Perceptions of children's body sizes among mothers living on the Texas-Mexico border (La Frontera)

Nutritional Beliefs and Practices of Arabic-Speaking Middle Eastern Mothers Living in the United States

INTRODUCTION

Culture and acculturation influence nutritional beliefs. Little is known about the Arabic population in the United States. In this study, Arabic-speaking Middle Eastern mothers' perceptions of motherhood and childhood nutritional beliefs and practices are explored.

METHOD

Semi-structured interviews with 12 mothers from Arabic-speaking Middle Eastern countries.

RESULTS

Food and family are central to everyday life. Mothers worked hard to maintain traditional nutritional practices with their school-age children.

DISCUSSION

Findings can enhance school nurses' ability to collaborate with mothers in nutritional education and address any issues in the classroom.

Obesity Prediction with EHR Data: A deep learning approach with interpretable elements

Childhood obesity is a major public health challenge. Early prediction and identification of the children at an elevated risk of developing childhood obesity may help in engaging earlier and more effective interventions to prevent and manage obesity. Most existing predictive tools for childhood obesity primarily rely on traditional regression-type methods using only a few hand-picked features and without exploiting longitudinal patterns of children's data. Deep learning methods allow the use of high-dimensional longitudinal datasets. In this paper, we present a deep learning model designed for predicting future obesity patterns from generally available items on children's medical history. To do this, we use a large unaugmented electronic health records dataset from a large pediatric health system in the US. We adopt a general LSTM network architecture and train our proposed model using both static and dynamic EHR data. To add interpretability, we have additionally included an attention layer to calculate the attention scores for the timestamps and rank features of each timestamp. Our model is used to predict obesity for ages between 3-20 years using the data from 1-3 years in advance. We compare the performance of our LSTM model with a series of existing studies in the literature and show it outperforms their performance in most age ranges.

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.

Maternal feeding style and child weight status among Hispanic families with low-income levels: a longitudinal study of the direction of effects

BACKGROUND

The home environment is a central and modifiable influence on the development of childhood obesity. Evidence supports the central role of parents in shaping problematic child eating behaviors and excess weight. Most studies of feeding emphasize parent-driven influences without taking into account the child's role in eating interactions. Few studies have addressed the bi-directional nature of feeding dynamics in studies of young children.

METHODS

The goals of this study were: 1) to examine if parental feeding styles during preschool (4-5 years) predict child weight status at 7-9 years, and 2) to examine the direction of effects between parental feeding styles and child weight status over time. Participants were part of a larger longitudinal study of Hispanic Head Start families living in the West South Central United States. Data from mother/child dyads were collected at three time points: Time 1 (ages 4-5), Time 2 (ages 5 ½-6 ½), and at Time 3 (ages 7-9). Only data from the Times 1 and 3 were used in the current analyses. A total of 128 mothers and their children had data on all variables needed for the analyses. Assessments included parent-reported feeding styles, feeding practices, acculturation, child eating behaviors, and child height and weight. Hierarchical regression was used to examine the first aim; a cross-lagged panel analysis examined the second aim.

RESULTS

An indulgent parental feeding style at ages 4-5 was associated with increased child BMI z-score at ages 7-9. Indulgent feeding significantly contributed to child BMI z-score beyond demographics, baseline child BMI z-score, parental acculturation, and child eating behaviors. Regarding the direction of effects in parental feeding interactions, the cross-lagged analyses showed that both indulgent feeding style and authoritative feeding style at Time 1 positively predicted child BMI z-scores at Time 3. Child effects were significant as well. Child BMI z-score at Time 1 positively predicted indulgent feeding and negatively predicted authoritarian feeding at Time 3.

CONCLUSIONS

Indulgent feeding should be addressed in future family-focused childhood obesity initiatives focused on young children and their parents.

Observations of Maternal Feeding Practices and Styles and Young Children's Obesity Risk: A Longitudinal Study of Hispanic Mothers with Low Incomes

Background: Maternal feeding practices and styles are well-established correlates of children's BMI z-scores in the preschool years. Most studies, however, are cross-sectional, using maternal self-reports to examine feeding. This study examined, over a 3½-year period, the relationship between observed and self-reported feeding practices/styles and children's BMI z-scores in a sample of Hispanic mothers with low incomes and their preschool children. Methods: One hundred eighty-seven mothers were observed feeding their 4- to 5-year old during a buffet meal in a laboratory setting and completed self-report measures on their feeding practices and styles. Children's BMI z-scores were assessed at this visit and 3½ years later. Results: Consistent with previous research, observed and self-reported pressure to eat and/or authoritarian feeding were negatively associated with children's BMI z-scores at the first time point; observed discouraging eating was positively associated. However, children's BMI z-scores 3½ years later, controlling for Time 1 BMI z-scores, were positively associated with observed pressure to eat. Observed maternal reasoning and self-reported monitoring of children's eating behavior at Time 1 were negatively associated with later BMI z-scores. Only self-reported feeding styles predicted later children's BMI z-scores, with indulgent and authoritative styles positively associated with children's BMI z-scores at the third time point. Conclusions: These findings demonstrate that mothers who ignore their children's fullness cues and pressure them to eat have children who are at greater risk for the development of later obesity. Implications for the development of family-focused childhood obesity prevention programs are discussed.

