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Chen J, Liu K, Zhang J, Liu S, Wang Y, Cao R, Peng X, Han M, Han H, Yao R, Fu L. Parental Pressure on Child Body Image, BMI, Body Image Dissatisfaction Associated with Eating Disorders in School-Age Children in China: A Path Analysis. Psychol Res Behav Manag 2023; 16:3247-3258. [PMID: 37609642 PMCID: PMC10440685 DOI: 10.2147/prbm.s418535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/05/2023] [Indexed: 08/24/2023] Open
Abstract
Background Children's eating behaviors, body shape and body image cognition may be more susceptible to the influence of their parents, but these influences may be weakened with age. There may be different association pathways between parental pressure on children's body image (PPCBI), body mass index (BMI), body image dissatisfaction (BID) and eating disorders (EDs) among children and adolescents at different developmental stages. Methods The stratified cluster sampling method (Stratified by grade, and took the classes as clusters) was used to select 486 students aged 8-15 years in two 9-year schools. Children's body height, weight, testicular volume and breast development were measured. PPCBI, BID, and EDs were investigated using the Appearance-related Social Stress Questionnaire, Body Size Questionnaire (BID-14), and EDI-1 scale, respectively. Results The boys before puberty initiation had significantly higher EDs score (182.3±50.8) than girls before puberty initiation (164.1±58.1) (P<0.05). There were significant association pathways of PPCBI→BMI→BID→EDs and PPCBI→BID→EDs in boys before puberty initiation (β=0.035, P<0.01; β=0.059, P<0.01), in boys after puberty initiation (β=0.032, P<0.01; β=0.175, P<0.001), and in girls after puberty initiation (β=0.026, P<0.01; β=0.172, P<0.001). There was a positive association pathway of PPCBI→EDs in boys before puberty initiation (β=0.30, P<0.001) and PPCBI→BID→EDs in girls before puberty initiation (β=0.176, P<0.01). Conclusion Parental pressure on children's body image may positively associate with children's eating disorders through BMI and body image dissatisfaction in boys and girls after puberty initiation and directly associate with eating disorders in boys before puberty initiation; however, it may indirectly associate with eating disorders only through BID in girls before puberty initiation.
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Affiliation(s)
- Jiaoyan Chen
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Keke Liu
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Juan Zhang
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Songhui Liu
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Yuanyuan Wang
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Ruiyao Cao
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Xingwang Peng
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Mei Han
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Hui Han
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Rongying Yao
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
| | - Lianguo Fu
- Department of Child and Adolescent Health, School of Public Health, Bengbu Medical College, Bengbu, Anhui, 233030, People’s Republic of China
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Wang H, Xu J, Cao W, Xu P, Gan Q, Yang T, Luo R, Pan H, Zhao W, Zhang Q. Perceptions of Primary Caregivers on Children's Weight Status Versus Actual Weight Status in Children Aged 6-15 Years - China, 2021. China CDC Wkly 2023; 5:538-541. [PMID: 37416903 PMCID: PMC10319909 DOI: 10.46234/ccdcw2023.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/11/2023] [Indexed: 07/08/2023] Open
Abstract
What is already known about this topic? Childhood obesity has been linked to adverse health outcomes during both childhood and adulthood. An accurate understanding of children's weight status by primary caregivers is essential for effective weight management strategies. What is added by this report? The data utilized in this study were obtained from the 2021 Nutrition Improvement Program for Rural Compulsory Education Students in China. It was found that over one-third of primary caregivers underestimated their children's weight status, and more than half of the primary caregivers of overweight or obese children underreported the weight status of those children. A low level of agreement was observed between primary caregivers' perceptions of their children's weight status and the actual weight status. What are the implications for public health practice? There is a relatively higher underestimation of children's weight in China, which necessitates more effective strategies to enhance the primary caregivers' perception of their children's weight status, especially in primary caregivers of males, younger children and children in urban areas.
