Parental Perceptions of the Schools’ Role in Addressing Childhood Obesity

Adolescent Body Weight Perception: Association With Diet and Physical Activity Behaviors

To assess the prevalence of weight misperception in American adolescents and its association with diet and physical activity behaviors, Youth Risk Behavior Survey data were utilized for this study. Based on reported and perceived weight, adolescents in the study were grouped into four categories (true negative [52.4%] = normal body mass index [BMI]/accurate weight perception; false negative [11.3%] = high BMI/weight misperception; false positive [11.6%] = normal BMI/weight misperception; and true positive [24.8%] = high BMI/accurate weight perception). Diet and physical activity of adolescents were compared in these categories. A total of 12,016 participants were included in our analysis (74.9% aged 15–17 years, 54.5% Whites, 52% females). Almost a third (31.8%) were overweight and obese, and more than a fifth (22.9%) misperceived their weight (11.6% overestimated and 11.3% underestimated their weight). In a gender-stratified analysis, the odds of avoiding a healthy diet and physical inactivity were higher among those with body weight misperception.

Parents' Perceptions and Use of School-Based Body Mass Index Report Cards

BACKGROUND

Obesity in children and adolescents has become one of the most critical public health problems in the United States. Schools may play an important role in raising awareness and possibly slowing the obesity epidemic.

METHODS

The purpose of this study was to gather information on parents' perception and use of body mass index (BMI) report cards provided by public schools through the administration of a questionnaire. The questionnaire was developed with the assistance of physical educators, pediatricians, and exercise scientists. The questionnaires were backpacked home with 1127 students in 6 Arkansas public schools. Parents completed and returned 404 questionnaires.

RESULTS

Findings indicate that parents are supportive of schools reporting BMI and providing information on healthier lifestyles. However, most parents reported not making any adjustment to their child's diet and physical activity habits based on the BMI reports. Approximately half of parents (55%) thought the BMI report accurately reflected their child's health status. Approximately half of the parents reported their child's BMI report led them to think about their family's health habits.

CONCLUSIONS

Although parents do support receiving BMI information from schools, many did not indicate using the data to initiate changes such as increased physical activity or healthy eating.

Understanding Parents' Perceptions of School-Based BMI Screening and BMI Report Cards Using Perceptual Mapping: Implications for School Nurses

Half of U.S. states measure students' body mass index (BMI), with many communicating that information to parents through a "BMI report card" or notification letter. School nurses are usually responsible for implementing these programs and communicating results to parents. The purpose of this study was to understand parents' perceptions of BMI screening programs to help inform school nurses about messages that are most helpful to use in report cards to motivate parents to follow-up with a health-care provider or to make behavioral changes for their child. Using a cluster analysis and perceptual mapping methods, a commercial marketing technique that creates three-dimensional graphic maps, we identified four unique clusters of parents based on their core attitudes and beliefs related to BMI screenings and report cards. Based on vector modeling techniques, key message strategies were developed that can be used by school nurses to enhance parent response to a BMI report card.

BMI Health Report Cards: Parents' Perceptions and Reactions

In 2003, Arkansas became the first state to require body mass index (BMI) testing in public schools to raise awareness of the growing obesity epidemic among children and adolescents. Limited information exists regarding the effectiveness of school-based BMI screening programs. The purpose of this study was to determine if BMI health report cards affected parents' knowledge or actions regarding their child's health and to determine the accuracy of parents' perceptions of their child as underweight, normal weight, or overweight according to their child's BMI. A questionnaire was developed with the help of physical educators, pediatricians, and exercise scientists to determine parents' perceptions and behaviors regarding BMI report cards. The questionnaire was distributed to parents/guardians of children who sought medical care at two pediatrician's offices in Arkansas. Based on responses to survey questions, parents are not making changes to their child's diet and exercise habits if their child is classified as "at risk" or "overweight." However, parents did report that BMI health report cards are influencing their knowledge about their child's health. The majority of parents in the study (approximately 66%) did not accurately perceive their child's BMI category.

General practice views of managing childhood obesity in primary care: a qualitative analysis

OBJECTIVE

To explore general practice staff views of managing childhood obesity in primary care.