Development of the MapMe intervention body image scales of known weight status for 4-5 and 10-11 year old children

Background

Parents tend to visually assess children to determine their weight status and typically underestimate child body size. A visual tool may aid parents to more accurately assess child weight status and so support strategies to reduce childhood overweight. Body image scales (BIS) are visual images of people ranging from underweight to overweight but none exist for children based on UK criteria. Our aim was to develop sex- and age-specific BIS for children, based on British growth reference (UK90) criteria.

Methods

BIS were developed using 3D surface body scans of children, their associated weight status using UK90 criteria from height and weight measurements, and qualitative work with parents and health professionals.

Results

Height, weight and 3D body scans were collected (211: 4–5 years; 177: 10–11 years). Overall, 12 qualitative sessions were held with 37 participants. Four BIS (4–5-year-old girls and boys, 10–11-year-old girls and boys) were developed.

Conclusions

This study has created the first sex- and age-specific BIS, based on UK90 criteria. The BIS have potential for use in child overweight prevention and management strategies, and in future research. This study also provides a protocol for the development of further BIS appropriate to other age groups and ethnicities.

Child weight status and accuracy of perceived child weight status as predictors of Latina mothers' feeding practices and styles

This study focused on the relationship between low-income Latina mothers' perceptions of their preschool children's weight status and maternal feeding practices and styles, also considering the effects of actual child weight status and maternal concern about child weight. A total of 186 low-income Latina mother-child dyads participated. The vast majority of mothers underestimated the weight status of their child, but this varied by child weight status. Although only 30% of mothers of healthy weight children underestimated their child's weight status, 97% of mothers of overweight or obese children did so. No mother overestimated her child's weight status. Contrary to our hypotheses, in most cases, maternal perceptions of child's body weight were not related to maternal feeding styles, nor were many feeding practices predicted by concern about child weight. Instead, children's actual weight status was the strongest predictor of maternal feeding practices and feeding styles. Mothers of children with higher BMI z-scores reported higher levels of healthy eating guidance and responsiveness during feeding and lower levels of pressure to eat, food as reward, and using food to regulate the child's emotions. These mothers were more likely to show an indulgent and less likely to show an authoritarian feeding style. Concern about child weight did not account for any of these significant correlations. Maternal perceptions only mattered for restriction for weight purposes where there were independent effects of both perceived and actual weight status. Implications for understanding the development of child obesity in low-income, Latino populations are considered, along with recommendations for future research and for childhood obesity prevention programs.

Exploratory factor analysis of The Comprehensive Feeding Practices Questionnaire (CFPQ) in a low-income hispanic sample of preschool aged children

The Comprehensive Feeding Practices Questionnaire (CFPQ) is an important measure to assess parent feeding practices as it encompasses a broad range of feeding behaviors, not just behaviors negatively associated with child weight outcomes. However, parent feeding practices have been shown to differ across ethnicities and the CFPQ has not been tested among low-income, Hispanic-American parents with preschool-aged children, a group at elevated risk for developing obesity. A confirmatory factor analysis was performed with the present Hispanic-American sample of Head Start mothers with preschoolers to confirm the original 12-factor, 49-item structure of the CFPQ. Because the original factor structure was not confirmed in the present Hispanic-American sample, an exploratory factor analysis was conducted to examine the psychometric properties of the CFPQ in this sample (n = 187). Among this sample, a five-factor model with 34 items was found to more appropriately assess parent feeding practices than the original 12-factor, 49-item CFPQ. This study provides preliminary validation of the CFPQ for use among low income, Hispanic-American families. Although future research is needed to replicate findings among a larger sample, this study takes an important first step toward more accurately assessing parent feeding practices among this high-risk population to inform tailored interventions that aim to reduce economic and ethnic disparities in child obesity.

Latino-American Mothers’ Perspectives on Feeding Their Young Children: A Qualitative Study

OBJECTIVE. We explored the cultural beliefs that influence Latino-American mothers’ feeding practices with their young children and the sources they referenced in making food choices for their children.

METHOD. We conducted semistructured interviews with 12 Latino-American mothers focusing on their experiences of feeding their young children. Data analysis, based in grounded theory, consisted of interview transcription, content analysis, coding, and theme development.

RESULTS. We identified four themes summarizing the mothers’ feeding practices: (1) “Grandma knows best,” (2) “I want my child(ren) to be healthy,” (3) “always soup and always rice,” and (4) “mealtime is family time.”

CONCLUSION. Occupational therapy practitioners need to obtain accurate information from families about feeding practices and to understand and interpret those practices in broader cultural contexts to design and implement targeted feeding intervention strategies that avoid stereotyping or misinterpreted information. To promote family-centered, meaningful interventions, practitioners must understand the cultural influences on feeding practices and be sensitive to mothers’ needs.

Is Childhood Overweight/Obesity Perceived as a Health Problem by Mothers of Preschool Aged Children in Bangladesh? A Community Level Cross-Sectional Study

Childhood obesity is rapidly rising in many developing countries such as Bangladesh; however, the factors responsible for this increase are not well understood. Being the primary caregivers of children, particularly in developing countries, maternal perceptions and knowledge could be important factors influencing the weight status of children. This study aimed to assess maternal perceptions of childhood obesity and associated socio-demographic factors in Bangladesh. A cross-sectional study using stratified random sampling was conducted among 585 mothers whose children aged 4 to 7 years attended preschools in a district town. Body Mass Index of the children was calculated and weight status categorized according to the Centers for Disease Control (CDC) criteria. Maternal perceptions were assessed using a self- or interviewer-administered questionnaire. Multinomial logistic regression was used to obtain crude and adjusted odds ratios. Fourteen percent of children were overweight or obese and approximately 30% were underweight. Only 3.1% of children were perceived as overweight/obese by their mothers. Over one-third (35%) of mothers perceived that childhood overweight/obesity could be a health problem and over two-thirds (68.6%) were not aware of any health consequences of childhood obesity. Maternal perceptions were significantly associated with maternal education, family income, and weight status of the child but were not associated with the sex of the child. We have identified knowledge gaps regarding maternal perception of childhood obesity and its contributing factors in a developing country. These findings can be used to develop and test parent-focused educational interventions for preventing childhood obesity in Bangladesh.

