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Koivumäki T, Kääriäinen M, Tuomikoski AM, Kaunonen M. Parent and carer experiences of health care professionals' communication about childhood obesity: a qualitative systematic review protocol. JBI Evid Synth 2023; 21:401-406. [PMID: 36059227 PMCID: PMC9901846 DOI: 10.11124/jbies-22-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of the systematic review is to identify, critically appraise, and synthesize the best available qualitative evidence on parent and carer experiences of health care professionals' communication about childhood obesity. INTRODUCTION Parents and carers play a key role in a child's environment and healthy development, which is why they can find it confronting to discuss their child's weight. This review will provide an insight into the experiences of parents and carers with health care professionals' communication about their child's overweight or obesity. INCLUSION CRITERIA This qualitative review will consider participants who are parents and carers with a child with overweight or obesity (birth to 12 years). The phenomenon of interest is parents' and carers' lived experiences of childhood obesity communication from a health care professional, and the context is health care settings. Communication includes verbal or written communication about a child's obesity from health care professionals received by a parent or carer. METHODS The proposed review will systematically search the following databases: MEDLINE (EBSCO), CINAHL (EBSCO), PsycINFO (Ovid), Scopus, LILACS, and the Finnish health sciences database MEDIC. ProQuest Dissertations and Theses (ProQuest) will be searched for unpublished articles. A manual search will supplement the database searches. The quality of included studies will be assessed independently by 2 reviewers, and the qualitative data will be extracted from papers by 2 independent reviewers using the standardized JBI data extraction tool. The recommended JBI approach to critical appraisal, study selection, data extraction, and data synthesis meta-aggregation will be used. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42022297709.
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Affiliation(s)
- Terhi Koivumäki
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Maria Kääriäinen
- Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland.,Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Oulu University Hospital, Finland
| | - Anna-Maria Tuomikoski
- Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland.,Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Oulu University Hospital, Finland
| | - Marja Kaunonen
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Oulu University Hospital, Finland.,General Administration, Pirkanmaa Hospital District, Tampere, Finland
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Alshahrani A, Shuweihdi F, Swift J, Avery A. Underestimation of overweight weight status in children and adolescents aged 0-19 years: A systematic review and meta-analysis. Obes Sci Pract 2021; 7:760-796. [PMID: 34877014 PMCID: PMC8633945 DOI: 10.1002/osp4.531] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Perceptions of children's weight status may be important in obesity prevention and treatment. AIMS This review identifies the prevalence of the underestimation of overweight status in children by parents/main carers, children, and healthcare professionals (HCP). The review critically synthesized both quantitative and qualitative evidence to explore the factors associated with this underestimation. The diverse methods used to assess this phenomenon are reported. METHODS Pooled effect sizes were calculated using random-effects model. Published studies, up to 2020, were accessed using the following search engines: CINAHL, EMBASE, PUBMED, and Psych-Info and including the "Cited by" and "Related Articles" functions. Hand-searching was used to retrieve further articles. Publication language and location had no bearing on the nature of the included studies. RESULTS A total of 91 articles were included. In the quantitative studies, 55% (95% CI 49%-61%) of caregivers underestimated their child's level of overweight and obesity using a verbal scale and 47% (95% CI 36%-55%) using visual scales. Of the children studied, 34% (95% CI 25%-43%) underestimated their own level of overweight and obesity using both scales. In (n = 3) articles, HCPs reflected this misperception, but limited studies prevented meta-analysis. Underestimation was associated with the child's age, gender, BMI and parental weight status, ethnicity and education. In the qualitative studies, parents/main carers of children with overweight and obesity described their child's weight in terms other than overweight, for example, "big boned," "thick," and "solid." CONCLUSION The results confirm the prevalence of underestimation of child overweight status across international studies. Understanding the factors which lead to this inaccuracy may help to improve communication within the therapeutic triad and facilitate the recognition and management of children's overweight status.
