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Sherrard A, Tan CC. Children's eating behavior and weight-related outcomes: A latent profile analysis of parenting style and coparenting. Eat Behav 2024; 52:101845. [PMID: 38324958 DOI: 10.1016/j.eatbeh.2024.101845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 11/29/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
Parenting style is associated with children's eating behavior, yet less is known about how parenting style and coparenting are both related to children's eating behavior (food approach behavior and palatable food intake) and weight-related outcomes (concern about child weight and perceived child weight). The aims of the current research were 1) to determine family profiles based on parenting style and coparenting, 2) to examine whether the family profiles were associated with parent (sex, BMI, age) and child (sex, age) characteristics, and 3) to examine whether the family profiles differed in children's outcomes. Parents (n = 185; Mage = 36.38 years, SD = 7.69) of 3- to 8-year-old children completed an online survey. Latent profile analysis revealed three family profiles: 1) Responsive and Cooperative, 2) Minimally Structured, and 3) Demanding and Competitive. The family profiles were not related to any parent or child characteristics. The Responsive and Cooperative family profile was associated with the lowest food approach behavior, palatable food intake, and weight-related outcomes, followed by the Minimally Structured family profile, and finally the Demanding and Competitive family profile with the highest scores. These findings suggest family dynamics play an important role in children's propensity to engage in food approach behavior and palatable food intake.
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López Siguero JP, Ramon-Krauel M, Pérez López G, Buiza Fernández MV, Assaf Balut C, Fernández-Aranda F. Attitudes, Behaviors, and Barriers among Adolescents Living with Obesity, Caregivers, and Healthcare Professionals in Spain: ACTION Teens Survey Study. Nutrients 2023; 15:3005. [PMID: 37447329 DOI: 10.3390/nu15133005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/15/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Although the prevalence of pediatric obesity is rising, understanding of the perceptions, attitudes, behaviors, and barriers to effective obesity care among Spanish adolescents living with obesity (ALwO), their caregivers, and healthcare professionals (HCPs) is lacking. In 2021, the cross-sectional ACTION Teens survey study was conducted in 10 countries; results from the Spanish cohort are presented herein. The survey was completed by 648 ALwO, 644 caregivers, and 251 HCPs in Spain. A total of 25% of ALwO and 43% of caregivers thought that their/their child's weight was normal, and more caregivers than ALwO perceived the ALwO's health to be at least good (95% vs. 59%, respectively). Only 53% of ALwO and 9% of caregivers reported receiving an obesity diagnosis, despite HCPs reporting they provide diagnoses to 87% of ALwO/caregivers. Although 65% of HCPs felt that ALwO may not be comfortable discussing weight, only 26% of ALwO who had discussed weight with an HCP (n = 488) reported not feeling comfortable. Inability to control hunger was a key barrier to ALwO losing weight identified by ALwO/caregivers, but not HCPs. Improved communication between the three groups, a better understanding of barriers to weight loss, and improved health education on obesity are needed in order to enhance obesity care in Spain.
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Affiliation(s)
| | - Marta Ramon-Krauel
- Department of Endocrinology, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Health Institute Carlos III, 28029 Madrid, Spain
| | - Gilberto Pérez López
- Department of Endocrinology and Nutrition, Hospital Gregorio Marañon, 28007 Madrid, Spain
| | | | | | - Fernando Fernández-Aranda
- Clinical Sciences Department, School of Medicine and Health Sciences, University of Barcelona, 08907 Barcelona, Spain
- Clinical Psychology Unit, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain
- Spanish Biomedical Research Center in Obesity and Nutrition (CIBEROBN), Health Institute Carlos III, 28029 Madrid, Spain
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Mazur A, Zachurzok A, Baran J, Dereń K, Łuszczki E, Weres A, Wyszyńska J, Dylczyk J, Szczudlik E, Drożdż D, Metelska P, Brzeziński M, Kozioł-Kozakowska A, Matusik P, Socha P, Olszanecka-Gilianowicz M, Jackowska T, Walczak M, Peregud-Pogorzelski J, Tomiak E, Wójcik M. Childhood Obesity: Position Statement of Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes, the College of Family Physicians in Poland and Polish Association for Study on Obesity. Nutrients 2022; 14:nu14183806. [PMID: 36145182 PMCID: PMC9505061 DOI: 10.3390/nu14183806] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Childhood obesity is one of the most important problems of public health. Searching was conducted by using PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases, from January 2022 to June 2022, for English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from all over the world. Five main topics were defined in a consensus join statement of the Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes and Polish Association for the Study on Obesity: (1) definition, causes, consequences of obesity; (2) treatment of obesity; (3) obesity prevention; (4) the role of primary care in the prevention of obesity; (5) Recommendations for general practitioners, parents, teachers, and regional authorities. The statement outlines the role of diet, physical activity in the prevention and treatment of overweight and obesity, and gives appropriate recommendations for interventions by schools, parents, and primary health care. A multisite approach to weight control in children is recommended, taking into account the age, the severity of obesity, and the presence of obesity-related diseases. Combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education are effective in improving metabolic and anthropometric indices. More actions are needed to strengthen the role of primary care in the effective prevention and treatment of obesity because a comprehensive, multi-component intervention appears to yield the best results.
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Affiliation(s)
- Artur Mazur
- Institute of Medical Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
- Correspondence: (A.M.); (A.Z.); (M.W.)
| | - Agnieszka Zachurzok
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Zabrze, Poland
- Correspondence: (A.M.); (A.Z.); (M.W.)
| | - Joanna Baran
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Katarzyna Dereń
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Edyta Łuszczki
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Aneta Weres
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Justyna Wyszyńska
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Justyna Dylczyk
- Children’s University Hospital, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Ewa Szczudlik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Paulina Metelska
- Department of Public Health and Social Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Michał Brzeziński
- Chair and Department of Paediatrics, Gastroenterology, Allergology and Child Nutrition, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Agnieszka Kozioł-Kozakowska
- Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Paweł Matusik
- Department of Pediatrics, Pediatric Obesity and Metabolic Bone Diseases, Chair of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Piotr Socha
- The Children’s Memorial Health Institute, 04-736 Warsaw, Poland
| | - Magdalena Olszanecka-Gilianowicz
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical Faculty in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Teresa Jackowska
- Department of Pediatrics, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Mieczysław Walczak
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Disorders and Cardiology of the Developmental Age, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Jarosław Peregud-Pogorzelski
- Department of Pediatrics, Pediatric Oncology and Immunology, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Elżbieta Tomiak
- The College of Family Physicians in Poland, 00-209 Warszawa, Poland
| | - Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, 31-008 Kraków, Poland
- Correspondence: (A.M.); (A.Z.); (M.W.)
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Obesity in Polish Children and Parents' Perception of Their Children's Weight Status: The Results of the SOPKARD-Junior Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084433. [PMID: 35457299 PMCID: PMC9026880 DOI: 10.3390/ijerph19084433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/29/2022]
Abstract
One way to counteract the spread of obesity in children is its early recognition by parents. Therefore, the aim of this study was to investigate whether parents’ perception of their children’s BMI category was consistent with their actual BMI assessment and to determine potential influential factors. The study was conducted as part of the “A program for the early detection of risk factors for lifestyle diseases SOPKARD-Junior” (SOPKARD-Junior), a preventive health program implemented in public elementary schools from 2017 to 2019. The results from 381 children with a mean age of 11.67 (SD = 1.52) were analyzed. Height and weight were measured and BMI was calculated. Surveys were conducted to assess parents’ perceptions of their child’s weight, along with their sociodemographic status. Nearly one in three parents were unable to correctly identify their children’s weight; 25.0% underestimated it, and 6.0% overestimated it. Underestimation was observed along with an increase in the children’s BMI weight category, with as many as 57.1% of parents of obese children misclassifying their weight. The child’s BMI was the only significant predictor of incorrect assessment. Polish parents cannot properly assess their children’s BMI, especially when their child is overweight or obese. In children, weight and height measurements should be taken regularly, rather than allowing weight category to be dependent upon parental weight assessments.
