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

Obesity in childhood: associations with parental neglect, nutritional habits, and obesity awareness

Background

The relationships underlying the dynamic between obesity and parental neglect in terms of nutritional habits and obesity awareness are unclear. Parental neglect remains a significant subject of concern that needs to be examined in the context of obesity.

Methods

The aim was to examine the relationships between childhood obesity, parental neglect, children's eating habits and obesity. The study group consisted of 404 children and their parents from Ankara, Turkiye. As data collection tools, an Individual Information Form, Obesity Awareness Scale, the Parents Form of the Multidimensional Neglectful Behaviors Scale were administered. In addition, information on the children's body mass indexes was obtained by anthropometric measurements and the findings were recorded on the questionnaires of each child.

Results

It was found that 98 (24.3%) of the children included in the study were overweight and 63 (15.6%) were obese. The results of the multinomial logistic regression analysis indicated that in the underweight and overweight group, the parents' perception of their child's weight predicted body mass index in children, and in the obese group, along with the parents' perception of their child's weight, the age and gender of the child, eating fast, obesity in the family and parental neglect were also predictors.

Conclusion

Practitioners such as nurses, dietitians and child developmentalists working in schools should consider weight problems in children as one of the indicators of parental neglect and should implement interventive efforts to enhance parental supervision of children at risk.

Impact of the child's birth weight on maternal misperceptions of young children's weight: A retrospective study with nationally representative data

AIM

A young child's abnormal birth weight (BW) can affect a mother's misperceptions of her child's weight, potentially hindering the child's health management. Therefore, this study investigated the impact of children's BW on maternal misperceptions of children's weight during early childhood.

METHODS

A retrospective study was conducted for 485,095 children who were 54-60 months of age, born between 2011 and 2013, and participated in South Korea's Sixth National Health Screening Program for Infants and Children (NHSPIC). Data on BW, weight, sex, birth year, preterm birth, breastfeeding history, maternal age, mothers' perceptions of the child's weight, and socioeconomic status were collected and incorporated in the final analysis via data linkage between the NHSPIC and Korean healthcare claims information. Multiple logistic regression analysis was applied to identity the impact of BW on mothers' misperceptions of children's weight, after adjustment for all variables.

RESULTS

Low BW (LBW) children had the lowest proportion (57.1%) of mothers who accurately identified their child's weight compared to normal or high BW. LBW was an independent factor affected maternal misperception of the child's weight (underestimation: adjusted odds ratio [aOR]: 1.46, 95% confidence interval [CI]: 1.41-1.52; overestimation: aOR: 0.84, 95% CI: 0.73-0.97). Overweight or underweight status, male gender, preterm birth, a younger mother, and low socioeconomic status were also associated with both underestimation and overestimation.

CONCLUSION

LBW emerged as an important risk factor for maternal misperception of a child's weight. Therefore, pediatric nurses need to apply interventions to improve perceptions of children's weight among mothers of young LBW children.

Empowering parents to optimize feeding practices with preschool children (EPO-Feeding): A study protocol for a feasibility randomized controlled trial

BACKGROUND

Parental feeding practices (PFPs) play a key role in fostering preschoolers' dietary habits and in mitigating the risk of childhood obesity. Nevertheless, parents often employ inappropriate feeding practices, leading to children's potential nutrition-related issues. Thus, research is needed to inform interventions that focus on optimizing feeding practices.

METHODS

This protocol describes the evaluation of a novel intervention-Empowering Parents to Optimize Feeding Practices (EPO-Feeding Program). The program will be evaluated with a two-arm feasibility randomized controlled trial (RCT) in Yangzhou, China. The program includes four weekly group-based training sessions led by healthcare professionals for parents of preschool children. The intervention incorporates sessions, group discussions, motivational interviewing, and supplementary materials (e.g., key messages and educational videos) aimed at enhancing parents' knowledge, skills, and behaviours related to feeding practices. The primary outcomes include i) implementation feasibility, primarily assessed through retention rates; and ii) program acceptability through a survey and qualitative process evaluation. Secondary outcomes encompass the potential impacts on i) PFPs, ii) parental perception of child weight (PPCW), iii) parenting sense of competence, iv) children's eating behaviours, and v) child weight status. Quantitative analyses include descriptive estimates for evaluating the feasibility and linear mixed regression analysis for testing the potential effects. Qualitative valuation will use thematic framework analysis.

DISCUSSION

If this study shows this program to be feasible to implement and acceptable to parents, it will be used to inform a fully powered trial to determine its effectiveness. The research will also help inform policy and practices in the context of child nutrition promotion, particularly regarding implementing group-based training sessions by healthcare providers in similar settings.

TRIAL REGISTRATION

Clinicaltrials.gov, Protocol #NCT06181773, 20/11/2023.

Agreement between parent-report and EMR height, weight, and BMI among rural children

Introduction

Remote anthropometric surveillance has emerged as a strategy to accommodate lapses in growth monitoring for pediatricians during coronavirus disease 2019 (COVID-19). The purpose of this investigation was to validate parent-reported anthropometry and inform acceptable remote measurement practices among rural, preschool-aged children.

Methods

Parent-reported height, weight, body mass index (BMI), BMI z-score, and BMI percentile for their child were collected through surveys with the assessment of their source of home measure. Objective measures were collected by clinic staff at the child's well-child visit (WCV). Agreement was assessed using correlations, alongside an exploration of the time gap (TG) between parent-report and WCV to moderate agreement. Using parent- and objectively reported BMI z-scores, weight classification agreement was evaluated. Correction equations were applied to parent-reported anthropometrics.

Results

A total of 55 subjects were included in this study. Significant differences were observed between parent- and objectively reported weight in the overall group (-0.24 kg; p = 0.05), as well as height (-1.8 cm; p = 0.01) and BMI (0.4 kg/m2; p = 0.02) in the ≤7d TG + Direct group. Parental reporting of child anthropometry ≤7d from their WCV with direct measurements yielded the strongest correlations [r = 0.99 (weight), r = 0.95 (height), r = 0.82 (BMI), r = 0.71 (BMIz), and r = 0.68 (BMI percentile)] and greatest classification agreement among all metrics [91.67% (weight), 54.17% (height), 83.33% (BMI), 91.67% (BMIz), and 33.33% (BMI percentile)]. Corrections did not remarkably improve correlations.

Discussion

Remote pediatric anthropometry is a valid supplement for clinical assessment, conditional on direct measurement within 7 days. In rural populations where socioenvironmental barriers exist to care and surveillance, we highlight the utility of telemedicine for providers and researchers.

Beyond correlates: the social gradient in childhood overweight

BACKGROUND

Health (in)equity has a high priority on research and policy agendas. Even though it is known that inequalities in overweight prevalence accumulate with age and are already existent among children below the age of six, research on this topic is scarce. In this young age group, parents play an important role in preventing overweight and associated adverse consequences. This study examines the magnitude of parental misclassification of child weight status and its correlates, focussing on the factors that determine social status and equity.

METHODS

Preschool children's weight and height was measured objectively. Parents gave information on their socioeconomic background. Family education was dichotomised into tertiary and non-tertiary educational level, according to CASMIN. Binary logistic regression, adjusted for parental BMI, was applied to detect odds of childhood overweight.

RESULTS

Data on family educational level and anthropometrics were available from 643 children (4.5 ± 0.82 years, 52.7% male) and their parents of which 46.5% (n = 299) had a tertiary educational background. The groups (tertiary vs. non-tertiary educational level) differ significantly in overweight prevalence (3.7% vs. 11.9%, p ≤ 0.001). Odds of overweight were two times higher in children with non-tertiary educational background (OR: 2.123, CI: 1.010-4.461, p < 0.05), adjusted for parental BMI.

CONCLUSION

Children from families with low educational background have an elevated risk of overweight, already at a very young age. Education in general (not explicitly health education) seems to play a tremendous role in the prevention of overweight and obesity and should therefore be implied in policies enhancing health equity.

TRIAL REGISTRATION

DRKS-ID: DRKS00010089.