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Affiliation(s)
- Hongliang Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Juan Xu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wei Cao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peipei Xu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qian Gan
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Titi Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ruihe Luo
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Pan
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenhua Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
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3
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Hartono S, Niyonsenga T, Cochrane T, Kinfu Y. Effect of migrant parents' bodyweight perception on children's body bodyweight: A longitudinal analysis of population cohort study. SSM Popul Health 2022; 21:101318. [PMID: 36582615 PMCID: PMC9793301 DOI: 10.1016/j.ssmph.2022.101318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/27/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Children of migrants in Australia are disproportionally affected by overweight/obesity. Their parents, however, are likely to put little effort into lifestyle changes if unable to recognise their children's suboptimal bodyweight. We examined the potential impact of migrant parents' bodyweight perception on their children's bodyweight over time and whether the region-of-birth of parents and acculturation to the host nation's way of life moderated the relationship, as very little is known about these in the Australian context. We analysed a sample of 2046 children of migrant parents drawn from 8 waves of population-based cohort data, the Longitudinal Study of Australian Children, capturing their lived experience from ages 2 to 17. After controlling for child, parent, family, and neighbourhood factors influencing children's bodyweight, multilevel models showed higher children's bodyweight in subsequent waves if their parents perceived children's bodyweight as lower than their actual bodyweight (i.e., underestimation). However, the rate of increase in children's bodyweight attenuated over time. The effect of migrant parents' underestimation on children's subsequent bodyweight differed by region-of-birth, with higher children's bodyweight in successive waves if their parents were from the Americas, compared to migrant parents from North/West Europe. Parents' acculturation, however, did not have a discernible effect. Although migrant parents' bodyweight perception of their children's bodyweight status influenced children's bodyweight in subsequent waves, this factor was not enough to explain the extent of disparities in children's bodyweight observed in the Australian migrant population. Further research is needed to assess the effects of other types of perception (such as perceptions of healthy weight and physical exercise) on bodyweight disparities in children of migrants.
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Affiliation(s)
- Susan Hartono
- Health Research Institute, University of Canberra, Bruce, A.C.T, Australia,Corresponding author.
| | - Theo Niyonsenga
- Health Research Institute, University of Canberra, Bruce, A.C.T, Australia,Faculty of Health, University of Canberra, Bruce, A.C.T, Australia
| | - Tom Cochrane
- Health Research Institute, University of Canberra, Bruce, A.C.T, Australia
| | - Yohannes Kinfu
- Faculty of Health, University of Canberra, Bruce, A.C.T, Australia
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The Relationships between Parenting Practices and Child Health-Related Behaviors in Children with Intellectual Disability: The Moderating Role of Child Body Weight Status. Nutrients 2022; 14:nu14245206. [PMID: 36558365 PMCID: PMC9784023 DOI: 10.3390/nu14245206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/27/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022] Open
Abstract
This study aimed to examine the associations between parenting practices and child health-related behaviors, and the moderating role of child body weight status in children with intellectual disability (ID). A cross-sectional study was conducted among a sample of children with ID in Hong Kong; 440 participants were included in this study. All the variables investigated were collected from questionnaires, except body weight status, which was objectively measured. Logistic regression analysis was used to examine the associations between parenting practices and children's unhealthy behaviors. Interaction items were added to investigate the moderation effect of child body weight status, adjusting for significant background characteristics. Results showed that the parenting practices of "restricting access to unhealthy food and sedentary behaviors (RA)" (OR range: 0.63-0.64) and "using food or sedentary behaviors as rewards (UR)" (OR range: 1.28-1.60) were significantly associated with some eating behaviors, but not with sedentary behaviors. Body weight status significantly moderated these associations. Only RA showed favorable effects on some eating behaviors in children with overweight and obesity (OR range: 0.17-0.28), whereas the effects of UR differed by body weight status. Future research should focus on developing educational interventions which encourage parents to use practices that are tailored towards children's individual characteristics.
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5
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Gketsios I, Foscolou A, Vassilakou T, Panagiotakos DB, Kosti RI. Parental Misperceptions of Their Offspring's Weight and Their Strategies for Child's Eating Behavior: A Narrative Review of the Recent Evidence. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101565. [PMID: 36291501 PMCID: PMC9600609 DOI: 10.3390/children9101565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022]
Abstract
The aim of the present review was to explore the effect of parental misperceptions of their offspring’s weight status during childhood and early adolescence on weight control strategies and children’s eating behavior. Literature searching was limited to the PubMed database and to the English language from January 2000 to August 2022. Eligible studies had clearly associated parental misperception of offspring’s weight with child eating habits or weight management and eating strategies in childhood to early adolescence. Sixteen studies (14 cross-sectional, 1 longitudinal and 1 with cross-sectional and longitudinal analyses) were included in the analysis. Weight loss attempts and child’s eating behavior were the main outcomes. Sixteen studies found significant associations. Parental misperceptions of their offspring’s weight status do influence their child’s weight and eating behavior, especially in overweight children. Parents tend to follow potentially harmful methods when they overestimate their children’s weight (food restriction) and when they underestimate their children’s weight (pressure to eat). However, additional longitudinal studies are needed to better understand the impact of parental weight status perception on health behaviors and children’s weight gain over time. The potential need for preventive intervention studies is warranted.