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Affiliation(s)
- Abrar Alshahrani
- Division of Nutritional SciencesUniversity of NottinghamNottinghamUK
| | - Farag Shuweihdi
- Leeds Institute of Health SciencesFaculty of MedicineLeeds UniversityLeedsUK
| | - Judy Swift
- Division of Nutritional SciencesUniversity of NottinghamNottinghamUK
| | - Amanda Avery
- Division of Food, Nutrition and DieteticsUniversity of NottinghamNottinghamUK
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Burkill S, Waterhouse P, Pazzagli L. The association between family structure and children's BMI over time-the mediating role of income. Ann Epidemiol 2020; 55:83-90.e1. [PMID: 33433327 DOI: 10.1016/j.annepidem.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 08/24/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Although both family structure and income have previously been indicated as being associated with body mass index (BMI), the extent to which the effect of family structure on BMI is mediated through income is incompletely understood. Taking the case of the United Kingdom, this study aims to investigate the association between family structure, defined in this study as whether children live in a one- or two-adult household, and childhood BMI, and whether this varies by child sex and with increased age. Second, the study aims to examine whether family equivalised income, as a proxy for socioeconomic status, mediates the association between family structure and childhood BMI. METHODS This study uses data from the Millennium Cohort Study. Data from 7478 children born between 2000 and 2001 in the UK at the ages of 3, 5, 7, 11, and 14 were used. Mediation analysis was used to consider, at each age, the extent to which the association between living in a one- or two-adult household and BMI was mediated through income overall and stratified by sex. To assess the robustness of the mediation analysis estimates, we used both E-values and multiple confounder adjustment. RESULTS At ages 3 and 5, there was no direct or indirect effect of family structure mediated by income on BMI. Between the ages of 7 and 11, the overall proportion of the association mediated vastly increased, from 19.70% at age 7 up to 42.70% at the age of 11. The E-values show that substantial unmeasured confounder associations would be needed to fully explain away the conclusions from the mediation analysis. Results remained significant when models were additionally adjusted for geographic region, the main respondent's (usually the mother's) highest educational attainment, and ethnicity. CONCLUSIONS An increasing proportion of the association between family structure and BMI is mediated by income as children grow older. The study focuses on the mediating role of income between family structure and BMI using the available data as an empirical application of the potential impact of income as mediator in the causal pathway.
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Affiliation(s)
- Sarah Burkill
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Philippa Waterhouse
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
| | - Laura Pazzagli
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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Li W, Homer K, Hull S, Boomla K, Robson J, Alazawi W. Obesity Predicts Liver Function Testing and Abnormal Liver Results. Obesity (Silver Spring) 2020; 28:132-138. [PMID: 31804018 DOI: 10.1002/oby.22669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/06/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Abnormal liver function tests in children and young people (CYP) predict a greater burden of liver disease in adulthood, especially in the context of obesity. This study aimed to determine whether obesity and metabolic risk factors predict liver function testing and abnormal liver test results in CYP. METHODS This was a retrospective cross-sectional population study using electronic health care records from 257,746 CYP aged 10 to 25 years who were registered with 170 contiguous general practices in London, UK. Demographic and clinical data were extracted, including serum alanine aminotransferase (ALT) tests between 2015 and 2017. BMI category thresholds were adjusted according to age group and ethnicity. RESULTS Fourteen percent of CYP had ALT measured, of whom 5.4% had abnormal results; 36.3% had BMI indicating overweight or obesity. Nonalcoholic fatty liver disease was the most common liver diagnosis. Multivariate analyses demonstrated that overweight or obesity was an independent predictor of ALT testing in young people (ages 18-25) but not in children (ages 10-17) and of abnormal test results in all CYP, irrespective of ALT threshold. CONCLUSIONS Overweight and obesity are predictors of liver testing (not in children) and abnormal test results, irrespective of ALT threshold. Given the rising prevalence of metabolic dysfunction, a coordinated strategy is needed for liver testing and interpreting results in this young population.
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Affiliation(s)
- Wenhao Li
- Barts Liver Centre, Blizard Institute, Queen Mary University of London, London, UK
| | - Kate Homer
- Centre of Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Sally Hull
- Centre of Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Kambiz Boomla
- Centre of Primary Care and Public Health, Queen Mary University of London, London, UK
| | - John Robson
- Centre of Primary Care and Public Health, Queen Mary University of London, London, UK
| | - William Alazawi
- Barts Liver Centre, Blizard Institute, Queen Mary University of London, London, UK
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Notara V, Magriplis E, Prapas C, Antonogeorgos G, Rojas-Gil AP, Kornilaki EN, Lagiou A, Panagiotakos DB. Parental weight status and early adolescence body weight in association with socioeconomic factors. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2019; 8:77. [PMID: 31143794 PMCID: PMC6512222 DOI: 10.4103/jehp.jehp_14_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Childhood obesity remains a major health issue. The understanding of the multifactorial nature of childhood obesity remains the cornerstone to eliminate the rising trends. This study aimed to examine the association between parental and childhood weight status, in relation to various socioeconomic (SE) factors. METHODS A cross-sectional survey was conducted including 1190 children aged 10-12 years and their parents, during school years 2014-2016. Primary schools from five Greek counties (including Athens metropolitan area) were randomly selected. Parental and child data were collected through self-administered, anonymous questionnaires. Children's weight status was based on gender- and age-specific tables derived from the International Obesity Task Force body mass index (BMI) cut offs. General Linear Model (GLM), Univariate and multivariate analyses were applied. Multiple logistic regressions was used to determine the association between children and parents' weight status. RESULTS Childhood prevalence of overweight and obesity was 25.9% (21.8% overweight and 4.1% obese), with prevalence being significantly higher in males (31.7% compared to 21.3%; P for gender differences < 0.001). The percent of overweight and obese male (34.4% and 43.1%) and female children (20.3% and 31.8%) significantly increased with paternal overweight and obesity status, respectively. The same relationship was observed between male children and maternal overweight and obesity status (43.4% and 65.7%). This was not evident among females (27% and 23.2%). Regression analysis showed a significant positive association with parental BMI, a negative association with both parental educational levels (low to high), living space, and parental age (P < 0.05, for all). Children's likelihood of being overweight or obese increased significantly with increasing parental weight status (P < 0.001). CONCLUSIONS Parental weight status remained the most significant predictive factor for early adolescence obesity among various SE factors. Health promotion strategies should consider parental education as an effective childhood obesity preventive measure.