Accuracy of Syrain Refugee Mothers' Perceptions of Newborn's Birth Size: Insights from a National Survey in Turkey

This study aims to assess the accuracy of maternally perceived birth size and its associated factors among the Syrian refugees in Turkey, using the data from 2018 Turkey Demographic and Health Survey Syrian Migrant Sample (TDHS-SM-18). The study includes information on the last-born child, singleton pregnancies, births in healthcare facilities, children under 5 living with their mothers, with recorded birth weight (n = 969). The study categorizes the mother's perception of size into three groups : compatible, overestimated, and underestimated. Various factors, including sociodemographic characteristics, financial aspects, maternal characteristics, and child characteristics, are considered as explanatory variables. The analysis employs a complex sample multiple logistic regression model. The findings reveal that the majority of mothers accurately perceive the birth size, but 17.1% of them do not. Maternal factors such as region of residence, literacy, occupation, age at birth, and child factors such as birth order, birth interval, gender, and birth weight are identified as associated factors with maternal misperception. This study provides valuable insights into the accuracy of maternally perceived birth size and sheds light on the factors influencing this perception among Syrian refugee mothers in Turkey.

Does the use of color coding facilitate parents' understanding of body mass index curves?

BACKGROUND

In France, national guidelines recommend early detection and management of overweight and obesity in children, with multi-year systematic generation of children's body mass index (BMI) curves in primary care. It is important for the parents to understand the BMI curves displayed in the child's health notebook and to become involved in the care with health professionals.

OBJECTIVE

The aim of the current study was to compare parents' understanding of a BMI curve displayed using color coding versus their understanding of the same curve displayed without color coding.

METHODS

An observational, cross-sectional, comparative study was performed between February 1, 2021 and November 15, 2021. Adult parents with at least one child attending primary school were included. Two questionnaires testing parents' understanding were completed: one showing BMI curves without color coding (five questions) and one showing BMI curve with color coding (five questions). The primary endpoint was the proportion of parents achieving fully correct answers. Comparisons of endpoints between the color-coded and non-color-coded curve were performed using the McNemar test. Factors associated with the primary endpoint were investigated by mixed logistic regression models with the subject as a random effect.

RESULTS

The 109 participants (45.4% response rate) had an average age of 39.4 ± 6.6 years; 81.7% were women. A total of 214 complete questionnaires were compared: The proportion of participants with fully correct responses was significantly higher using the BMI curve with color coding compared to the curve without color coding (86.0% vs. 54.2%, p<0.0001). In multivariate analysis, the use of color coding was significantly associated with a higher likelihood of achieving fully correct responses (odds ratio: 5.9, 95% CI: 3.0-11.2, p<0.0001).

CONCLUSION

The use of color coding improved parents' understanding of BMI curves. Further research should explore equally the benefits and risks associated with weight loss and mental health when using a colored BMI curve for the detection and management of overweight and obese children.

A Randomised Control Trial Investigating the Efficacy of the MapMe Intervention on Parental Ability to Correctly Categorise Overweight in Their Child and the Impact on Child BMI Z-Score Change at 1 Year

Research suggests parental ability to recognise when their child has overweight is limited. It is hypothesised that recognition of child overweight/obesity is fundamental to its prevention, acting as a potential barrier to parental action to improve their child's health-related behaviours and/or help seeking. The purpose of this study was to investigate the efficacy of an intervention (MapMe) to improve parental ability to correctly categorise their child as having overweight one-month post-intervention, and reduce child body mass index (BMI) z-score 12 months post-intervention. MapMe consists of body image scales of known child BMI and information on the consequences of childhood overweight, associated health-related behaviours and sources of support. We conducted a three-arm (paper-based MapMe, web-based MapMe and control) randomised control trial in fifteen English local authority areas with parents/guardians of 4-5- and 10-11-year-old children. Parental categorisation of child weight status was assessed using the question 'How would you describe your child's weight at the moment?' Response options were: underweight, healthy weight, overweight, and very overweight. Child weight status and BMI z-scores were calculated using objectively measured height and weight data and UK90 clinical thresholds. There was no difference in the percentage of parents correctly categorising their child as having overweight/very overweight (n = 264: 41% control, 48% web-based, and 43% paper-based, p = 0.646). BMI z-scores were significantly reduced for the intervention group at 12 months post-intervention compared to controls (n = 338, mean difference in BMI z-score change -0.11 (95% CI -0.202 to -0.020, p = 0.017). MapMe was associated with a decrease in BMI z-score 12 months post-intervention, although there was no direct evidence of improved parental ability to correctly categorise child overweight status. Further work is needed to replicate these findings in a larger sample of children, investigate mechanisms of action, and determine the use of MapMe as a public health initiative.

Do Childcare Teachers Evaluate Children's Weight Status More Accurately Than Parents? A Brief Report

PURPOSE

Parents' underestimation of young children's weight can reduce their engagement and readiness to implement changes in children's diet and physical activity. Childcare teachers can support parents' identification of children at risk for being overweight only if they can accurately do this themselves.

DESIGN

Quantitative, cross-sectional study.

SETTING

Fifteen kindergartens near Lisbon, Portugal.

SUBJECTS

319 parents, 32 teachers (47.5% and 100% response rate, respectively), and 319 children.

MEASURES

Caregivers classified the children's weight, considering their height and age as underweight, healthy weight, or overweight; children's body mass index (BMI) status for age and sex was assessed.

ANALYSIS

Differences in caregivers' accuracy of children's weight perception were assessed. Multilevel multivariate logistic regression models were used to analyze the predictors of the accuracy of teachers' and parents' weight perception as a binary outcome.

RESULTS

The proportion of children with overweight correctly assessed differed significantly (P = 0.004) between teachers (31.1%) and parents (17.5%). The child's BMI percentile was the only significant positive predictor for both caregivers' weight perception accuracy (P < 0.001 and P = 0.004, for parents and teachers, respectively), holding the child's age and sex constant.

CONCLUSION

Although childcare teachers were better raters than parents when evaluating children's weight status, the percentage of children with overweight that childcare teachers misclassified was still relatively high.

Rate of obesity within a mixed-breed group of horses in Ireland and their owners' perceptions of body condition and useability of an equine body condition scoring scale

BACKGROUND

Equine obesity is a significant health and welfare concern. The proportion of domestic horse populations that are overweight are as high as 45%. As the primary decision-makers for their horses' care, owners are theoretically ideally placed to identify whether their horses are appropriately conditioned, however, research in other countries has shown that many owners are unable to accurately judge their horse's body condition. In this study, through the comparison of body condition scoring (BCS) performed by an expert and the horse owners and interviews with owners, we aimed to identify the proportion of horses that were overweight or obese, to assess the accuracy of horse owners' BCS assessment both prior to and after receiving information and instructions on body condition scoring, and to identify common themes amongst owners' views regarding BCS assessment and the Henneke BCS system.

RESULTS

Forty-five percent of the horses in this study were overweight or obese. The agreement between the owners and an equine veterinarian regarding the horses' BCS was fair to good both prior to (κ = .311, P < 0.001; ICC = .502, P < 0.001) and after (κ = .381, P < 0.001; ICC = .561, P < 0.001) receiving information and instructions on scoring. Three quarters of the owners who took part in the study did not use any method of monitoring their horse's body condition. Thematic analysis of owner responses was varied, with the most common theme being an awareness of the need to monitor or make changes to their horse's condition with responses in this theme split between owners who felt in control and those who did not. Owner feedback on the utility and useability of the scorning system was that it was useful however parts are too technical or need improvement.

CONCLUSIONS

Equine obesity is a significant problem in this population in Ireland. Horse owners' ability to accurately judge their horse's condition does not improve with provision of instructions on body condition scoring. These results combined with owners' feedback on the Henneke BCS system indicate that it is not a tool that can be reliably used by owners.

How do looking patterns, anti-fat bias, and causal weight attributions relate to adults' judgements of child weight?