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Affiliation(s)
- Ioannis Gketsios
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Alexandra Foscolou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17671 Athens, Greece
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens, Greece
| | - Demosthenes B. Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17671 Athens, Greece
- Faculty of Health, University of Canberra, Canberra 2617, Australia
| | - Rena I. Kosti
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 42132 Trikala, Greece
- Correspondence:
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How Parenting and Family Characteristics Predict the Use of Feeding Practices among Parents of Preschoolers: A Cross-Sectional Study in Beijing, China. Nutrients 2022; 14:nu14153109. [PMID: 35956286 PMCID: PMC9370555 DOI: 10.3390/nu14153109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023] Open
Abstract
Parental coercive and structured feeding practices are linked with children’s weight gain. Thus, identifying their predictors will assist in childhood obesity prevention. We explored how parents’ concerns and perceptions of children’s weight, parenting stress, parenting competence, parents’ family roles, and only child status (of both parent and child) predict the use of restriction, pressure to eat, and monitoring practices among parents of preschoolers. Parent–child dyads (n = 2990) were recruited in Beijing in 2019. Parenting competence, parents’ weight perceptions and feeding practices were assessed using the Chinese version of Parenting Sense of Competence Scale and Child Feeding Questionnaire (CFQ), respectively. Parenting stress and other variables were collected through self-administered questionnaires. Multivariate linear associations between parents’ weight perceptions and feeding practices were significant among normal-weight children. Parents’ concerns about children being overweight were positively associated with restriction and monitoring, and negatively associated with pressure to eat. Higher levels of parenting stress and parenting competence significantly improved the adoption of restriction and pressure to eat. Parents’ only child status and that of children had an impact on parents’ feeding practices. The fathers’ feeding preferences were substantially different from what mothers preferred. In conclusion, such parenting and family characteristics significantly influenced feeding practices of preschoolers’ parents. These were long neglected in China.
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7
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Hsu PC, Hwang FM, Chien MI, Mui WC, Lai JM. The impact of maternal influences on childhood obesity. Sci Rep 2022; 12:6258. [PMID: 35428792 PMCID: PMC9012806 DOI: 10.1038/s41598-022-10216-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 04/04/2022] [Indexed: 12/17/2022] Open
Abstract
There was a lack of detailed information about maternal influences on their children’s body mass index (BMI) in Taiwan. The aim of this study was to find the evidence to describe how mothers’ factors could affect their 2 to 9-year-old children’s BMI, with data collected from May 2021 to June 2021. Anonymous self-administered questionnaires were completed by 1035 participants from Taiwan’s six metropolitan cities and eight counties. After controlling for children’s factors, such as number of children in a family, children’s constitution, children’s age and gender, hierarchical regression models were used to analyze the effects of five maternal factors on their children’s BMI: maternal BMI, age, education level, monthly household income, and marital status (single parent or not). The results were found as follow: maternal BMI [β = .24], maternal educational level [β = −.141], and monthly household income [β = .071], significantly (p < 0.05) influenced their children’s BMI. Higher maternal BMI was associated with a higher children’s BMI. Mothers with lower levels of education background were more likely to have children with a higher BMI. Monthly household income was a positive factor influencing children’s BMI. In conclusion, this study is the first detailed description of maternal influences on their 2–9 years old children’s BMI in Taiwan. Although the study could not cover all of the factors influencing Taiwan’s childhood obesity, we have discovered maternal BMI, education level, and monthly household income were significant factors associated with children’s BMI.
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Affiliation(s)
- Pei-Chuan Hsu
- Department of Early Childhood Educare, Tainan University of Technology, Tainan City, 710, Taiwan
| | - Fang-Ming Hwang
- Department of Education, National Chiayi University, Chiayi City, 600, Taiwan
| | - Mei-I Chien
- Department of Early Childhood Education, National Chiayi University, Chiayi City, 600, Taiwan
| | - Wui-Chiu Mui
- Chiayi Christian Hospital, Chiayi City, 600, Taiwan
| | - Jyh-Mirn Lai
- College of Veterinary Medicine, Department of Veterinary Medicine, National Chiayi University, Chiayi City, 600, Taiwan.
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8
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Obesity in Polish Children and Parents' Perception of Their Children's Weight Status: The Results of the SOPKARD-Junior Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084433. [PMID: 35457299 PMCID: PMC9026880 DOI: 10.3390/ijerph19084433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/29/2022]
Abstract
One way to counteract the spread of obesity in children is its early recognition by parents. Therefore, the aim of this study was to investigate whether parents’ perception of their children’s BMI category was consistent with their actual BMI assessment and to determine potential influential factors. The study was conducted as part of the “A program for the early detection of risk factors for lifestyle diseases SOPKARD-Junior” (SOPKARD-Junior), a preventive health program implemented in public elementary schools from 2017 to 2019. The results from 381 children with a mean age of 11.67 (SD = 1.52) were analyzed. Height and weight were measured and BMI was calculated. Surveys were conducted to assess parents’ perceptions of their child’s weight, along with their sociodemographic status. Nearly one in three parents were unable to correctly identify their children’s weight; 25.0% underestimated it, and 6.0% overestimated it. Underestimation was observed along with an increase in the children’s BMI weight category, with as many as 57.1% of parents of obese children misclassifying their weight. The child’s BMI was the only significant predictor of incorrect assessment. Polish parents cannot properly assess their children’s BMI, especially when their child is overweight or obese. In children, weight and height measurements should be taken regularly, rather than allowing weight category to be dependent upon parental weight assessments.
