Parental practices and children's lifestyle correlates of childhood overweight/obesity in Europe: The Feel4Diabetes study

Parent and carer experiences of health care professionals' communications about a child's higher weight: a qualitative systematic review

OBJECTIVE

The objective of this systematic review was to identify, critically appraise, and synthesize the best available qualitative evidence on parent and carer experiences of communications from health care professionals concerning their child's higher weight.

INTRODUCTION

Public discourse on obesity has shifted in recent years and created pressure to change the way that weight is discussed in health care. A child's higher weight can be a sensitive issue to discuss in health care, but successful communication with parents can increase parental compliance with treatment and improve overall family welfare. It is, therefore, important to explore how parents and carers experience the communication about children's higher weight to ensure effective, up-to-date, and ethical counseling on childhood obesity.

INCLUSION CRITERIA

This qualitative review included studies that focused on the experiences of parents or carers of children (birth to 12 years) with a higher weight who received verbal or written communication from health care professionals about their child's weight.

METHODS

The following databases were systematically searched from 2010 onward: MEDLINE (EBSCOhost), CINAHL (EBSCOhost), PsycINFO (Ovid), Scopus, LILACS, and the Finnish health sciences database MEDIC. ProQuest Dissertations and Theses (ProQuest) was searched for unpublished articles. The search was conducted in July 2022 and updated in October 2023. No country or language limits were applied. A manual search was used to supplement the database searches. Study selection including title and abstract screening, full-text screening, critical appraisal, and data extraction were performed by 2 reviewers. The research findings were categorized and aggregated into synthesized findings. The synthesized findings were assigned confidence scores, and categories and finalized synthesized findings were agreed upon by all reviewers.

RESULTS

The 33 included studies varied in qualitative study design and methodological quality. There were over 900 eligible participants (parents and carers) and 147 unequivocal and credible research findings. The research findings yielded 8 categories and 3 synthesized findings with low confidence scores. The synthesized findings were as follows: i) Parents receiving communication on a child's higher weight experience strong feelings that can affect their parenting; ii) A health care professional's active and individual communication, with the sensitive use of words, creates a good communication experience for parents; and iii) Parents want to receive information about the child's higher weight that is useful to them and is based on an acceptable weight estimation.

CONCLUSION

Although confidence in the synthesized findings is low, this review indicates that communication from a health care professional on a child's higher weight should meet the parents' expectations and the family's situation and needs. Having the skills to deal with heightened emotions, using expertise and empathy as a professional, and providing appropriate information create a good communication experience for parents. In addition, parents' desire to protect their child and the strengthening of the parenting experience should be acknowledged to conduct safe communication.

SUPPLEMENTAL DIGITAL CONTENT

A Finnish-language version of the abstract of this review is available at: http://links.lww.com/SRX/A92 .

Psychosocial risks in metabolic dysfunction-associated steatotic liver disease

INTRODUCTION

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly becoming more prevalent in the general population. MASLD is more common in persons with low socioeconomic status (SES), yet little is known about the psychosocial challenges associated with this disease, and clinical recommendations on how to approach psychosocial challenges are lacking.

AREAS COVERED

A PubMed search using the search terms MASLD, psychosocial risks, stigmatization, psychiatric comorbidities (i.e. depression, bipolar disorder, psychosis, attention deficit hyperactivity disorder, and substance abuse), SES, quality of life (QoL), over the past 20 years (2004-2024) was performed.

EXPERT OPINION

Persons with MASLD often experience psychosocial adversities that may be expressed as lower SES, high prevalence of depression, and reduced QoL. Knowledge gaps remain regarding the association between severe mental disorders (e.g. psychosis and bipolar disorders). Timely detection and treatment of MASLD in persons with psychosocial risks may require attention and cross-field collaboration. Studies on QoL in persons with MASLD differ in methodology which makes formal comparisons difficult. Psychosocial adversity may be a barrier to lifestyle modifications, which remain the cornerstone of MASLD management. Guidelines on how to address psychosocial adversities in a clinical setting are warranted to improve outcomes and decrease further multimorbidity.

Risky Behaviors for Non-Communicable Diseases: Italian Adolescents' Food Habits and Physical Activity

BACKGROUND

Driving adolescents to more correct food habits and physical activity is crucial to promoting health and avoiding the increase in morbidity and mortality in adulthood. Literature has focused on these behaviors in the adult population, while studies on adolescents are more limited. This study aims to explore the level of knowledge, attitudes, and behaviors regarding nutrition and physical activity to acquire insight into adolescents and identify the associated predictors.