Prevailing weight-normative approaches to health pressure adults to visually categorise children's weight, despite little understanding of how such judgements are made. There is no evidence this strategy improves child health, and it may harm children with higher weights. To understand decision-making processes and identify potential mechanisms of harm we examined perceptual and attitudinal factors involved in adults' child weight category judgements. Eye movements of 42 adults were tracked while categorizing the weight of 40 computer-generated images of children (aged 4-5 & 10-11 years) varying in size. Questionnaires assessed child-focused weight bias and causal attributions for child weight. Participants' eye movement patterns resembled those previously reported for adult bodies. Categorisation data showed a perceptual bias towards the 'mid-range' category. For higher weight stimuli, participants whose category judgements most closely matched the stimulus's objective weight had higher child-focused anti-fat bias and weaker genetic attributions for child weight - i.e,. adults who 'label' higher weight in children in line with BMI categories report more stigmatising beliefs about such children, suggesting a possible mechanism of harm. Overall, adults' judgements reflect both unalterable perceptual biases and potentially harmful attitudinal factors, calling into question the feasibility and appropriateness of public health efforts to promote visual child weight categorisation.

The relationships between caregivers' self-reported and visual perception of child weight and their non-responsive feeding practices: A systematic review and meta-analysis

BACKGROUND

The impacts of caregivers' perception of child weight on their non-responsive feeding practices are inconclusive. This systematic review aimed to examine their relationships.

METHODS

A systematic search of five databases was conducted from inception to March 2022, following PRISMA guidelines. Data synthesis was performed using semi-quantitative approach and meta-analysis.

RESULTS

Twenty-two studies with 12005 respondents were included for semi-quantitative analyses. Eighteen studies examined 26 associations between caregivers' perception of child weight and food restriction with 12 statistically significant associations being observed. A total of 22 relationships between caregivers' perception of child weight and pressure to eat were investigated, with 13 being statistically significant. The statistically significant associations consistently reported that caregivers' visual and self-reported perception of child weight was positively associated with their restrictive feeding and negatively associated with pressure to eat. The pooled odds ratios (ORs) indicated that caregivers who perceived their child as overweight were found to apply pressure to eat less frequently (OR = 0.61; 95%CI: 0.44, 0.84) compared with those who did not. However, caregivers' perception of child weight was not statistically significantly associated with restrictive feeding (OR = 1.37; 95%CI: 0.74, 2.55).

CONCLUSION

Caregivers' self-reported and visual perception of child weight may be important risk factors for non-responsive feeding practices, particularly food restriction and pressure to eat. Thus, interventions need to consider the role of caregivers' perception of child weight, which may optimize feeding practices. Furthermore, longitudinal and intervention-based studies using validated measurements while controlling for potential covariates are needed to provide more evidence on their causal relationships.

Effect of migrant parents' bodyweight perception on children's body bodyweight: A longitudinal analysis of population cohort study

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.

The Association between Body Weight Misclassification in Adolescence and Body Fat and Waist Circumference in Adulthood: A Longitudinal Study

This study examined the longitudinal association between adolescent body weight misclassifications and body fat and waist circumference during adulthood. A sample was derived from a large Australian birth cohort study. The data analyses were restricted to 1002 participants for whom data on both measured and perceived weight at a 14-year follow-up and the actual measure of adult body fat and waist circumference at a 30-year follow-up were available. To determine misclassifications, we compared the perceived weight with the measured weight. The results were presented as means and mean differences (with a 95% confidence interval) of the body fat percentages and waist circumference levels across the weight misclassification groups, adjusting for potential covariates. For both male and female adolescents, weight underestimation was significantly associated with an increase in body fat percentages and waist circumference in adulthood as compared to those who correctly estimated their weight. In the mean difference analyses, adolescent males and females who underestimated their weight were found to have significantly higher body fat, and waist circumference means than those who correctly estimated their weight in the unadjusted and adjusted comparisons. The adolescent males who overestimated their weight had higher body fat, and waist circumference means when they reached adulthood. Increased awareness of weight misclassification and actual weight among adolescents might contribute to better control of weight gain in adulthood.

Parental Misperceptions of Their Offspring's Weight and Their Strategies for Child's Eating Behavior: A Narrative Review of the Recent Evidence

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.

Preventing the Early Introduction of Juice and Sugar-Sweetened Beverages in Infants' Diets: A Randomized Controlled Trial

A randomized controlled trial was conducted to determine whether a simple educational intervention targeting parents of young infants could have an impact on the consumption of juice and sugar-sweetened beverages (SSBs) in early childhood and decrease overweight and obesity rates. Parents of 2- to 4-month-old infants were randomized into intervention (n = 67) and control (n = 77) groups. Parents completed questionnaires about juice and SSB consumption and knowledge at baseline and 1-year follow-up. Intervention parents received informational handouts and watched videos about the health effects of juice and SSBs. Knowledge about juice increased significantly in the intervention group compared with control (P < .01) and was significantly higher in black/African American parents (P < .05) and those with some college education (P < .05). The intervention had a significant impact on the knowledge gained by parents about the health effects of juice and SSBs but did not decrease the consumption of sugary drinks or change children's weight status.

Impacts of an early childhood obesity prevention program in Mexico

The Healthy Change Program aimed to improve the accuracy of maternal perceptions of children's weight (MPCW), maternal feeding style (MFS) and feeding practices. Using a randomized control trial design, the intervention group received 4-weekly group sessions focusing on MPCW, MFS and healthy behaviors. The control group received the same dose of attention-control sessions on food hygiene. Data were collected at the baseline and at the end of the program via self-administered questionnaires and anthropometric measurements. Participants included 294 mother-child dyads with 149 in the intervention group and 145 in the control group. The accuracy of MPCW significantly increased at the study end point in the intervention group (57.0-67.1%, P < 0.05) but not in the control group (67.6-69.7%, P > 0.05), with no between-group difference in pre- and post-change (P > 0.05). At the study end point, more mothers of overweight and obese children in the intervention group had accurate MPCW than their control counterparts (31.4% versus 11.1%, P < 0.01). The intervention group had a shift toward an authoritative style at the study end point (17.4% versus 26.2%, P < 0.001) and favorable changes in feeding practices. The Healthy Change Program contributed to improving the accuracy of MPCW and shifts toward favorable MFS and feeding practices.

How Parenting and Family Characteristics Predict the Use of Feeding Practices among Parents of Preschoolers: A Cross-Sectional Study in Beijing, China

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.

Challenges and opportunities of remote public involvement and community engagement during a pandemic: refining the MapMe childhood healthy weight intervention

AIMS

Including parents and other stakeholders in the development of interventions to address the sensitive public health issues such as childhood obesity, through public involvement is critical. However, the Covid-19 pandemic has created a challenge for public involvement and engagement activities (PICE). The aim of this paper is to describe the process and challenges of setting up, maintaining, evaluating, and recording impact of three public and stakeholder groups via remote methods in the context of the MapMe2 study during the Covid-19 pandemic. Parental reaction to result letters received as part of the National Child Measurement Programme (NCMP) informing parents of their child's overweight status is often one of hostility or disbelief. As a result, parents often do not act on these letters to address child overweight. The MapMe2 study is working in collaboration with the NCMP and local authorities, building on previous work (MapMe) and aims to support parents of primary school-aged children to recognise and maintain a healthy weight in their child. The existing MapMe Intervention includes an enhanced NCMP child weight result letter, supplemented with Body Image Scales (BIS), and an intervention website with material to support healthy eating, physical activity, and signposting supporting information. The intervention was to be refined and the evaluation informed with PICE input.

METHODS

Covid-19 restrictions meant that planned face-to-face PICE methods had to be altered with all recruitment, all correspondence, and activities taking place remotely. A Parent Involvement Panel (PIP), a child panel, and an expert panel were established. Several adaptations were made to accommodate a new way of involving the public in research.

RESULTS/CONCLUSIONS

Working remotely created many challenges and was a learning experience for all involved. However, an active group was successfully established. Using continuous assessment and evaluation methods, we were able to demonstrate successful involvement and engagement in the refinement of the MapMe2 study. Through the sharing of PICE methods practice, this paper adds to the literature, the value of partnership working.

