REVIEW
Jennifer Martin-Biggers,4 Kim Spaccarotella,4,5 Amanda Berhaupt-Glickstein,4 Nobuko Hongu,6 John Worobey,4
and Carol Byrd-Bredbenner4*
4
Department of Nutritional Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ; 5Department of Biological Sciences, Kean
University, Union, NJ; and 6Department of Nutritional Sciences, University of Arizona, Tucson, AZ
ABSTRACT
The L.E.A.D. (Locate, Evaluate, and Assemble Evidence to Inform Decisions) framework of the Institute of Medicine guided the assembly of
transdisciplinary evidence for this comprehensive, updated review of family meal research, conducted with the goal of informing continued
work in this area. More frequent family meals are associated with greater consumption of healthy foods in children, adolescents, and adults.
Adolescents and children who consume fewer family meals consume more unhealthy food. School-aged children and adolescents who
consume more family meals have greater intakes of typically underconsumed nutrients. Increased family meal frequency may decrease risk of
overweight or obesity in children and adolescents. Frequent family meals also may protect against eating disorders and negative health
behaviors in adolescents and young adults. Psychosocial benefits include improved perceptions of family relationships. However, the benefits of
having a family meal can be undermined if the family consumes fast food, watches television at the meal, or has a more chaotic atmosphere.
Although these findings are intriguing, inconsistent research methodology and instrumentation and limited use of validation studies make
comparisons between studies difficult. Future research should use consistent methodology, examine these associations across a wide range of
ages, clarify the effects of the mealtime environment and feeding styles, and develop strategies to help families promote healthful mealtime
habits. Adv. Nutr. 5: 235–247, 2014.
Introduction
Reciprocal determinism, a key construct of Bandura’s Social
Cognitive Theory, posits that an individual’s characteristics,
behaviors, and environment within which the behaviors occur
simultaneously and reciprocally affect each other (1,2). The
environment provides both the setting and resources for individuals to use motivation, self-efficacy, and knowledge to perform behaviors. If, for example, environments do not support
weight-management behaviors, it is difficult for individuals to
avoid unhealthy weight gain (3–5).
An important, yet understudied, environment that profoundly affects health and body weight is the home, especially
for children (6–8). Home environment factors include the
physical environment, such as availability and accessibility of
food and physical activity opportunities, as well as behavioral
1
Supported by USDA/National Institute of Food and Agriculture grant 2011-68001-30170.
Author disclosures: J. Martin-Biggers, K. Spaccarotella, A. Berhaupt-Glickstein, N. Hongu,
J. Worobey, C. Byrd-Bredbenner, no conflicts of interest.
3
Supplemental Table 1 is available from the “Online Supporting Material” link in the online
posting of the article and from the same link in the online table of contents at
http://advances.nutrition.org.
* To whom correspondence should be addressed. E-mail: [email protected].
2
ã2014 American Society for Nutrition. Adv. Nutr. 5: 235–247, 2014; doi:10.3945/an.113.005116.
environments, such as self-efficacy to change, self-regulation
abilities, and feeding practices parents use with their children.
A behavior that occurs within the home environment
that deserves particular attention is sharing mealtimes. Evidence supporting the benefits of frequent family meals has
grown to the point that family meals are recognized as being
an important component of health promotion for children
(9,10). Moreover, the American Academy of Pediatrics recommends that families regularly eat meals together as part
of childhood obesity prevention strategies (11).
Numerous cross-sectional studies and a handful of longitudinal analyses examined family meals. Published reviews
of the effects of family meals tend to be older (12,13), narrow in scope [e.g., examination of the anthropologic timeline of family meals in the United States (14), focused on
a single population segment (9,15,16), limited breadth of
outcomes (16)], or brief (9). Thus, this review was prepared
to update and expand existing reviews and identify gaps in
the literature with regard to the effects of family meals.
A comprehensive literature search, guided by the L.E.A.D.
(Locate, Evaluate, and Assemble Evidence to Inform Decisions)
235
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Come and Get It! A Discussion of Family Mealtime
Literature and Factors Affecting Obesity Risk1–3
What We Already Know about Family Meals
Family meal definitions used in research
Throughout history, family meals have taken many forms
(20). In Table 1, it is indicated that the current concept of
a family meal used by researchers is generally defined as
those occasions when food is eaten simultaneously in the
same location by more than 1 family member. Definitions
vary with regard to the number of people who must be present to constitute a family meal (Supplemental Table 1),
ranging from all or most family members (21–33) (or people living with you) (34–40) to at least 1 parent and 1 child
(41–46). Other surveys simply ask about the “family” and do
not provide a more specific definition (47–58). Definitions
also vary with regard to the meal type, with some restricting
the definition to only the dinner meal (30,42,45,46,50–52,54–
56,58,59) and others recognizing any eating occasion as potentially a family meal (21–24,35–38,40,41,43,44,57,60).
Inconsistencies in definition, instrumentation, and lack of
validation studies limit the comparison of results across studies.