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Kengneson CC, Blanchet R, Sanou D, Batal M, Phillips KP, Giroux I. Maternal perceptions and concerns about children's weight status and diet quality: a study among Black immigrant families. Public Health Nutr 2021; 25:1-14. [PMID: 34865677 PMCID: PMC9991773 DOI: 10.1017/s1368980021004729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify factors influencing Black immigrant mothers' perceptions and concerns about child weight and to compare children's diet quality according to these perceptions and concerns. DESIGN Mothers' perceptions and concerns about child weight were assessed with sex-specific figure rating scales and the Child Feeding Questionnaire, respectively. Participants' weights and heights were measured and characterised using WHO references. Children's dietary intakes were estimated using a 24-h dietary recall. Children's diet quality was evaluated using the relative proportion of their energy intake provided by ultra-processed products, which were identified with the NOVA classification. χ2 tests, multivariate logistic regressions and t tests were performed. SETTING Ottawa, Ontario, Canada. PARTICIPANTS Black immigrant mothers of Sub-Saharan African and Caribbean origin (n 186) and their 6-12-year-old children. RESULTS Among mothers, 32·4 % perceived their child as having overweight while 48·4 % expressed concerns about child weight. Girls and children with overweight or obesity were significantly more likely to be perceived as having overweight by their mothers than boys and normal-weight children, respectively. Mothers of children living with obesity, but not overweight, were significantly more likely to be concerned about their child's weight than mothers of normal-weight children. Children's diet quality did not differ according to mothers' perceptions and concerns. CONCLUSIONS Children's gender and weight status were major determinants of perceptions and concerns about child weight among Black immigrant mothers. Including knowledge about mothers' perceptions and concerns about child weight will help nutrition professionals develop interventions tailored to specific family needs within the context of their cultural backgrounds.
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Affiliation(s)
- Cris-Carelle Kengneson
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Rosanne Blanchet
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Québec, Canada
| | - Dia Sanou
- FAO Sub-Regional Office for Eastern Africa, Food and Agricultural Organizations of the United Nations, Addis Ababa, Ethiopia
| | - Malek Batal
- Nutrition Department, Faculty of Medicine, Université de Montréal, Centre de recherche en santé publique (CReSP), Québec, Canada
| | - Karen P Phillips
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Isabelle Giroux
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ONK1N 6N5, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
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Alshahrani A, Shuweihdi F, Swift J, Avery A. Underestimation of overweight weight status in children and adolescents aged 0-19 years: A systematic review and meta-analysis. Obes Sci Pract 2021; 7:760-796. [PMID: 34877014 PMCID: PMC8633945 DOI: 10.1002/osp4.531] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 01/21/2023] Open
Abstract
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.
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Affiliation(s)
- Abrar Alshahrani
- Division of Nutritional SciencesUniversity of NottinghamNottinghamUK
| | - Farag Shuweihdi
- Leeds Institute of Health SciencesFaculty of MedicineLeeds UniversityLeedsUK
| | - Judy Swift
- Division of Nutritional SciencesUniversity of NottinghamNottinghamUK
| | - Amanda Avery
- Division of Food, Nutrition and DieteticsUniversity of NottinghamNottinghamUK
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Health belief model factors as predictors of parental misclassification of the weight of the preschool child. PLoS One 2021; 16:e0252981. [PMID: 34506502 PMCID: PMC8432774 DOI: 10.1371/journal.pone.0252981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background Parental misperception and underestimation of their child’s weight are documented in studies. Demographic factors like age and gender have been linked to misclassification. However, modifiable factors that could potentially frame future intervention and prevention strategies have not been explored. This study aimed to assess factors that could predict parental misclassification of their preschool child’s weight. Methods This was a cross-sectional study with 198 parents and their 2- to 5-year-old children who attended standalone preschools or childcare centers with preschools. Parents completed a questionnaire that asked about demographic features, personal and family health, and the assessment of their child’s weight using the three most frequently utilized measures. Logistic regression was conducted to assess the association between parental factors and child weight classification status. Instruments included the Parental Self-Efficacy for Promoting Healthy Physical Activity and Dietary Behaviors in Children Scale (PSEPAD), the Obesity Risk Scale (ORK-10), and the Adolescent Obesity Risk Scale (AORK). Analyses included frequencies, chi-square tests, Kappa coefficients, and logistic regressions. Results Parents were least accurate (35.9%) identifying child weight when selecting a picture (κ = -.028, p = .42). The pictorial and Likert method (κ = -.032, p = .37) showed parental agreement with child weight was not significantly better than chance. Statistically, a significant agreement was found in the weight-reporting method (κ = .21). Two of the three HBM-related measures were significantly related to accurate classification. Logistic regression showed child sex, PSEPAD scores, and ORK-10 scores were statistically significant predictors in the Likert method. The model had no statistical significance for the pictorial or weight-reporting method. Conclusion Results indicate parents support intervening if aware of child weight problems. However, parents do not accurately recognize healthy versus unhealthy weights and report that health providers are not informing them of weight deviations. Further, important relationships between the HBM variables were identified. Results show barriers (self-efficacy) mediate the impact of perceived severity (knowledge) regarding the parental ability to assess child weight accurately. These relationships and incorporation of the HBM principles of barriers and severity into prevention/intervention strategies need further exploration.
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Concordance Between the Weight of Spanish Adolescent Soccer Players, Their Self-Perceived Weight, and Their Weight as Perceived by Their Parents. J Pediatr Nurs 2021; 60:e13-e18. [PMID: 33618980 DOI: 10.1016/j.pedn.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/20/2022]
Abstract
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.
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Paediatric teams in front of childhood obesity: A qualitative study within the STOP project. An Pediatr (Barc) 2021; 95:174-185. [PMID: 34362718 DOI: 10.1016/j.anpede.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/13/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Understanding the underlying factors that influence the approach to overweight and obesity in children is basic to best support families searching a solution to this important public health problem. OBJECTIVE To assess attitudes and feelings of paediatric staff in addressing overweight and childhood obesity to parents, exploring perceived barriers and facilitators, for an effective care. PARTICIPANTS AND METHOD Qualitative study by means of individual semi-structured questionnaires of paediatric staff (paediatricians and paediatrician nurses; n = 57; 68% female) of primary health care centres and hospitals in Mallorca. Thematic analysis was done. RESULTS Three themes emerged from the data: "Parents' attitude in childhood obesity" (sub-themes "The conscience of parents", "The parents ask for help"), "Paediatric staff and childhood obesity" (sub-themes "Approaching to the problem: The interview with parents", "Looking together for the solution"), and "System barriers" (sub-themes "Improving teamwork and health policy", "Family participation in addressing childhood obesity"). CONCLUSIONS Paediatric staffs know how to treat childhood obesity, but demand training on motivation. Effectivity on therapy of childhood obesity will be obtained after parents/carers recognize the problem and establish a trustful relationship with paediatric staff. The health system is still a barrier to the activity of paediatric personnel.
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Derwig M, Tiberg I, Björk J, Hallström I. Child-Centred Health Dialogue for primary prevention of obesity in Child Health Services - a feasibility study. Scand J Public Health 2021; 49:384-392. [PMID: 31854251 PMCID: PMC8135234 DOI: 10.1177/1403494819891025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 10/04/2019] [Accepted: 10/28/2019] [Indexed: 12/11/2022]
Abstract
Aims: The aim of this study was to test a Child-Centred Health Dialogue model for primary prevention of obesity for 4-year-old children in Child Health Services, for its feasibility and the responsiveness of its outcomes. Methods: A feasibility study was set up with a non-randomised quasi-experimental cluster design comparing usual care with a structured multicomponent Child-Centred Health Dialogue consisting of two parts: (1) a universal part directed to all children and (2) a targeted part for families where the child is identified with overweight. Results: In total, 203 children participated in Child-Centred Health Dialogue while 582 children received usual care. Nurses trained in the model were able to execute both the universal health dialogue and the targeted part of the intervention. Tutorship enabled the nurses to reflect on and discuss their experiences, which strengthened their confidence and security. One year after the intervention fewer normal-weight 4-year-olds in the intervention group had developed overweight at the age of five compared with the control group, and none had developed obesity. The difference in overweight prevalence at follow-up did not reach statistical significance. Conclusions: This study demonstrates that a child-centred, multicomponent, interactive intervention for the promotion of healthy lifestyles and primary prevention of obesity for all 4-year-old children participating in Child Health Services is feasible on a small scale. As almost all caregivers make use of Child Health Services in Sweden, the findings should be confirmed in a randomised controlled trial before the intervention can be implemented on a larger scale.