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Affiliation(s)
- Venetia Notara
- Department of Public and Community Health, University of West Attica, Athens, Greece
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Christos Prapas
- Department of Public and Community Health, University of West Attica, Athens, Greece
| | - George Antonogeorgos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Andrea Paola Rojas-Gil
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | | | - Areti Lagiou
- Department of Public and Community Health, University of West Attica, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
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Kovacs BE, Gillison FB, Barnett JC. Is children's weight a public health or a private family issue? A qualitative analysis of online discussion about National Child Measurement Programme feedback in England. BMC Public Health 2018; 18:1295. [PMID: 30477468 PMCID: PMC6257949 DOI: 10.1186/s12889-018-6214-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/12/2018] [Indexed: 02/08/2023] Open
Abstract
Background The National Child Measurement Programme (NCMP) is a child weight monitoring system in England, taking place in the first and final years of primary school. Many local authorities consider it important to inform parents if their child is overweight, and do so by letter alongside the offer of support and advice. Such letters have been met with mixed reactions from parents, but research seeking to better understand parents’ responses is often limited by reliance on survey data and low participation rates. This study aimed to collect a broad variety of perspectives on the programme by analyzing views expressed in parent-to-parent discussions posted online. Methods UK-based online parenting fora were used to identify discussion threads based around the NCMP between 2010 and 2017. Thirty-one discussion threads from two parent fora were identified. Thematic analysis was used to identify themes in these data. Results The primary themes identified related to (1) the legitimacy of feedback and judgement from health professionals, (2) the relative importance of collecting population level data above individual preferences, and (3) risks versus benefits of having conversations with children about weight. Most threads adopted an ‘argument, counter-argument’ format, providing two sides to each issue raised. Information and opinions consistent with public health messages were frequently provided, such as how data are used, that feedback is intended to be helpful, and the importance of collecting national data. There was little evidence of individual parents shifting their views in response to others’ arguments. Conclusions This study provides novel insight into peer-to-peer debates about the NCMP, including the arguments parents find convincing and acceptable for and against a national programme to weigh children and provide feedback to parents about their weight. Online fora were used as an opportunity to express criticism or distress, but also to seek advice from peers regarding concerns about whether or not to opt-out. Thus, both general issues related to the legitimacy of population screening and outcomes for individual children were of concern to parents.
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Affiliation(s)
- B E Kovacs
- Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - F B Gillison
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
| | - J C Barnett
- Department of Psychology, University of Bath, Bath, UK
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Preferred Child Body Size and Parental Underestimation of Child Weight in Mexican-American Families. Matern Child Health J 2017; 20:1842-8. [PMID: 27016351 DOI: 10.1007/s10995-016-1987-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective To determine whether parents who prefer a heavier child would underestimate their child's weight more than those who prefer a leaner child. Methods Participants were Mexican-American families (312 mothers, 173 fathers, and 312 children ages 8-10) who were interviewed and had height and weight measurements. Parents reported their preferred child body size and their perceptions of their child's weight. Parents' underestimation of their child's weight was calculated as the standardized difference between parent's perception of their child's weight and the child's body mass index (BMI) z-score. Demographic factors and parental BMI were also assessed. Results Although 50 % of children were overweight or obese, only 11 % of mothers and 10 % of fathers perceived their children as being somewhat or very overweight. Multiple regressions controlling for covariates (parental BMI and child age) showed that parents who preferred a heavier child body size underestimated their children's weight more, compared to those who preferred a leaner child (β for mothers = .13, p < .03; β for fathers = .17, p < .03). Conclusions for Practice Parents who preferred a heavier child body size underestimated their child's weight to a greater degree than parents who preferred a leaner child. Attempts by pediatricians to correct parents' misperceptions about child weight may damage rapport and ultimately fail if the misperception is actually a reflection of parents' preferences, which may not be readily amenable to change. Future research should address optimal methods of communication about child overweight which take into account parent preferences.