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9
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Gadaire CB, Armstrong LM, Levens SM. Development and validation of the Child Weight Risk Questionnaire. Eat Weight Disord 2022; 27:525-534. [PMID: 33860465 DOI: 10.1007/s40519-021-01181-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 03/24/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The study objective was to develop and validate a measure of parent perception of child weight-related risk, the Child Weight Risk Questionnaire (CWRQ), among a sample of US parents. METHODS A cross-sectional survey was conducted in a sample of 216 parents of 6- to 12-year-old children who were overweight. The CWRQ was used to assess parent beliefs about their child's susceptibility to physical, social-emotional, and behavioral health problems due to weight. RESULTS Confirmatory factor analysis supported the three-factor structure of the CWRQ and acceptable fit was achieved. The internal consistency of the measure was excellent. Convergent, discriminant, and incremental validity analyses provided initial evidence for CWRQ validity. CONCLUSION The CWRQ is a reliable and valid instrument for assessing parent perception of child weight-related risk. This measure could be utilized in research and applied settings to capture the multifaceted nature of parent risk perception and support efforts to tailor family weight interventions in ways that align with parent beliefs. LEVEL OF EVIDENCE Level V, cross-sectional, descriptive study.
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Affiliation(s)
- Cecily B Gadaire
- Department of Psychological Science, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA. .,Health Psychology Ph.D. Program, University of North Carolina at Charlotte, Charlotte, NC, USA.
| | - Laura Marie Armstrong
- Department of Psychological Science, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA. .,Health Psychology Ph.D. Program, University of North Carolina at Charlotte, Charlotte, NC, USA.
| | - Sara M Levens
- Department of Psychological Science, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA.,Health Psychology Ph.D. Program, University of North Carolina at Charlotte, Charlotte, NC, USA
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Xiang C, Zhang Y, Yong C, Xi Y, Huo J, Zou H, Liang J, Jiang Z, Lin Q. Association between Parents' Perceptions of Preschool Children's Weight, Feeding Practices and Children's Dietary Patterns: A Cross-Sectional Study in China. Nutrients 2021; 13:nu13113767. [PMID: 34836023 PMCID: PMC8624819 DOI: 10.3390/nu13113767] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/20/2021] [Accepted: 10/23/2021] [Indexed: 12/20/2022] Open
Abstract
Parental perception of children’s weight may influence parents’ feeding practices, and in turn, child dietary intake and weight status; however, there is limited evidence generated for preschoolers. The aim of this cross-sectional study was to investigate associations between Chinese parents’ perceptions of child weight, feeding practices and preschoolers’ dietary patterns. Participants (1616 parent-child pairs) were recruited from six kindergartens in Hunan, China. Parents’ misperception, concern, and dissatisfaction on child weight were collected through a self-administered caregiver questionnaire. Parental feeding practices and children’s dietary intake were, respectively, assessed using the Child Feeding Questionnaire and a Food Frequency Questionnaire. Linear regression models were applied to analyze associations between parental weight perceptions, feeding practices, and preschooler’s dietary patterns. Associations between parents’ weight perceptions and dietary patterns were significant only among underweight children. Regardless of child weight status, parental weight underestimation and preference for a heavier child were positively associated with pressure-to-eat. Parental weight concern was positively associated with restriction in normal weight child, but this was not found in other weight groups. In conclusion, Parents’ misperception, concern, and dissatisfaction about child weight are associated with parents’ feeding practices and may influence preschoolers’ dietary quality, but the relationships vary by children’s actual weight status.
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Affiliation(s)
- Caihong Xiang
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (C.X.); (C.Y.); (Y.X.); (J.H.); (H.Z.); (J.L.)
| | - Youjie Zhang
- Department of Child and Adolescent Health and Social Medicine, School of Public Health, Medical College of Soochow University, 199 Ren Ai Road, Suzhou 215123, China;
| | - Cuiting Yong
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (C.X.); (C.Y.); (Y.X.); (J.H.); (H.Z.); (J.L.)
| | - Yue Xi
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (C.X.); (C.Y.); (Y.X.); (J.H.); (H.Z.); (J.L.)
| | - Jiaqi Huo
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (C.X.); (C.Y.); (Y.X.); (J.H.); (H.Z.); (J.L.)
| | - Hanshuang Zou
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (C.X.); (C.Y.); (Y.X.); (J.H.); (H.Z.); (J.L.)
| | - Jiajing Liang
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (C.X.); (C.Y.); (Y.X.); (J.H.); (H.Z.); (J.L.)
| | - Zhiqian Jiang
- Faculty of Agriculture, Life and Environment Science, Nutrition and Food Science Program, University of Alberta, 116st 85 Avenue, Edmonton, AB T6G 2R3, Canada;
| | - Qian Lin
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha 410078, China; (C.X.); (C.Y.); (Y.X.); (J.H.); (H.Z.); (J.L.)