Mexican mothers' perceptions of their child's body weight

Currently, Mexico holds one of the top rankings in childhood obesity worldwide. This present qualitative study aims to explore and describe mothers' perceptions concerning the body weight of their children and, based on these findings, be able to arrive at a typology. Research included 91 semi-structured interviews administered to mothers of children who were underweight (UW), normal weight (NW), overweight (OW) or obese (OB). The data were collected between June 2011 and December 2013. The information was analysed with MAXQDA qualitative software. It was found that overestimated perception in UW children is observed in mothers who fear gaining weight. Mothers of NW children tend to gauge the weight of their children close to that which is normal. OW children are appropriately perceived by their mothers; however, these mothers are not concerned by this situation because for them, it is something temporary that will disappear as the child grows. The majority of boys who were OB were underestimated in their weight; those who were appropriately perceived showed class II or III obesity. Mothers typically perceived OW and OB girls with greater precision. The mothers who perceived obesity in their sons or daughters felt responsible, which motivated them to change their children's habits and behaviours. Therefore, health professionals should communicate and help these mothers recognise OW and OB status in their children. Furthermore, the importance of prevention should be stressed when a child is OW, and they should be informed of the high health risks that accompany obesity.

Obese children are thin in parents' eyes: A psychologically, socially, or culturally driven bias?

Although obesity presents a serious health problem in children, parents often underestimate their children's overweight and obesity status. Therefore, scientific literature was systematically screened through PubMed and PsycINFO to demonstrate the psychological, social, and cultural processes that underlie this evaluation bias. A total of 37 papers that focused on research conducted in different geopolitical contexts were taken into account. Furthermore, a lexicometric analysis of the papers' conclusions was performed. The findings showed that education plays a key role in promoting parents' awareness and their realistic recognition of their children's weight. Accordingly, adequate educational support for parents should be implemented in all healthcare policies addressing childhood obesity.

Mirror, Mirror on the Wall: Children's Preferences and Self-Perceptions of Weight in a Rural Hispanic Community

INTRODUCTION

Although studies have documented parents' misperceptions regarding their children's weight, studies examining preadolescent children's self-perceptions of weight-in particular, Hispanic children's self-perceptions of weight-are limited.

METHOD

A convenience sample of 424 children from a rural community, aged 8 to 11 years and in grades 3 through 5, participated in this cross-sectional, descriptive, nonexperimental study. Using the Children's Body Image Scale, the children were asked to select a figure representing their actual body perception and a figure representing their ideal body perception. The children were weighed and measured, body mass index (BMI) was calculated, and each child was assigned to one of the Centers for Disease Control and Prevention weight categories: underweight, normal or healthy weight, overweight, or obese.

RESULTS

Only BMI category was found to be significantly associated with accurate perception, χ²(3) = 201.4, p < .001, with only 9% of overweight or obese children selecting figures representing their actual BMI category. Actual BMI category, χ²(3) = 8.8, p = .032, and grade level, χ²(2) = 6.7, p = .036, had a significant association with selection of an underweight ideal. Overall, 32% of children selected an underweight figure as ideal.

DISCUSSION

Prepubertal children who are either overweight or obese do not accurately perceive their weight status. Rather than focusing solely on weight reduction programs, emphasis should be placed on promoting healthy lifestyles and choices.

Health Issues in Hispanic/Latino Youth

This review focuses on obesity, asthma and mental health functioning as salient health issues affecting Hispanic youth. Burden of these conditions and consequences for adult health are also discussed. Hispanic youth are affected by obesity at an early age; the prevalence of obesity among Hispanic children 6-11 years old is twice as high as the prevalence for non-Hispanic White children of the same age, but among 2-5 years old is 4 times higher. Asthma disproportionally affects certain Hispanic groups, notably children of Puerto Rican ancestry, and the comorbidity of asthma and obesity is an emerging health issue. Another area of concern is the scant data on mental health functioning among Hispanic youth. Research on Hispanic youth mental health have reported high rates of depressive symptomatology and high rates of alcohol use among Hispanic adolescents but despite these findings, they have inadequate access to mental health services. This review highlights the need for better data to gain a better understanding of the health status of Hispanic youth and help develop preventive programs that addresses the need of this population. Improving access to health services, in particular mental health services, is also a crucial aspect.

Hispanic parents' perceptions of their preschool children's weight status

PURPOSE

The purpose of this study was to examine the accuracy of Hispanic parents' perceptions of their preschool children's weight status.

DESIGN AND METHODS

A cross-sectional descriptive design with Hispanic parent-child dyads (n = 83) from a Head Start setting was used to compare parents' perceptions of their children's weight status with their 2- to 5-year-old children's body mass index (BMI) and weight categories. Methods included a word choice from five response options, and varying body size silhouettes presented in a linear fashion and a random circular pattern. Parents' perceptions were compared with the children's BMI, and in relationship to parents' demographic characteristics and BMI.