Family meal consumption typically is assessed with self-report
surveys, and, as discussed above, there are many differences in
question formatting and wording. Self-report surveys also
should undergo validation procedures (61), yet few studies
236 Martin-Biggers et al.
discuss performing cognitive testing to ascertain that study
participants interpret survey items as intended by researchers
or use of other validation techniques or report using validated
questions for family meal assessment (25,45,46,53,60,62–68).
Assessment of family meal frequency in research
Considerable research focused on the effect of family meal
frequency on health, developmental, and BMI outcomes.
Reviewed studies typically assessed family meal frequency
via retrospective self-report items instructing respondents to report how often family meals are eaten “usually”
(29,49,56,69,70), were eaten “within the last week”
(21,22,24,26–28,30,31,33,40,45,46,53,60,63,65,68,71),
or
were eaten “within the last month” (43) (Table 1).
Parents typically supplied family meal frequency data in
studies involving younger children, whereas older youth
generally reported these data (31,36,48,56,72,73). Reporting
bias may affect the veracity of family mealtime frequency
data: in a study of 902 adolescents and their parents, parents
were significantly more likely to report eating $5 family
meals per week than their adolescent children (57% vs. 47%)
(34). In particular, 10% of the adolescents surveyed vs. 22%
of parents surveyed reported having family meals 7 times per
week (34). Alternately, differences in reporting could be due
to inadequately pretested and validated survey items. Although
self-report items benefit from validation and reliability studies
(74), limited evidence could be located that discussed the development and psychometrics of family meal frequency assessments (23,27,28,34,36,39,41,62,71,73,75–78).
Temporal changes in family mealtime frequency
The decline in shared family time and shared meals is often
lamented in popular media and by parents anecdotally comparing differences between their own childhood and that of
their progeny (70). A detailed search of family meal frequency research found limited evidence that supports this
notion. Extant evidence includes a longitudinal survey of
>4000 Belgian families from 1966 to 1999 that reported
that the number of family meals declined from 1.56 to
0.88 meals per day (44). Another study found that the frequency of family meals in a single age group remained the
same from 1999 to 2012 yet showed declines in subgroups
of girls, middle school students, and children from low socioeconomic backgrounds (79). A Gallup telephone survey
of American adults found that, from February 1997 to December 2003, the number of adults with children aged
<18 y who had family dinner 7 nights per week fell from
37% to 28% (52). However, because of the lack of published
evidence, it is difficult to establish a solid assessment of family meal decline or stability in the United States over the past
few decades.
Why family meals are important: effects of family
meal frequency
The relations between frequency of family meals and nutrient
intake, food intake, obesity, disturbed/disordered eating practices, and psychosocial effects have been reported in the
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framework of the Institute of Medicine (17) was conducted to
describe family meal research methodology, identify links between family meals (frequency and atmosphere) and health,
developmental, and BMI outcomes across the lifespan. The
L.E.A.D. framework provides a suitable approach for the review
reported here in that it calls for assembling evidence using a
transdisciplinary perspective, assessing its quality, and putting
it in a context that can be used to support decision making
with regard to programming and research vis-à-vis obesity prevention and other public health problems (17,18). The L.E.A.
D. framework emphasizes selection of relevant “why,” “what,”
and “how” questions to guide the gathering of evidence that
will inform decision making (19).
Key search terms [i.e., family, meals, dinner, child(ren),
youth, and/or parent(s)] were used to locate pertinent research papers. Because family meal research is conducted
in a broad array of disciplines, such as nutrition, psychology,
child development, and family studies, both PubMed and
CINAHL (Cumulative Index to Nursing and Allied Health
Literature) were used to maximize the comprehensive,
transdisciplinary nature of this review. Searches were limited
to studies published in English from January 1999 to July
2013. The initial search yielded 1965 articles. A review of article abstracts to ensure congruence with the purpose of this
review and an inspection of the bibliographies of these articles yielded 81 articles. Following the L.E.A.D. guidelines
(17), a team of researchers reviewed the articles to identify
salient findings, including differences in methodologies,
possible interactions between factors, and gaps in the literature. Results were then organized by theme and summarized
to inform decision making of researchers and practitioners
and strengthen the evidence base associated with family
meals.