Caregiver Perception of Weight Status in 5-Year-Old Children From a Community of High Socioeconomic Deprivation in New Zealand

Background

Early childhood obesity is highly prevalent in Aotearoa New Zealand (NZ). Little is known about caregiver perception of children's weight status among those living in areas of high socioeconomic deprivation, particularly Māori and Pacific children.

Aims

To explore caregiver perception of weight status among children starting school in areas of high socioeconomic deprivation and examine potential associations between the child's body mass index (BMI) z-score and their caregiver's perception of their child's body size or health.

Methods

Participants were 5-year-old children living in a community of high socioeconomic deprivation and their caregivers. Children had their weight and height measured. BMI z-scores were calculated according to World Health Organization standards. Caregivers were asked to assess their child's BMI and health status, and choose a silhouette that best represented their child's body size.

Results

One hundred and six children (>75% Māori or Pacific) were included. Over half (58%) had overweight or obesity, with only 16% correctly perceived by their caregiver as overweight. These children tended to have higher BMI z-scores than those not correctly perceived as overweight. Caregivers chose larger silhouettes to represent children's body sizes as children's BMI z-scores increased. There was no discernible association between children's BMI z-scores and caregiver perception of children's health.

Conclusions

Caregivers appeared to judge their child's body size in comparison to other children. The normalization of childhood obesity and infrequent caregiver recognition of this condition in children in communities with a high prevalence may impact the uptake and efficacy of intervention initiatives.

Is obesity in the brain? Parent perceptions of brain influences on obesity

Neuroimaging studies demonstrate associations of brain structure and function with children's eating behaviour and body weight, and the feasibility of integrating brain measures into obesity risk assessment and intervention is growing. However, little is known about lay perceptions of how the brain influences obesity. We investigated parent perceptions of brain contributions to obesity in three separate studies: 1) a study of mothers of adolescents recruited for neuroimaging research (n = 88), 2) a study of ethnically Chinese parents of 5-13 year olds participating in a parent feeding survey (n = 277), and 3) a study of parents of 3-15 year olds completing an online survey (n = 113). In general, parents believed that brain factors influence obesity, but considered them less influential than behaviours such as diet and exercise. Causal attributions for brain factors were correlated with attributions for genetic factors and biological factors (e.g., metabolism). Parents who perceived their child to be overweight or had a high concern about their child becoming overweight in the future rated brain factors as more important in determining their child's weight and more likely to lessen their child's ability to control their weight. Our results suggest that parents attribute obesity to the brain to a moderate degree, and that education or feedback regarding brain influences on obesity could be a promising obesity intervention component.

Assessment of Actual Weight, Perceived Weight and Desired Weight of Romanian School Children-Opinions and Practices of Children and Their Parents

Objective: Children and parental awareness regarding weight is linked to the development and management of overweight and obesity. The aim of this study is to assess the actual weight, perceived weight, and desired weight of Romanian school children. Methods: A cross-sectional study was conducted in 2019 in seven schools from two counties of Romania and included 880 pupils aged between 10 and 15 years old and 665 parents. We administrated confidential questionnaires to the participants, and we measured children’s weight and height during school activities. Results: A total of 61.0% of pupils had normal weight, 7.4% were underweight, and 31.6% were overweight or obese. A total of 66.7% of normal weight children, 56.5% of overweight children, and 40% of underweight children perceived their weight accurately. Regarding parents, a majority correctly appreciated the weight of their normal weight children and only a third appreciated correctly the body weight of their underweight and overweight children. Factors such as body mass index, gender, weight related behaviors, parents’ estimation about their children’s weight, discussions of weight topics inside family, and bullying, cyberbullying and exclusion from groups were associated with misperceptions. Conclusion: The study provides useful information for health education activities targeting both children and their parents regarding appropriate body weight management of children.

Maternal perception of child weight and concern about child overweight mediates the relationship between child weight and feeding practices

OBJECTIVE

To examine the mediating effects of maternal perception of child weight (weight perception) and concern about overweight (weight concern) on the paths between child weight and maternal feeding practices.

SETTING

Pudong District, Shanghai, China.

PARTICIPANTS

A convenience sample of 1164 mothers who were primary caregivers of preschool children.

RESULTS

Sixty per cent of the mothers perceived their overweight/obese children as normal weight or even underweight. The disagreement between actual child weight and maternal weight perception was statistically significant (Kappa = 0·212, P < 0·001). Structural equation modelling indicated that weight perception fully mediated the relationship between child BMI Z-scores and pressure to eat. Weight concern fully mediated the relationships between child BMI Z-scores and the other three feeding practices. The serial mediating effects of weight perception and concern were statistically significant for the paths between child BMI Z-score and monitoring (β = 0·035, P < 0·001), restriction (β = 0·022, P < 0·001), and food as a reward (β = -0·017, P < 0·05).

CONCLUSION

Child weight may influence maternal feeding practices through weight perception and concern. Thus, interventions are needed to increase the accuracy of weight perception, which may influence several maternal feeding practices and thereby contribute to child health.

Parental perception of child's weight, their attitudes towards child's dietary habits and the risk of obesity

BACKGROUND

The association between parental perception of child's weight and their attitudes towards his/her dietary habits has not been reported yet. This study aimed to assess the association between parental underestimation of child's weight and parental attitudes towards child's dietary habits.

METHODS

We conducted a cross-sectional analysis of SENDO cohort participants recruited between January 2015 and June 2020. All information was collected through online questionnaires completed by parents. We calculated crude and multivariable-adjusted odds ratio (OR) and 95% confidence intervals (CI) for unhealthy attitudes towards child's dietary habits associated with parental underestimation of child's weight.

RESULTS

Sixteen percent of children in the SENDO project had parents who underestimated their weight. Parents who underestimated their child's weight status were more likely to have unhealthy attitudes toward his/her dietary habits [OR 3.35; 95% CI (1.71-6.53)].

CONCLUSIONS

Parental underestimation of child's weight was associated with unhealthy attitudes towards child's dietary habits. Pediatricians and public health practitioners should pay attention to the parental perception of child's weight to identify parents who underestimate it as an at-risk group in which to inquire about lifestyle and dietary habits.

Effectiveness of a Multifaceted Intervention for Prevention of Obesity in Primary School Children in China: A Cluster Randomized Clinical Trial

IMPORTANCE

A rapid nutritional transition has caused greater childhood obesity prevalence in many countries, but the repertoire of effective preventive interventions remains limited.

OBJECTIVE

To determine the effectiveness of a novel multifaceted intervention for obesity prevention in primary school children.

DESIGN, SETTING, AND PARTICIPANTS

A cluster randomized clinical trial was conducted during a single school year (from September 11, 2018, to June 30, 2019) across 3 socioeconomically distinct regions in China according to a prespecified trial protocol. Twenty-four schools were randomly allocated (1:1) to the intervention or the control group, with 1392 eligible children aged 8 to 10 years participating. Data from the intent-to-treat population were analyzed from October 1 to December 31, 2019.

INTERVENTIONS

A multifaceted intervention targeted both children (promoting healthy diet and physical activity) and their environment (engaging schools and families to support children's behavioral changes). The intervention was novel in its strengthening of family involvement with the assistance of a smartphone app. The control schools engaged in their usual practices.

MAIN OUTCOMES AND MEASURES

The primary outcome was the change in body mass index (BMI; calculated as weight in kilograms divided by height in square meters) from baseline to the end of the trial. Secondary outcomes included changes in adiposity outcomes (eg, BMI z score, prevalence of obesity), blood pressure, physical activity and dietary behaviors, obesity-related knowledge, and physical fitness. Generalized linear mixed models were used in the analyses.