DESIGN

A qualitative study to elicit the views of clinical and non-clinical general practice staff on managing childhood obesity.

SETTING

Interviews were conducted at 30 general practices across England. These practices were interviewed as part of the Quality and Outcomes Framework Pilot Study.

PARTICIPANTS

A total of 52 staff from 30 practices took part in a semi-structured interview.

MAIN OUTCOME MEASURES

Key themes were identified through thematic analysis of transcripts using an inductive approach.

RESULTS

Three themes were identified: lack of contact with well children, sensitivity of the issue, and the potential impact of general practice. Identifying overweight children was challenging because well children rarely attended the practice. Interviewees felt ill equipped to solve the issue because they lacked influence over the environmental, economic and lifestyle factors underpinning obesity. They described little evidence to support general practice intervention and seemed unaware of other services. Raising the issue was described as sensitive.

CONCLUSION

General practice staff were unconvinced that they could have a significant role in managing childhood obesity on a large scale. Participants believed schools have more contact with children and should coordinate the identification and management of overweight children. Future policy could recommend a minor role for general practice involving opportunistically identifying overweight children and signposting to obesity services.

Assessing Child Body Mass Index Perceptions Among African American Caregivers in a Rural Community

In the USA, African American children residing in rural areas are disproportionately affected by childhood obesity. One strategy for preventing childhood obesity is helping caregivers to recognize their child is overweight or obese. The purpose of this study is to assess African American caregivers' perceived level of their child's obesity status and concordance between caregiver's reported height and weight of their children compared to the objective measure of their child's height and weight. Caregivers completed a paper-based survey about perceptions of their child's weight status including body silhouettes (n = 119) and self-reported their child's body mass index status (n = 68). Children's (n = 71) height and weight were objectively measured. Spearman rho and independent sample t tests were calculated to assess the relationship between caregiver's self-reported and objective BMI status. Caregiver's visually perceived their child's weight status to be underweight; yet, self-reported that their child's body mass index status was obese. The Spearman's rho correlation indicated a significant relationship between caregiver's self-reported and objective body mass index (r = .39, p < .001). The independent sample t test reflected that the mean self-reported body mass index and objective body mass index were statistically significant with calculated body mass index perception. The investigation of three different methods for assessing body mass index perceptions may contribute to the development of tailored programs and interventions that include counseling strategies that increase parental education about their child's body mass index.

Parental Perceptions of Body Mass Index Notification: A Qualitative Study

BACKGROUND

There is a worldwide epidemic of obesity in children. To address obesity in children, emphasis must be on factors within family, school, and community environments. Although most parents and school officials are aware of the problem of overweight children, there are few data available to guide decision making about the acceptability of school-based body mass index (BMI) screening and referral programs. Parental insight is essential to determine the efficiency and effectiveness of BMI notification.

METHODS

The purpose of this qualitative study was to explore the perceptions of parents whose school-age children received a BMI referral letter stating their child is overweight. Purposeful convenience sampling was used to obtain 21 parents. Semistructured interviews were used to collect the data.

RESULTS

Eight themes and corresponding subthemes emerged. The themes regarding parental perceptions were feelings about receiving the letter, causes of obesity, capabilities, barriers, role modeling, primary care provider response, school's role, and health screening process.

CONCLUSIONS

The findings of this study can serve as the foundation and provide guidance for parents, schools, healthcare professionals, and communities when attempting to implement changes and programs to combat the epidemic of childhood obesity.

A comprehensive review of school-based body mass index screening programs and their implications for school health: do the controversies accurately reflect the research?

BACKGROUND

Whereas legislation for body mass index (BMI) surveillance and screening programs has passed in 25 states, the programs are often subject to ethical debates about confidentiality and privacy, school-to-parent communication, and safety and self-esteem issues for students. Despite this debate, no comprehensive analysis has been completed that compares and contrasts how these issues differentially affect schools, parents, and students.

METHODS

A keyword search from electronic databases and a review of state legislation related to BMI surveillance and screening were used to identify relevant literature and data focused on surveillance and screening policies, BMI report cards, and parental perceptions of BMI screenings and their child's weight status [corrected].