RESULTS

Approximately half of parents underestimated their child's weight status, and overweight/obese parents tended to underestimate their overweight/obese children's weight status.

PRACTICE IMPLICATIONS

Eliciting parent perception of their child's weight is one way providers can engage in obesity prevention dialogue.

Low-Income Immigrant Hispanic Mothers' Concerns and Perceptions of Their Young Child's Weight

OBJECTIVES

To describe how low-income Hispanic immigrant mothers' concerns and perceptions of her child's health, along with her concerns for herself becoming overweight, relate to her (a) concerns that her child will become overweight and (b) underestimation of her child's weight status.

DESIGN AND SAMPLE

Cross-sectional survey and direct body composition assessments were collected among 96 low-income Hispanic mothers and their young children from Houston-area community centers.

MEASURES

Data were collected on maternal concerns and perceptions of child's weight and health, concerns about her own weight, demographic characteristics, and measured child's height and weight.

RESULTS

Fifty-four percent of mothers with an overweight/obese child perceived their child was "about the right weight." Mothers concerned with becoming overweight themselves had 3 times higher odds of being concerned that her child would become overweight (OR = 3.01, p < .01). Mothers who perceived their child as less healthy had approximately 2 times higher odds of underestimating their child's weight (OR = 1.86, p < .01).

CONCLUSIONS

Short screeners that focus on maternal concerns about herself and her child becoming overweight, along with perceptions of her child's health and weight status, may assist nurses in effectively tailoring their health message at point of care.

Hispanic Parental Perceptions of Child Weight in Preschool-Aged Children: An Integrated Review

BACKGROUND

Obesity continues to disproportionately affect ethnic minorities. Parents play an integral role in early childhood, and parental perceptions regarding their child's weight are key to obesity prevention. Cultural differences contribute to parental perceptions, and increased understandings of these characteristics provide a basis to address obesity in high-risk populations at an earlier age. The aim of this integrative review was to analyze extant literature to identify Hispanic parental perceptions of their preschool-aged child's weight status.

METHODS

An integrative review of studies measuring Hispanic parental perception was conducted. Computerized searches were completed using MEDLINE, PubMed, CINHAL, Eric, and PsychINFO. Articles were included if they were English, included children 2-5 years of age, included a Hispanic population, and evaluated parental perception of their child's weight status. A total of 14 articles (n=8 qualitative; n=6 quantitative) met criteria and were included in the review. Cooper's integrative review methodology was used, and articles were evaluated for quality using Polit and Beck's evidence hierarchy leveling system.

RESULTS

The results revealed six themes of Hispanic parental perceptions relative to their preschool-aged child's weight: parental perception of body weight; relationship between child weight and health; causes and consequences of overweight; familial roles and influences on child weight; prevention of overweight; and cultural influences within the United States.

CONCLUSIONS

This review highlights the importance of developing sociocultural approaches to addressing childhood obesity within the Hispanic population. Additional research is needed to incorporate what is known about Hispanic parental perceptions to positively influence behavior change during early childhood.

Food security, maternal feeding practices and child weight-for-length

BACKGROUND

Over consumption of energy-dense nutrient-poor foods may contribute to childhood obesity. We hypothesized that greater than recommended servings of sugar sweetened beverages and foods, indicators of food security, and a high maternal recumbent weight-for-length are positively associated with high percentages of child overweight/obesity.

METHODS

This secondary data analysis consisted of a sample of 240 mother-child dyads. The original studies were designed to examine the effect of a public health nursing intervention on optimal childhood growth for low-income, minority children. Eligibility to participate included: 1) mothers self-identified as Hispanic; 2) children were 12-24 months old; and 3) children were enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC); and 4) children were free of any major disease. Multivariate logistic regression examined the association between child weight, weight-for-length, maternal recumbent weight-for-length, child's eating schedule, maternal attitudes on feeding, food security, and consumption of sugar-sweetened beverages, desserts and fatty meats.

RESULTS

Receiving SNAP was positively associated with child weight-for-length (WL). Children whose mothers reported ever having received SNAP were 2.01 times more likely to be overweight compared to children whose mothers did not report ever having received SNAP (95% CI=1.04-3.90). Children who consumed desserts were 2.87 times more likely to be overweight compared to children who did not consume desserts (95% CI=1.19-6.88). Also, child's caloric intake was significantly associated with child WL. Children who consumed more calories were 1.00 times more likely to be overweight compared to children who consumed fewer calories (95% CI=1.00-1.00).

DISCUSSION

Research on food security and children's weight has reported mixed findings. Methodological issues have been identified as contributory to the inconsistent findings. Of paramount importance to these studies is the measurement of low food security.

CONCLUSION

Children in this sample who were food insecure, as indicated by SNAP recipients, were more likely to have a higher WL measurement. Future studies should focus on the correlation between food security and hunger/satiety cues.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Parental feeding patterns and child weight status for Latino preschoolers

OBJECTIVE

To examine the relationships between parental patterns regarding child feeding and child body mass index (BMI) percentile in Latino parent€-preschooler dyads participating in a clinical trial.