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Affiliation(s)
- Mariette Derwig
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Irén Tiberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Jonas Björk
- Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Inger Hallström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Maternal perception, concern and dissatisfaction with child weight and their association with feeding practices in the Generation XXI birth cohort. Br J Nutr 2021; 127:1106-1116. [PMID: 34016202 DOI: 10.1017/s0007114521001653] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
What a mother thinks about her child's weight status might influence what and how she feeds her child. We examined the association between maternal perception, concern and dissatisfaction with child weight alongside feeding practices. Participants were from the Generation XXI birth cohort (n = 3233). A validated version of the Child Feeding Questionnaire and the Overt/Covert Control scale were used. Associations were evaluated by linear regression models (β coefficients and 95 % confidence intervals (95 % CI) with Bonferroni correction). Perceived underweight was associated with practices promoting food intake, such as higher pressure to eat at ages 4 and 7 years (β = 0·229; 95 % CI: 0·059, 0·398 and β = 0·190; 95 % CI:0·005, 0·376, respectively) and lower restriction at age 4 (β = -0·175; 95 % CI: -0·0310, -0·039). At age 7, perceived overweight was associated with higher covert control (β = 0·203; 95 % CI: 0·029, 0·376). Mothers who were concerned about child weight reported higher restriction (β = 0·226; 95 % CI: 0·142, 0·310 at 4 years and β = 0·261; 95 % CI: 0·169, 0·353 at 7 years) and covert control (β = 0·183; 95 % CI: 0·083, 0·282 at 4 years and β = 0·171; 95 % CI: 0·073, 0·269 at 7 years). Maternal desire for a heavier child was associated with higher pressure to eat at both ages (β = 0·285; 95 % CI: 0·163, 0·406 and β = 0·393; 95 % CI: 0·266, 0·520), while the desire for a thinner child was related to higher covert control at 7 years of age (β = 0·158; 95 % CI: 0·001, 0·316). Maternal perceptions and concern for child weight status are associated with feeding practices independently of actual weight status.
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Karavida V, Tympa E, Panousis G, Psyrropoulos Z. Parents' perception of their children's weight status in an urban area of Western Greece. J Family Med Prim Care 2021; 10:718-723. [PMID: 34041067 PMCID: PMC8138345 DOI: 10.4103/jfmpc.jfmpc_1140_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/05/2020] [Accepted: 09/28/2020] [Indexed: 01/20/2023] Open
Abstract
Context: A lot of parents whose children are overweight or even obese are in no position to accurately acknowledge the real weight of their children. Parents' perception of their children's weight plays a significant role in the prevention and treatment of childhood obesity. Aims: This paper describes parents' opinions on the real weight status of their children and the sufficiency of quality nutrients in their diet. Settings and Design: The research methodology used in the particular study was based on survey research in preschool settings in West Greece. Methods and Material: The research methodology used in the particular study was based on survey research. Data were collected through questionnaires answered by parents of children attending preschool settings aged between two and five. One hundred and seventy-eight children and their parents participated. All parents had been informed of the aim of the study beforehand and gave their consent on condition that they could withdraw at any stage they wished. Statistical Analysis Used: Data were analyzed using SPSS (Statistical Package for the Social Sciences). Results: Comparing the Body Mass Index of children with the parents' opinion of their children's weight, we noticed 85,71% and 78,13% of the parents whose children were obese and overweight respectively, regarded their weight as normal. The majority of the overweight and obese children's parents were of the opinion that their children's diet was proper and healthy. Conclusions: Most parents whose children were obese or overweight underestimated the real weight of their children and considered their nutrition healthy.
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Affiliation(s)
- Vasiliki Karavida
- Department of Early Years Learning and Care, University of Ioannina, Ioannina, Greece
| | - Eleni Tympa
- Department of Early Years Learning and Care, University of Ioannina, Ioannina, Greece
| | - Georgios Panousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | - Zissis Psyrropoulos
- Department of Physical Education and Sport Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Tommerup K, Smith AD, Evans EH, Croker H, Steptoe A, Tovee MJ, Fildes A, Llewellyn C. The acceptability and feasibility of using a 3D body size scale to initiate conversations about weight in toddlerhood: a mixed-methods study. Pediatr Obes 2021; 16:e12715. [PMID: 32820620 DOI: 10.1111/ijpo.12715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Kristiane Tommerup
- Obesity Research Group, Department of Behavioural Science and Health, University College London (UCL), London, UK
| | - Andrea D Smith
- Obesity Research Group, Department of Behavioural Science and Health, University College London (UCL), London, UK
| | | | - Helen Croker
- Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London (UCL), London, UK
| | - Andrew Steptoe
- Obesity Research Group, Department of Behavioural Science and Health, University College London (UCL), London, UK
| | - Martin J Tovee
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Alison Fildes
- School of Psychology, University of Leeds, Leeds, UK
| | - Clare Llewellyn
- Obesity Research Group, Department of Behavioural Science and Health, University College London (UCL), London, UK
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Castor C, Derwig M, Borg SJ, Ollhage ME, Tiberg I. A challenging balancing act to engage children and their families in a healthy lifestyle - Nurses' experiences of child-centred health dialogue in child health services in Sweden. J Clin Nurs 2021; 30:819-829. [PMID: 33377556 DOI: 10.1111/jocn.15622] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/26/2020] [Accepted: 12/10/2020] [Indexed: 01/03/2023]
Abstract
AIMS AND OBJECTIVES To describe nurses' experiences of a child-centred family guided intervention of obesity tested within the child health services targeting children identified with overweight and their caregivers. BACKGROUND Interventions aiming to support families towards a healthier lifestyle can lead to decreased risk of overweight evolving into obesity in a child. At the same time, nurses have found dialogues on weight challenging and may therefore avoid them. DESIGN Qualitative descriptive inductive design following content analysis applying to the COREQ guidelines. METHODS Content analysis was used to analyse 13 individual semi-structured interviews with nurses in the child health service in Sweden after completed training in CCHD, including how to facilitate the dialogue with the use of illustrations. RESULTS The theme Health dialogue about weight is a challenging balancing act facilitated by a supportive intervention emerged through eight subcategories in three main categories. Nurses experienced that CCHD with children identified with overweight and their caregivers provoked an emotional response both for themselves and for the caregivers of the child. The training in child-centred health dialogues promoted the nurses' work with structure and professionalism, as the nurses carefully took tentative steps to engage the family for a healthy lifestyle. CONCLUSIONS Emotional and practical challenges in performing CCHD still remained among nurses after customised training, which might comprise the child's rights to be involved in his or her own care when the child was identified as overweight. However, training for nurses, including lectures and tutorials, was found to increase the quality and professionalism of performing CCHD by providing structure, tools and tutorial support. RELEVANCE TO CLINICAL PRACTICE Customised training and illustrations can support nurses when performing a structured intervention such as child-centred health dialogues.
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Affiliation(s)
- Charlotte Castor
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Mariette Derwig
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | | | | | - Iren Tiberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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15
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Argelich E, Alemany ME, Amengual-Miralles B, Argüelles R, Bandiera D, Barceló MA, Beinbrech B, Bouzas C, Capel P, Cerdà AL, Colom M, Corral H, de Sotto-Esteban D, Fleitas G, Garcias C, Juan D, Juan J, Mateos D, Martín MI, Martínez MÀ, Mínguez M, Moncada E, Nadal M, Pont JM, Puigserver B, Suñer CA, Ugarriza L, Yeste D, Yeste S, Tur JA. [Paediatric teams in front of childhood obesity: a qualitative study within the STOP project]. An Pediatr (Barc) 2021. [PMID: 33478849 DOI: 10.1016/j.anpedi.2020.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Understanding the underlying factors that influence the approach to overweight and obesity in children is basic to best support families searching a solution to this important public health problem. OBJECTIVE To assess attitudes and feelings of paediatric staff in addressing overweight and childhood obesity to parents, exploring perceived barriers and facilitators, for an effective care. PARTICIPANTS AND METHOD Qualitative study by means of individual semi-structured questionnaires of paediatric staff (paediatricians and paediatrician nurses; n=57; 68% female) of primary health care centres and hospitals in Mallorca. Thematic analysis was done. RESULTS Three themes emerged from the data: «Parents' attitude in childhood obesity» (sub-themes «The conscience of parents», «The parents ask for help»), «Paediatric staff and childhood obesity» (sub-themes «Approaching to the problem: The interview with parents», «Looking together for the solution»), and «System barriers» (sub-themes «Improving teamwork and health policy», «Family participation in addressing childhood obesity»). CONCLUSIONS Paediatric staffs know how to treat childhood obesity, but demand training on motivation. Effectivity on therapy of childhood obesity will be obtained after parents/carers recognize the problem and establish a trustful relationship with paediatric staff. The health system is still a barrier to the activity of paediatric personnel.
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Affiliation(s)
- Emma Argelich
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo de investigación en Nutrición Comunitaria y Estrés Oxidativo, Universidad de las Islas Baleares & IDISBA, Palma de Mallorca, España; Hospital de Manacor, Manacor, España
| | | | | | | | | | | | | | - Cristina Bouzas
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo de investigación en Nutrición Comunitaria y Estrés Oxidativo, Universidad de las Islas Baleares & IDISBA, Palma de Mallorca, España
| | | | | | | | | | | | | | | | | | | | - David Mateos
- Grupo de investigación en Nutrición Comunitaria y Estrés Oxidativo, Universidad de las Islas Baleares & IDISBA, Palma de Mallorca, España; Hospital Universitario Son Espases, Palma de Mallorca, España
| | | | | | | | | | | | | | | | | | | | | | | | - Josep A Tur
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo de investigación en Nutrición Comunitaria y Estrés Oxidativo, Universidad de las Islas Baleares & IDISBA, Palma de Mallorca, España.