RESULTS

This article addresses the gap of previous literature by outlining the ethical considerations and implications that BMI screening programs and report cards have for schools, parents, and students, and links these with outcome studies to address whether these controversies are supported by research.

CONCLUSIONS

Despite the controversies surrounding these programs, this review shows that they can be valuable for all parties and demonstrates BMI screening programs to be vital to the development of robust school-based obesity prevention programs and promotion of healthy lifestyles in schools.

Child's Weight Status and Parent's Response to a School-Based Body Mass Index Screening and Parent Notification Program

This study examined the response of parents of elementary school-aged children to a school-based body mass index (BMI) screening and parent notification program conducted in one Minnesota school district in 2010-2011 and whether parent's response was moderated by child's weight status. Randomly selected parents (N = 122) of second- and fourth-grade students completed a mailed self-administered anonymous survey. Child's weight status was determined using measured height and weight. Most parents read the BMI notification letter and considered it helpful, independent of child's weight status. Parents of overweight children were significantly more likely than parents of normal weight children to report healthy lifestyle changes. This low-intensity intervention has the potential to support children, especially overweight children, and their parents to make healthy lifestyle changes. Future studies should investigate whether parent's response contributes to improved short- and long-term health outcomes for children.

Childhood obesity prevention: a review of school nurse perceptions and practices

PURPOSE

The purpose of this review is to examine key school nurse perceptions that may promote or deter school nurse involvement in childhood obesity prevention (COP) practices.

CONCLUSIONS

Ten research articles were identified through a systematic review of the literature. School nurse participation in COP is inconsistent, and this variation is not well understood. Some variations in COP practices may be explained by differences in self-efficacy, perceived benefits, and perceived barriers.

PRACTICE IMPLICATIONS

Efforts are needed to develop and implement interventions and policies to modify those perceptions that may promote school nurse active engagement in COP practices.

The Massachusetts BMI letter: a qualitative study of responses from parents of obese children

OBJECTIVES

Massachusetts (MA) public schools conduct mandated body-mass index (BMI) screening and until recently, communicated results in a letter to parents/caregivers, to encourage primary care visits and provide aggregate data to the state Department of Public Health. This study assessed the letter's readability and qualitatively explored parents' responses to it.

METHODS

Readability of the BMI letter was calculated. Audio-taped 1-h focus groups were conducted with parents/caregivers of 8- to 14-year-old obese (≥95th BMI-for-age percentile) children. A semi-structured interview guide was used to elicit responses. Qualitative content analysis was conducted on transcripts to identify emergent themes.

RESULTS

Readability analysis showed higher grade levels than recommended. Eight focus groups consisting of two to six parents each were conducted (n=29); 83% were female, mean age 41±9years, and 65% self-identified as Hispanic/Latino. Key themes identified included usefulness of the BMI letter, concerns about utility of BMI for screening, concerns about impacting self-esteem, and failure to understand the letter.

CONCLUSIONS

The MA BMI letter may not have been achieving its desired goal with some parents.

PRACTICE IMPLICATIONS

Emergent themes from this study could be used to test effectiveness of similar BMI letters nationwide and develop strategies to improve communication to parents.

Parent interest in a school-based, school nurse-led weight management program

Because one in three children is already overweight or obese, school-based interventions targeting secondary obesity prevention merit consideration. This study assessed parent interest in participating in a school-based, school nurse-led weight management program for young school-aged children. A random sample of parents (n = 122) of second and fourth grade students in one large midwestern suburban school district completed a mailed survey. Associations between parent and child characteristics and interest in a school nurse-led after school weight management program for children, parent support group, and school nurse meeting with parent and child for weight management education were assessed using multivariate logistic regression. Non-White parents, parents concerned about their child's weight, and parents of girls were significantly more likely to express interest in program components than their counterparts. Future studies that develop, implement, and evaluate school-based, school nurse-led weight management programs targeting children who are overweight and obese merit attention.

Parents' perceptions of their children's weight, eating habits, and physical activities at home and at school

INTRODUCTION

Parental perceptions of their young children's weight and habits may play an important role in determining whether children develop and maintain healthy lifestyles. This study was conducted to determine perceptions of parents of third-grade children in an urban school setting regarding their children's weight, eating habits, and physical activities.

