Weight and health status of inner city African American children: Perceptions of children and their parents

Underestimation of overweight weight status in children and adolescents aged 0-19 years: A systematic review and meta-analysis

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.

Psychosociocultural Contributors to Maladaptive Eating Behaviors in African American Youth: Recommendations and Future Directions

Childhood overweight and obesity disproportionately affects African Americans, and these children benefit less from standard pediatric weight management treatment programs compared to other racial/ethnic groups. Maladaptive eating behavior has been identified as a behavioral contributor to obesity and is also associated with the development of nonrestrictive eating disorders over time. Unique psychosociocultural factors have been identified that may promote higher risk for maladaptive eating behaviors in African American children beyond the effects of economic disparity. To best treat this group, it is important for practitioners to have a thorough understanding of these factors. We review several of these considerations and describe ways they may interact to contribute to the subsequent development of maladaptive eating behaviors and increased weight. Recommendations are made regarding how attention to these factors could be incorporated into current pediatric weight management treatments to better serve this population via a patient-centered care approach. Future directions will also be discussed.

Perception of childhood obesity in mothers of preschool children

Objectives

The purpose of this study was to identify the perception of childhood obesity in mothers of preschool children using Q methodology.

Methods

A total of 38 Q statements about childhood obesity were obtained from 41 participants. The QUANL PC program was used to analyze the results.

Results

There were three types of perception toward obesity in mothers of preschool children: the “authoritative discipline type,” the “generous home meal focused type,” and the “home meal based on household financial situation type.”

Conclusion

The perception of mothers toward childhood obesity can affect the extent of maternal interaction with children or meal preparation for the family. Based on these results, it is necessary to plan specific programs according to the types of maternal perception toward childhood obesity.

Parental underestimates of child weight: a meta-analysis

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.

Preventing Obesity and Promoting Fitness

The prevalence of overweight and obesity among youth has increased markedly in the past 2 decades in the United States. According to the Centers for Disease Control and Prevention, in 2010, more than one-third of children and adolescents were overweight or obese. A number of obesity prevention and intervention programs focus on the individual by utilizing intrapersonal theories to encourage the individual to eat healthy and participate in physical activity. The purpose of the current article is to go beyond the individual level and approach obesity with an ecological perspective because it may prove to have a larger influence. The ecological systems theory (EST) by Bronfenbrenner postulated that human development is influenced by a reciprocal relationship between the individual and their social system. In the context of physical activity, health behaviors occur within and are influenced by the multiple systems within which youth reside. This manuscript explores Bronfenbrenner’s EST framework comprising 4 systems: microsystem, mesosystem, exosystem, and macrosystem. Each level of the system is explored and applied to the obesity epidemic among youth.

A systematic review of parent role modeling of healthy eating and physical activity for their young African American children

PURPOSE

We systematically reviewed current literature on parent role modeling of healthy eating and physical activity as a strategy to influence healthy weight of middle school-age African American children.

CONCLUSIONS

The evidence for parent role modeling is low to average. Most studies did not target African American participants or middle school-age children.

PRACTICE IMPLICATIONS

Nurses can begin to remedy deficient knowledge of parent role modeling by assessing parent attitudes, beliefs, and healthy behaviors, as well as the children's. Existing dietary and physical activity guidelines are not specific to African Americans but can be a starting point for educating parents.

Difference between parental perception and actual weight status of children: a systematic review

An increasing number of children worldwide are overweight, and the first step in treating obesity is to identify overweight. However, do parents recognise overweight in their child and which factors influence parental perception? The aim of the present review is to systematically study differences between parental perception and the actual weight status of children. Medline, EMbase, CINAHL and PsychINFO were searched. After screening 2497 abstracts and 106 full texts, two reviewers independently scored the methodological quality of 51 articles (covering 35 103 children), which fulfilled the inclusion criteria. The primary outcome parameters were sensitivity and specificity of parental perception for actual weight status of their child. The methodological quality of the studies ranged from poor to excellent. Pooled results showed that according to objective criteria 11 530 children were overweight; of these, 7191 (62.4%) were incorrectly perceived as having normal weight by their parents. The misperception of overweight children is higher in parents with children aged 2-6 years compared with parents of older children. Sensitivity (correct perception of overweight) of the studies ranged from 0.04 to 0.89, while specificity (correct perception of normal weight) ranged from 0.86 to 1.00. There were no significant differences in sensitivity or specificity for different cut-off points for overweight, or between newer and older studies. Therefore we can conclude that parents are likely to misperceive the weight status of their overweight child, especially in children aged 2-6 years. Because appropriate treatment starts with the correct perception of overweight, health care professionals should be aware of the frequent parental misperception of the overweight status of their children.