METHODS

This secondary analysis examined data collected during a randomized clinical trial of a culturally tailored healthy lifestyle intervention focused on childhood obesity prevention, Salud Con La Familia. We analyzed 77 Latino parent-child dyads who completed baseline and 3-month follow-up data collection, assessing associations between preschool child BMI percentile and parental response to the Child Feeding Questionnaire (CFQ) over time.

RESULTS

Higher child BMI was related to higher parental CFQ concern scores (r = 0.41, p < .001). A general inverse association between child BMI percentile and parental responsibility was also observed (r = -0.23, p = .040). Over the 3-month period, no statistically significant associations between changes in the CFQ subscale scores and changes in child BMI percentile were identified.

CONCLUSIONS

Child BMI percentile consistent with overweight/obese is associated with parental concern about child weight and child BMI percentile consistent with normal weight is associated with perceived responsibility for feeding. Emphasizing parental responsibility to help children to develop healthy eating habits could be an important aspect of interventions aimed at both preventing and reducing pediatric obesity for Latino preschoolers.

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.

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.

Perception: a concept analysis

PURPOSE

Concept analysis methodology by Walker and Avant (2005) was used to define, describe, and delimit the concept of perception.

DATA SOURCE

Nursing literature in the Medline database was searched for definitions of "perception."

DATA SYNTHESIS

Definitions, uses, and defining attributes of perception were identified; model and contrary cases were developed; and antecedents, consequences, and empirical referents were determined.

CONCLUSIONS

An operational definition for the concept was developed.

IMPLICATIONS FOR NURSING PRACTICE

Nurses need to be cognizant of how perceptual differences impact the delivery of nursing care. In research, a mixed methodology approach may yield a richer description of the phenomenon and provide useful information for clinical practice.

Childhood obesity: a Wilsonian concept analysis

The rate of childhood obesity in the United States has tripled since 1980, with approximately 17% of U.S. children between the ages of 2 and 19 years currently identified as obese. Although a multitude of programs have been implemented to prevent and treat childhood obesity, no single strategy has been identified as the most effective method. Part of the problem in identifying successful interventions is clarifying what is meant by the term obesity as it applies to children. This article provides a concept analysis of the term obesity in relation to children using a Wilsonian approach.

Parental perception of preschool child body weight

Obesity in preschoolers has risen dramatically in the last decade. Although studies have demonstrated that parents of preschoolers have incorrect perceptions of their child's body weight, little is known about the factors that may be associated with these perceptions. The purpose of this study was to examine the relationships between parental perceptions of preschool child body weight and parental psychosocial factors. Quantitative analyses included descriptive statistics, correlations, and regression analyses. More than one third of the children in the sample were at risk for being overweight or were already overweight. However, less than 6% of parents felt that their child had an elevated body weight. Results from univariate logistic regression analyses demonstrated that the parent's health literacy level was a significant predictor of the accuracy of their perceptions regarding their child's body weight (p < .05). Parental concern regarding child weight and perceived level of efficacy did not significantly predict the accuracy of their perceptions. Results from this study indicate that assessing parental perceptions of preschool child body weight can help providers accurately understand how parents view their children and lead to tailored educational interventions. In addition, the results support previous research suggesting that parental health literacy is a key to providing high-quality family-centered care.

Nativity is associated with sugar-sweetened beverage and fast-food meal consumption among Mexican-origin women in Texas border colonias

BACKGROUND

Trends of increasing obesity are especially pronounced among Mexican-origin women. There is little understanding of dietary patterns among U.S.- and Mexico-born Mexican-origin individuals residing in new-destination immigrant communities in the United States, especially behaviors related to obesity, such as consumption of sugar-sweetened beverages (SSB) and fast-food meals (FFM).

METHODS

The study used survey data of 599 adult Mexican-origin women from the 610 women who completed the 2009 Colonia Household and Community Food Resource Assessment (C-HCFRA), which was completed in person by trained promotora-researchers in 44 colonias near the Texas border towns of Progreso and La Feria. Data included demographic characteristics (age, education, nativity or country of birth, household income, household composition, and employment status), access to transportation, self-reported height and weight, food and nutrition assistance program participation, and consumption of SSB and FFM. Descriptive statistics were calculated by nativity (U.S.-born vs. Mexico-born); multivariable linear regression models were estimated for correlates of consumption of SSB and FFM.

RESULTS

There are three major findings related to nativity. First, U.S.-born women consumed more SSB and FFM than Mexican-born counterparts in the same areas of colonias. Second, in the combined sample and controlling for other population characteristics, being born in Mexico was independently associated with FFM (fewer FFM), but not with SSB. Third, in analyses stratified by nativity, FFM and SSB were associated with each other among both nativity groups. Among Mexico-born women only, age, presence of a child, or being a lone parent was significantly associated with SSB; full-time employment, being a lone parent, and SSB consumption were each independently associated with increased frequency of FFM.

CONCLUSIONS

Our analyses revealed differences in prevalence and correlates of SSB and FFM based on country of birth. Nativity, as a proxy for acculturation, may indicate the extent that immigrants have adopted behaviors from their new environment. However, nativity could also indicate limited accessibility to resources such as food/nutrition assistance programs, transportation, and proper documentation. Additionally, future research should focus on expanding our understanding of the meaning of nativity among individuals who share common contextual factors, but may have different life course experiences and resources needed to transition into a new place. Additional measures should be considered such as educational and occupational background, migration history, documentation status, and dietary acculturation, which may better explain heterogeneity within Hispanic subgroups.