METHODS

Parents anonymously completed surveys about their child's weight, eating habits, and daily activities. The survey also asked about how schools could encourage healthy eating and increased physical activity.

RESULTS

Overall, 26% of the parents perceived their child to be overweight and expressed concern, but 40% of these parents believed that overweight is a condition that will be outgrown. Parents who reported eating more than eight meals per week with their child were less likely to report their child as overweight and more likely to believe that their child's physical activity level was appropriate.

DISCUSSION

Most parents of third-grade students demonstrated concern regarding their child's weight and perceive obesity as a problem. Parents support school interventions such as nutrition education and fitness classes.

The Development and Evaluation of a Measure Assessing School Nurses' Perceived Barriers to Addressing Pediatric Obesity

School nurses represent an important resource for addressing pediatric obesity and weight-related health. However, school nurses perceive numerous barriers that prevent them from addressing the weight-related health of students. The current study developed and tested a new, comprehensive measure of nurses' perceptions of 10 types of barriers to addressing pediatric weight in a nationally representative sample of 214 school nurses. The measure was developed in the context of Bronfenbrenner’s (1979) ecological systems theory and includes subscales assessing nurses' perceptions of skills-based, job-related, and societal barriers. Confirmatory factor analyses (CFAs) provided evidence for the validity of the measure, including the three barrier subscales. In addition, the subscales demonstrated adequate internal consistencies. Results indicate that school nurses perceive barriers to addressing weight-related health on multiple ecological levels, which may inform intervention or continuing education efforts. Future pediatric weight programs that involve school nurses might consider using the measure to assess nurses' perceptions of barriers.

The role of physical therapists in pediatric health promotion and obesity prevention: comparison of attitudes

PURPOSE

To identify attitudes of teachers, parents, and physical therapists (PTs) toward PTs' roles in health promotion (HP), obesity prevention (OP), and physical activity (PA) for preschoolers.

METHODS

Surveys (n = 618) were distributed to preschools and pediatric PTs.

RESULTS

Overall response rate was 42%. Dietitians or physicians were selected as most knowledgeable about HP/OP/PA. Teachers were selected as most appropriate to educate preschoolers, whereas PTs were identified as appropriate to educate parents and teachers about HP/OP/PA. Most respondents were unaware of PTs' involvement in HP/OP/PA.

CONCLUSIONS

Physical therapist expertise is underrecognized and underused for pediatric HP/OP/PA. Parents and teachers are open to PT's involvement. Physical therapists need to improve awareness and become involved.

Parental Perceptions of the Rural School’s Role in Addressing Childhood Obesity

This study employed cross-sectional, descriptive design with convenience sampling to explore rural parent perceptions of child obesity, use of Body Mass Index (BMI) in schools, preferences for receipt of BMI information and, the rural school’s role in obesity prevention/treatment. The survey “Parental Perceptions of BMI and Obesity in the School-Age Child” was used. Of the 183 surveys distributed, 65 were returned (35.5%). Fifty-five percentage of parents were in agreement of school-based BMI screening. Fifty-four percentage of parents selected a combination of ways to receive BMI information (letter from school nurse, face-to-face conference with nurse, or via report card). Few parents (6.2%) were reluctant to schools addressing obesity. Significant relationships were identified between non-White, overweight parents who had overweight children ( n = 3). They were more likely to disagree with removal of junk food, increasing physical activity, and recommending weight loss. Recommendations to involve parents in BMI screening are presented.

Obesity in Hong Kong Chinese preschool children: where are all the nurses?

We report an ethnographic study of 10 preschool children aged 2-6 years recruited from kindergartens in Hong Kong, 6 of whom were overweight or obese. Each was followed for 12-18 months. We confirmed previously described risk factors and showed how these interacted to produce obesity in some but not all at-risk children. Despite much rhetoric in the literature about holistic care of the preschool child, we were struck by the lack of coordinated professional input to the needs of children at risk of obesity and by the absence of nursing input in particular. We argue that a "whole-systems" nursing role, based in the community and with remit that includes clinical care, education, and policy, is urgently needed, as well as review examples of such roles from other countries.