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Pedraza DF, Sousa CPDC, Olinda RAD. AGREEMENT BETWEEN MEASURED AND PERCEIVED NUTRITIONAL STATUS REPORTED BY PRESCHOOL CHILDREN'S MOTHERS. ACTA ACUST UNITED AC 2017; 35:289-295. [PMID: 28977296 PMCID: PMC5606179 DOI: 10.1590/1984-0462/;2017;35;3;00011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/18/2016] [Indexed: 11/30/2022]
Abstract
Objective: To verify the agreement between nutritional status perceived by mothers and that diagnosed in preschool children, by providing the differences according to children’s sex and age. Methods: Study with data from a cohort of 269 preschool children assisted in public daycare centers of Campina Grande, Paraíba (Northeast Brazil). Children’s information about their date of birth, sex and nutritional status (weight/stature Z scores) was collected. Furthermore, the mothers were asked about their perception of children’s weight. The diagnostic agreement between the measured nutritional status and that perceived by mothers was assessed through the weighted Kappa test, with a 5% significance level. Results: The percentage of disagreement between the measured nutritional status and that perceived by mothers was 32.7%, with Kappa of 0.122, which is considered insignificant. There was a remarkable overweight underestimation (69.6%). Agreement between maternal perception of overweight and the diagnosed nutritional status was higher for older children (36-59 months versus 24-35 months) and for girls. Conclusions: The study regarding maternal perception of preschool children’s nutritional status showed the difficulty that mothers face in recognizing the real nutritional status of their children, especially the underestimation of overweight. Maternal perception of overweight in children is misrepresented in boys and in younger children with more importance.
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Parental Perception of the Children’s Weight Status in Indonesia. Nurs Midwifery Stud 2016. [DOI: 10.5812/nmsjournal.38139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Syahrul, Kimura R, Tsuda A, Susanto T, Saito R, Agrina A. Parental Perception of the Children’s Weight Status in Indonesia. Nurs Midwifery Stud 2016. [DOI: 10.17795/nmsjournal38139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Parrino C, Vinciguerra F, La Spina N, Romeo L, Tumminia A, Baratta R, Squatrito S, Vigneri R, Frittitta L. Influence of early-life and parental factors on childhood overweight and obesity. J Endocrinol Invest 2016; 39:1315-1321. [PMID: 27312861 DOI: 10.1007/s40618-016-0501-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 06/07/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE We recently reported that a high BMI and high waist circumference prevalence is present in Sicilian children and that the male gender is associated with a significant risk of obesity. Early-life and parent-related risk factors were investigated 1521 Sicilian children (752 females and 769 males, aged 9.0-14.0 years) to identify biological and environmental factors that can contribute to obesity onset. METHODS Anthropometric measurements of children, their urban vs rural area provenience, birth weight and neonatal feeding were collected. In addition, the BMI and educational level of their parents and the perception of their child weight status were investigated. RESULTS In the study cohort, the prevalence of overweight and obesity was 27.2 and 14.1 %, respectively, significantly (p < 0.05) higher in males than in females. Breastfeeding emerged as a protective factor (OR 0.64; p < 0.0005), while risk factors for developing childhood obesity were a birth weight ≥4.0 kg (OR 1.83; p < 0.05), an overweight or obese mother (OR 2.33; p < 0.0001) or father (OR 1.68; p < 0.0001) and a mother with a low/medium education level (OR 1.72; p < 0.005). CONCLUSION Understanding risk factors for pediatric obesity is a prerequisite to identify children at highly risk of being obese and to predispose early intervention strategies.
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Affiliation(s)
- C Parrino
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy
| | - F Vinciguerra
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy
| | - N La Spina
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy
| | - L Romeo
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy
| | - A Tumminia
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy
| | - R Baratta
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy
- "S. Signorelli" Diabetes and Obesity Center, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - S Squatrito
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy
| | - R Vigneri
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy
- Institute of Biostructures and Bioimages, National Research Council, CNR, Catania, Italy
| | - L Frittitta
- Endocrinology Unit, Garibaldi-Nesima Hospital, Department of Clinical and Experimental Medicine, University of Catania, Via Palermo 636, 95122, Catania, Italy.