RESULTS

Among the 1392 participants (mean [SD] age, 9.6 [0.4] years; 717 boys [51.5%]; mean [SD] BMI, 18.6 [3.7]), 1362 (97.8%) with follow-up data were included in the analyses. From baseline to the end of the trial, the mean BMI decreased in the intervention group, whereas it increased in the control group; the mean between-group difference in BMI change was -0.46 (95% CI, -0.67 to -0.25; P < .001), which showed no evidence of difference across different regions, sexes, maternal education levels, and primary caregivers (parents vs nonparents). The prevalence of obesity decreased by 27.0% of the baseline figure (a relative decrease) in the intervention group, compared with 5.6% in the control group. The intervention also improved other adiposity outcomes, dietary, sedentary, and physical activity behaviors, and obesity-related knowledge, but it did not change moderate- to vigorous-intensity physical activity, physical fitness, or blood pressure. No adverse events were observed during the intervention.

CONCLUSIONS AND RELEVANCE

The multifaceted intervention effectively reduced the mean BMI and obesity prevalence in primary school children across socioeconomically distinct regions in China, suggesting its potential for national scaling.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03665857.

Parental Perception of Body Weight Status of Their 8-year-old Children: Findings from the European CHOP Study

BACKGROUND

Maternal perception of child weight status in children with overweight or obesity has received a lot of attention but data on paternal perception of children from presumably healthy cohorts are lacking.

OBJECTIVE

We aimed to investigate paternal and maternal perception of child weight status at the age of 8 years in a cohort of 591 children from 5 European countries.

MATERIAL AND METHODS

Included were 8-year-old children and their parents participating in the European Childhood Obesity Project (EU CHOP). Weight and height of children and parents were measured and Body Mass Index (BMI, kg/m²) was calculated. Both parents were asked to assess their perception of child weight status using Eckstein scales and their concern about child overweight. The agreement between mother and father perceptions was assessed by Cohen kappa coefficient and their relationship was analyzed by linear mixed effects models based on ordinal logistic regression, accounting for country, child gender and BMI, parental BMI, level of education, concern and type of feeding during first year of life.

RESULTS

Data from children and both parents were available for 432 girls and boys. Mean BMI was comparable in boys and girls (16.7 ± 2.31 vs. 16.9 ± 2.87 kg/m², P = 0.55). In total, 172 children (29.3%) were overweight or obese. There was a high degree of agreement between mother and father perceptions of their child's weight status (Cohen kappa 0.77). Multivariate modelling showed that perception levels significantly increased with child BMI but were globally lower than assessed. They differed between countries, gender and types of feeding during first year of life, were influenced by education level of the father but were not related to parental BMI and concern about childhood overweight.

CONCLUSIONS

The study showed no overall differences between mothers and fathers in rating their child's weight status but both parents had a propensity to underestimate their child's actual weight, particularly in boys. The EU CHOP trial registered at clinicaltrials.gov as NCT00338689.

Caregivers' perceptions of the relationship among weight, health status, and asthma in their children

Asthma and obesity are the two most common childhood illnesses and are physiologically interrelated. Few studies have assessed parental perceptions and beliefs about this relationship to better target education and therapy. This study aimed to determine caregiver beliefs and perceptions regarding weight, health status, and asthma diagnoses. Data from a survey of caregivers to children aged 4-11 years are merged with corresponding anthropometric and medical data from the electronic medical record. Caregivers of children with asthma completed a supplemental questionnaire. Univariable and multivariable logistic regressions were used to evaluate associations between perception of health problem, asthma, and weight status. Increased weight status was ≥ 85th body mass index percentile per Centers for Disease Control classifications. Compared to caregivers of healthy children and those of children with healthy weight and asthma, caregivers of dual diagnosis children were more likely to identify weight as a health problem (OR = 3.89, 95% confidence interval [1.48, 10.21]). Nevertheless, only 31% of caregivers of children with dual diagnosis believed weight contributed to the severity of their child's asthma. Less than one third of caregivers of dual diagnosis children believed that these diagnoses are interrelated. Addressing this gap in understanding is a critical next step to developing family-centered interventions.

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.

Association between Parents' Perceptions of Preschool Children's Weight, Feeding Practices and Children's Dietary Patterns: A Cross-Sectional Study in China

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.

Parental perceptions of actual and ideal body weight in early childhood prospectively predict adolescent perceptions of actual and ideal body weight among a low-income population

PURPOSE

To examine the longitudinal associations between parental perceptions of their child's actual weight (PPCA = parental perception of child's actual) and ideal weight (PPCI = parental perception of child ideal) in early childhood and the child's own perceptions of their actual weight (APA = adolescent perceived actual) and ideal weight (API = adolescent perceived ideal) during early adolescence among a low-income population.

METHODS

Using a longitudinal study design, 136 child/parent pairs were asked to assess the child's actual and ideal weight using figure rating scales. When children were 4-7 years old, parents reported on their perception of their child's weight; when children were 10-12 years old, the child reported on their own weight perceptions. Actual weight, ideal weight, and the difference between ideal and actual weight perception were assessed at the respective timepoints. Regressions were used to examine the relationship between parental weight perceptions (PPCA and PPCI) and later adolescent weight perception (APA and API).

RESULTS

On average, PPCI was higher than PPCA, whereas API was lower than APA. We found a positive relationship between PPCI and API (β = 0.309, p = .029). PPCA was positively associated with API (β = 0.304, p = .015) and marginally positively associated with the APA (β = 0.242, p = .077). However, the difference between PPCI and PPCA did not predict either APA or API.

CONCLUSIONS

Parental perception of their child's weight may relate to the adolescent's weight perception, particularly ideal weight. However, several null and marginal associations suggest that parental weight perception in early childhood may not be the most salient factor in determining weight perception in early adolescence.

LEVEL OF EVIDENCE

Level III, well-designed longitudinal cohort study.

Concordance Between the Weight of Spanish Adolescent Soccer Players, Their Self-Perceived Weight, and Their Weight as Perceived by Their Parents

PURPOSE

In the context of soccer clubs, to analyze the concordance between players' actual weight, their self-perceived weight, and their weight as perceived by their parents; to determine which variables might explain the presence of concordance between parents' perception of adolescents' weight and their actual weight. Design and study: A cross-sectional study involving 330 soccer players aged between 13 and 16. Data on personal characteristics of adolescents and parents were analyzed, as well as parents' perceptions of adolescents' weight status and their self-perception. A descriptive analysis of the personal characteristics of the sample (adolescents and parents) and an analysis of the variables explaining the presence of concordance between the parents' perception of adolescents' weight and their actual weight were performed.

RESULTS

19% of the adolescents were overweight and 3.4% were obese. The concordance between parents' perceptions of players' weight and players' actual weight was weak. The concordance between adolescents' self-perceived weight and their actual weight was moderate. The difference in BMI scores according to presence or absence of concordance was statistically significant: these scores were higher in the absence of concordance. Discordance between adolescents' weight and their parents' perception of their weight was associated with parents having lower levels of education.

CONCLUSION

A high percentage of parents and players misperceived their actual weight. This discrepancy was associated with higher BMI scores for adolescents.

PRACTICE IMPLICATIONS

Nurses should include promotion of accurate weight perception in educational interventions on excess weight.

Longitudinal patterns of food insecurity, the home food environment, and parent feeding practices during COVID-19

Background

The economic impacts of the coronavirus disease 2019 (COVID-19) have drastically increased food insecurity in the United States. Initial data, collected a few months into the pandemic, showed that families, particularly those experiencing food insecurity, reported detrimental changes to their home food environment and parent feeding practices, compared to before COVID-19.

Objective

This follow-up study obtained longitudinal data from a sample of parents in the United States to quantify changes in food security status, the home food environment, and parent feeding practices, from before to across COVID-19 as the pandemic continued to persist.

Methods

Parents (N = 433) completed online surveys May (T1) and September (T2) 2020 during COVID-19. Food security, home food environment, and parent feeding practices were reported at each timepoint. At T1, parents also retrospectively reported on these factors pertaining to before COVID-19. Chi square analyses and repeated measure mixed models examined associations among study variables.