BMI measurement in schools

BACKGROUND AND OBJECTIVE

School-based BMI measurement has attracted attention across the nation as a potential approach to address obesity among youth. However, little is known about its impact or effectiveness in changing obesity rates or related physical activity and dietary behaviors that influence obesity. This article describes current BMI-measurement programs and practices, research, and expert recommendations and provides guidance on implementing such an approach.

METHODS

An extensive search for scientific articles, position statements, and current state legislation related to BMI-measurement programs was conducted. A literature and policy review was written and presented to a panel of experts. This panel, comprising experts in public health, education, school counseling, school medical care, and parenting, reviewed and provided expertise on this article.

RESULTS

School-based BMI-measurement programs are conducted for surveillance or screening purposes. Thirteen states are implementing school-based BMI-measurement programs as required by legislation. Few studies exist that assess the utility of these programs in preventing increases in obesity or the effects these programs may have on weight-related knowledge, attitudes, and behaviors of youth and their families. Typically, expert organizations support school-based BMI surveillance; however, controversy exists over screening. BMI screening does not currently meet all of the American Academy of Pediatrics' criteria for determining whether screening for specific health conditions should be implemented in schools.

CONCLUSION

Schools initiating BMI-measurement programs should adhere to safeguards to minimize potential harms and maximize benefits, establish a safe and supportive environment for students of all body sizes, and implement science-based strategies to promote physical activity and healthy eating.

Preventing childhood obesity: can we do it?

PURPOSE OF REVIEW

This review critically examines recent publications on prevention of childhood obesity and places these publications within a biologic, epidemiologic, public health, and policy context. It should help practitioners advocate effective preventive strategies and develop effective plans of action for research and policy.

RECENT FINDINGS

Risk factors for childhood obesity include low socioeconomic status, maternal obesity, rapid infancy weight gain, and decreased physical activity. Changes in food availability and activity levels during the past 30 years are well documented. Obesity prevention programs have had limited success but they demonstrate that changes in school and community environments can decrease childhood weight gain. Legislative approaches to the obesity epidemic have not led to changes in governmental agricultural policy or in the food and marketing industry.

SUMMARY

Obesity in childhood is a major public health problem and contributes to significant morbidity in adulthood. It is the natural biologic outcome of an unprecedented increase of food availability and intake, coupled with decreased energy output. Present obesity prevention measures have been small scale and timid. Public policy measures to address the obesity epidemic have not yet been sufficiently strong to be effective. Suggestions are made to intensify public education and change national behaviors.

Body mass index measurement in schools

BACKGROUND

School-based body mass index (BMI) measurement has attracted much attention across the nation from researchers, school officials, legislators, and the media as a potential approach to address obesity among youth.

METHODS

An expert panel, convened by the Centers for Disease Control and Prevention (CDC) in 2005, reviewed and provided expertise on an earlier version of this article. The panel comprised experts in public health, education, school counseling, school medical care, and a parent organization. This article describes the purposes of BMI measurement programs, examines current practices, reviews existing research, summarizes the recommendations of experts, identifies concerns, and provides guidance including a list of safeguards and ideas for future research.

RESULTS

The implementation of school-based BMI measurement for surveillance purposes, that is, to identify the percentage of students in a population who are at risk for weight-related problems, is widely accepted; however, considerable controversy exists over BMI measurement for screening purposes, that is, to assess the weight status of individual students and provide this information to parents with guidance for action. Although some promising results have been reported, more evaluation is needed to determine whether BMI screening programs are a promising practice for addressing obesity.

CONCLUSIONS

Based on the available information, BMI screening meets some but not all of the criteria established by the American Academy of Pediatrics for determining whether screening for specific health conditions should be implemented in schools. Schools that initiate BMI measurement programs should evaluate the effects of the program on BMI results and on weight-related knowledge, attitudes, and behaviors of youth and their families; they also should adhere to safeguards to reduce the risk of harming students, have in place a safe and supportive environment for students of all body sizes, and implement science-based strategies to promote physical activity and healthy eating.