METHODS

A cross-sectional study was conducted among adolescents aged 10 to 19 years from public middle and high schools randomly selected in the Campania Region, Southern Italy. A self-administered questionnaire, including closed and open-ended questions, assessed socio-demographic and health-related characteristics, dietary habits, physical activity, and sources of health information.

RESULTS

Regarding socio-demographic and health-related characteristics, among 1433 adolescents who completed the survey, the mean age was 15.2 years, 50.5% were boys, 16.8% reported having a non-communicable disease, and 18% were overweight or obese. Multivariate analysis showed that older age, male gender, daily breakfast with at least one parent, higher self-rated knowledge on nutrition, awareness of fruit and vegetables consumption recommendations, correct dietary attitudes (daily breakfast, consumption of fruit and vegetables at least once a day, of legumes at least twice a week, and of carbonated sugary drinks less than once a day), the need for additional dietary information, meeting WHO physical activity recommendations, and less than two hours of daily screen time are determinants of a high quality diet score. Conversely, living with a single family member and current smoking were negatively associated with high quality diet. Older age, male gender, risk of alcohol abuse, higher quality diet, and lower mobile phone use are associated with meeting WHO physical activity recommendations. Since we investigated risky behaviors, potential limitations of this study could include social desirability and recall bias.

CONCLUSIONS

Many adolescents lead unhealthy lifestyles, but younger adolescents and girls appear to be at higher risk of unhealthy behaviors. Targeted initiatives promoting regular physical activity and balanced diets in schools, involving parents and teachers in a collaborative plan, are essential to improving adolescents' health and well-being.

Association between Screen Time and Sociodemographic Factors, Physical Activity, and BMI among Children in Six European Countries (Feel4Diabetes): A Cross-Sectional Study

Screen time among children in most European countries is notably high and is influenced by various sociodemographic and other factors. Our study aimed to explore the associations between parents' sociodemographic characteristics, socioeconomic status, body mass index (BMI), physical activity, risk status for type 2 diabetes, and their children's BMI, physical activity, and screen time. The data were sourced from the 2016 Feel4Diabetes study, involving 12,280 parents and 12,211 children aged 6-9 years (average age 8.21 years) in a cross-sectional study design. We used a logistic regression model to identify potential factors associated with children's screen time. The results showed that mothers with tertiary education (OR = 0.64; 95%CI = 0.49-0.82; p < 0.001), the middle age group (45-54 years) (OR = 0.81 95%CI = 0.66-0.98; p = 0.033), and families with higher incomes (middle-OR = 0.85; 95%CI = 0.75-0.97; p = 0.014; high-OR = 0.8; 95%CI = 0.69-0.93; p = 0.003) were associated with a decreased chance of children spending more than 2 h/day in front of the screen. In contrast, maternal overweight/obesity (OR = 1.15; 95%CI = 1.03-1.29; p = 0.013) and lower physical activity in children were linked to an increased likelihood of more than 2 h of screen time per day. Our findings suggest that targeted interventions should be developed to mitigate excessive screen time, particularly focusing on low-income families and mothers with low educational levels.

The Role of Parental Adherence to the Mediterranean Diet and Family Time Together in Children's Weight Status: The BeE-School Project

The family context has been associated with children's weight status. This study aims to investigate the association of parents' adherence to the Mediterranean diet and family time with the weight status of children. The research is part of BeE-school, a cluster-randomized trial implemented in primary schools located in socially vulnerable contexts. A total of 735 children (380 boys and 355 girls) aged 6 to 10 participated in the study. Anthropometrics were assessed during school time, and weight status was categorized, while parents self-reported sociodemographic variables, adherence to the Mediterranean diet (MEDAS questionnaire), and family time. Children from families with higher education levels whose parents have a high adherence to the Mediterranean diet have lower odds of overweight/obesity (odds ratio (OR) 0.301, 95% CI 0.143-0.634, p = 0.002). Also, children from families with lower education levels who have more time together with their family have lower odds of overweight/obesity (OR 0.731, 95% CI 0.573-0.934, p = 0.012). The family environment, mainly family time together and adherence to the Mediterranean diet, exerts a significant influence on children's weight status. Professionals working in children's health should consider the family when fostering health-promoting behaviors.