- Correspondence:
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11
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Robinson E, Daly M, Sutin A. Association of parental identification of child overweight and mental health problems during childhood. Int J Obes (Lond) 2020; 44:1928-1935. [PMID: 32398752 DOI: 10.1038/s41366-020-0587-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Public health policies attempt to increase parental identification of child overweight and obesity. The objective of the present research was to determine the cross-sectional, prospective and longitudinal associations between parental identification of child overweight and child mental health problems. METHODS We made use of two cohort studies of Australian (Longitudinal Study of Australian Children, LSAC) and Irish children (Growing up in Ireland Study, GUI) that measured parental identification of child overweight and child mental health problems. Participant included 6502 (LSAC) and 7503 (GUI) children (49% female) and their parents. Child mental health problems were measured using child, parent and teacher-reported Strengths and Difficulties Questionnaires (SDQ) at ages 9/10 years old to 12/13 years old. In all analyses we controlled for child Z-BMI. RESULTS In LSAC children whose parents identified them as being overweight at age 10 experienced worse mental health at age 10 (β = 0.21, SE = 0.04) and age 12 (β = 0.13, SE = 0.04) than children whose parents failed to identify them as overweight. In GUI children whose parents identified them as being overweight at age 9 experienced worse mental health at age 9 (β = 0.20, SE = 0.04) and age 13 (β = 0.22, SE = 0.04). In LSAC parental identification of child overweight at age 10 did not significantly predict changes in mental health problems from age 10 to 12 (β = -0.02, SE = 0.03). In GUI parental identification of child overweight was predictive of increases in mental health problems from age 9 to 13 (β = 0.08, SE = 0.03). CONCLUSIONS Parental identification of child overweight and obesity is associated with worse child mental health, independent of child body weight. Parents should be aware of the potential stigma and mental health difficulties associated with labelling a child as overweight.
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Affiliation(s)
- Eric Robinson
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool, UK.
| | - Michael Daly
- Behavioural Science Centre, Stirling Management School, University of Stirling, Stirling, UK.,UCD Geary Institute, University College Dublin, Dublin, Ireland.,Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Angelina Sutin
- Florida State University College of Medicine, Tallahassee, FL, USA
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12
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Gao L, Ma L, Xue H, Min J, Wang H, Wang Y. A 3-year longitudinal study of effects of parental perception of children's ideal body image on child weight change: The Childhood Obesity Study in China mega-cities. Prev Med 2020; 132:105971. [PMID: 31899255 PMCID: PMC7024657 DOI: 10.1016/j.ypmed.2019.105971] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/06/2019] [Accepted: 12/27/2019] [Indexed: 12/24/2022]
Abstract
This study examined prevalence of childhood overweight and obesity (ov/ob) and central obesity in five mega-cities across China (Beijing, Shanghai, Xi'an, Nanjing and Chengdu); described parental perceptions of children's ideal body image (IBI); and prospectively examined associations between parental perception of child IBI and child weight changes over 3 years. In this NIH-funded, open cohort study, data were collected from students and their parents in 2015, 2016 and 2017 (n = 3298, in 3 waves). Cross-sectional analysis included all 3298 children; longitudinal data analysis used mixed effects models and included 1691 children aged 6-17 years with ≥two body mass index (BMI) measurements during 2015-2017. Ov/ob prevalence based on Chinese age-sex-specific BMI cut-points was 30.0%. Based on waist-to-height ratio (WHtR), the abdominal obesity rate was 19.8%. Parents reported different preferred IBI for boys vs girls, being about 3 times more likely to select ov/ob as ideal for boys than for girls (4.5% vs 1.5%, respectively, P < .001). In longitudinal analysis, children whose parents selected ov/ob as ideal had higher BMI Z-scores and WHtR increase over time than those whose parents selected an average body image (β [SE] = 0.042 [0.011], and β [SE] = 0.010 [0.004], respectively, all P < .05). Ov/ob rates were high among children in major cities in China. Chinese parents preferred a heavier ideal body image for their boys. Health promotion programs should help empower parents and their children to develop appropriate body images and maintain healthy body weight.