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16
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Bektas G, Boelsma F, Baur VE, Seidell JC, Dijkstra SC. Parental Perspectives and Experiences in Relation to Lifestyle-Related Practices in the First Two Years of a Child's Life: A Qualitative Study in a Disadvantaged Neighborhood in The Netherlands. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165838. [PMID: 32806644 PMCID: PMC7460357 DOI: 10.3390/ijerph17165838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023]
Abstract
The first two years of a child's life are a critical period in preventing several lifestyle-related health problems. A qualitative study was conducted to explore parental experiences and perspectives in relation to lifestyle-related child-rearing practices in order to minimize risk factors at an early stage. Data were collected through interviews (n = 25) and focus groups (n = 4) with parents of children aged 0-2 years, in a disadvantaged neighborhood in Amsterdam, the Netherlands. Results showed that parents were often uncertain about a number of lifestyle-related practices. Ambiguity also appeared regarding the parents' intentions to engage in certain practices and what they were able to achieve in everyday life. In addition, parents experienced strong sociocultural influences from their family, which interfered with their ability to make their own decisions on lifestyle-related practices. Parents also expressed a need for peer-support and confirmation of their practices. Future studies should focus on supporting parents in their parental practices during the first two years of their child's life. Any such study should take into account the specific sociocultural context accompanying lifestyle-related parental practices.
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Affiliation(s)
- Gülcan Bektas
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands; (F.B.); (J.C.S.)
- Correspondence: (G.B.); (S.C.D.); Tel.: +31-20-598-28-02 (G.B.); +31-20-598-61-28 (S.C.D.)
| | - Femke Boelsma
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands; (F.B.); (J.C.S.)
| | - Vivianne E. Baur
- Department of Care Ethics, University of Humanistic Studies, Kromme Nieuwegracht 29, 3512 HD Utrecht, The Netherlands;
| | - Jacob C. Seidell
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands; (F.B.); (J.C.S.)
| | - S. Coosje Dijkstra
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands; (F.B.); (J.C.S.)
- Correspondence: (G.B.); (S.C.D.); Tel.: +31-20-598-28-02 (G.B.); +31-20-598-61-28 (S.C.D.)
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17
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Prevalence of short stature and malnutrition among Egyptian primary school children and their coexistence with Anemia. Ital J Pediatr 2020; 46:91. [PMID: 32600418 PMCID: PMC7325115 DOI: 10.1186/s13052-020-00855-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/22/2020] [Indexed: 01/15/2023] Open
Abstract
Background Under nutrition and overweight typically occur during nutritional transition periods in developing countries including Egypt. Short stature and anemia are public health concern due to its strong link with malnutrition which is a preventable risk factor. Objectives to estimate the prevalence of overweight, obesity, underweight and short stature and its concurrence with anemia, also to determine the etiological profile of short stature among primary school children in Egypt. Methods A cross-sectional study was carried out on 33,150 Egyptian children aged 6–11 years old from January 2018 to January 2020, allocated in 59 primary schools from diverse geographical districts in Egypt. Complete anthropometric measurements were conducted and applied according to WHO growth charts. Hemoglobin level was measured. Systematic approach to detect the etiology of short stature was applied randomly to a sample of 380 stunted children. Results The prevalence of underweight was 8.2%, while obesity and overweight represented 21.8% (9.6 and 12.2% respectively). Overall short stature constituted 17%. The main etiologies of short stature were familial (40.8%) and constitutional (24.2%). Anemia was diagnosed in 26% of children; while concurrent anemia and stunting was reported in 9.9%. Regarding anemia and anemia with stunting were more common among girls (30.0% (OR = 1.50, CI95%: 1.43–1.58) and 11.4% (OR = 1.39, CI95%:1.29–1.49) respectively), who were living in rural areas (33.4% (OR = 1.96, CI 95%:1.87–2.06) &12.7% (OR = 1.72, CI 95%:1.60–1.85)) and those who had low socioeconomic status)34.6% (OR = 2.54, CI 95%:2.29–2.82) & 17.2% (OR = 3.32, CI 95%:2.85–3.88() respectively. Anemia with stunting was significantly higher among children aged ≥9 years old representing 12% (OR = 1.40, CI 95%:1.30–1.51). Conclusion Prevalence of short stature, obesity and anemia was high among primary school children in Egypt with a strong concurrence between anemia and stunting. Intensive parental health education and in-depth nutritional assessment are required.
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18
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Blanchet R, Kengneson CC, Bodnaruc AM, Gunter A, Giroux I. Factors Influencing Parents' and Children's Misperception of Children's Weight Status: a Systematic Review of Current Research. Curr Obes Rep 2019; 8:373-412. [PMID: 31701349 DOI: 10.1007/s13679-019-00361-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Misperception of children's weight status is prevalent among parents and children themselves and may impact parents' and children's health behaviors. This study was conducted in order to provide a descriptive systematic review of research on factors influencing parents' and children's misperceptions of children's weight status published in the past 5 years. RECENT FINDINGS Factors studied most often in relation to parents' and children's misperception included children's weight status, gender, and age, as well as parents' weight status, parental education levels and socioeconomic status, and ethnicity. Most determinants that were found to have a significant influence on misperception in parents also did in children. The literature on misperception of children's weight status is extensive. Most determinants assessed in included studies were known determinants of childhood obesity. Further research should be directed toward better understanding the impact of weight status perception (whether it is accurate or not) on health behaviors and weight gain over time.
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Affiliation(s)
- Rosanne Blanchet
- Department of Agricultural, Food & Nutritional Sciences, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, Canada
| | - Cris-Carelle Kengneson
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Alexandra M Bodnaruc
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Ashley Gunter
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Isabelle Giroux
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
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19
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Sjunnestrand M, Nordin K, Eli K, Nowicka P, Ek A. Planting a seed - child health care nurses' perceptions of speaking to parents about overweight and obesity: a qualitative study within the STOP project. BMC Public Health 2019; 19:1494. [PMID: 31706318 PMCID: PMC6842180 DOI: 10.1186/s12889-019-7852-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/28/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Nurses in child health care (CHC) centers in Sweden play a key role in the early detection and management of childhood overweight/obesity, through meeting families early, regularly and over many years. However, research focusing on CHC nurses' perceptions of their role in childhood overweight/obesity management is scarce. As part of the EU-funded project "Science and Technology in childhood Obesity Policy" (STOP), this study examines CHC nurses' perceptions of speaking to parents about children's overweight/obesity and of their role in referring children to treatment for overweight/obesity. METHODS All registered CHC nurses in Stockholm County (n = 442) received an email invitation letter explaining the study. Individual face-to-face visits (n = 15) in selected centers, and phone calls (n = 24) to nurses working in these centres were also conducted. In total, 17 CHC nurses (all female, average work experience 6.7 years (SD ± 4.9 years)) from 10 municipalities (including four of the top five municipalities with the highest prevalence of overweight and obesity) in Stockholm County were interviewed. The interviews were conducted by phone, transcribed and analyzed using thematic analysis. RESULTS Two main themes were developed through the analysis: 1) The relationship between the nurse and the parent and 2) Glitch in the system. Under the first theme, nurses reported that weight-related discussions were facilitated by building and maintaining trust with parents. However, nurses also said they were reluctant to address children's weights if this could compromise parents' trust. Under the second theme, nurses highlighted several organizational barriers to addressing a child's weight with parents, including insufficient cooperation with other healthcare providers and limited time for visits. Nurses also identified lack of sufficient knowledge about what to offer the family and lack of confidence in their communication skills as additional barriers. CONCLUSIONS We found that pediatric nurses perceive relational and organizational factors as barriers to address childhood obesity with parents. To improve care, it is necessary to provide nurses with continuing education about obesity and communication skills and organizational support to improve communication within the healthcare system. TRIAL REGISTRATION ClinicalTrials.gov NCT03800823; 11 Jan 2019, prospectively registered.
