identify both intervention studies and qualitative studies investigating the family meal. Thirty-two articles were deemed eligible for inclusion in this review. Qualitative data were synthesised via the meta-aggregation approach; however, the quantitative data were too heterogeneous to perform meta-analysis. Only one intervention included in this review exclusively targeted the family meal, the remaining studies had other target strategies as part of their intervention (e.g. physical activity, snacking, sleep routines). Only two of the eight interventions reported a statistically significant difference between control and intervention groups for family meal frequency or quality, therefore we were unable to fully explore the causal relationship between family meals and health and wellbeing outcomes. The qualitative studies identified multiple barriers to the family meal, including scheduling conflicts, exhaustion and lack of time, and reported family connection and communication as the main perceived benefits of the family meal. There is a gap between the benefits and barriers to the family meal identified through qualitative research, and current intervention strategies, with few interventions exclusively targeting the family meal. Interventions that are informed by qualitative literature and exclusively target the family meal are needed to further investigate the causal relationship between family meals and potential health and wellbeing outcomes.

Introduction

The family meal has received a great deal of attention across the scientific literature, particularly in the last few decades. Coming together regularly for a family meal has been associated with dietary and weight benefits for both adults and children (Dallacker, Hertwig, & Mata, 2017; Fulkerson, Larson, Horning, & Neumark-Sztainer, 2014). Positive associations have also been reported between the family meal and improvements in wellbeing (Goldfarb, Tarver, Locher, Preskitt, & Sen, 2015), reduced risk-taking behaviours (Goldfarb et al., 2015) and fewer disordered eating behaviours in adolescents (Harrison et al., 2015). However, it is still unclear what aspects of the family meal are responsible for these health and wellbeing benefits.

Family meal research has been largely observational, specifically longitudinal or cross-sectional in design (Fulkerson et al., 2014). While these types of studies have provided us with insight into the lives of families and their eating habits, these study designs are not able to draw causal links between the family meal and the associated benefits. While our confidence in these findings increases with the breadth of observational studies conducted in this area, still they can only prove associations or correlations between regularly engaging in the family meal and positive outcomes (Peat, Mellis, Williams, & Xuan, 2002). Thus, the study of family meals using experimental intervention designs is vital if we are to establish causality with confidence.

Experimental studies have started emerging in the area of family meals, attempting to bridge this gap. A systematic review of experimental research was published by Dwyer and colleagues in 2015 (Dwyer, Oh, Patrick, & Hennessy, 2015). Dwyer's review included randomised controlled trials, pre-test post-test, cross-sectional, longitudinal and qualitative study designs, was limited to studies conducted in the United States and focused on families with children aged 5–18 years (Dwyer et al., 2015). The focus of Dwyer's review was on one component of family meals, changes to the frequency of the family meal, with four of the six included interventions reporting positive, statistically significant changes to family meal frequency (Dwyer et al., 2015). However only two of these interventions included comparison against control groups (DeBar et al., 2012; Johnson, Birkett, Evens, & Pickering, 2006). Dwyer's review did not explore other elements of the family meal that may be responsible for positive health outcomes, such as the environment or nutritional quality of the meal. Additionally, the focus on studies from the United States with a limited age-range of children means there is a lack of transferability to other countries and families with younger children (Dwyer et al., 2015). Given the positive trajectory of the experimental studies in the Dwyer review, and as experimental studies in this area are only just emerging, it is timely to update the search and to broaden exploration into other countries and contexts.

While research into family meals is extensive, most studies, including Dwyer's review, focus on the frequency of the family meal as the main variable responsible for positive health outcomes. However, it has been proposed that the food served at the family meal and the environment of the family meal (who is present, what the mood is like, whether the TV is on etc.) may also be influencing factors (Fulkerson et al., 2014). As the component of the family meal (frequency, environment or quality of food) responsible for positive health outcomes has not yet been identified, all three aspects should be considered. In order to understand the impact the family meal may have on the health and wellbeing of those engaging in it, it is vital to understand the components that may be responsible for those outcomes.

Observational and intervention research can only take us so far in our understanding of the family meal and how it is experienced. The perceptions and experiences of the family meal from those participating in it is an important piece of the puzzle in determining the importance, value and health benefits of the family meal. Qualitative studies provide another view of the family meal, not to determine causality, but rather to delve deeper into the perceptions of the family meal (Liamputtong, 2013). This data is equally as important as the observational and intervention data, as it provides a depth of understanding that can help with interpreting the value of the family meal and where it fits in family life. The qualitative research, in combination with the experimental studies examining different components of the family meal, will allow us to understand the benefits to the family meal more comprehensively and completely.

The aim of this systematic review was to complete the triangulation of data on the family meal. We aim to provide a review of the intervention data to help with understanding the causal pathway between family meals and health and wellbeing outcomes. This will be complemented with the qualitative data to help with understanding family members’ perceptions of the family meal. By reviewing both intervention and qualitative studies we will be closer to answering the question of whether family meals are beneficial for health and wellbeing, and how we can best utilise the family meal to promote health and wellbeing in families.