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Affiliation(s)
- Liwang Gao
- Global Health Institute, Xi'an Jiaotong University Health Science Center, China; School of Public Health, Xi'an Jiaotong University Health Science Center, China
| | - Lu Ma
- Global Health Institute, Xi'an Jiaotong University Health Science Center, China; School of Public Health, Xi'an Jiaotong University Health Science Center, China
| | - Hong Xue
- Department of Health Behavior and Policy, Virginia Commonwealth University, USA
| | - Jungwon Min
- Healthcare Analytics Unit, Children's Hospital of Philadelphia, USA; Fisher Institute of Health and Well-Being, Department of Nutrition and Health Science, College of Health, Ball State University, USA
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, China
| | - Youfa Wang
- Global Health Institute, Xi'an Jiaotong University Health Science Center, China; School of Public Health, Xi'an Jiaotong University Health Science Center, China; Fisher Institute of Health and Well-Being, Department of Nutrition and Health Science, College of Health, Ball State University, USA.
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13
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Blanchet R, Kengneson CC, Bodnaruc AM, Gunter A, Giroux I. Factors Influencing Parents' and Children's Misperception of Children's Weight Status: a Systematic Review of Current Research. Curr Obes Rep 2019; 8:373-412. [PMID: 31701349 DOI: 10.1007/s13679-019-00361-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Misperception of children's weight status is prevalent among parents and children themselves and may impact parents' and children's health behaviors. This study was conducted in order to provide a descriptive systematic review of research on factors influencing parents' and children's misperceptions of children's weight status published in the past 5 years. RECENT FINDINGS Factors studied most often in relation to parents' and children's misperception included children's weight status, gender, and age, as well as parents' weight status, parental education levels and socioeconomic status, and ethnicity. Most determinants that were found to have a significant influence on misperception in parents also did in children. The literature on misperception of children's weight status is extensive. Most determinants assessed in included studies were known determinants of childhood obesity. Further research should be directed toward better understanding the impact of weight status perception (whether it is accurate or not) on health behaviors and weight gain over time.
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Affiliation(s)
- Rosanne Blanchet
- Department of Agricultural, Food & Nutritional Sciences, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, Canada
| | - Cris-Carelle Kengneson
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Alexandra M Bodnaruc
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Ashley Gunter
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Isabelle Giroux
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
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14
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Estimating and differentiating maternal feeding practices in a country ranked first in childhood obesity. Public Health Nutr 2019; 23:620-630. [PMID: 31747985 DOI: 10.1017/s1368980019003173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Mexico ranks first in childhood obesity worldwide. However, little is known about the factors influencing maternal feeding practices. The present study aimed to estimate the prevalence of feeding practices and explore associations between weight concern, weight perception, sociodemographic characteristics and those feeding practices. DESIGN Cross-sectional. SETTING North-eastern Mexico. PARTICIPANTS Mothers aged ≥18 years who were in charge of feeding a singleton child aged 2-6 years with no endocrine disease or visible genetic malformations (n 507). Information on six maternal feeding practices, concern and perception of the child's weight and demographics were collected by interview. The mother's and child's height and weight were measured. The feeding practices questionnaire was subject to content, construct and convergent validity analysis. Then, mean feeding scores were obtained and prevalence and 95 % CI were determined for scores ≥3; multivariate logistic regression was performed. RESULTS Not modelling (63·5 %; 95 % CI 59·2, 67·8 %) and pressuring to eat (55·6 %; 95 % CI 51·2, 60·0 %) were the most frequent feeding practices, followed by easy access to unhealthy foods (45·4 %; 95 % CI 40·9, 49·8 %) and child control (43·2 %; 95 % CI 38·8, 47·6 %). They prevailed despite concern about the child's excess weight or a perception of the child as overweight/obese. Education was associated with the highest number of practices (educated mothers used more pressuring to eat, less regulation and less easy access; or monitoring was less absent). CONCLUSIONS The frequency of certain feeding practices needs to be improved. Emphasis on the child's weight concern, obesity perception and maternal education is essential for optimizing intervention planning.
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Butler ÉM, Suhag A, Hong Y, Liang L, Gong C, Xiong F, Luo F, Liu G, Chen S, Taylor RW, Cutfield WS, Fu J, Derraik JGB. Parental Perceptions of Obesity in School Children and Subsequent Action. Child Obes 2019; 15:459-467. [PMID: 31408357 DOI: 10.1089/chi.2018.0338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Despite perceiving their child as being above a healthy weight, many parents do not intervene. Little is known about the factors influencing parental action. We assessed parental perception of child's weight status, the prevalence of mitigating parental action, and the underlying factors. Methods: We studied 20,242 children and adolescents from 6 centers across China. Anthropometry was measured by research nurses. Parents answered questionnaires, including their perception of their child's weight status, and any subsequent weight treatment. Results: A total of 3254 children had obesity (16.1%), with 63.0% correctly perceived as overweight by their parents. These children were more likely to be older (≥8 years; p < 0.0001), have severe obesity [adjusted relative risk (aRR) 1.41; p < 0.0001], and have mothers with overweight/obesity (aRR 1.15; p < 0.0001). In particular, parents of children aged <8 years were over five times more likely to perceive their child with overweight/obesity as "thin" than parents of teenagers. Conversely, girls, older children/adolescents, and urban youth were more likely to be wrongly perceived by parents as having an overweight issue. Only one in four children (27.8%) with available information received treatment for their perceived weight problem. Children with severe obesity were more likely to be treated (aRR 1.34; p < 0.0001), as were children of mothers with overweight/obesity (aRR 1.18; p = 0.002). Conclusions: Only one in four Chinese children perceived as overweight by their parents received treatment for their weight problem. Given that overweight/obesity in childhood tracks into adulthood and many parents did not intervene despite perceiving an overweight problem in their child, interventions for childhood obesity need to extend beyond parental perception of children's weight status.