TABLE 1
Family meal definitions and response options used in reviewed articles
Definition
category
Main meal
Family eating any
meal together
Eating meal together
as a family
Child eats meals with parent
or other family members
Meals eaten together
as a family
Meals family food preparer
shared with children,
meals shared with
spouse/partner
Eating a meal with other
members of your household
Number of family members
eating each meal together
Eating with partner and child
Eat any meal with at least 1
family member
Eating regular family meals
Eating a family meal together
at a table
Family ate main meal together
Eat your main meal with all or
most of your immediate
family together
Eating any meal with family
Sit down together for a main meal
Dinner
Family ate dinner together
Family eats the evening meal
together
Family ate dinner together
Eat family dinner together
at home
Sit down at a table to eat
dinner together
At least 1 parent present
during evening meal
All or most of the family in
your house eat a meal
together
Cognitive testing
conducted
References
#2, 3–4, $5 times per week
Not specified
(47)
$4 d/wk, yes/no
Not specified
(48)
Never, rarely, sometimes,
often, always
Additive score [from a score
of 0 (no meals eaten
together) to a score of 3
(all meals eaten together)]
Times in the past 7 d
Internal consistency,
test–retest
Not specified
(62)
(49)
Not specified
(21–24)
0, 1–2, 3–4, 5–6, 7, .7 times
per week
Not specified
(23,35–39,73,79,91)
0, 1–2, 3–4, 5–6, 7, .7 times
per week
None, 1 or 2, 3 or 4, 5 or 6, 7, $8
times per week
Meals per week during the
past month
Not specified
(41)
(9,99)
Not specified
(43)
Frequency in the past 7 d
Yes
(60)
Frequency in the past 7 d
Content validity and
test–rest reliability
determined during
pilot testing
Not specified
(53)
Not specified
(128)
Open-ended
Always vs. sometimes vs. never
Pilot tested with focus groups
Validated 24-h food recall used
(64)
(82)
Times per week
Yes/no
Not specified
Yes
(90)
(25)
Percentage of the time (0–100%)
Questions reviewed by health
professionals and dietitians
and pilot tested
Yes
(67)
(57)
Hours per working day, Saturday
and Sunday
Days per week
Never/rarely, ,1, 1, 2, 3, 4, 5, or
.5 times per week
(70)
Never, sometimes (1–3 times
per week), most (4–6 times
per week), and every day (daily)
0–7 d
Not specified
(51)
Not specified
(55)
1–2, 3–4, 5–6, 7 d per typical week
Number of days per week
Not specified
Yes
(38)
(63,65)
Times per week
Not specified
(58)
#3, 4–5, 6–7 meals per the past 7 d
Yes
Open-ended, times during the past 7 d
Not specified
(45,46,68)
(40)
(Continued)
Discussion of the family mealtime literature 237
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Eat a meal together
with all or most of the
family in your house
Eating a meal with most
of the family members
who currently live with you
Whole household family
eats a meal together
Eat family meals together
Measurement and
response options
TABLE 1 (Continued )
Definition
category
Family meal (no additional
definition)
Sit down to eat dinner or
supper with other members
of your family
Eating dinner with their family
Eating any meal with family
Eating dinner with at least
some of the family
Family sitting down together
for dinner
Family ate dinner together
All or most of the people in
your family who live with
you eat dinner
Eat dinner with a parent
or guardian
Family ate dinner together
Family ate dinner together
at home
Do you have the family
eat the evening meal together?
Breakfast or breakfast and/or dinner
Parent eating breakfast with child
Some of the family eats breakfast
together
Family eats breakfast and dinner
All or most of the family
in your home eat dinner
or breakfast together
At least some of the family
eats dinner or breakfast
together
References
0, 1–2, 3–4, 5–6, 7, .7 times per week
Not specified
(86)
Never, some days, most days, every day
Not specified
(69)
Never, frequently, very frequently
Percentage of the time (0–100%)
Not specified
Questions reviewed by
health professionals
and dietitians and
pilot tested
Face validity and pilot tested
(129)
(67)
Not specified
(59)
,1, 1–3, $4 times per week
Not specified
(50)
Never, sometimes (1–3 times per
week), most (4–6 times per
week), and every day (daily)
0–1, 2–4, and 5–7 times per week
in an average week
Not specified
(51)
Not specified
(30)
Not specified
(42)
Times per month (never, #1, 2–3)
or times per week (1–3 or $4)
.5 times/week, yes/no
(72)
Never, hardly ever, sometimes, a
lot/all the time
At least once a day, a few times
a week, and approximately
once or less than once a week
0–3, 4–6, 7 d per week or “depends”
Not specified
(54)
Not specified
(52)
Yes/no
Yes
(66)
Times per week
0–7 d
Not specified
Not specified
(83)
(55)
No one eats breakfast, no breakfast
is served and everyone takes
something to eat, breakfast is
served but usually the family
does not eat together, and
breakfast is served and usually
the family eats it together (same
for dinner)
0, 1–2, 3–4, 5–6, 7 times during the
past week
Not specified
(84)
Not specified
(26–29,31,32,34,71)
Not specified
(89)
Times per week
literature. Most of these studies are cross-sectional and focused on adolescents.
Nutrient intake. Three cross-sectional studies demonstrated improved nutrient intakes among school-aged and
adolescent children as family meal frequency increased
(35,49,69). Youths who had family dinner on most days in
a week had significantly higher intakes of protein, fiber, calcium, iron, folate, and vitamins A, B-6, B-12, C, and E than
those eating dinner with their family less often (35,69). Fiber
238 Martin-Biggers et al.
Cognitive testing
conducted
intake was significantly and positively correlated with family
meal frequency among Mexican-American children and
teens (49). The role of family meals in improving adolescents’ intake of calcium and iron is particularly noteworthy
given that this group typically has a lower than recommended intake of these minerals (80).