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Affiliation(s)
- My Sjunnestrand
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Nordin
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Eli
- Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paulina Nowicka
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. .,Department of Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden.
| | - Anna Ek
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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20
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Jones AR, Tovée MJ, Cutler LR, Parkinson KN, Ells LJ, Araujo-Soares V, Pearce MS, Mann KD, Scott D, Harris JM, Adamson AJ. Development of the MapMe intervention body image scales of known weight status for 4-5 and 10-11 year old children. J Public Health (Oxf) 2019; 40:582-590. [PMID: 29190364 PMCID: PMC6266708 DOI: 10.1093/pubmed/fdx129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 09/18/2017] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- A R Jones
- Institute of Health & Society, Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - M J Tovée
- School of Psychology, University of Lincoln, Lincoln, UK.,Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - L R Cutler
- Institute of Health & Society, Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - K N Parkinson
- Institute of Health & Society, Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - L J Ells
- School of Health and Social Care, Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - V Araujo-Soares
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - M S Pearce
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - K D Mann
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - D Scott
- Department of Public Health and Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - J M Harris
- School of Psychology and Neuroscience. University of St Andrews, Fife, UK
| | - A J Adamson
- Institute of Health & Society, Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
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21
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Butler ÉM, Suhag A, Hong Y, Liang L, Gong C, Xiong F, Luo F, Liu G, Chen S, Taylor RW, Cutfield WS, Fu J, Derraik JGB. Parental Perceptions of Obesity in School Children and Subsequent Action. Child Obes 2019; 15:459-467. [PMID: 31408357 DOI: 10.1089/chi.2018.0338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Despite perceiving their child as being above a healthy weight, many parents do not intervene. Little is known about the factors influencing parental action. We assessed parental perception of child's weight status, the prevalence of mitigating parental action, and the underlying factors. Methods: We studied 20,242 children and adolescents from 6 centers across China. Anthropometry was measured by research nurses. Parents answered questionnaires, including their perception of their child's weight status, and any subsequent weight treatment. Results: A total of 3254 children had obesity (16.1%), with 63.0% correctly perceived as overweight by their parents. These children were more likely to be older (≥8 years; p < 0.0001), have severe obesity [adjusted relative risk (aRR) 1.41; p < 0.0001], and have mothers with overweight/obesity (aRR 1.15; p < 0.0001). In particular, parents of children aged <8 years were over five times more likely to perceive their child with overweight/obesity as "thin" than parents of teenagers. Conversely, girls, older children/adolescents, and urban youth were more likely to be wrongly perceived by parents as having an overweight issue. Only one in four children (27.8%) with available information received treatment for their perceived weight problem. Children with severe obesity were more likely to be treated (aRR 1.34; p < 0.0001), as were children of mothers with overweight/obesity (aRR 1.18; p = 0.002). Conclusions: Only one in four Chinese children perceived as overweight by their parents received treatment for their weight problem. Given that overweight/obesity in childhood tracks into adulthood and many parents did not intervene despite perceiving an overweight problem in their child, interventions for childhood obesity need to extend beyond parental perception of children's weight status.
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Affiliation(s)
- Éadaoin M Butler
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, New Zealand
| | - Alisha Suhag
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Department of Experimental Psychology, University of Bristol, Bristol, United Kingdom
| | - Ye Hong
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li Liang
- First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunxiu Gong
- Beijing Children's Hospital of Capital Medical University, Beijing, China
| | - Feng Xiong
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Feihong Luo
- Department of Endocrinology, Children's Hospital of Shanghai Fudan University, Shanghai, China
| | - Geli Liu
- General Hospital of Tianjin Medical University, Tianjin, China
| | - Shaoke Chen
- Maternal and Children Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Rachael W Taylor
- A Better Start-National Science Challenge, New Zealand.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, New Zealand
| | - JunFen Fu
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - José G B Derraik
- Department of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Liggins Institute, University of Auckland, Auckland, New Zealand.,A Better Start-National Science Challenge, New Zealand.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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22
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Abstract
OBJECTIVES Obtaining accurate pediatric weight is necessary during emergency resuscitation. Although several weight estimation methods exist, the most precise method has not been conclusively determined. This study aimed to evaluate the validity, reliability, and practicality of these tools. METHODS A prospective observational study was conducted in healthy Thai children aged 6 months to 12 years. Correlations between estimated and actual weights were tested. Validity was assessed by mean bias (estimated weight minus actual weight) and accuracy (10% error). Practicality was evaluated by time usage and data derived from user questionnaires. RESULTS Four hundred thirty participants with mean age of 6.7 years and mean weight of 26 kg were enrolled. A strong correlation between estimated weight and actual weight in all methods was demonstrated. Parental estimation was the most accurate tool in all age groups, with the lowest overall mean error (ME) of -0.83 kg and the highest accuracy of 88.7%. The Broselow tape was the second most accurate tool in ages younger than 1 year and 1-to-5-year age groups (ME = 0.23 and 0.50 kg; accuracy = 55.3% and 54.1%, respectively). The Mercy method was the second most accurate tool in the 6-to-10-year and 11-to-12-year age groups (ME = -2.47 and -2.77; accuracy = 54.6% and 67.9%, respectively). The Broselow tape had the highest score for practicality of use. CONCLUSIONS Parental estimation was the most accurate method in every age group. The next best alternative is the Broselow tape in children aged 5 years or younger and the Mercy method in children aged older than 5 years.
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Firman N, Dezateux C. Does parental concern about their child's future risk of overweight vary by their ethnic background? Cross-sectional analysis of a national cohort study. BMJ Open 2019; 9:e027226. [PMID: 31471432 PMCID: PMC6720322 DOI: 10.1136/bmjopen-2018-027226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Children from South Asian ethnic backgrounds are at increased risk of obesity and its associated future health risks; however, evidence is lacking as to whether parental concern about their child's future overweight risk varies by ethnic background. We hypothesised that parents of 5-year-old children from South Asian backgrounds would be more likely to express such concerns. DESIGN Cross-sectional. SETTING UK. PARTICIPANTS 15 039 singleton 5-year-old Millennium Cohort Study participants (48.9% girls; 86.7% White). PRIMARY OUTCOME MEASURE Parent-reported concern (some/none) about future overweight risk. METHODS We estimated the adjusted ORs (aORs) of some parental concern (ranging from a little to very concerned) by child's ethnic background (reference group: White), adjusted for parent and child weight status, and child sex. RESULTS Parents of girls from Pakistani (aOR 0.4; 95% CI 0.2 to 0.5), Bangladeshi (0.3; 0.2 to 0.5), Black African (0.5; 0.3 to 0.7) and Mixed (0.7; 0.5 to 0.99) ethnic backgrounds and of boys from Pakistani ethnic backgrounds (0.6; 0.4 to 0.9) were less likely to report concern about their child's future overweight risk than parents of White girls and boys, respectively. Overweight (2.5; 2.2 to 2.8) and obesity (6.7; 5.7 to 7.9) in children, and overweight (1.4; 1.2 to 1.5) and obesity (1.9; 1.7 to 2.2) in parents, were associated with increased likelihood of concern. CONCLUSIONS Parents of children from South Asian ethnic backgrounds express less concern about their child's future overweight risk. Qualitative studies are needed to understand the concerns of parents from different ethnic backgrounds to inform weight-management interventions in ethnically diverse populations.
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Affiliation(s)
- Nicola Firman
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Carol Dezateux
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Factors that Influence Parental Misperception of Their Child's Actual Weight Status in South Carolina. Matern Child Health J 2019; 22:1077-1084. [PMID: 29473136 DOI: 10.1007/s10995-018-2491-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives Studies suggest that parents tend to misperceive their child's actual weight status and typically underestimate their child's weight. Since few studies examine the factors that influence parental misperception, this study aims to assess the influence of parent and child factors with parental misperception of their child's actual weight status who were either at their recommended weight or overweight/obese in South Carolina in 2013 and 2014. Methods Secondary data were obtained from the Behavioral Risk Factor Surveillance System (BRFSS) and the Children's Health Assessment Survey (CHAS) in 2013 and 2014 in SC. Parental misperception of child's actual weight status was measured by comparing parental perception to their child's actual weightstatus measured via BMI. Logistic regression was conducted to assess the association between parental and child factors with parental misperception of child's weight status. Results In the adjusted multivariate analysis, only child's age was significantly and positively associated with parental misperception of their child's actual weight status. Conclusions for Practice This cross sectional analysis showed an association between child's age and parental misperception of child's actual weight status. It is essential to educate parents about their children's weight status, especially among young children.