Results

Low or very low food security increased from before COVID-19 (37%) to T1 (54%) and decreased by T2 (45%). About 30% of families who became food insecure, and 44% who stayed food insecure from T1 to T2, reported a decrease in total food in their home; only 3%-6% who became/stayed food secure reported this decrease. Parents' concern for child overweight and use of monitoring increased from before COVID-19 to T1, and decreased by T2, but remained elevated above pre-COVID-19 values.

Conclusion

Rates of food insecurity remain high as this pandemic persists. Continued assessment of nutrition-related factors and increased economic supports are critical for families to endure COVID-19 and prevent long-term obesity and health risks.

Association of Nursery School-Level Promotion of Vegetable Eating with Caregiver-Reported Vegetable Consumption Behaviours among Preschool Children: A Multilevel Analysis of Japanese Children

Nursery schools can play an important role in children developing healthy eating behaviours, including vegetable consumption. However, the effect of school-level vegetable promotion on vegetable consumption and body mass index (BMI) remains unclear. This study examined the associations of nursery school-level promotion of eating vegetables first at meals with Japanese children’s vegetable consumption behaviours and BMI. We used cross-sectional data collected in 2015, 2016, and 2017 on 7402 children in classes of 3–5-year-olds in all 133 licensed nursery schools in Adachi, Tokyo, Japan. Caregivers were surveyed on their children’s eating behaviours (frequency of eating vegetables, willingness to eat vegetables and number of kinds of vegetables eaten), height and weight. Nursery school-level promotion of eating vegetables first at meals was assessed using individual responses, with the percentage of caregivers reporting that their children ate vegetables first at meals as a proxy for the school-level penetration of the promotion of vegetable eating. Multilevel analyses were conducted to investigate the associations of school-level vegetable-eating promotion with vegetable consumption behaviours and BMI. Children in schools that were 1 interquartile range higher on vegetable promotion ate vegetable dishes more often (β = 0.04; 95% CI: 0.004–0.07), and were more often willing to eat vegetables (adjusted odds ratio = 1.17; 95% CI: 1.07–1.28), as well as to eat more kinds of vegetables (adjusted odds ratio = 1.19 times; 95% CI: 1.06–1.34). School-level vegetable-eating promotion was not associated with BMI. The school-level health strategy of eating vegetables first may be effective in increasing children’s vegetable intake but not in preventing being overweight.

The association of co-morbid asthma and overweight/obese status with healthcare utilization and caregiver perception of health in children 4-17 years, a NHANES study

OBJECTIVE

Asthma and obesity are two of the most common chronic childhood illnesses. The purpose of this study was to better understand the relationship between co-morbid asthma and obesity in children aged 4-17 and whether it impacts the caregiver's perception of health and/or healthcare utilization.

METHODS

This was a secondary analysis of the National Health and Nutrition Examination Surveys (NHANES) datasets from 2007 to 2018. Cumulative logistic regression models were used to analyze the caregiver's perception of health, received healthcare, and overnight hospital stay as dependent variables. Asthma and weight status were included as covariates, with adjustment for age, income, head of the household's education, gender, race, and insurance.

RESULTS

The sample included 15,386 children. When looking at weight status in addition to asthma, compared to caregivers of children with current asthma and normal weight, caregivers of children with current asthma and with obesity are more likely to perceive their children as having worse health (OR = 1.73, 95%CI = [1.30, 2.32], p = 0.0003), and are more likely to have more frequent healthcare utilization but the results did not reach a statistical significance.

CONCLUSIONS

Caregiver's perception of overall health was worse in caregivers of those with co-morbid obesity/asthma than in caregivers of children with asthma alone. This indicates that caregivers of children with co-morbid asthma and obesity have insight into their children's condition and may be primed for discussion and counseling in the healthcare setting.

Childhood overweight and obesity among the Saudi population: a case-control study among school children

BACKGROUND

Childhood obesity is a global public health concern with major consequences. In Saudi Arabia, the percentage of children who are overweight or obese has significantly increased in the past two decades, raising concerns about the physical and psychosocial consequences of this burden. This study aimed at investigating the different risk factors contributing to childhood obesity in Saudi Arabia.

METHODS

A case-control study was conducted among 492 school children (246 overweight/obese children, and 246 normal weight control children aged 5-9 years). Using valid and reliable instruments, parental and child characteristics, behavioral practices, screen use, and other activities were assessed as risk factors for childhood obesity using logistic regression analysis.

RESULTS

An unemployed father (OR=11.90; 95% CI: 7.47-18.93), a father with overweight/obesity (OR=2.04; 95% CI: 1.40-2.96), an incorrect parental perception of child's weight status (OR=2.54; 95% CI: 1.75-3.68), cesarean delivery (OR=2.52; 95% CI: 1.56-4.09), daily time in active play for less than 30 min (OR=2.18; 95% CI: 1.44-3.28), frequent snacking (OR=1.74; 95% CI: 1.05-2.93), and screen time use for more than 2 h per day outside of school (OR=1.62; 95% CI: 1.12-2.34) were all independent risk factors for being overweight or obese among the selected cases.

CONCLUSION

Efforts to prevent childhood overweight and obesity in this population should focus primarily on the early identification and confrontation of risk factors. Such risk factors include parental characteristics and awareness of the magnitude of the burden obesity poses, behavioral practices such as frequent snacking, screen time use, and physical activity.

Barriers to Behavior Change in Parents With Overweight or Obese Children: A Qualitative Interview Study

Overweight and obesity among children and adolescents are global problems of our time. Due to their authority and role modeling, parents play an essential part in the efficacy of prevention and intervention programs. This study assessed the barriers that parents of overweight/obese children face in preventive and interventional health care utilization. Sixteen parents were qualitatively interviewed. A content analysis was performed, and barriers to change were allocated to their stage of change according to the transtheoretical model. Among the main barriers is the underestimation of health risks caused by overweight/obesity in association with diminished problem awareness. Parents seem not necessarily in need of theoretical knowledge for prevention and interventions. They do however need support in evaluating the weight status of their child and the knowledge of whom to turn to for help as well as specific and hands-on possibilities for change. The results extend past studies by adding specific barriers to change that parents commonly experience. Possibilities to address these barriers, e.g., through trainings at the pediatric practice or adoption of conversation techniques, are discussed. Future studies might identify subgroups experiencing specific barriers and thus be able to address these in an individualized way.

Intake of Fibre-Associated Foods and Texture Preferences in Relation to Weight Status Among 9-12 Years Old Children in 6 European Countries

Plant foods, rich in fibre, can offer textures that children find difficult to orally manipulate, resulting in low preferences but are important for a healthy diet and prevention of overweight in children. Our aim was to investigate preferences for food texture, intake of fibre-associated foods and the relation to BMI. Three hundred thirty European children (9-12 years, 54% female) indicated their texture preferences using the Child-Food-Texture-Preference- Questionnaire (CFTPQ), and their parents responded on fibre-associated food consumption and anthropometric information. BMI was significantly lower for children with higher intake of wholegrain alternatives of common foods; in addition to being significantly influenced by country and the wearing of a dental brace. Overall BMI-for-age-percentiles (BMI_pct) were negatively associated with the consumption of wholegrain cereals, white pasta and wholemeal products and positively associated with the intake of legumes and white biscuits. In males, BMI_pct were negatively associated with wholegrain products and dried fruits, and in females, positively with legume consumption. A few country-related associations were found for BMI_pct and wholegrain biscuits, seeds and nuts and refined products. No overall correlation was found between BMI_pct and the texture preference of soft/hard foods by CFTPQ, except in Austria. We conclude that this study revealed evidence of a connection between fibre-associated foods and children's BMI at a cross-cultural level and that sex is an important determinant of fibre-associated food intake and the development of overweight in childhood.

The acceptability and feasibility of using a 3D body size scale to initiate conversations about weight in toddlerhood: a mixed-methods study

BACKGROUND

Health Care Professionals struggle to initiate conversations about overweight in toddlerhood. A novel 3D body size scale (3D BSS) may facilitate engagement with this topic during pediatric appointments.

OBJECTIVES

To explore barriers and facilitators to using the 3D BSS through a mixed-methods design.