- "S. Signorelli" Diabetes and Obesity Center, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
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Abstract
BACKGROUND AND OBJECTIVES Although the prevalence of childhood obesity has increased significantly in Saudi Arabia, parents are unable to appreciate obesity in their child. The objective of the study was to identify the percentage of parents who misclassify the status of child's weight, and determine whether there is a difference between those parents whose children are overweight and obese and those with children of normal weight. MATERIALS AND METHODS This cross-sectional study included 601 children aged 6-10 years. The children were recruited from the primary schools located in Al-Qassim, Saudi Arabia. The body mass index of the children was assessed in the school, and their parents responded to a self-administered questionnaire which contained questions on parental perception of the children's weight/obesity status. Data were entered and analyzed using SPSS. RESULTS Parents with overweight/obese children had significantly more misclassification than those with normal weight children. Ninety percent of parents of the 81 overweight children misclassified and reported that their child had normal weight, while 65% of parents of the 61 obese children, misclassified the child's weight status. CONCLUSIONS The level of misclassification of children's weight status by parents is high. Saudi parents with overweight and obese children do not recognize their child's weight status. Parents' awareness of childhood obesity and its negative health impact needs to be improved.
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Affiliation(s)
- Abdulrahman A Al-Mohaimeed
- Department of Family and Community Medicine, College of Medicine, Qassim University, Kingdom of Saudi Arabia
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Musaad SMA, Donovan SM, Fiese BH. Parental perception of child weight in the first two years-of-life: a potential link between infant feeding and preschoolers' diet. Appetite 2015; 91:90-100. [PMID: 25843938 DOI: 10.1016/j.appet.2015.03.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 02/02/2023]
Abstract
Approximately 23% of preschoolers are overweight or obese. Establishing a healthy dietary lifestyle at an early age can improve later child diet and body weight. This study examined the determinants of past infant feeding practices that do not follow standard feeding recommendations (breastfeeding for less than 6 months duration, cow's milk prior to the first year of age and solid foods at or before 4 months of age). It also examined the role of parental perception of child weight in the first 2 years-of-life on past infant feeding practices as well as current child diet and body weight. Families of 497 preschoolers aged 22-63 months (39.0 ± 8.2) were recruited from 30 child care centers in East-Central Illinois. Main findings indicate that past infant feeding practices were common and varied by socio-demographic factors including race/ethnicity, parental education and child gender. Children perceived as overweight in the first 2 years-of-life tended to breastfeed for lesser duration. Additionally, the majority (79.8%) of preschoolers who were classified as overweight using BMI percentile were perceived as non-overweight by the parent in the first 2 years-of-life. Mean daily total fatty/sugary food intake was higher among those perceived to be non-overweight in the first 2 years-of-life. These findings have identified parental perception of child weight in the first 2 years-of-life as a modifiable risk factor for unhealthy child diet and obesity among preschoolers.
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Affiliation(s)
- Salma M A Musaad
- Family Resiliency Center, Department of Human and Community Development, University of Illinois at Urbana-Champaign, 904 W. Nevada, MC-081, Urbana, IL 61801, USA.
| | - Sharon M Donovan
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Barbara H Fiese
- Family Resiliency Center, Department of Human and Community Development, University of Illinois at Urbana-Champaign, 904 W. Nevada, MC-081, Urbana, IL 61801, USA
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Ruggieri DG, Bass SB. African-American Parents' Knowledge and Perceptions About BMI Measurements, School-Based BMI Screening Programs, and BMI Report Cards: Results from a Qualitative Investigation and Implications for School-to-Parent Communication. J Racial Ethn Health Disparities 2015; 3:320-30. [DOI: 10.1007/s40615-015-0149-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/30/2015] [Accepted: 07/08/2015] [Indexed: 10/23/2022]
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Jeffery AN, Metcalf BS, Hosking J, Mostazir MBA, Voss LD, Wilkin TJ. Awareness of body weight by mothers and their children: repeated measures in a single cohort (EarlyBird 64). Child Care Health Dev 2015; 41:434-42. [PMID: 24912623 DOI: 10.1111/cch.12167] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mothers often do not realize when their child is overweight. We aimed to compare mothers' perceptions of children's weight before and during puberty, and to explore factors at 7 years predicting recognition of overweight at 16 years. METHODS Mothers of 237 children (136 boys) from the EarlyBird study estimated their own weight category and that of their child aged 7 years and 16 years. The children estimated their own weight category at 16 years. Annual measures: body mass index standard deviation score (BMIsds), per cent fat, physical activity. Pubertal development assessed by age at peak height velocity (APHV). MATERNAL MEASURES: BMI, education, socio-economic status. RESULTS At 7 years 21% of girls and 16% of boys were overweight or obese, rising to 27% and 22% respectively at 16 years. The accuracy of the mother's perception of her child's weight category improved from 44% at 7 years to 74% at 16 years, but they were less able to judge overweight in sons than daughters. The mothers' level of concern about overweight was greater for girls than boys, and increased for girls (52% mothers of overweight/obese girls were worried at 7 years, 62% at 16 years), but remained static in the boys (42% vs. 39%). Over 80% of the youngsters realized when they were overweight, but 25% normal-weight girls also classed themselves as overweight. Only BMI predicted a mother's ability to correctly perceive her child's weight. Neither her awareness, nor concern, about the child's weight at 7 years had any impact on the trajectory of the child's BMI from 7 years to 16 years. CONCLUSIONS Parents are central to any successful weight reduction programme in their children, but will not engage while they remain ignorant of the problem. Crucially, any concern mothers may have about their child's excess weight at 7 years appears to have no impact on subsequent weight change.