It's all about the children: a participant-driven photo-elicitation study of Mexican-origin mothers' food choices

BACKGROUND

There is a desperate need to address diet-related chronic diseases in Mexican-origin women, particularly for those in border region colonias (Mexican settlements) and other new destination communities in rural and non-rural areas of the U.S. Understanding the food choices of mothers, who lead food and health activities in their families, provides one way to improve health outcomes in Mexican-origin women and their children. This study used a visual method, participant-driven photo-elicitation, and grounded theory in a contextual study of food choices from the perspectives of Mexican-origin mothers.

METHODS

Teams of trained promotoras (female community health workers from the area) collected all data in Spanish. Ten Mexican-origin mothers living in colonias in Hidalgo County, TX completed a creative photography assignment and an in-depth interview using their photographs as visual prompts and examples. English transcripts were coded inductively by hand, and initial observations emphasized the salience of mothers' food practices in their routine care-giving. This was explored further by coding transcripts in the qualitative data analysis software Atlas.ti.

RESULTS

An inductive conceptual framework was created to provide context for understanding mothers' daily practices and their food practices in particular. Three themes emerged from the data: 1) a mother's primary orientation was toward her children; 2) leveraging resources to provide the best for her children; and 3) a mother's daily food practices kept her children happy, healthy, and well-fed. Results offer insight into the intricate meanings embedded in Mexican-origin mothers' routine food choices.

CONCLUSIONS

This paper provides a new perspective for understanding food choice through the eyes of mothers living in the colonias of South Texas -- one that emphasizes the importance of children in their routine food practices and the resilience of the mothers themselves. Additional research is needed to better understand mothers' perspectives and food practices with larger samples of women and among other socioeconomic groups.

Factors associated with parental recognition of a child's overweight status--a cross sectional study

Background

Very few studies have evaluated the association between a child's lifestyle factors and their parent's ability to recognise the overweight status of their offspring. The aim of this study was to analyze the factors associated with a parent's ability to recognise their own offspring's overweight status.

Methods

125 overweight children out of all 1,278 school beginners in Northern Finland were enrolled.

Weight and height were measured in health care clinics. Overweight status was defined by BMI according to internationally accepted criteria. A questionnaire to be filled in by parents was delivered by the school nurses. The parents were asked to evaluate their offspring's weight status. The child's eating habits and physical activity patterns were also enquired about. Factor groups of food and physical activity habits were formed by factor analysis. Binary logistic regression was performed using all variables associated with recognition of overweight status in univariate analyses. The significant risk factors in the final model are reported using odds ratios (ORs) and their 95% confidence intervals (CIs).

Results

Fifty-seven percent (69/120) of the parents of the overweight children considered their child as normal weight. Child's BMI was positively associated with parental recognition of overweight (OR 3.59, CI 1.8 to 7.0). Overweight boys were less likely to be recognised than overweight girls (OR 0.14, CI 0.033 to 0.58). Child's healthy diet (OR 0.22, CI 0.091 to 0.54) and high physical activity (OR 0.29, CI 0.11 to 0.79) were inversely related to parental recognition of overweight status.

Conclusions

Child's healthy eating habits and physical activity are inversely related to parental recognition of their offspring's overweight. These should be taken into account when planning prevention and treatment strategies for childhood obesity.

Urban parents' perceptions of healthy infant growth

To examine how urban parents' perceptions of healthy infant size and growth relate to objective weight-for-length percentiles of their children, parents of 222 (69% minority) 6- to 27-month-old infants were surveyed. In all, 41% of parents said growth charts had never been explained to them, and 31% were not confident they understood the meaning of chart percentiles. A total of 20% of parents preferred their child weigh ≥75th percentile, and these children had higher mean weight-for-length percentiles than their peers (P = .05). Similarly, 37% of parents agreed that "a chubby baby is a healthy baby," and these children had higher mean weight-for-length percentiles than others in the cohort ( P = .02). Additionally, 58% of parents ranked a growth curve with consistent growth at the 10th percentile as the "least healthy" of 6 infant growth curves. Growth charts are not consistently explained to or understood by urban parents, and many prefer early life growth patterns associated with later obesity.

Mexican American Mothers’ Perceptions of Childhood Obesity

Childhood obesity continues to increase, disproportionately affecting Mexican American children. The aims of this review are to (a) assess the literature regarding Mexican American mothers’ knowledge and perceptions of childhood obesity, prevention, and their role in prevention; (b) critically evaluate the methodological quality of the research conducted on mothers’ perceptions of childhood obesity; and (c) make recommendations for future research on parental perceptions of childhood obesity. Four databases were searched for relevant articles and 22 studies met inclusion criteria and were included in the review. Social cognitive theory was used to sort findings across studies. Major findings included the following: (a) barriers to childhood obesity prevention included lack of education regarding prevention and role modeling, (b) only 23% of studies explicitly used a theoretical framework to guide their study, and (c) most studies used heterogeneous groups to examine perceptions. Implications for future research and practice are presented.

Latina mothers' beliefs and practices related to weight status, feeding, and the development of child overweight

OBJECTIVE

To examine maternal beliefs and practices related to weight status, child feeding, and child overweight in the Latino culture that may contribute to the rising rates of overweight among preschool Latino children in the United States.

DESIGN AND SAMPLE

This 2-phase qualitative study relies on data obtained in 6 focus groups with a total of 31 primarily Spanish-speaking, low-income mothers, followed by 20 individual, in-depth interviews with women participating in a health promotion educational program.