METHODS

For the qualitative phase, parents of toddlers (n = 38) participated in semi-structured interviews introducing the 3D BSS of 4-5-year-old children. For the quantitative phase, pre- and post-interview questionnaires were administered to ascertain the acceptability of the 3D BSS.

RESULTS

Parents rated the 3D BSS as "very" (n = 20, 52.6%) to "moderately" (n = 12, 31.6%) acceptable. Thematic analysis revealed four barriers to acceptability: i) the sensitive nature of child weight, ii) the belief that weight does not determine health, iii) the visual normalisation of overweight and iv) the need to account for individual variation in growth patterns. However, these barriers could be overcome through three facilitators: i) the provision of expert guidance ii) the value of simple tools, and iii) tailoring conversations to familial needs.

CONCLUSIONS

Parents considered the 3D BSS an acceptable visual resource to discuss child weight during routine appointments. However, the acceptability of the tool was conditional on a sensitive, collaborative, and tailored delivery approach.

The accuracy of parental suspicion of hearing loss in children

OBJECTIVES

Parental suspicion of hearing impairment in their children is generally inaccurate. Parents tend to underestimate hearing problems in their children. The aim of the study was to assess the accuracy of parental suspicion of hearing loss in their children.

METHODS

This was a population-based, epidemiological study conducted in elementary schools in villages and small towns in Poland. The study sample was 64,750 children aged 6-13 years old. The children underwent hearing screening with pure-tone audiometry. The parents answered a question about hearing problems in their children. The outcome parameters were sensitivity, specificity, and predictive value of parental perception of hearing problems in their children. Parental suspicion of hearing problems was assessed by a questionnaire. Pure-tone air-conduction hearing thresholds were obtained from 0.5 to 8 kHz. Hearing loss was defined as a pure-tone average higher than 20 dB in one or both ears in at least one of the three following pure-tone averages: four-frequency pure-tone average, high-frequency pure-tone average, and low-frequency pure-tone average.

RESULTS

Positive results of hearing screening were obtained in 16.3% of children. Hearing loss was detected in 6025 children (9.3%), of whom 1074 (17.8%) were correctly perceived by parents as having hearing problems. The degree of hearing loss was a significant factor which influenced the sensitivity of parental suspicion of HL in their children. Sensitivity of detecting hearing loss by parents reached about 20% for mild hearing loss and above 31% for moderate or worse hearing loss.

CONCLUSIONS

Parents underestimate hearing problems in their children, but they are more able to accurately detect hearing loss if it involves speech-related frequencies and is at least a moderate hearing loss or bilateral loss.

Risk Factors for Overweight and Obesity in Children Attending the First Year of Primary Schools in Modena, Italy

Over the last four decades, childhood overweight/obesity has dramatically increased, becoming a significant public health concern. The main aims of this study were to investigate the prevalence of overweight/obesity among first-year primary schools children in Modena and to identify the associated risk factors. Data were collected on the socio-demographic characteristics of family and weight, height, dietary habits and sedentary behaviours of the children, and on the parents' perception of their child's weight status, through an anonymous questionnaire administered to parents. The questionnaires were delivered by 660 out of 890 (74.2%) families, and after excluding those without anthropometric data, 588 children were included in the study. The prevalence of overweight/obesity among the children was 25.2%, significantly lower in children born to parents with a high education, and higher among children born to foreign parents and overweight/obese mothers. The multivariable analysis showed that the children most likely to become overweight/obese were those who skipped breakfast (OR 2.3, 95%CI 1.3-4.2) and/or mid-morning snacks (OR 3.2, 95%CI 1.5-6.5). Breakfast consumption was positively associated with higher parental education levels, whereas skipping mid-morning snacks is more frequent among children born to foreign parents and overweight/obese mothers. Moreover, 84.7% of the parents of overweight/obese children underestimated their child's weight status. One in four 6-7 year-old children is already overweight or obese. Childhood overweight/obesity is significantly associated with unhealthy lifestyles and family lifestyle. It is therefore essential to implement public health intervention programs aimed at both parents and children, in order to promote healthy lifestyles in early childhood.

The "Stages Towards Completion Model": what helps and hinders children with overweight or obesity and their parents to be guided towards, adhere to and complete a group lifestyle intervention

Purpose: Lifestyle interventions can be effective in the management of overweight and obesity in children. However, ineffective guidance towards interventions and high attrition rates affect health impacts and cost effectiveness. The aim of this study was to gain insight into the factors influencing participation, in particular guidance towards, adherence to and completion of an intervention.

Methods: A narrative literature review was performed to identify factors related to participation, leading to the development of the “Stages towards Completion Model”. Semi-structured interviews (n = 33) and three focus group discussions (n = 25) were performed with children and parents who completed two different group lifestyle interventions, as well as with their coaches.

Results: The main barrier to participating in a lifestyle intervention was the complex daily reality of the participants. The main facilitator to overcome these barriers was a personal approach by all professionals involved.

Conclusions: Participation in a lifestyle intervention is not influenced by one specific factor, but by the interplay of facilitators and barriers. A promising way to stimulate participation and thereby increase the effectiveness of interventions would be an understanding of and respect for the complex circumstances of participants and to personalize guidance towards and execution of interventions.

Determinants of accurate visual perception of child anthropometric phenotype among ethnically diverse preschool parents in the United States

The literature reports that regardless of the high obesity prevalence estimates in young children, parents often do not accurately perceive their child's weight status. The purpose of this analysis was to examine the association between parent/child demographic characteristics including ethnicity, country of birth and years living in the United States and the perception of child's anthropometric phenotype status based on a visual silhouette instrument. Caregiver (n = 456) and child sociodemographic, perception of child anthropometric phenotype status and height/weight measurements were collected in 2015, from 24 childcare centres in Miami, Florida, among children ages 2-to-5 years old. Chi-square analysis determined parent perception accuracy by actual child healthy (<body mass index [BMI] 85th percentile) or unhealthy (≥ BMI 85th percentile) status. Multivariable linear regression modelled phenotype trends by caregiver perception. Twenty-eight per cent of the sample was of unhealthy weight. Overall, 74.6% of caregivers did not accurately identify their child's BMI phenotype category versus 25% who did (p < .001); 8% of Hispanic and 13% of non-Hispanic parents of a child with an unhealthy BMI correctly identified their child's anthropometric phenotype. A higher proportion of Cuban (22%) caregivers of a child with an unhealthy BMI percentile versus Mexican caregivers (13.9%) visually identified their child as healthy weight. Child BMI percentile was significantly associated with parent perception of child healthy phenotype (OR: 1.05, 95% CI 1.04, 1.06). Findings here add evidence to the existing body of literature that emphasise parent perception of child weight status as a critical lynchpin in the childhood obesity epidemic. Intervention efforts must continue to educate parents on healthy weight development strategies.

The Smartphone-Assisted Intervention Improved Perception of Nutritional Status among Middle School Students

Misperception of nutritional status is common and hinders the progress of childhood obesity prevention. This study aimed to examine the effectiveness of a smartphone-assisted intervention to improve student and parental perception of students’ nutritional status (underweight, normal weight, overweight, obese). We conducted a parallel-group controlled trial with a non-randomized design in three junior middle schools of Beijing, China in 2019. One school was allocated to the intervention group and two schools to the control group. A total of 573 students (aged 13.1 ± 0.4 years) participated in the trial. The 3-month intervention included three components: health education sessions for students and parents, regular monitoring of students’ weight, and the provision of feedback via a smartphone application. Schools in the control group continued their usual practice. Primary outcomes included the student and parental accurate perception of students’ nutritional status. The percentage of students’ accurate perception of their own nutritional status in the intervention group increased from 49.0% to 59.2% from baseline to three months, whereas it decreased from 64.1% to 58.1% in the control group; the adjusted odds ratio (OR) between the two groups was 1.71 (95% confidence interval (CI): 1.13, 2.59). The intervention did not significantly improve parental perception of students’ nutritional status (p > 0.05). The study findings provided a brief approach for improving perception of nutritional status among middle school students.