Nutrient-dense food intake. Research provides consistent
evidence of a positive relation between frequent family
meals and greater intake of dietary components related to
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Eating dinner together as a family
Measurement and
response options
Low nutrient-dense food intake. Increased frequency of
family meals is associated with decreased intakes of low nutrient density foods and beverages (27,35,69,81,84). Four
cross-sectional studies examined soft drink consumption
and family meal frequency in youth. Although 1 study found
no association between regular soda consumption and family meal frequency (27), 3 studies reported significant inverse relations between soft drink intake and family meal
frequency (35,69,84). Adolescents who never had family
meals drank significantly more soda than those who had 7
or more family meals per week (35). Youth who had family
dinners on most days had a 27% lower OR for drinking soda
(as measured by 24-h food recall) than those who ate dinner
with their families less often or never (69).
A cross-sectional study that examined relations between
fried food, saturated fat, and trans fat intake and family
meal frequency reported that youths who had family dinner
on most days had a 33% lower OR for eating any fried foods
away from home than those eating family meals never or
only on some days (69). Youths eating family dinners on
most days also had significantly lower intakes of saturated
and trans fats as a percentage of total calories (69). However,
another study of youths found no association between family meal frequency and high-fat food intake or fast food restaurant use (27). Fathers of adolescents also benefit from
family meals: those who ate $7 family meals per week consumed significantly less fast food compared with those who
ate fewer family meals (81).
Finally, a pooled OR from a cross-sectional study of “unhealthy” eating patterns indicated that younger children in
families sharing at least 3 meals per week had 20% less
chance of having unhealthy eating patterns than those who
ate family meals less often (OR: 0.81%; 95% CI: 0.68,
0.95) (85). Unhealthy eating patterns included skipping
breakfast and eating <2 servings of fruits or vegetables daily.
Both nutrient and food intake at family meals depends on
the foods served (57). Indeed, serving fast food or takeout
foods at family meals may negate the nutritional benefits associated with family meals. Youths whose family meals comprised fast food served at home at least once per week drank
more soda and consumed more fat than those who ate less
fast food at home (49). Adolescents in families in which
fast food was served as family meals >3 times weekly were
significantly less likely to have vegetables and milk served
with meals at home than those in families serving fast foods
less often (86). For parents of these adolescents, serving fast
food at least 3 times per week was negatively associated with
vegetable intake and significantly increased likelihood of
overweight compared with parents with fewer fast food purchases (86). The effect of fast food and takeout food on food
and nutrient intake, whether eaten in the restaurant or at
home, or eaten with or separate from family members, is
likely unrelated to family meal frequency. Meals and snacks
prepared away from home supply more calories and fat per
eating occasion and less fiber, calcium, and iron per calorie
than foods prepared at home (87). Increased frequency of
eating family meals at home is associated with lower family
BMI, and increased frequency of family meals eaten away
from home is associated with higher family weights (41).
Serving fast food at family meals may be potentiated by
other, non-food characteristics. For example, children
whose mothers consider their employment as their most important role eat at fast food restaurants more often than
mothers who feel their family is more important than their
work (88).
Obesity. Associations between weight status and family
meal frequency suggest that obesity may be less common
among those who share more frequent family meals. For instance, 4-y-old children who engaged in at least 1 routine
(such as having a shared family dinner 6 or 7 nights per
Discussion of the family mealtime literature 239
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improved health (i.e., fruits, vegetables, calcium-rich foods)
among all age groups (27,35,40,45,48,51,57,69,81,82). For
example, among parents participating in the Special Supplemental Nutrition Program for Women, Infants, and Children, the number of servings of fruits, vegetables, and
milk products they provided for their preschoolers at mealtime was significantly and positively associated with the
number of family dinners per week (51). However, a study
of 2- to 5-y-old children in the United Kingdom found
that eating the same food as the parents was a better predictor of preschooler vegetable consumption than eating family
meals (57). Research with older children and adolescents
showed that those with greater frequencies of family meals
ate more servings of fruits, vegetables, grains, and calcium-rich foods (35,69). However, another study of adolescents found that family dinner frequency was positively
associated with fruit intake only (27) and that having a parent present at dinner was associated with higher fruit and
vegetable but not dairy intake among adolescents (45). Similar findings have been reported for parents. Adults who had
family meals with greater frequency also ate more fruits and
vegetables, with increases of 0.18 and 0.30 weekly servings of
fruits and vegetables, respectively, per increase of 1 shared
meal per week (40).
In addition to dinner meals, positive relations also exist
between having breakfast as a family meal and intake of
fruits and vegetables. Low-acculturated Latino children
who ate breakfast with their family at least 4 times per week
were significantly more likely to consume at least 5 servings
of fruits and vegetables per week than those who ate family
meals less often (48). Additionally, a study of limited-resource
families also reported significant, positive associations between
eating family breakfast at least 5–6 d/wk and consumption of
milk by the oldest child (53).
Longitudinal data suggest that the benefits of family
meals extend into the teen and young adult years. For instance, sharing breakfast with parents when a child is 10 y
old is associated with that child having more frequent breakfasts when aged 16 y (83). Young adults who ate $7 family
meals per week during adolescence had 0.7 more servings of
fruits and vegetables daily as young adults than peers who
never shared family meals in adolescence (33).