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Affiliation(s)
- Éadaoin M Butler
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, New Zealand
| | - Alisha Suhag
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Experimental Psychology, University of Bristol, Bristol, United Kingdom
| | - Ye Hong
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li Liang
- First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunxiu Gong
- Beijing Children's Hospital of Capital Medical University, Beijing, China
| | - Feng Xiong
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Feihong Luo
- Department of Endocrinology, Children's Hospital of Shanghai Fudan University, Shanghai, China
| | - Geli Liu
- General Hospital of Tianjin Medical University, Tianjin, China
| | - Shaoke Chen
- Maternal and Children Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Rachael W Taylor
- A Better Start-National Science Challenge, New Zealand.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, New Zealand
| | - JunFen Fu
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - José G B Derraik
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, New Zealand.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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The Associations between Body Mass Index of Seven- and Eight-Year-Old Children, Dietary Behaviour and Nutrition-Related Parenting Practices. ACTA ACUST UNITED AC 2019; 55:medicina55010024. [PMID: 30669687 PMCID: PMC6359571 DOI: 10.3390/medicina55010024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/11/2019] [Accepted: 01/17/2019] [Indexed: 01/16/2023]
Abstract
Background and objective: Body mass index (BMI) is one of the key indicators used to measure the growth of children. It could be affected by the children’s nutrition, which is essential for the proper development of the child. Nutrition of children could be affected by many environmental factors, for example, the socioeconomic environment of the family. The aim of this study was to identify the associations between the BMI of seven- and eight-year-old children, dietary behaviour and nutrition-related parenting practices. Materials and Methods: The study was carried out as part of the World Health Organization European Childhood Obesity Surveillance Initiative (WHO COSI). Data were collected using two instruments: objective anthropometric measurements and a questionnaire. The target participant group was 3969 Lithuanian first-formers. Factor analysis was used to summarise questions from the family form. Linear regression analysis was used to identify the associations between various factors and the BMI value of the children. The association between two groups of factors was analysed using Spearman correlation. Results: Factors of dietary behaviour like unhealthy food and proteins were significantly positively associated with BMI in children, while consumption of plant-based, dairy and confectionery items was significantly negatively associated with BMI. Factors of nutrition-related parenting practices like control of unhealthy food, food as a reward or punishment, and mealtime were significantly positively associated with BMI, while encouragement, pressure to eat, and liberal attitude were significantly negatively associated with BMI. The strongest associations were between control of unhealthy food and unhealthy food; cost of and preferences for food and plant-based food; variety of food and proteins; variety of food and plant-based food compared to other associations. Conclusions: The dietary behaviour and nutrition-related parenting practices were associated with BMI in children.
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Min J, Yan AF, Wang Y. Mismatch in Children's Weight Assessment, Ideal Body Image, and Rapidly Increased Obesity Prevalence in China: A 10-Year, Nationwide, Longitudinal Study. Obesity (Silver Spring) 2018; 26:1777-1784. [PMID: 30281208 PMCID: PMC6202186 DOI: 10.1002/oby.22310] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/17/2018] [Accepted: 08/18/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study examined secular trends in children's weight-status assessment, measured weight status, and ideal body image and their associations with subsequent changes in BMI, and it explored the differences between sociodemographic groups in China. METHODS Longitudinal data from the China Health and Nutrition Survey of 4,605 children aged 6 to 17 collected between 2000 and 2011 were used and fitted to mixed models. RESULTS From 2000 to 2011, overweight/obesity prevalence increased from 6.5% to 16.8%, but the percentage of children with self-perceived weight status as "fat" remained around 2.0%; 49.0% of children underestimated their weight status at baseline. Self-perceived body image of most participants was tracked during follow-up. Children who perceived themselves as being fat at baseline had a higher BMI increase over time during follow-up than those with an average body image (β [SE] = 0.99 [0.14] kg/m2 per year, P < 0.001). Boys, young children, recent cohorts, and rural children had higher BMI increases than their counterparts. Over time, the thin-body silhouette became more desirable (8.4 percentage points higher, P < 0.001). CONCLUSIONS Chinese children experience a large incongruence between their weight-status assessment, ideal body image, and actual weight status. Health promotion programs should examine their role in assisting children in developing a healthy body image and gaining greater self-motivation toward promoting a healthy lifestyle.