A Mobile-Based Tailored Recommendation System for Parents of Children with Overweight or Obesity: A New Tool for Health Care Centers

Childhood obesity is associated with unbalanced lifestyle patterns, and new strategies are needed to support parents in the compliance with the guidelines for children's age. Tailored automatic recommendations mimic interpersonal counseling and are promising strategies to be considered for health promotion programs. This study aimed to develop and test a mobile recommendation system for parents of preschool children identified with overweight/obesity at health care centers. Evidence-based recommendations related to children's eating, drinking, moving, and sleeping habits were developed and tested using a questionnaire. A pilot study was conducted in a health care center to test how using an app with those tailored recommendations, in video format, influenced parents' perceptions of the child's weight status and their knowledge about the guidelines, compared to a control group. The chi-squared test was used for categorical variables and the Mann-Whitney U test for continuous variables (p < 0.05). A high proportion of parents were already informed about the guidelines, but their children were not meeting them. After watching the tailored recommendations, there was an increased knowledge of the guideline on water intake, but there was no improvement in the perception of the child's excessive weight. Parents may benefit from a mobile-based tailored recommendation system to improve their knowledge about the guidelines. However, there is a need to work with parents on motivation to manage the child's weight with additional strategies.

A randomized controlled trial examining an exam room poster to prompt communication about weight

BACKGROUND

Recognition of childhood weight status is important to the adoption of healthy lifestyle behaviours.

OBJECTIVES

We assessed whether an exam room educational poster addressing weight and healthy lifestyle behaviours was acceptable to parents, prompted parent-provider communication or improved parental weight perception accuracy.

METHODS

In this multi-site randomized controlled trial, exam rooms were randomized to display the posters (English and Spanish) or not. Children ages 3 to 8 years (N = 965) attending well visits were weighed and roomed per usual clinic protocol. After the visit, parents completed a questionnaire assessing demographics, child weight status perceptions and whether they discussed weight status with provider or were shown growth charts. We used separate logistic regression analyses to examine associations between intervention status and: asking provider about child weight, being shown growth charts, and accuracy of weight perception, adjusting for covariates and clustering by exam room.

RESULTS

Of the parents who saw the poster, 97% liked seeing it and reported greater understanding of weight status visualization (96%) and healthy lifestyle behaviours (94%). Parents who saw the poster were more likely to report being shown a growth chart (OR 1.87, 95% 1.06, 3.30) but were not more likely to ask about their child's weight status nor accurately report their child's weight status.

CONCLUSIONS

An educational exam room poster about healthy weight was well-received by parents and prompted providers to show the child's growth chart but did not prompt parent-initiated conversations about weight status nor improve parental weight perception accuracy.

Change in Growth and Diet Quality Among Preschool Children in Tokyo, Japan

Dietary intake of adequate quality and quantity in early life is essential for healthy growth and development. This study aimed to examine the association between one-year change in growth and diet quality in preschool children in Adachi City, Tokyo, Japan. A total of 110 participants (49% boys, four to five years old at baseline) were included in this analysis. Body mass index for age z-score (BAZ) and height for age z-score (HAZ) were calculated in accordance with WHO reference. Dietary intakes were assessed using the brief-type self-administered diet history questionnaire for children (BDHQ3y), and daily quality score was calculated based on the Japanese Food Guide Spinning Top (JFGST score). Regression analyses found no significant association between one-year change in growth and diet quality (compared to a low JFGST score, BAZ: β = 0.16, 95% CI: −0.29 to 0.60 for a middle JFGST score, β = −0.14, 95% CI: −0.61 to 0.33 for a high JFGST score, HAZ: β = −0.15, 95% CI: −0.50 to 0.21 for a middle JFGST score, β = −0.06, 95% CI: −0.43 to 0.30 for a high JFGST score). Further studies are needed to develop an appropriate diet quality index for healthy growth in Japanese preschool children.

Food Insecurity Associated With Underestimation of Weight Status in Children With a Healthy Weight

OBJECTIVE

Accurate parental weight perception of one's child is an important step in addressing healthy behaviors, but its associations with socioeconomic status (SES) and household food insecurity (HFI) are unclear. We aimed to assess the association of parental weight perception with HFI.

METHODS

This was a secondary data analysis of a cross-sectional study of 284 children ages 2 to 8 years whose parents completed surveys about weight perception, SES, and HFI. Height and weight were measured to determine the children's body mass index scores and were self-reported by parents. We performed chi-square tests to compare HFI and accuracy of parental weight perception and used logistic regression to assess accuracy, adjusting for significant covariates and stratifying by child weight category.

RESULTS

Approximately two thirds of children had healthy weight, 18% had overweight, and 15% had obesity. About one third of parents inaccurately identified their child's weight category, almost always underestimating weight status. Twenty-eight percent of the families were food insecure. HFI was not associated with parental weight perception in bivariate analysis. When stratified by weight status, food insecure families with children at healthy weight had 0.16 times the odds of accurately perceiving their children's weight status. There was no association between HFI and accuracy of weight perception in children with overweight or obesity.

CONCLUSIONS

Food insecurity was associated with a decrease in the accuracy of parental weight perceptions in children with healthy weight. Pediatricians should clearly communicate about weight status, as families with HFI may adopt unhealthy eating behaviors under the incorrect assumption that their child is underweight.

Improving the assessment and management of obesity in UK children and adolescents: the PROMISE research programme including a RCT

Background

Five linked studies were undertaken to inform identified evidence gaps in the childhood obesity pathway.

Objectives

(1) To scope the impact of the National Child Measurement Programme (NCMP) (study A). (2) To develop a brief evidence-based electronic assessment and management tool (study B). (3) To develop evidence-based algorithms for identifying the risk of obesity comorbidities (study B). (4) To conduct an efficacy trial of the Healthy Eating and Lifestyle Programme (HELP) (study C). (5) To improve the prescribing of anti-obesity drugs in UK adolescents (study D). (6) To investigate the safety, outcomes and predictors of outcome of adolescent bariatric surgery in the UK (study E).

Methods

Five substudies – (1) a parental survey before and after feedback from the National Childhood Measurement Programme, (2) risk algorithm development and piloting of a new primary care management tool, (3) a randomised controlled trial of the Healthy Eating and Lifestyle Programme, (4) quantitative and qualitative studies of anti-obesity drug treatment in adolescents and (5) a prospective clinical audit and cost-effectiveness evaluation of adolescent bariatric surgery in one centre.

Results

Study A – before the National Childhood Measurement Programme feedback, three-quarters of parents of overweight and obese children did not recognise their child to be overweight. Eighty-seven per cent of parents found the National Childhood Measurement Programme feedback to be helpful. Feedback had positive effects on parental knowledge, perceptions and intentions. Study B – risk estimation models for cardiovascular and psychosocial comorbidities of obesity require further development. An online consultation tool for primary care practitioners is acceptable and feasible. Study C – the Healthy Eating and Lifestyle Programme, when delivered in the community by graduate mental health workers, showed no significant effect on body mass index at 6 months (primary outcome) when compared with enhanced usual care. Study D – anti-obesity drugs appear efficacious in meta-analysis, and their use has expanded rapidly in the last decade. However, the majority of prescriptions are rapidly discontinued after 1–3 months of treatment. Few young people described positive experiences of anti-obesity drugs. Prescribing was rarely compliant with the National Institute for Health and Care Excellence guidance. Study E – bariatric surgery appears safe, effective and highly cost-effective in adolescents in the NHS.

Future work and limitations

Work is needed to evaluate behaviour and body mass index change in the National Childhood Measurement Programme more accurately and improve primary care professionals’ understanding of the National Childhood Measurement Programme feedback, update and further evaluate the Computer-Assisted Treatment of CHildren (CATCH) tool, investigate delivery of weight management interventions to young people from deprived backgrounds and those with significant psychological distress and obtain longer-term data on anti-obesity drug use and bariatric surgery outcomes in adolescence.

Trial registration

Current Controlled Trials ISRCTN99840111.

Funding

This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 8, No. 3. See the NIHR Journals Library website for further project information.