Disturbed/disordered eating practices. Some evidence indicates that increased family meal frequency may protect
240 Martin-Biggers et al.
against disturbed or disordered eating practices among teens
and young adults. A retrospective survey of females enrolled
in college showed an inverse relation between frequency of
having family dinners while growing up and bulimic behaviors (47). Findings from a longitudinal survey of adolescent
girls indicated that those who had more frequent family
meals 5 y earlier were less likely to use extreme weight control behaviors as peers who had less frequent family meals
(73). A meta-analysis of pooled results from 3 studies found
that teens who had $5 family meals per week had 45%
lower odds of having an eating disorder (OR: 0.65; 95%
CI: 0.58, 0.73) than their counterparts who had #1 shared
meals weekly (85). Even mothers who had $7 family meals
per week had fewer dieting and binge eating behaviors compared with those with fewer shared meals (91).
Psychosocial effects. Several studies investigated associations
between family meal frequency and psychosocial factors, including family relationships, academic performance, and
risk-taking behaviors.
Family relationships. Qualitative data indicate that family
meals improve perceptions of family relationships (e.g., perceived family support, communication, and parental involvement). Focus groups with parents of children under
the age of 5 y found that parents consider family meals to
be an opportunity to teach children manners, social skills,
how to clean up, share responsibility, and cook healthy
meals (92). Parents also consider family meals to be an opportunity to increase family connectedness (92) and share
values associated with food and eating (64). Parents identified lack of communication and lack of closeness among
family members to be negative outcomes of not eating together (92). Working parents of school-aged children indicated that they enjoyed the opportunity to bond with their
children during meals (26). Two-thirds of parents of 8- to
10-y-old children participating in focus groups reported
that they enjoyed conversation, togetherness, relaxing, and
laughing as a family unit during mealtimes (31). Adolescent
focus group participants named family interactions as an
important reason to have family meals (93).
Survey data support qualitative findings with regard to
beneficial effects of shared meals on family relationships.
Adolescents and their parents both viewed family meals in
a positive light (34), with parents having a more positive
view of family meals than adolescents (36). For both adults
and adolescents, there is a significant positive association between family meal frequency and strength of family cohesion (40). Interestingly, 1 research group reported a
significant negative association between family cohesion
and teens’ intake of sweets, thereby suggesting that family
meals may indirectly improve diet by strengthening feelings
of family cohesion (40).
Academic success. Sharing family meals may affect chil-
dren’s cognitive development and academic achievement.
Children’s participation in mealtime conversations provides
them with an opportunity to acquire new vocabulary words,
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week) had 23–25% lower odds of being obese than peers
who did not have a routine (including the routine of family
dinners 6 or 7 nights per week) (59). Among another group
of young children, those who both watched more television
and ate fewer family meals during kindergarten and grade
1 were more likely to be overweight in grade 3 than those
who spent less time watching television and ate more family
meals (89). Both male and female 17-y-old adolescents in
South Africa who had infrequent family meals (never to
once per week) had higher fat mass and BMI Z-scores
(90). In a racially diverse sample of “at risk” adolescents,
those who reported having no family meals the previous
week were almost 3 times more likely to be overweight
and 6 times more likely to be food insecure (defined as going
hungry $1 mo during the past 12 mo) than those reporting
having $5 family dinners per week (27). In addition, family
meal frequency was significantly associated with weight status
among younger white youths (analyses adjusted for gender,
socioeconomic status, and age), with those reporting no family meals being at greater risk of overweight (OR: 2.3; 95% CI:
1.0, 5.5) than those having $3 family meals weekly (28).
However, longitudinal models indicate that family meal frequency is not associated with overweight status in adolescents
(28). In addition, results from some cross-sectional studies are
mixed. For example, white adolescents who had more frequent
family dinners had a lower OR of being overweight, but this association did not hold true for black and Hispanic adolescents
(56). Another survey reported an inverse correlation between
frequency of family meals and BMI for the family unit yet
was significant for sons and not daughters (41). Negative maternal attitudes toward eating together, not actual family meal
frequency, increased the risk of overweight in Australian adolescents (54). Furthermore, a meta-analysis of 8 studies examining relations among shared family meals and overweight risk
of children and teens (85) reported that half of the studies reported no significant relations (28,46,54,56). However, when
the data from 8 studies were combined (n = 44,106 children
aged 4–17 y), there was a significant pooled OR (OR: 0.88;
95% CI: 0.81, 0.97), suggesting that children and adolescents
were 12% less likely to be overweight if they shared $3 meals
with their families each week than those who had family meals
less often (85).
The effect of family meal frequency on parent weight status is less clear. The Cornell National Social Survey, an annual
random digit dialing telephone survey of 1000 households
(38), reported no significant associations between frequency
of family meals and BMI, overweight, or obesity (39). However, family meal frequency was negatively associated with
lower BMI among adults in households with children (39).
Similarly, fathers’ BMI was found to be negatively correlated
with family meal frequency (41). In contrast, a study of parents of adolescents found no significant BMI differences
among parents who ate $7 meals per week compared with
those who ate fewer (91).