MEASURES

Child-feeding beliefs, practices, and weight status perceptions were elicited.

RESULTS

The findings indicated that most respondents reported personal struggles with weight gain, particularly during and after pregnancy, and were concerned that their children would become obese. Although subjects understood the health and social consequences related to overweight, many discussed the pressures of familial and cultural influences endorsing a "chubby child."

CONCLUSIONS

Education and interventions that incorporate "culturally mediated" pathways to address mothers' feeding practices are essential for the prevention and control of childhood overweight among low-income Latinos. Nurses should be aware of the social and cultural influences on Latina mothers' beliefs and practices related to weight status and feeding practices and address these in their education approaches to prevent childhood overweight and obesity with this population group.

Perceptions of childhood obesity on the Texas-Mexico border

OBJECTIVES

We sought to determine the extent of intracultural consensus in perceptions of childhood obesity among Mexican American mothers living on the Texas-Mexico border.

DESIGN AND SAMPLE

A descriptive, cross-sectional study examined women's judgments about the parameters of childhood obesity. The convenience sample consisted of 61 Mexican American women who were mothers of at least 1 child under age 18.

MEASURES

Participants underwent an anthropometric assessment and were surveyed regarding self-perceived weight and household food security. They were then shown photographs of 36 Mexican American boys ages 6 and 7 and asked to sort them into categories by weight status; they also selected 3 children they believed represented the healthiest, most appropriate weight for age. Accuracy scores were computed and examined for bivariate relationships with women's own body mass index (BMI) and survey responses.

RESULTS

We found considerable intracultural variation in women's judgments, which could not be explained by the anthropometric and survey variables tested. Women selected a wide range of percentiles as representative of a healthy child. On average, about half of the truly overweight children (BMI>or=95th percentile), however, were considered normal or even underweight.

CONCLUSIONS

Local perceptions and language may not correspond to CDC/WHO clinical standards. Larger studies are needed to confirm these preliminary findings.

Parent perception of healthy infant and toddler growth

We hypothesized that parents of infants prefer growth at higher percentiles and are averse to growth at lower percentiles. Of 279 participating parents, only 10% desired their child's weight to be in the lowest quartile. For children weighing in the lowest quartile, 57% of parents thought their child's weight was "too low." In contrast, 66% of parents whose child's weight was in the top quartile preferred their child weigh that much. When viewing hypothetical infant growth trajectories, 47% ranked a growth chart demonstrating growth along the 10th percentile for weight as "least healthy" of 6 growth patterns, and 29% chose charts showing an infant at the 90th percentile for weight at age 1 as "healthiest." In conclusion, parents are averse to growth at the bottom of the weight growth chart but are much less likely to feel negatively about growth at higher percentiles. This is troubling given the childhood obesity epidemic.

Changes in family variables among normal and overweight preschoolers

PURPOSE

The purpose of this study was to examine differences in the weight and height of normal and overweight children in variables relating to the individual, home/family and community across a six month time period. RESEARCH QUESTIONS/HYPOTHESES: What are the ecological factors that influence the body mass index (BMI) of preschool children?

SIGNIFICANCE

The rate of overweight preschool children aged 2 to 5 years has more than doubled in the past 30 years. Low socioeconomic and ethnic minority groups have higher rates. Research shows a strong correlation between a child's size (height, weight, and BMI) and the ecological factors present in the family's environment.

METHODS

This study is a secondary data analysis from a cross sectional study of 200 Mexican American children ages 2-3 years old receiving WIC services. The sample consisted of 100 children with a BMI > 95% for age and 100 children with a BMI of <85% for age. Variables and measurements included: host/child (BMI percentile, diet, TV watching hours); agent/food (feeding assistance); microsystem/parent (parental BMI, acculturation level, employment, physical activities); microsystem/home (stimulation, TV hours); and microsystem/mother-child relationship (NCAST Teaching Scale).This study is limited to populations with similar characteristics.

RESULTS

Both overweight and normal weight children showed decreases in BMI, but maintained their between group differences even while slimming down (p = .000). Overweight children consumed significantly more fruit, bread and other carbohydrates, and total calories, than did normal weight children. Both groups of children increased significantly in their consumption of water, fruit juice and juice drinks, as well as meat and other protein. Maternal BMIs for overweight children were higher than those for the mothers of the normal weight children and increased across time. More overweight children ate in the presence of another person. The interaction patterns between mothers and overweight children were significantly more positive and responsive than were the interaction patterns of mothers and normal weight children.

DISCUSSION/CONCLUSION

multiple ecological factors influence the BMI of the preschooler leading to obesity. Nurses can use these findings to teach parents about the importance managing the environmental factors that contribute to childhood obesity and growth.

Head Start children's lifestyle behaviors, parental perceptions of weight, and body mass index

This study examined lifestyle behaviors (food intake, active play, and screen time), parental perception of children's weight, and body mass index (BMI) of children enrolled in Head Start. Ninety-six parent-child dyads participated. Obesity prevalence (15.6%) was higher than the national average (10.4%); however, most parents (86.5%) of obese children did not perceive their children as obese. Regardless of BMI, food intake and active play levels generally did not meet recommended guidelines. Further, children who were less active were more likely to eat snacks (chi(2) = 6.24, p < or = .04). The role of pediatric nurses in counseling and referring Head Start families is explored.