Feeding behaviors of low-income mothers: directive control relates to a lower BMI in children, and a nondirective control relates to a healthier diet in preschoolers

BACKGROUND

A topic of interest in the etiology of child obesity is whether and how parental feeding behaviors are associated with the food intake and weight status of children.

OBJECTIVE

The objective was to explore whether and how directive (overt) and nondirective (covert and food environmental structure) types of parental feeding control were associated with children's food intake and weight status.

DESIGN

This was a cross-sectional exploratory study using structural equation modeling to determine directional associations between maternal feeding practices and children's food intake and weight status. Researchers collected data from 330 dyads of children aged 3-5 y and mothers participating in a federal preschool program for low-income families (Head Start) in Michigan. The mothers' feeding practices (directive and nondirective control), the children's food intakes, and the height and weight of both the mothers and children were measured. Structural equation models tested the relations between maternal feeding practices, the children's food intake, and weight status.

RESULTS

The structural equation model confirmed that children's weight status was inversely associated with mothers' directive control, and mothers' nondirective control was associated with children's intakes of more nutrient-dense foods and less energy-dense foods. No association was found between the mothers' directive control and the children's food intakes.

CONCLUSIONS

Mothers' use of nondirective feeding practices was associated with children's intakes of more nutrient-dense foods. However, use of more directive feeding control was associated with lower weight status in preschoolers of low-income mothers. These findings need to be examined in longitudinal studies. This trial was registered at clinicaltrials.gov as NCT01525186.

Percepção da imagem corporal e nível socioeconômico em adolescentes: revisão sistemática

OBJETIVO: Discutir as relações entre percepção da imagem corporal e fatores socioeconômicos como renda, grau de escolaridade e etnia em adolescentes. FONTES DE DADOS: Artigos selecionados nas bases PubMed e SciELO, sem limite de data de publicação, com amostras de adolescentes, nos idiomas inglês, espanhol, português ou francês, utilizando os descritores: "percepção da imagem corporal", "nível socioeconômico" e "adolescentes". SÍNTESE DOS DADOS: A influência do contexto socioeconômico na percepção da imagem corporal e satisfação/insatisfação com o corpo é tema relevante no entendimento da saúde dos adolescentes. Identificou-se que as relações entre imagem corporal e nível socioeconômico são complexas e os resultados dos estudos publicados não são conclusivos. As principais tendências observadas foram: jovens norte-americanos de classe baixa apresentaram maior chance de serem obesos ao contrário dos brasileiros; moças e rapazes apresentaram comportamentos diferenciados na percepção da imagem corporal, independentemente da etnia e do nível socioeconômico; moças brancas apresentaram maior insatisfação com a imagem corporal e maior busca por dietas do que moças negras, as quais parecem sofrer menos influência dos padrões de beleza em voga; jovens de menor nível socioeconômico apresentaram uma tendência a desejarem corpos maiores. CONCLUSÕES: Considerando-se amostras estrangeiras, houve uma tendência de maiores índices de insatisfação com o corpo em adolescentes de classe socioeconômica mais privilegiada. Em amostras brasileiras, análises sobre o assunto são escassas e pesquisas são necessárias, especialmente pelo fato de a população estar passando por modificações tanto econômicas como nutricionais.