Risk-taking behaviors. Family mealtimes may help teens re-
sist engaging in risky behaviors. Results from a longitudinal
study indicate that having less frequent family meals at baseline was significantly and positively associated with substance use (i.e., cigarettes, alcohol, and marijuana) 5 y
later in teen females (23). A cross-sectional study of teens reported no significant association between family dinner frequency and substance use, although teens who reported
having $5 family dinners in the past week tended to use illegal substances less often than those eating family dinners
less frequently (27). The impact of family meals on risktaking behaviors may be due to the positive family cohesion
influences attributed to family meals. Adolescents who had
at least 5 family meals per week felt that they had significantly more positive life assets (e.g., family support, adult
role models, self-esteem) than teens having #1 family
meal weekly (30). Additional research should determine
how other factors, such as income, may interact with and
predict risky behaviors.
What Factors Mediate Family Meal Frequency?
The literature revealed numerous factors that appear to mediate the frequency of family mealtimes. The most commonly reported factors are described below.
Demographic characteristics
Myriad demographic characteristics appear to mediate the
frequency of family mealtimes. For instance, parental employment and family meal frequency are inversely related
(35,39), whereas the opposite is true when parents are married (39) or have higher education amounts (21). Among
high school–aged girls, those whose parents had earned at
least a college degree had significantly more family meals
per week compared with those whose parents had not completed high school (5.4 vs. 3.8 meals per week) (21). However, adolescent boys reported significantly greater totals of
weekly family meals than girls (4.5 vs. 4.2 meals) (35).
When weekly family meals were compared by race,
Asian-American families ate together most often and
African-American families least often (5.3 vs. 4.1 meals
per week) (35). Another study also found that AfricanAmerican families had few family meals (44% consumed
family meals #2 times per week) (99). Hispanic families
with preschool-aged children ate significantly more
family meals and fewer meals in front of the television
than other ethnicities (65).
Socioeconomic status also may affect family meal frequency: a study of lower-income families reported that
most (84%) families ate dinner together $5 times per
week (53). However, when comparing families across socioeconomic status, others reported significantly fewer family
meals per week for those at the lowest vs. highest socioeconomic status levels (4.2 vs. 4.9 meals per week) (35).
The age of children in the family also affects family meal
frequency, with these meals occurring more often when children are young and declining in frequency as children move
into adolescence (28,34,90). More than half of the children
who were 4 y old (59), 9 y old (69), or in grades 6–8 (30)
had family dinners at least 5 times weekly, whereas only approximately one-third of youths aged 14 y (69) or in grades
9–12 (30) did so. Parenting style is an additional influence
on family meal frequency, with adolescents whose mothers
demonstrate more authoritative parenting styles reporting
more frequent family meals (22).
Mealtime environments
An individual’s interpersonal or social environment affects
behaviors such as family mealtimes (2). If these environments do not support a behavior, it is difficult for individuals to engage in that behavior (3–5). Evidence from
parents of children aged 3–12 y indicates that having a
more “traditional” meal structure (e.g., frequent family
meals eaten in the kitchen or dining room, no television
on during meals) resulted in fewer problematic behaviors
in their children at mealtimes (62). The ritual aspect of having family meals also provides a setting for parents to encourage healthful behaviors in their families (81). The
interplay of environment and behavior underscores the importance of studying the setting in which family meals occur.
Mealtime atmosphere. Positive, argument-free mealtime
environments appear to promote greater daily energy intake,
perhaps above what is required for energy balance, among
preschoolers (100) (even after controlling for various variables) and offer adolescents protection against disordered eating behaviors (37,73,101). Although data are limited,
factors, such as lingering at the table, pressure to eat more
in the presence of others who do so, or a permissive parent
Discussion of the family mealtime literature 241
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“practice producing and understanding stories and explanations, acquire general knowledge, and learn to talk in culturally appropriate ways” (94). Additionally, scores for effective
communication within the family were higher for adolescents who had frequent family meals (42). Shared family
mealtimes also provide an opportunity for parents to engage
in “explanatory talk,” which allows children to ask questions
and discuss topics and events with parents, who help expose
children to new words and cause and effects (95,96).
By enhancing communication skills, it follows that family
mealtimes contribute to academic success. However, the 2
studies that assessed the relation between academic outcomes in children and family meal frequency had differing
results. Analysis of cross-sectional data from 4746 adolescents revealed that frequency of family meals was inversely
associated with low grade point average (97). In contrast,
a large, longitudinal study (n = 21,400) from the United
Kingdom found no relation between family meal frequency
and academic outcomes in children followed from kindergarten to grade 8 (55). A third study cited by several academic
studies as a secondary reference, a Lou Harris-Reader’s Digest
poll of high school seniors in 1994, reported better academic
scores among those who had more frequent and consistent
family meals (98). (The original study could not be located
for inclusion in the current literature review.)