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Affiliation(s)
- A N Jeffery
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
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16
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Ruggieri DG, Bass SB. A comprehensive review of school-based body mass index screening programs and their implications for school health: do the controversies accurately reflect the research? THE JOURNAL OF SCHOOL HEALTH 2015; 85:61-72. [PMID: 25440454 DOI: 10.1111/josh.12222] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 04/23/2014] [Accepted: 07/08/2014] [Indexed: 06/04/2023]
Abstract
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.
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Affiliation(s)
- Dominique G Ruggieri
- Department of Health Services, Saint Joseph's University, 5600 City Avenue, 116 Post Hall, Philadelphia, PA 19131
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17
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Abstract
OBJECTIVE To determine what factors are associated with parental motivation to change body weight in overweight children. DESIGN Cross-sectional study. SETTING Dunedin, New Zealand. SUBJECTS Two hundred and seventy-one children aged 4-8 years, recruited in primary and secondary care, were identified as overweight (BMI ≥ 85th percentile) after screening. Parents completed questionnaires on demographics; motivation to improve diet, physical activity and weight; perception and concern about weight; parenting; and social desirability, prior to being informed that their child was overweight. Additional measures of physical activity (accelerometry), dietary intake and child behaviour (questionnaire) were obtained after feedback. RESULTS Although all children were overweight, only 42% of parents perceived their child to be so, with 36% indicating any concern. Very few parents (n 25, 8%) were actively trying to change the child's weight. Greater motivation to change weight was observed for girls compared with boys (P = 0.001), despite no sex difference in BMI Z-score (P = 0.374). Motivation was not associated with most demographic variables, social desirability, dietary intake, parenting or child behaviour. Increased motivation to change the child's weight was observed for heavier children (P < 0.001), those who were less physically active (P = 0.002) and more sedentary (P < 0.001), and in parents who were more concerned about their child's weight (P < 0.001) or who used greater food restriction (P < 0.001). CONCLUSIONS Low levels of parental motivation to change overweight in young children highlight the urgent need to determine how best to improve motivation to initiate change.
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Sand L, Lask B, Hysing M, Stormark KM. In the parents' view: weight perception accuracy, disturbed eating patterns and mental health problems among young adolescents. J Eat Disord 2014; 2:9. [PMID: 24666691 PMCID: PMC3994925 DOI: 10.1186/2050-2974-2-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/02/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND An accurate weight perception has been associated with motivation to change eating habits in the case of under- or overweight. However, recent studies have reported frequent misperceptions among parents and their offspring, both in the form of under- and overestimation of weight status. The aim of the present study was to investigate weight perception accuracy among parents of young adolescents in relation to reports on disturbed eating patterns and mental health problems. METHODS Weight perception accuracy was assessed among parents of young adolescents (N = 5,781, aged 11 - 13 years) who participated in the ongoing Bergen Child Study (BCS). Parental weight perception was classified in overestimation, underestimation and accurate. Other measures included demographic variables, the parents' evaluations of disturbed eating patterns and mental health problems among their offspring as well as the adolescents' own weight perception accuracy. RESULTS The parents accurately perceived more than 80% of normal weight adolescents, but nearly 60% of the underweight adolescents were overestimated, and a substantial proportion of overweight girls (34. 8%) and boys (12.8%) were underestimated. In general, parents who were aware of deviations from average weight in their child also reported higher levels of disturbed eating patterns, emotional problems, and behavioral problems. After controlling for demographic factors, the risk of parental over- and underestimation was significantly predicted by weight status, the adolescents' weight perception accuracy as well as disturbed eating patterns reported by the parents (p < .05). CONCLUSIONS Adolescents with under- or overweight proved most likely to be misperceived by their parents in this study. The pattern of perceptually correcting deviations from normal weight was interpreted as a positivity bias among the parents. These results suggest that weight perception accuracy should be targeted in family-focused interventions in order to strengthen adequate weight control among young adolescents.
