Parents' healthy weight perceptions and preferences regarding obesity counseling in preschoolers: pediatricians matter

Parental perceptions of weight terminology that providers use with youth

OBJECTIVES

Little research has been performed to examine patient perceptions of weight-related language, especially related to childhood obesity. In this study we assessed parental perceptions of weight-based terminology used by health care providers to describe a child's excess weight and assessed perceived connotations associated with these terms including stigma, blame, and motivation to reduce weight.

METHODS

A national sample of American parents with children aged 2 to 18 years (N = 445) completed an online survey to assess their perceptions of 10 common terms to describe excess body weight in youth (including "extremely obese," "high BMI," "weight problem," "unhealthy weight," "weight," "heavy," "obese," "overweight," "chubby," and "fat"). Parents were asked to use a 5-point rating scale to indicate how much they perceived each term to be desirable, stigmatizing, blaming, or motivating to lose weight.

RESULTS

Regression models revealed that the terms "weight" and "unhealthy weight" were rated as most desirable, and "unhealthy weight" and "weight problem" were rated as the most motivating to lose weight. The terms "fat," "obese," and "extremely obese" were rated as the most undesirable, stigmatizing, blaming, and least motivating. Parents' ratings were consistent across sociodemographic variables, body weight, and child's body weight.

CONCLUSIONS

The results of this study have important implications for the improvement of health care for youth with obesity; it may be advantageous for health care providers to use or avoid using specific weight-based language during discussions about body weight with families. Pediatricians play a key role in obesity prevention and treatment, but their efforts may be undermined by stigmatizing or offensive language that can hinder important discussions about children's health.

Building capacity for childhood obesity prevention and treatment in the medical community: call to action

Large gaps exist in the capacity of the US medical system to participate meaningfully in childhood obesity-prevention efforts and to meet the treatment needs of obese children. Current primary care practice for the prevention and treatment of childhood obesity often varies from evidence-based recommendations. Childhood obesity specialists have partnered successfully with schools of medicine, professional societies, and other organizations to collaboratively engage with primary care providers in quality improvement for obesity prevention and treatment. This review and commentary targets 2 audiences. For childhood obesity experts and their organizational partners, methods to support change in primary practice and the evidence supporting their use are outlined. For primary care providers and non-obesity specialists, effective strategies for changing practice and the potential benefits of addressing childhood obesity systematically are discussed.

Comparison of measured and parents' reported height and weight in children and adolescents

The objectives of this study were to (i) compare parent-reported height and weight to measured height and weight in children between ages 2 and 17 years, (ii) investigate correlations between magnitude of error of parent-reported data or refusal to estimate height and weight with gender, race/ethnicity, child's age, and age-specific BMI z-score, and (iii) determine sensitivity and specificity of identifying obese youth based on parent-reported data. The authors studied 1,430 consecutive outpatients between ages 2 and 17 years at an outpatient orthopedic clinic. At the initial visit, parents completed a questionnaire including their child's height and weight; height and weight were then measured. Mean height error was very small, with slight overestimation in boys and underestimation in girls. Mean weight error increased with age (P < 0.001), and girls had a larger mean weight error (1.29 kg, 95% confidence interval (CI): 0.65, 1.45) than boys (0.85 kg, 95% CI: 0.8: 0.58, 1.12). Mean weight error also increased with age-specific BMI z-score (r = 0.32, P < 0.001). Correlation between weight error and age-specific BMI z-score was higher among black children (r = 0.45, P < 0.001) than among Hispanic children (r = 0.37, P < 0.001) and was lowest among white children (r = 0.29, P < 0.001). Refusal or inability to estimate weight did not correlate with age-specific BMI z-score. Twenty-one percent of children who were obese would not be identified by using parent-reported data to calculate the BMI.