Television. Watching television during family meals appears
to negate benefits associated with frequent shared meals
(37,52,86–88). Individuals may be more likely to overeat
when also watching television (102–110) and may learn unhealthy food habits from advertisements and programs
(119–116). Four studies examined the influence of television
being on during family meals (50,73,96,106). Children never
or rarely exposed to television during family meals were significantly less likely to consume soda and chips (48). Children who watched television during $2 meals per day
consumed fewer servings of fruits, grains, green and yellow
vegetables, beans, and nuts and more red and processed
meat, salty snacks, soda, and pizza than children from families in which television was never on during mealtime or
was on for only 1 meal daily (117). Fitzpatrick et al. (51) reported that, for each night television was on during family
meals, the odds of serving vegetables and fruits at meals at
least twice a day decreased significantly, thereby negating
the increases in vegetables consumed as family dinner frequency increased. However, a unique interaction between
television viewing and mealtime atmosphere also has been
reported. Among a sample of 4-y-old children and their parents, more meal conflicts were predictive of less time watching television but improved fruit and vegetable consumption
in the children (118). The authors hypothesized that parents
may have spent more time scolding their children to eat better, which left limited time for television viewing and created
the perception of an unpleasant mealtime atmosphere.
Participation in interventions to increase family meal
frequency
Although the literature suggests that family meals have many
benefits, only 2 studies could be located that taught families
about the importance of family meals. The “Promoting
Family Meals” materials incorporated multiple modes of
242 Martin-Biggers et al.
nutrition education to promote family mealtimes among
Special Supplemental Nutrition Program for Women, Infants, and Children families, resulting in significant increases in family meal frequency (60). The Healthy Home
Offerings via the Mealtime Environment program, a randomized intervention trial focusing on healthy cooking
and creating positive family meals in families with 8- to
10-y-old children, successfully improved several outcomes
among children, including food preparation skills and intake of dietary fiber, as well as parent meal preparation
self-efficacy (29).
Parental cognitions of family meals
No studies could be located that investigated parents’ family
meal cognitions (i.e., attitudes toward family meals, barriers
to family meals, and strategies for overcoming barriers to
family meals). Thus, to address this literature gap, trained
researchers conducted qualitative interviews with 25 demographically diverse parents who had at least 1 child aged 2–5 y
(mean 6 SD age: 32 6 7 y; 34% had a high school degree or
less) (119). Standard methods were used to analyze qualitative
data for themes and trends (120,121).
Attitudes toward family meals. Parents overwhelmingly
stated that they enjoyed and valued sharing meals with their
families. The majority either agreed or strongly agreed with
the statement “I look forward to eating family meals.” Parents felt that family meals gave them a time to encourage
healthy eating, form closer family bonds, “reconnect” with
their family, support and value their children, practice social
skills and manners, and enjoy and learn from each other
(119). These results are similar to previous findings: among
families with children and adolescents, family meals are important opportunities to improve communication and family closeness (31,64,92,93). However, 2 Canadian surveys
also found that one-fifth of married mothers considered
the dinner meal to be the most stressful event of their day
(122), and another reported that one-sixth found family
meals to be unpleasant and regularly involved arguments between family members (100). Focus groups of employed
mothers indicated that many women feel pressure to provide family meals and have difficulty making healthy meals
although they recognize their importance (66).
Perceived barriers to family meals. Parents named numerous barriers to having frequent family meals, with work
schedules and children’s after-school activities being the
most commonly cited barriers (119). Other barriers included lack of meal planning, not having a regular time
for meals, inability of young children to sit still at meals,
family members being hungry at different times, and picky
eaters making mealtimes difficult (119).
Adoption of strategies for overcoming barriers to family
meals. When asked “what helps you have family meals often,” parents reported using several strategies, including
making grocery lists and planning meals (119). They also
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feeding style that results in less mealtime arguing, may all
lead to increased energy intake in a positive meal atmosphere (100). Thus, public health initiatives to curb obesity
may need to emphasize the characteristics of healthful family meals, such as serving appropriate portions and limiting
fast food, rather than simply promoting happy, family
mealtimes.
Arguments at mealtime are common (72,100). Among
adults, arguments during dinner about eating behaviors
are associated with higher fat consumption (50). Parents’
perceptions of mealtime atmosphere may differ from that
of their children. A study of middle school students and
their parents reported that the adults perceived more arguments during dinner than did their teens (72). The authors
suggested that the varied levels of cognitive development
among adolescent participants may have influenced ability
to remember and estimate frequencies of mealtime events.
Additional research is needed to clarify the environmental
factors that affect mealtime behavior and understand the
role of response or social desirability bias in reports of mealtime atmosphere.
Implications for Research and Development of
Uniform Family Meal Interventions and
Assessment Tools
The overarching goal of the L.E.A.D. framework is to use evidence to inform continued work in this area (18,19). Although growing evidence points to the importance of
family meals in promoting health and well-being (9,10),
the present review also highlights gaps and future research
that is needed. Varying definitions of family meals make it
difficult to compare study findings. Thus, a standard definition used by all researchers would facilitate cross-study comparisons. A possible standard definition for family meal is
“meals eaten at the same time in the same location by all
or most family members living in the same household.” In
addition, there are numerous studies that assess meal frequency in adolescents, yet few involve preschool-aged samples, and even fewer include adults. There also are limited
data on temporal changes in family mealtime frequency,
which precludes the possibility of determining how family
meal frequency has evolved and its associations with other
changes in society and health outcomes. Recent evidence
with children and adolescents suggests that classifications
of <3 vs. $3 meals per week eaten as a family could assess
nutritional health and classifications of #1 to $5 (85). Additional research should confirm the applicability of these
findings across demographic groups.