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Foster BA, Winkler P, Weinstein K, Parra-Medina D. Developing a patient-centered outcome for targeting early childhood obesity across multiple stakeholders. BMC OBESITY 2018; 5:39. [PMID: 30524744 PMCID: PMC6276184 DOI: 10.1186/s40608-018-0216-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/04/2018] [Indexed: 11/10/2022]
Abstract
Background Patient-centered outcome measures for childhood obesity are limited. Identifying outcomes that patients and families consider important could be a viable avenue for better engagement of patients and interventions that are efficacious and acceptable to patients. Latino children experience high rates of obesity, and under-recognition of obesity in preschool aged children is common. Methods We used growth chart data to identify low-income, Latino children 2-5 years of age with obesity who decreased their adiposity (positive deviants) and a set of controls. We used qualitative interview data to identify themes around goals parents used in addressing weight. Then, we applied a modified Delphi approach across groups of caregivers and providers to identify common goals. We conducted focus groups to explore conflicts and congruency between caregivers and providers related to goals. Using the focus group data, we developed a decision tool for use between patients and providers relevant for early childhood obesity. Results We identified 257 children who successfully reduced adiposity (positive deviants) from 1621 eligible growth charts. From interviews with 44 parents (21 positive deviants and 23 controls), we coded and categorized outcomes such as increased happiness, clothing size and improved activity. We recruited 81 parents, grandparents and health care providers to participate in the modified Delphi process of ranking outcomes by importance and feasibility. Focus groups (2, total n = 24) suggested potential methods for a common framework to discuss goals, including a modified growth chart. We created a decision-tool that incorporated a growth chart and a section for discussion of patient-centered goals. A final focus group (1, n = 10) provided feedback on the tool as acceptable and potentially useful. Conclusions The development of a patient-centered tool around achieving a healthy weight in early childhood identified common goals between providers and parents. While the tool has been developed, prospective testing of this patient-centered tool and its effects on engagement, parent motivation, and behavior change would be a useful next step.
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Affiliation(s)
- Byron A Foster
- 1Departments of Pediatrics and Dermatology, Oregon Health & Science University, Portland, OR USA
| | - Paula Winkler
- 2Center for Research to Advance Community Health, University of Texas Health San Antonio, San Antonio, TX USA
| | - Kelsey Weinstein
- 1Departments of Pediatrics and Dermatology, Oregon Health & Science University, Portland, OR USA
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Gregori D, Hochdorn A, Azzolina D, Berchialla P, Lorenzoni G. Does Love Really Make Mothers Blind? A Large Transcontinental Study on Mothers' Awareness About Their Children's Weight. Obesity (Silver Spring) 2018; 26:1211-1224. [PMID: 29932519 DOI: 10.1002/oby.22214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/23/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aim of this study was to assess maternal misperception rates (perception as normal or underweight of a child with overweight or obesity) and their role in affecting the chance of implementing actions to change children's weight. METHODS Obesogeneicity of Gadgets Marketed with Snacks (OBEY-AD) is an international study investigating factors promoting childhood overweight and obesity in 10 countries, in which 2,720 child-mother dyads have been enrolled. Mothers' perception of their children's weight was assessed using a projective test. Children's weight status was measured according to the anthropometric standards established by the World Health Organization. RESULTS Mothers classified 89% of children with overweight and 52% of children with obesity as normal weight. The odds ratio of mothers' misperception was significantly higher for higher parental BMI, higher children's International Brand Awareness Inventory score, and high family socioeconomic status. Children with overweight and/or obesity who were perceived as normal weight by their mothers were less likely to be referred to specific health care services. CONCLUSIONS Most children with overweight and/or obesity were perceived as normal weight by their mothers. Such lack of concern regarding a severe disease might interfere with the effectiveness of prevention programs. Considering the contextual factors that frame the etiological causes of a disease may help in finding effective and enduring solutions to target childhood obesity.
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Affiliation(s)
- Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Alexander Hochdorn
- Department of Social, Work and Organisational Psychology, University of Brasília, Brasília, Brazil
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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'A little bit offended and slightly patronised': parents' experiences of National Child Measurement Programme feedback. Public Health Nutr 2018; 21:2884-2892. [PMID: 29914583 DOI: 10.1017/s1368980018001556] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To develop a descriptive account of parents' experiences of written feedback from the National Child Measurement Programme (NCMP), based on primary data collected from semi-structured focus groups. DESIGN Four focus groups were held with a purposive sample of parents who had recently received written weight feedback from the NCMP in one local authority in England. Thematic data analysis was undertaken to develop a narrative of emergent themes regarding parents' experiences and the social influences shaping this.Setting/SubjectsThe population of interest was parents of 4- and 5-year-olds who had recently received written feedback from the NCMP. Eighteen parents participated and represented the full spectrum of categories provided in NCMP feedback (under-, healthy, over- and very overweight). RESULTS Participants often rejected overweight feedback as lacking in credibility and considered NCMP communication to be targeting parents other than themselves. Family and peers collaborated in the dismissal of overweight feedback, further legitimising participants' decision to disregard their child's overweight categorisation. CONCLUSIONS Our study provides an insight into parents' experiences of NCMP feedback, including how they relate to and understand that experience within a social context. By doing so, it makes a unique contribution to the existing body of evidence. Recommendations for practice based on the findings include further efforts to raise parents' and communities' awareness of childhood obesity, risks associated with childhood excess weight and obesity prevalence as a mainstream issue.
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Zhang T, Cai L, Jing J, Ma L, Ma J, Chen Y. Parental perception of child weight and its association with weight-related parenting behaviours and child behaviours: a Chinese national study. Public Health Nutr 2018; 21:1671-1680. [PMID: 29510769 PMCID: PMC10284714 DOI: 10.1017/s136898001800006x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/23/2017] [Accepted: 01/02/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Parents commonly fail to correctly recognize the weight status of their child. Whether parental perception of child weight is associated with weight-related parenting behaviours and child behaviours is unclear. The present study aimed to investigate the distribution of parental perception of child weight and its associations with weight-related parenting behaviours and child behaviours in China. DESIGN Cross-sectional study. SETTING Seven provinces in China. SUBJECTS A total of 47 417 children aged 6-17 years and their parents were included from a national survey in 2013. Parental perception of child weight, weight-related parenting behaviours and child behaviours were self-reported. Child's weight and height were objectively measured. RESULTS A total of 30·5 % of parents underestimated and 8·7 % overestimated the child's weight. Parental underestimation was more common among younger children, boys and children with a lower BMI Z-score. Parents who perceived that their child had a healthy weight (accurately or inaccurately) were more likely to prepare breakfast for the child, exercise with him/her, set apart his/her exercise time, restrict his/her screen time, and were less likely to store soft drinks for the child. Children perceived to have a healthy weight, regardless of their actual weight status, behaved healthier on dietary intake, physical activity and homework time. CONCLUSIONS Parental underestimation of their child's weight was prominent in China, especially among younger children, boys and children with a lower BMI Z-score. Parental recognition of their child being overweight did not appear to translate into healthy changes in weight-related parenting behaviours or child behaviours.
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Affiliation(s)
- Ting Zhang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, People’s Republic of China
| | - Li Cai
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, People’s Republic of China
| | - Jin Jing
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, People’s Republic of China
| | - Lu Ma
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, People’s Republic of China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, People’s Republic of China
| | - Yajun Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, People’s Republic of China
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Berggren S, Roswall J, Alm B, Bergman S, Dahlgren J, Almquist-Tangen G. Parents with overweight children two and five years of age did not perceive them as weighing too much. Acta Paediatr 2018; 107:1060-1064. [PMID: 29210112 DOI: 10.1111/apa.14174] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/06/2017] [Accepted: 11/30/2017] [Indexed: 11/27/2022]
Abstract
AIM This study examined whether the parents of children who were overweight at two and five years of age perceived their children as being too heavy and related the findings to sociodemographic factors. METHODS The data collection included parental questionnaires and anthropometric data from a longitudinal birth cohort of 2666 children born in the south-west region of Sweden in 2007-2008. RESULTS We found that 14.9 and 11.8% of the children were considered overweight or obese at the age of two and five, but 96.4 and 87.1% of their parents perceived their weight to be just about right at these ages. The difference was statistically significant (p < 0.001). Parents who were overweight themselves and had a low educational level were associated with a higher probability of misperception: at two years of age, the odds ratio was 2.75 (95% confidence interval 1.80-4.21), and at the age of five, it was 1.92 (1.24-2.97). CONCLUSION Most parents did not perceive that their overweight children weighed too much, but their judgement improved as the child got older. Parents who were overweight or had a low educational level were more likely to misperceive their child's weight. Health Care professionals need to be aware of this gap in perception.