How pediatricians can improve diet and activity for overweight preschoolers: a qualitative study of parental attitudes

OBJECTIVE

This study sought feedback from parents of overweight preschoolers on terms for overweight and treatment strategies pediatricians could use to help parents improve diet and activity for their children.

METHODS

Twenty-three parents of 21 children aged 2 to 6 years and between the 85th and 94th percentile body mass index participated in focus groups conducted by a pediatrician to assess 1) terms and health risks that motivate parents, 2) barriers that prevent adoption of recommended behaviors, and 3) recommendations for pediatricians on strategies to help parents improve child diet and activity.

RESULTS

With regard to weight status, parents preferred the terms overweight and obese as long as pediatricians provided rationale for the classification. Parents recommended that pediatricians avoid colloquial terms to describe weight status. With regard to American Academy of Pediatrics recommendations for weight management in overweight preschoolers, parents were reluctant to restrict 100% fruit juice, needed specific strategies to increase vegetable consumption, and said limiting screen time would be difficult, especially when busy or during inclement weather. Despite identification of barriers, parents reported confidence in adopting all recommended behaviors except vegetable intake if given the rationale for the recommendation and strategies for implementation.

CONCLUSION

Parents recommended that pediatricians speak clearly about weight status, explain rationale for concern, relate that concern to family history, and provide specific advice and treatment recommendations.

Opportunities for the primary prevention of obesity during infancy

Many parents, grandparents, and clinicians have associated a baby’s ability to eat and gain weight as a sign of good health, and clinicians typically only call significant attention to infant growth if a baby is failing to thrive or showing severe excesses in growth. Recent evidence, however, has suggested that pediatric healthcare providers should pay closer attention to growth patterns during infancy. Both higher weight and upward crossing of major percentile lines on the weight-for-age growth chart during infancy have long term health consequences, and are associated with overweight and obesity later in life. Clinicians should utilize the numerous available opportunities to discuss healthy growth and growth charts during health maintenance visits in the first two years after birth. Further, providers should instruct parents on strategies to promote healthy behaviors that can have long lasting obesity preventive effects.

Accurate parental classification of overweight adolescents' weight status: does it matter?

OBJECTIVE

Our goal was to explore whether parents of overweight adolescents who recognize that their children are overweight engage in behaviors that are likely to help their adolescents with long-term weight management.

METHODS

The study population included overweight adolescents (BMI >/= 85th percentile) who participated in Project EAT (Eating Among Teens) I (1999) and II (2004) and their parents who were interviewed by telephone in Project EAT I. Cross-sectional analyses were conducted with 314 adolescent-parent dyads, and longitudinal analyses were completed with 170 dyads.

RESULTS

Parents who correctly classified their children as overweight were no more likely than parents who did not correctly classify their children as overweight to engage in the following potentially helpful behaviors: having more fruits/vegetables and fewer soft drinks, salty snacks, candy, and fast food available at home; having more family meals; watching less television during dinner; and encouraging children to make healthful food choices and be more physically active. However, parents who recognized that their children were overweight were more likely to encourage them to diet. Parental encouragement to diet predicted poorer adolescent weight outcomes 5 years later, particularly for girls. Parental classification of their children's weight status did not predict child weight status 5 years later.

CONCLUSIONS

Accurate classification of child overweight status may not translate into helpful behaviors and may lead to unhealthy behaviors such as encouragement to diet. Instead of focusing on weight per se, it may be more helpful to direct efforts toward helping parents provide a home environment that supports healthful eating, physical activity, and well-being.

Preschooler feeding practices and beliefs: differences among Spanish- and English-speaking WIC clients

This study explored preschooler feeding practices and beliefs among Spanish- and English-speaking WIC participants in Texas. The Preschooler Feeding Questionnaire examined 9 dimensions of the parent-child feeding interaction among 235 caregivers. Results from ANOVA and post hoc analyses demonstrated significant differences in reported preschooler feeding practices and beliefs among Spanish-speaking Hispanics in comparison with English-speaking Hispanics and non-Hispanics. No significant differences were found between English-speaking Hispanics and non-Hispanics. Results indicated that acculturation may impact behaviors apart from ethnicity. Nutrition professionals should understand and acknowledge the cultural context of the parent-child feeding interaction when developing programs.

Obesity prevention and the primary care pediatrician's office

PURPOSE OF REVIEW

The obesity epidemic confronts the pediatrician every day in the office. Pediatricians should help curb the epidemic through prevention and the usual pediatric primary care tasks of screening, communication and anticipatory counseling. This review highlights findings from recent literature to guide office-based prevention of obesity in children.

RECENT FINDINGS

More and more, children and society feel the effects of the obesity epidemic; prevention efforts need to begin earlier. Pediatricians' efforts to screen help identify at-risk children who may benefit from early lifestyle changes. The identification of overweight children also helps foster the appropriate work up of comorbidities. Pediatricians' communication of weight trajectories, which includes techniques like motivational interviewing, may help parents to adopt behavioral prescriptions. Pediatricians should focus on promoting breastfeeding, limiting television, increasing physical activity and reducing sugar-sweetened beverages. New tools used in the training setting show promising results.

SUMMARY

Pediatricians must focus efforts on preventing childhood overweight, while awaiting effective treatment options for this chronic illness with its many associated morbidities. Such prevention involves sensitively communicating early body mass index screening results to parents and helping them to adopt key behavioral changes in diet and physical activity.