Social implications of overweight and obesity in children

Effects of Malnutrition on the Immune System and Infection and the Role of Nutritional Strategies Regarding Improvements in Children's Health Status: A Literature Review

Malnutrition refers to a person's status as under- or overnourished, and it is usually associated with an inflammation status, which can subsequently imply a different health status, as the risk of infection is increased, along with a deterioration of the immune system. Children's immune systems are generally more susceptible to problems than adults. In the situation of malnutrition, because malnourished children's immune systems are compromised, they are more likely to die. However, little is known about the underlying mechanism of altered immune functioning and how it relates to starvation. Nutritional interventions have been reported as cost-effective strategies to prevent or treat the development of malnourishment, considering the link between food intake and health, especially in children, and also the susceptibility of this population to diseases and how their health status during childhood might affect their long-term physiological growth. The ingestion of specific nutrients (e.g., vitamins or oligoelements) has been reported to contribute to the proper functioning of children's immune systems. In this review, we aim to describe the basis of malnutrition and how this is linked to the immune system, considering the role of nutrients in the modulation of the immune system and the risk of infection that can occur in these situations in children, as well as to identify nutritional interventions to improve their health.

The "Stages Towards Completion Model": what helps and hinders children with overweight or obesity and their parents to be guided towards, adhere to and complete a group lifestyle intervention

Purpose: Lifestyle interventions can be effective in the management of overweight and obesity in children. However, ineffective guidance towards interventions and high attrition rates affect health impacts and cost effectiveness. The aim of this study was to gain insight into the factors influencing participation, in particular guidance towards, adherence to and completion of an intervention.

Methods: A narrative literature review was performed to identify factors related to participation, leading to the development of the “Stages towards Completion Model”. Semi-structured interviews (n = 33) and three focus group discussions (n = 25) were performed with children and parents who completed two different group lifestyle interventions, as well as with their coaches.

Results: The main barrier to participating in a lifestyle intervention was the complex daily reality of the participants. The main facilitator to overcome these barriers was a personal approach by all professionals involved.

Conclusions: Participation in a lifestyle intervention is not influenced by one specific factor, but by the interplay of facilitators and barriers. A promising way to stimulate participation and thereby increase the effectiveness of interventions would be an understanding of and respect for the complex circumstances of participants and to personalize guidance towards and execution of interventions.

Walking in the shoes of caregivers of children with obesity: supporting caregivers in paediatric weight management

To incorporate the perspectives and experiences of family caregivers of children with obesity, the KidFit Health and Wellness Clinic, a paediatric weight management programme, embedded feedback opportunities into various stages of programme development. Caregivers were eligible to participate if their children had completed initial 4-week group-based pilot programming or were currently receiving treatment in 10 or 12 week group-based programming. Data were collected through feedback session discussions, audio-recorded, transcribed verbatim and analysed thematically. In total, 6 caregivers participated in the pilot group feedback session and 32 caregivers participated in the structured group feedback sessions. Caregivers reported that healthy lifestyle strategies first communicated by clinic staff to children during group sessions provided expert validation and reinforcement when discussing similar messages at home. Caregivers reported feeling isolated and blamed for causing their children's obesity and appreciated the supportive forum that group-based programming provided for sharing experiences. Since experiences of blame and isolation can burden caregivers of children with obesity, paediatric weight management programmes might consider including peer support opportunities and discussion forums for ongoing social support in addition to education about lifestyle change.

Characterization of Courtesy Stigma Perceived by Parents of Overweight Children with Bardet-Biedl Syndrome

Background

A child’s obesity is generally perceived by the public to be under the control of the child’s parents. While the health consequences of childhood obesity are well understood, less is known about psychological and social effects of having an obese child on parents. We set out to characterize stigma and courtesy stigma experiences surrounding obesity among children with Bardet-Biedl syndrome (BBS), a multisystem genetic disorder, and their parents.

Methods

Twenty-eight parents of children with BBS participated in semi-structured interviews informed by social stigmatization theory, which describes courtesy stigma as parental perception of stigmatization by association with a stigmatized child. Parents were asked to describe such experiences.

Results

Parents of children with BBS reported the child’s obesity as the most frequent target of stigmatization. They perceived health care providers as the predominant source of courtesy stigma, describing interactions that resulted in feeling devalued and judged as incompetent parents.

Conclusions

Parents of children with BBS feel blamed by others for their child’s obesity and described experiences that suggest health care providers may contribute to courtesy stigma and thus impede effective communication about managing obesity. Health care providers may reinforce parental feelings of guilt and responsibility by repeating information parents may have previously heard and ignoring extremely challenging barriers to weight management, such as a genetic predisposition to obesity. Strategies to understand and incorporate parents’ perceptions and causal attributions of their children’s weight may improve communication about weight control.

A meta-analysis of weight status and anxiety in children and adolescents

OBJECTIVE

Although some posit that youth who are overweight/obese experience greater amounts of anxiety than their peers who are normal weight, extant literature shows that the association between weight status and anxiety in youth is equivocal. Therefore, the purpose of this study was to elucidate the association between weight status and anxiety in children and adolescents through meta-analytic methods.

METHOD

Electronic databases and review articles were searched for studies including quantitative data on weight status and anxiety in youth aged ≤18 years. Data were analyzed using a random effects model. Putative moderators were selected a priori.