An exploration of body dissatisfaction and perceptions of Black and White girls enrolled in an intervention for overweight children

Silhouette measures are one approach to assessing body dissatisfaction in children, although little is known about their use among racially diverse, overweight girls seeking weight-loss treatment. This study assessed racial differences in body dissatisfaction and body size perceptions of 58 girls (ages 6-11, 66% Black, 34% White) participating in a randomized trial for pediatric overweight. Body dissatisfaction did not differ between races; 99% of girls reported an ideal figure smaller than their current one. Black girls selected a larger silhouette to represent their ideal body size, and most girls in both racial groups underestimated their actual size. Outcomes strengthen the argument that, despite an overall preference for a larger body size, obesity might mitigate cultural factors that protect Black girls from body dissatisfaction. Additional research is needed to enhance understanding of children's body size perceptions and dissatisfaction to inform assessment and treatment of pediatric obesity and associated disordered eating symptoms.

Weight ratings of others: The effects of multiple target and rater features

The present study investigated factors that affect the subjective analysis of the weight of other individuals. Three hundred and thirty-three participants viewed figures varying in muscularity, adiposity, gender, and race. For each of the eighteen figures (targets), a 2 (rater gender: male, female)x3 (rater race/ethnicity: Caucasian, African American, Hispanic)x3 (target race/ethnicity: Caucasian, African American, Hispanic) repeated measures ANCOVA was conducted (BMI was covaried). Overall, there were few significant effects, however, for some of the figural stimuli, African American raters assigned lower weight ratings than did Caucasian and Hispanic raters. The findings offer support for further investigation of ethnic differences in weight ratings as a potential factor that might inform ethnic differences in overweight and obesity prevalence.

Childhood obesity prevention: an intervention targeting primary caregivers of school children

Community-based participatory research (CBPR) was used to design and evaluate the effectiveness of a culturally relevant, science-based intervention for the prevention of childhood obesity in the Commonwealth of the Northern Mariana Islands (CNMI), a US Commonwealth in the western Pacific. This cognitive behavioral lifestyle intervention, Project Familia Giya Marianas (PFGM), was offered during the 2005-2007 school years in all CNMI public elementary schools over eight sessions to primary caregivers of 3rd grade children (N = 407). A crossover design was utilized with half of the schools offering the intervention in the Fall term, while the other half delivered the sessions in the Spring term. The primary outcome measure was change in BMI z-score. There was an intervention-dependent effect on BMI z-score, with program impact being a function of baseline BMI and the number of lessons attended. This effect was most apparent in students whose baseline BMI z-score was in healthy range (>/=5 to <85 percentile). In both Asian and Pacific Island groups, children whose caregivers completed 5-8 lessons experienced a significant change in BMI z-score as compared to those with 0 lessons (P < 0.05). Research that integrates multidisciplinary and multimethod approaches is effective in identifying and/or devising solutions to address a complex condition such as childhood obesity. PFGM demonstrated that community participation can be successfully utilized in the development and implementation of childhood obesity prevention programs.

Understanding body image in African American and Caucasian first-graders: a partnership with the YMCA

BACKGROUND

Research suggests that body dissatisfaction can develop by first grade or 6 years of age. Few studies have examined the relationship between parental body image factors on child body image among this population using a CBPR approach.

OBJECTIVE

We sought to examine parental influence on body image in African American and Caucasian first-graders through a community-based participatory research (CBPR) partnership with the YMCA of Metropolitan Washington, DC.

METHODS

Quantitative data were collected by after-school teachers and academic researchers. Children were administered a silhouette measure to assess body image. Body image and eating behavior measures were given to parents. Correlational and descriptive analyses were employed to examine the association and characteristics of child body image factors.

RESULTS

Participants were 58 child-parent dyads attending YMCA after-school programs in the Washington, DC, area. Descriptive analyses found significant body dissatisfaction among first graders. Only 12.1% of first graders were satisfied with their bodies, and among the 38 children of normal weight, 89.5% were dissatisfied with their current body size. No significant correlations emerged between child body image and parental eating factors. However, correlations did emerge between child and parent body image indices.

CONCLUSION

Findings from this study were used to develop programming focused on promoting positive body image and self-esteem for young children in YMCA sites in the DC metro area. Additionally, future studies should further delineate body image among young children and the clinical and educational implications of early onset of body dissatisfaction in this population using a CBPR approach.