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Affiliation(s)
- Liv Sand
- Regional Centre for Child and Youth Mental Health and Welfare, Uni Health, PO Box 7810, N-5020 Bergen, Norway.
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19
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Abstract
BACKGROUND AND OBJECTIVE Parental perceptions of their children's weight play an important role in obesity prevention and treatment. The objective of this study was to determine the proportion of parents worldwide who underestimate their children's weight and moderators of such misperceptions. METHODS Original studies published to January 2013 were chosen through literature searches in PUBMED, PSYCHINFO, and CINAHL databases. References of retrieved articles were also searched for relevant studies. Studies were published in English and assessed parental perceptions of children's weight and then compared perceptions to recognized standards for defining overweight based on anthropometric measures. Data were extracted on study-level constructs, child- and parent-characteristics, procedural characteristics, and parental underestimates separately for normal-weight and overweight/obese samples. Pooled effect sizes were calculated using random-effects models and adjusted for publication bias. Moderators were explored using mixed-effect models. RESULTS A total of 69 articles (representing 78 samples; n = 15,791) were included in the overweight/obese meta-analysis. Adjusted effect sizes revealed that 50.7% (95% confidence interval 31.1%-70.2%) of parents underestimate their overweight/obese children's weight. Significant moderators of this effect included child's age and BMI. A total of 52 articles (representing 59 samples; n = 64,895) were included in the normal-weight meta-analysis. Pooled effect sizes indicated that 14.3% (95% confidence interval 11.7%-17.4%) of parents underestimate their children's normal-weight status. Significant moderators of this effect included child gender, parent weight, and the method (visual versus nonvisual) in which perception was assessed. CONCLUSIONS Half of parents underestimated their children's overweight/obese status and a significant minority underestimated children's normal weight. Pediatricians are well positioned to make efforts to remedy parental underestimates and promote adoption of healthy habits.
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Affiliation(s)
- Alyssa Lundahl
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska
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20
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Bonde AH, Bentsen P, Hindhede AL. School nurses' experiences with motivational interviewing for preventing childhood obesity. J Sch Nurs 2014; 30:448-55. [PMID: 24488337 DOI: 10.1177/1059840514521240] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Motivational interviewing is a counseling method used to bring about behavior change; its application by school nurses for preventing obesity in children is still new. This study, based on in-depth interviews with 12 school nurses, shows how school nurses adapted motivational interviewing and integrated it into their daily practice along with other methods they knew from the past. Three dilemmas for school nurses were revealed: when the child was severely overweight and the parents did not perceive this as a problem, when the child and the parents were at different stages of motivation to change, and when applying an individualized approach such as motivational interviewing for preventing a complex societal problem, in this instance obesity. The study raises an important issue to consider, with implications for school nursing and obesity prevention: motivational interviewing as either a counseling method or a prevention strategy.
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Affiliation(s)
| | - Peter Bentsen
- Steno Health Promotion Center, Steno Diabetes Center A/S, Gentofte, Denmark
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21
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Sharifi M, Marshall G, Goldman R, Rifas-Shiman SL, Horan CM, Koziol R, Marshall R, Sequist TD, Taveras EM. Exploring innovative approaches and patient-centered outcomes from positive outliers in childhood obesity. Acad Pediatr 2014; 14:646-55. [PMID: 25439163 PMCID: PMC4322896 DOI: 10.1016/j.acap.2014.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 07/23/2014] [Accepted: 08/04/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE New approaches for obesity prevention and management can be gleaned from positive outliers-that is, individuals who have succeeded in changing health behaviors and reducing their body mass index (BMI) in the context of adverse built and social environments. We explored perspectives and strategies of parents of positive outlier children living in high-risk neighborhoods. METHODS We collected up to 5 years of height/weight data from the electronic health records of 22,443 Massachusetts children, ages 6 to 12 years, seen for well-child care. We identified children with any history of BMI in the 95th percentile or higher (n = 4007) and generated a BMI z-score slope for each child using a linear mixed effects model. We recruited parents for focus groups from the subsample of children with negative slopes who also lived in zip codes where >15% of children were obese. We analyzed focus group transcripts using an immersion/crystallization approach. RESULTS We reached thematic saturation after 5 focus groups with 41 parents. Commonly cited outcomes that mattered most to parents and motivated change were child inactivity, above-average clothing sizes, exercise intolerance, and negative peer interactions; few reported BMI as a motivator. Convergent strategies among positive outlier families were family-level changes, parent modeling, consistency, household rules/limits, and creativity in overcoming resistance. Parents voiced preferences for obesity interventions that include tailored education and support that extend outside clinical settings and are delivered by both health care professionals and successful peers. CONCLUSIONS Successful strategies learned from positive outlier families can be generalized and tested to accelerate progress in reducing childhood obesity.