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Affiliation(s)
- Sara Berggren
- Department of Paediatrics; Halland Hospital Halmstad; Halmstad Sweden
| | - Josefine Roswall
- Department of Paediatrics; Halland Hospital Halmstad; Halmstad Sweden
- Department of Paediatrics; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Bernt Alm
- Department of Paediatrics; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Child Health Care Unit; Region Halland Sweden
| | - Stefan Bergman
- Primary Health Care Unit; Department of Public Health and Community Medicine; Institute of Medicine; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Research and Development Centre Spenshult; Halmstad Sweden
| | - Jovanna Dahlgren
- Department of Paediatrics; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Gerd Almquist-Tangen
- Department of Paediatrics; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Child Health Care Unit; Region Halland Sweden
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Mårild S. Tackling parents' misperceptions about their children's weight issues needs careful handling. Acta Paediatr 2018; 107:919-920. [PMID: 29573282 DOI: 10.1111/apa.14273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Staffan Mårild
- Department of Pediatrics; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Perceived child eating behaviours and maternal migrant background. Appetite 2018; 125:302-313. [PMID: 29438715 DOI: 10.1016/j.appet.2018.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 11/21/2017] [Accepted: 02/09/2018] [Indexed: 01/28/2023]
Abstract
The Child Eating Behaviour Questionnaire (CEBQ) is a well-established instrument in the study of obesity-related eating behaviours among children. However, research using the CEBQ in multicultural samples is limited. This study aims to identify and examine differences in child eating behaviours as reported by Swedish-born and non-Swedish-born mothers living in Sweden. Mothers (n = 1310, 74 countries of origin, mean age 36.5 years, 63.6% with higher education, 29.2% with overweight or obesity) of children aged 3-8 years (mean age 4.8 years, 18.1% with overweight or obesity) completed the CEBQ. Responses were analysed using CEBQ subscales Food Responsiveness, Emotional Overeating, Enjoyment of Food, and Desire to Drink, clustering into Food Approach, and subscales Satiety Responsiveness, Slowness in Eating, Emotional Undereating, and Food Fussiness, clustering into Food Avoidance. Data were compared across seven regional groups, divided by maternal place of birth: (1) Sweden (n = 941), (2) Nordic and Western Europe (n = 68), (3) Eastern and Southern Europe (n = 97), (4) the Middle East and North Africa (n = 110), (5) East, South and Southeast Asia (n = 52), (6) Sub-Saharan Africa (n = 16), and (7) Central and South America (n = 26). Crude, partly and fully adjusted linear regression models controlled for child's age, gender and weight status, and mother's education, weight status and concern about child weight. The moderation effect of maternal concern about child weight was examined through interaction analyses. Results showed that while Food Approach and Food Avoidance behaviours were associated with maternal migrant background, associations for Food Fussiness were limited. Notably, mothers born in the Middle East and North Africa reported higher frequencies of both Food Approach (except for Enjoyment of Food) and Food Avoidance. The study highlights the importance of examining how regionally-specific maternal migrant background affects mothers' perceptions of child eating behaviours.
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Nemecek D, Sebelefsky C, Woditschka A, Voitl P. Overweight in children and its perception by parents: cross-sectional observation in a general pediatric outpatient clinic. BMC Pediatr 2017; 17:212. [PMID: 29273009 PMCID: PMC5741955 DOI: 10.1186/s12887-017-0964-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 12/08/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Childhood overweight is a growing problem in industrialized countries. Parents play a major role in the development and the treatment of overweight in their children. A key factor here is the perception of their child's weight status. As we know of other studies, parental perception of children's weight status is very poor. This study aimed to determine factors associated with childhood overweight and parental misperception of weight status. The height and weight of children, as reported by parents were compared with measured data. METHODS The study was conducted at a general pediatric outpatient clinic in Vienna, Austria. A total of 600 children (aged 0-14 years) participated in the study. Collection of data was performed by means of a questionnaire comprising items relating to parental weight and social demographics. The parents were also asked to indicate their children's weight and height, as well as the estimated weight status. Children were weighed and measured and BMI was calculated, allowing a comparison of estimated values and weight categories with the measured data. RESULTS Parental BMI, parental weight and a higher birth weight were identified as factors associated with childhood overweight. No association with the parents' educational status or citizenship could be proven. We compared parents' estimations of weight and height of their children with measured data. Here we found, that parental estimated values often differ from measured data. Using only parental estimated data to define weight status leads to misclassifications. It could be seen that parents of overweight children tend to underestimate the weight status of their children, compared to parents of children with normal weight. CONCLUSIONS Pediatricians should bear in mind that parental assessment often differs from the measured weight of their children. Hence children should be weighed and measured regularly to prevent them from becoming overweight. This is of particular importance in children with higher birth weight and children of overweight parents. TRIAL REGISTRATION Study was not registered. The study was approved by the Ethic committee of the city of Vienna. (EK 13-146-VK).
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Affiliation(s)
| | | | | | - Peter Voitl
- First Vienna Pediatric Medical Center, Vienna, Austria
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Almqvist-Tangen G, Arvidsson S, Alm B, Bergman S, Roswall J, Dahlgren J, Nevonen L. What makes parents act and react? Parental views and considerations relating to 'child health' during infancy. J Child Health Care 2017; 21:415-423. [PMID: 29110521 DOI: 10.1177/1367493517727069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Lifestyle factors and behaviours are adopted very early in life and tend to persist throughout life. Considering that the parents are the primary gatekeepers for their child's health, there is a need to gain more knowledge and deeper understanding about what causes parents to act and react in order for early preventive efforts to have any effect. The aim was to explore the parental views and considerations concerning 'child health' among parents with infants 8-10 months old. The sample was strategic and 16 parents (aged 23-41) were recruited from three child health centres in Sweden. Open-ended interviews were conducted and a qualitative, manifest content analysis approach was utilized. The parents described the subject 'child health' as a large, multifaceted concept. Three categories emerged during data analysis: developing a sixth sense, being affected by perceptions and believing health and ill health as a continuum. The parents perceived food and feeding issues as one of the most worrying aspects and a significant indicator of 'child health'. In order to meet the parents on their turf, the 'healthy health message' conveyed needs to take the parental perspective into consideration rather than attempting to educate the parents from predetermined assumption, belief and values.
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Affiliation(s)
- Gerd Almqvist-Tangen
- 1 Child Healthcare Team, Region Halland, Sweden.,2 Department of Paediatrics, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Susann Arvidsson
- 3 School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Bernt Alm
- 1 Child Healthcare Team, Region Halland, Sweden.,2 Department of Paediatrics, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Bergman
- 4 Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,5 Research and Development Centre Spenshult, Halmstad, Sweden
| | - Josefine Roswall
- 2 Department of Paediatrics, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,6 Department of Paediatrics, County Hospital, Region Halland, Sweden
| | - Jovanna Dahlgren
- 2 Department of Paediatrics, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lauri Nevonen
- 7 School of Health and Medical Sciences, Örebro University, Örebro, Sweden.,8 Department of Neuroscience, Institute of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Gomes AI, Barros L, Pereira AI. Predictors of parental concerns about child weight in parents of healthy-weight and overweight 2–6 year olds. Appetite 2017; 108:491-497. [DOI: 10.1016/j.appet.2016.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 10/14/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
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Parental Perception of the Children’s Weight Status in Indonesia. Nurs Midwifery Stud 2016. [DOI: 10.5812/nmsjournal.38139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Syahrul, Kimura R, Tsuda A, Susanto T, Saito R, Agrina A. Parental Perception of the Children’s Weight Status in Indonesia. Nurs Midwifery Stud 2016. [DOI: 10.17795/nmsjournal38139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Controlling feeding practices and maternal migrant background: an analysis of a multicultural sample. Public Health Nutr 2016; 20:848-858. [DOI: 10.1017/s1368980016002834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AbstractObjectiveParental feeding practices shape children’s relationships with food and eating. Feeding is embedded socioculturally in values and attitudes related to food and parenting. However, few studies have examined associations between parental feeding practices and migrant background.DesignCross-sectional study. Parental feeding practices (restriction, pressure to eat, monitoring) were assessed using the Child Feeding Questionnaire. Differences were explored in four sub-samples grouped by maternal place of birth: Sweden, Nordic/Western Europe, Eastern/Southern Europe and countries outside Europe. Crude, partly and fully adjusted linear regression models were created. Potential confounding variables included child’s age, gender and weight status, and mother’s age, weight status, education and concern about child weight.SettingMalmö and Stockholm, Sweden.SubjectsMothers (n1325, representing seventy-three countries; mean age 36·5 years; 28·1 % of non-Swedish background; 30·7 % with overweight/obesity; 62·8 % with university education) of pre-school children (mean age 4·8 years; 50·8 % boys; 18·6 % with overweight/obesity).ResultsNon-Swedish-born mothers, whether European-born or non-European-born, were more likely to use restriction. Swedish-born mothers and Nordic/Western European-born mothers reported lower levels of pressure to eat compared with mothers born in Eastern/Southern Europe and mothers born outside Europe. Differences in monitoring were small. Among the potential confounding variables, child weight status and concern about child weight were highly influential. Concern about child weight accounted for some of the effect of maternal origin on restriction.ConclusionsNon-European-born mothers were more concerned about children being overweight and more likely to report controlling feeding practices. Future research should examine acculturative and structural factors underlying differences in feeding.