RESULTS

A total of 61 studies yielded 78 effect sizes (N = 180,136) and a small but significant overall summary effect (r = .08; 95% confidence interval, 0.06-0.11; z = 6.41; p < .001). Gender, age group, and type of weight status measure significantly moderated the association. Specifically, studies with girls, children aged 12 years and under, or norm-referenced measures of weight status (e.g., body mass index [BMI] z-score) evidenced significantly higher effect sizes between weight status and anxiety than studies with boys, adolescents aged 13 years and over, or non-norm-referenced measures of weight status (e.g., BMI), respectively. Sample type, publication type, anxiety type, anxiety informant, and race/ethnicity were not significant moderators.

CONCLUSION

Overall, the association between weight status and anxiety is small; however, study or methodological characteristics may modestly influence the effect. Longitudinal studies are needed to determine the directionality of the association, and consequently, the intended target of intervention.

Qualitative studies among obese children and adolescents: a systematic review of the literature

Childhood obesity is a complex condition involving medical, social, moral and cultural issues. Qualitative approaches are of great value in understanding this complexity. This meta-synthesis of 45 qualitative studies deals specifically with the issue of obesity in children and adolescents from different perspectives--those of obese children and adolescents, of parents, and of health professionals providing support to the family. Our aim was to obtain a coherent view of child and adolescent obesity, focused on clinical and personal experience. The themes derived from the synthesis process fall under three main axes: 'Seeing others, seeing oneself', 'Understanding others, understanding oneself', and 'Treating others, treating oneself'. It emerges that participants in all three groups had equal difficulty in perceiving and labelling obesity, mainly because of their lack of any real common ground. The insufficiency of shared representations destabilizes the therapeutic relationship and its construction: an important issue in the doctor-child-parent relationship in this context is the need to exchange their viewpoints of obesity. Health workers may also expand their understanding of obesity by incorporating the personal experiences of obese children and their parents in order to match treatment plans to their needs and expectations.

Do cell phones, iPods/MP3 players, siblings and friends matter? Predictors of child body mass in a U.S. Southern Border City Middle School

SUMMARY

OBJECTIVE

This study examines the association of children's (i) micro-social environment, specifically siblings [kin-friends] and friends from school and neighborhood [non-kin-friends], and (ii) ownership of information and communication technologies (ICT), specifically cell phones and iPod/MP3 players, with body mass index percentile (BMIp).

SUBJECTS

Fifty-five randomly selected 6th graders with a mean age of 12 years, stratified by gender (23 boys and 32 girls), from a Texas middle school located in a city along the U.S. southern border.

METHODS

The linear regression of BMIp on number of siblings and of non-kin-friends, and ownership of cell phone and of iPod/MP3 player was examined using two models: M1 was based on the manual selection of predictors from a pool of potential predictors. M2 was derived from the predictors specified in M1 using backward elimination technique. Because sample size was small, the significance of regression coefficients was evaluated using robust standard errors to calculate t-values. Data for predictors were obtained through a survey. Height and weight were obtained through actual anthropometric measurements. BMIp was calculated using the on-line BMI calculator of the Center for Disease Control and Prevention.

RESULTS

Findings reveal that children's social environment and ICT ownership predict BMIp; specifically, number of siblings (M2: β = -0.34, p-value < .001), and ownership of iPod/MP3 players (M2: β = 0.33, p-value < .001). These results underscore the importance of family in configuring, and of new personal technical devices (that encourage solitary, and oftentimes sedentary, activities) in predicting child body mass.

Turkish mothers' perceptions of their children's weight

PURPOSE

This study was designed to determine mothers' perceptions and concerns about their preschool children's weight.

DESIGN AND METHOD

This descriptive survey was carried out with mothers of 4- to 6-year-old children attending preschool.

RESULTS

The prevalence of overweight among preschool children was 25.4%, but 73.3% of mothers of overweight children did not think that their children were overweight. Only 12.8% of mothers were concerned about their children being currently overweight; 8.1% worried that their children would become overweight.

PRACTICE IMPLICATIONS

Understanding parental views about their children's weight is a key step for designing effective prevention strategies.

Perceptions of exercise in obese school-aged children

BACKGROUND

Although the prevalence of obesity continues to increase worldwide, information related to obese school-aged children's perceptions of exercise remains limited.

PURPOSE

This study aimed to explore perceptions of exercise held by obese school-aged children.

METHODS

This study used a qualitative research design. Using purposive sampling, 11 obese students who were 11 to 13 years old, currently enrolled at two primary schools, and in the precontemplation stage were recruited from a total population of 1,714 to participate in the study. An interview guide with five open-ended questions was used to guide focus group discussions. Data were analyzed using content analysis to identify significant themes.

RESULTS

Six themes emerged from collected data, including (a) positive impressions about doing exercise, (b) recognition of negative effects associated with not doing exercise, (c) feelings of discomfort after exercise, (d) self-ambivalence, (e) false beliefs about exercise, and (f) making excuses for not doing exercise.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Study findings provided information giving a better understanding of exercise perceptions among obese children. Such may be used to assist obese children to increase exercise levels as part of efforts to improve health in this vulnerable population.