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Affiliation(s)
- Mona Sharifi
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, Mass.
| | - Gareth Marshall
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Roberta Goldman
- Warren Alpert Medical School, Brown University, Providence, RI and Harvard School of Public Health, Boston, MA
| | - Sheryl L Rifas-Shiman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA
| | - Christine M Horan
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Renata Koziol
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA
| | | | - Thomas D Sequist
- Harvard Vanguard Medical Associates, Boston, MA,Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA,Department of Health Care Policy, Harvard Medical School, Boston, MA,Partners Healthcare System, Boston, MA
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, MA,Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA
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Childhood overweight/obesity and pediatric asthma: the role of parental perception of child weight status. Nutrients 2013; 5:3713-29. [PMID: 24064571 PMCID: PMC3798930 DOI: 10.3390/nu5093713] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/13/2013] [Accepted: 09/04/2013] [Indexed: 01/31/2023] Open
Abstract
Childhood obesity and asthma are on the rise in the U.S. Clinical and epidemiological data suggest a link between the two, in which overweight and obese children are at higher risk for asthma. Prevention of childhood obesity is preferred over treatment, however, in order to be receptive to messages, parents must perceive that their child is overweight. Many parents do not accurately assess their child’s weight status. Herein, the relation between parental perceptions of child weight status, observed body mass index (BMI) percentiles, and a measure of child feeding practices were explored in the context of asthma, food allergy, or both. Out of the children with asthma or food allergy that were classified as overweight/obese by BMI percentiles, 93% were not perceived as overweight/obese by the parent. Mean scores for concern about child weight were higher in children with both asthma and food allergy than either condition alone, yet there were no significant differences among the groups in terms of pressure to eat and restrictive feeding practices. In summary, parents of children with asthma or food allergy were less likely to recognize their child’s overweight/obese status and their feeding practices did not differ from those without asthma and food allergy.
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Mareno N. Parental perception of child weight: a concept analysis. J Adv Nurs 2013; 70:34-45. [DOI: 10.1111/jan.12143] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Nicole Mareno
- WellStar School of Nursing; Kennesaw State University; Georgia USA
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Fuchs T, Eschenbeck H, Krug S, Schlaud M, Kohlmann CW. Perception makes the difference: the association of actual and perceived weight status with self-reported and parent-reported personal resources and well-being in adolescents. Appl Psychol Health Well Being 2012; 4:321-40. [PMID: 23081766 DOI: 10.1111/j.1758-0854.2012.01077.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The study analyzed associations between actual weight status and weight perceptions with personal resources, physical and psychological health, as well as physical performance among adolescents (N = 5,518; age: 11-17 years). Analyses are based on data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Self-report measures, parental reports, as well as objective test data were considered. Results indicate that weight perceptions, rather than actual weight status, were associated with personal resources, health, and perceived physical performance. Comparing groups, we found that adolescents who felt they had "just the right weight" achieved more favourable results than those who perceived themselves as "too fat", regardless of their actual weight status. However, actual physical performance was predicted better by actual weight status. Furthermore, weight perceptions were found to mediate the link between actual weight status and all the assessed outcomes (personal resources, health, and physical performance). With respect to self-reports, the mediational effect was consistently stronger for girls, whereas the reverse was true regarding physical performance. Parental reports were not moderated by sex. Findings provide further evidence that among overweight adolescents there are subgroups that differ significantly with regard to risks and resources. Implications for practice are discussed.
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Affiliation(s)
- Tanja Fuchs
- University of Education Schwäbisch Gmünd, Germany University of Education Weingarten, Germany Robert Koch-Institut, Berlin, Germany.
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Shirasawa T, Ochiai H, Ohtsu T, Nishimura R, Shimizu T, Hoshino H, Tajima N, Kokaze A. Parental perceptions and childhood overweight/obesity: A population-based study among school children in Japan. Health (London) 2012. [DOI: 10.4236/health.2012.48081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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