Variations in items used to assess frequency of family
meals, as well as a dearth of psychometric data, further complicate comparisons of study results. Standard language used
by all family meal researchers, such as, “How many meals
did all or most of the family members living in your household eat together in the past month?”, would enhance the
ease of comparison of data across studies and strengthen
the evidence base. In addition, cognitive testing of this definition across age groups as well as test–retest reliability
studies could improve the usefulness of mealtime frequency
assessments and reduce the degree of incongruence in family
mealtime frequency reporting by parents and their children
(34,74). Although all self-reported data are subject to bias,
use of consistent, validated questionnaires would facilitate
evidence building and comparisons between studies.
Future research also should explore factors that mediate
family meal frequency. Parental employment, marital status,
education amount, ethnicity, parenting style, and child age
appear to affect family meal frequency. In addition, mealtime distractions, such as arguments and television viewing
during mealtimes, may lead to unhealthy family mealtimes
by promoting overeating and less healthy foods. Although
there is limited evidence about the effects of mealtime atmosphere on intake, the available data suggest that education about basic meal planning and nutrition principles,
rather than simply promoting a happy, family mealtime environment, could benefit many families.
Despite the limitations and gaps in the current peerreviewed literature, research findings demonstrated many
benefits of family meals. These confirm conclusions made
by Fulkerson et al. (124) in their recent study, published after
the literature search for the current review was conducted.
Children and adolescents who have more frequent family
meals appear to have higher intakes of nutrients and dietary
components related to improved health (i.e., fruits, vegetables, calcium-rich foods) and decreased intake of foods experts recommend consuming in limited amounts (i.e., soft
drinks, fast foods) (27,33,35,40,45,48,49,51,57,69,85). However, family meal benefits may be attenuated by the foods
served at the mealtimes. Families who eat fast foods at family
meals (either at home or away) do not have improved nutrient intakes and may be more overweight (86,88), although
additional research is needed to determine whether the foods
eaten or factors that influence families to serve fast foods at
family meals cause the nutrient differences noted.
Cross-sectional studies indicate that children and adolescents who consume more family meals have healthier BMIs
(28,41,56,59,85). The mechanism for this association may
be related to parental control of the eating environment
and maintaining routines for children, but this association
appears to be less clear in adults (38,39,41). Sharing family
meals during adolescence may be a protective factor against
the development of disturbed and disordered eating, especially among females (47,73,85). Sharing family meals also
appears to help families create stronger bonds and improve
family communication with children and adolescents, and
these improvements are valued by parents and children
(26,31,34,36,40,64,92,93). Finally, teens who have more frequent family meals appear to engage in less risk-taking behaviors, including drinking alcohol and using illegal
substances (23,27). This may be because of the presence of
more positive life influences among those with more frequent family meals (30).
Discussion of the family mealtime literature 243
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reported making meals ahead of time and storing them for use
later in the week and using time/effort-saving appliances, such
as slow cookers and microwave ovens. Some indicated that they
found “pockets” of time to prepare foods, such as when children were napping. Those who successfully had family meals
frequently did so by creating a family mealtime culture with
the expectation that family members were to be present at
meals, developing a structured mealtime routine (e.g., set the
table, institute a regular time to eat each day), and communicating work and after-school schedules with family members
(119). A Canadian study reported that parents having high
cooking self-efficacy were more likely to overcome barriers
and have significantly more family meals than those with low
self-efficacy (68).
Other parents indicated that a strategy they used to overcome resistance to attending family meals was making meals
enjoyable and minimizing mealtime stress (119). Enjoymentheightening and stress-reduction techniques included serving
foods that children enjoy, getting children involved in food
preparation and shopping, and keeping mealtime conversation
fun and interesting for the whole family. Some parents used
strategies that were incongruent with recommended child feeding methods (123), such as rewarding children for eating and
insisting children eat specific foods, such as vegetables.
244 Martin-Biggers et al.
improved health (e.g., fruits, vegetables) and decreased intake of components that are recommended to be consumed in limited amounts (e.g., soft drinks, fried foods)
(27,33,35,40,48,51,69,80,85,125) among children, adolescents, and adults. Youths who have more frequent family
meals tend to have lower BMIs. Increased family meal frequency also may be a protective factor against negative
health behaviors (e.g., alcohol consumption, illegal substance use) among adolescents. Family meals also offer
child development and family bonding benefits that are
valued by parents. Despite the many benefits, few interventions have focused on increasing family meal frequency.
Given the benefits of family meals, continued research is
justified to confirm and expand present knowledge. Currently, there are numerous interventions underway to
improve family mealtime frequency and environment
(29,60,64,127,128); these and future projects could greatly
contribute to our understanding of family meals by using
consistent, validated measures that permit comparisons
across studies.
Acknowledgments
All authors read and approved the final version of the
manuscript.
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