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Affiliation(s)
- Jungwon Min
- Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University, Muncie, IN
| | - Alice Fang Yan
- Community and Behavioral Health Promotion, Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Youfa Wang
- Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-being, College of Health, Ball State University, Muncie, IN
- Department of Nutrition and Health Sciences, College of Health, Ball State University, Muncie, IN
- Correspondence: Youfa Wang, MD, PhD, MS, John & Janice Fisher Endowed Chair of Wellness, Associate Director, Fisher Institute of Health and Well-being, Director, Systems-Oriented Global Childhood Obesity Intervention Program, Professor, Department of Nutrition and Health Sciences, College of Health, Ball State University, Office: HP 302, Muncie, IN 47306, USA, Phone: 765-285-8121,
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18
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Min J, Yan AF, Wang VHC, Wang Y. Obesity, body image, and its impact on children's eating and exercise behaviors in China: A nationwide longitudinal study. Prev Med 2018; 106:101-106. [PMID: 29066373 PMCID: PMC5962018 DOI: 10.1016/j.ypmed.2017.10.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/06/2017] [Accepted: 10/18/2017] [Indexed: 12/31/2022]
Abstract
Body image seems to mediate the association between obesity and health behaviors as well as weight control attempts. We examined the distribution of children's body image by demographic characteristics and their subsequent associations with eating, exercise, and weight change. Child body image and health behaviors from the China Health National Survey 2000-2011 were assessed at baseline and in follow-up for 6- to 17-year-old children during 2000-2011 using mixed models. There was a large discrepancy between children's actual weight status (overweight: 16.9%) vs. self-rated body image (fat: 2.4% in 2011). Less than 1% of children desired a fat body; girls were more likely to want to be thin (52.5% vs. 40.9%) than boys. About 11% of children needed to lose weight in order to be at their desired baseline. During follow-up, those needing weight loss to be as desired were more likely to attempt dieting to change their weight (OR, 95% CI=1.9, 1.1-3.5 in boys; 1.7, 1.1-2.5 in girls) and less likely to feel they had enough physical activity (OR, 95% CI=0.5, 0.4-0.7 in boys; 0.6, 0.5-0.9 in girls), although their weight gain had been significantly higher than those having consistent self and desired body images (β [SE]=0.4 [0.1] in boys; 0.2 [0.1] in girls, all p<0.05). However, no significant difference was shown in subsequent health behaviors among overweight children by body image discrepancy. The discrepancy in self vs. desired body image motivated children to change their obesity-related health behaviors among non-overweight children in China.
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Affiliation(s)
- Jungwon Min
- Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-Being, College of Health, Ball State University, USA
| | - Alice Fang Yan
- Community and Behavioral Health Promotion, Joseph J. Zilber School of Public Health, University of Wisconsin-, Milwaukee, USA
| | - Vivian H C Wang
- The Robert F. Wagner Graduate School of Public Service, New York University, NY, USA
| | - Youfa Wang
- Systems-Oriented Global Childhood Obesity Intervention Program, Fisher Institute of Health and Well-Being, College of Health, Ball State University, USA; Department of Nutrition and Health Sciences, College of Health, Ball State University, USA.
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Hernandez DC, Reesor L, Kabiri LS. Maternal concerns and perceptions of elementary school-age children's weight status. J SPEC PEDIATR NURS 2017; 22. [PMID: 28876514 DOI: 10.1111/jspn.12191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 07/10/2017] [Accepted: 08/01/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to identify characteristics associated with maternal concerns for her child becoming overweight, and how these concerns are related to her perceptions of her child's weight. DESIGN A school-based sample of 55 children and their mothers from Houston, Texas, participated in a cross-sectional survey. Mothers reported on their concerns and perceptions regarding their child's weight. Child and mother height and weight were directly assessed to calculate body mass index (BMI). Covariate-adjusted logistic regression models were conducted. RESULTS Over one-third of mothers misperceived their child's weight status [9% (n = 5) overestimated; 27% (n = 15) underestimated]. Mothers of sons were less accurate compared with mothers of daughters. For every one unit increase in maternal BMI, mothers had 13% higher odds of being concerned of their child becoming overweight. Concerned mothers had 82% lower odds of underestimating their child's weight. PRACTICE IMPLICATIONS In order for school-based childhood obesity prevention and intervention programs to be successful, parents must accurately perceive their elementary school-age child's weight status. School nurses can be vital to these efforts through proper training and resources. Nurses can use the "School Nurse Childhood Obesity Toolkit" and motivational interviewing techniques to address parental concerns and perceptions prior to teaching behavior modification strategies to children/families.
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Affiliation(s)
- Daphne C Hernandez
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Layton Reesor
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Laura S Kabiri
- Physical Therapist Assistant Program, Houston Community College, Houston, TX, USA
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