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de Munter JS, Friedl A, Lind S, Kark M, Carlberg M, Andersson N, Georgellis A, Rasmussen F. Stability in the prevalence of Swedish children who were overweight or obese in 2003 and 2011. Acta Paediatr 2016; 105:1173-80. [PMID: 26833765 DOI: 10.1111/apa.13351] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 10/05/2015] [Accepted: 01/27/2016] [Indexed: 11/29/2022]
Abstract
AIM We aimed to explore the prevalence and determinants of overweight including obesity among children in Sweden in 2003 and 2011. METHODS Two population-based cross-sectional surveys included 7728 and 12 882 12-year-old children in Sweden, and 1198 and 2699 eight-year-old children in Stockholm County, in 2003 and 2011. Weighted prevalence of overweight including obesity and multivariate-adjusted relative risks (RRs) with 95% confidence intervals (CIs) was calculated. RESULTS In 2011, the overweight prevalence was lower for 12-year-old girls than boys (RR=0.84, CI=0.77-0.92), lower for girls and boys with a higher rather than a lower educated mother (for example, RRgirls =0.76, CI=0.65-0.88), but higher for girls and boys in smaller rather than main cities (RRgirls =1.52, CI=1.28-1.82). There was no difference in overweight prevalence between 2003 and 2011 among the 12-year-old children. However, eight-year-old girls had a lower overweight prevalence in 2011 than in 2003 (RR=0.76, CI=0.59-0.97). The strongest decrease in overweight was among eight-year-old girls with mothers with lower levels of education (RR=0.63, CI=0.47-0.86). CONCLUSION The prevalence of overweight including obesity was stable among Swedish children between 2003 and 2011. Gradients in the determinants of overweight persisted. There was some evidence of a less steep socio-economic gradient in overweight in eight-year-old girls over time.
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Affiliation(s)
- Jeroen S. de Munter
- Child and Adolescent Public Health Epidemiology; Department of Public Health Sciences; Karolinska Institutet; Stockholm Sweden
| | - Andrea Friedl
- Child and Adolescent Health Unit; Centre for Epidemiology and Community Medicine; Stockholm County Council; Stockholm Sweden
| | - Simon Lind
- Child and Adolescent Public Health Epidemiology; Department of Public Health Sciences; Karolinska Institutet; Stockholm Sweden
| | - Malin Kark
- Public Health Agency of Sweden; Stockholm Sweden
| | - Magdalena Carlberg
- Child and Adolescent Health Unit; Centre for Epidemiology and Community Medicine; Stockholm County Council; Stockholm Sweden
| | - Niklas Andersson
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - Antonis Georgellis
- Unit of Environmental Medicine; Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
| | - Finn Rasmussen
- Child and Adolescent Public Health Epidemiology; Department of Public Health Sciences; Karolinska Institutet; Stockholm Sweden
- Child and Adolescent Health Unit; Centre for Epidemiology and Community Medicine; Stockholm County Council; Stockholm Sweden
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Ek A, Sorjonen K, Eli K, Lindberg L, Nyman J, Marcus C, Nowicka P. Associations between Parental Concerns about Preschoolers' Weight and Eating and Parental Feeding Practices: Results from Analyses of the Child Eating Behavior Questionnaire, the Child Feeding Questionnaire, and the Lifestyle Behavior Checklist. PLoS One 2016; 11:e0147257. [PMID: 26799397 PMCID: PMC4723125 DOI: 10.1371/journal.pone.0147257] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 01/02/2016] [Indexed: 01/29/2023] Open
Abstract
Introduction Insight into parents’ perceptions of their children’s eating behaviors is crucial for the development of successful childhood obesity programs. However, links between children’s eating behaviors and parental feeding practices and concerns have yet to be established. This study aims to examine associations between parental perceptions of preschoolers’ eating behaviors and parental feeding practices. First, it tests the original 8-factor structure of the Child Eating Behavior Questionnaire (CEBQ). Second, it examines the associations with parental feeding practices, measured with the Child Feeding Questionnaire (CFQ). Materials and Methods Questionnaires were sent to parents from 25 schools/preschools in Stockholm, Sweden and to parents starting a childhood obesity intervention. The CEBQ factor structure was tested with confirmatory factor analysis (CFA). Associations between CEBQ subscales Food approach and Food avoidance and CFQ factors Restriction, Pressure to eat and Monitoring were examined with structural equation modelling (SEM), adjusting for child and parental characteristics, and parental confidence, measured with the Lifestyle Behavior Checklist (LBC). CFQ Concern for child weight and Perceived responsibility for child eating were used as mediators. Results 478 parents completed the questionnaires (children: 52% girls, mean age 5.5 years, 20% overweight/obese). A modified 8-factor structure showed an acceptable fit (TLI = 0.91, CFI = 0.92, RMSEA = 0.05 and SRMR = 0.06) after dropping one item and allowing three pairs of error terms to correlate. The SEM model demonstrated that Food approach had a weak direct effect on Restriction, but a moderate (β = 0.30) indirect effect via Concern, resulting in a substantial total effect (β = 0.37). Food avoidance had a strong positive effect on Pressure to eat (β = 0.71). Discussion The CEBQ is a valid instrument for assessing parental perceptions of preschoolers’ eating behaviors. Parental pressure to eat was strongly associated with children’s food avoidance. Parental restriction, however, was more strongly associated with parents’ concerns about their children’s weights than with children’s food approach. This suggests that childhood obesity interventions should address parents’ perceptions of healthy weight alongside perceptions of healthy eating.
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Affiliation(s)
- Anna Ek
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Kimmo Sorjonen
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Karin Eli
- Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, Oxford, United Kingdom
| | - Louise Lindberg
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Jonna Nyman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Paulina Nowicka
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
- * E-mail:
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Abstract
BACKGROUND Accurate parental perceptions of their children's underweight status are needed to prevent overlooking potential disordered eating patterns or health conditions affecting growth. PURPOSE The aim of this study is to determine overall proportion of parents who misperceive children's underweight status and correlates of such misperceptions. METHODS Original studies published to January 2013 were chosen through a literature search in established databases. Studies included assessed parental perceptions of their children's underweight and then compared perceptions to recognized standards for defining underweight based on anthropometric measures. Random- and mixed-effects models were used. RESULTS Thirty-seven articles (representing 39 studies; N = 4,039) were included. Pooled effect sizes indicated that 46.58 % (95 % CI 40.90-52.35 %) of parents misperceive their children's underweight status, though the extent of misperceptions depended on a number of moderators. CONCLUSIONS Nearly half of parents perceive their underweight children as weighing more than they actually do. Health care professionals are well positioned to take steps to remedy misperceptions and encourage healthy behaviors.
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Pearce A, Rougeaux E, Law C. Disadvantaged children at greater relative risk of thinness (as well as obesity): a secondary data analysis of the England National Child Measurement Programme and the UK Millennium Cohort Study. Int J Equity Health 2015; 14:61. [PMID: 26242408 PMCID: PMC4524014 DOI: 10.1186/s12939-015-0187-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 07/17/2015] [Indexed: 11/10/2022] Open
Abstract
Introduction Young children living in more disadvantaged socio-economic circumstances (SECs) are at an increased risk of overweight and obesity. However, there is scant research examining the prevalence and social distribution of thinness in early childhood, despite potential negative consequences for health and development across the life-course. Methods We examined the social gradient in thinness (and overweight and obesity for comparison) for 2,620,422 four-to-five year olds attending state maintained primary schools from 2007/8 to 2011/12, in the England National Child Measurement Programme (NCMP), and 16,715 children from the UK Millennium Cohort Study (MCS), born in 2000–2002, and measured at ages of three, five and seven. Children were classified as being thin, healthy weight (and, for completeness, overweight or obese) using international age and sex adjusted cut-offs for body mass index (BMI). Prevalences (and 95 % confidence intervals (CIs)) were estimated, overall, and according to SECs: area deprivation (NCMP, MCS); household income, and maternal social class and education (MCS only). Relative Risk Ratios (RRRs) and CIs for thinness, overweight and obesity were estimated in multinomial models by SECs (baseline healthy weight). In the MCS, standard errors were estimated using clustered sandwich estimators to account for repeated measures, and, for thinness, RRRs by SECs were also estimated adjusting for a range of early life characteristics. Results In 2007/8 to 2011/12, 5.20 % of four-to-five year old girls (n = 66,584) and 5.88 % of boys (78,934) in the NCMP were thin. In the MCS, the prevalence of thinness was 4.59 % (693) at three, 4.21 % (702) at five, and 5.84 % (804) at seven years. In both studies, and for all measures of SECs, children from the most disadvantaged groups were more likely to be thin than those from the most advantaged groups. For example, MCS children whose mothers had no educational qualifications were fifty percent more likely to be thin (RRR 1.5 (CI: 1.24, 1.8)) than those whose mothers had a degree. These patterns were attenuated but remained after adjusting for early life characteristics. Conclusions Children from more disadvantaged backgrounds are at elevated relative risk of thinness as well as obesity. Researchers and policymakers should consider environmental influences on thinness in addition to overweight and obesity. Electronic supplementary material The online version of this article (doi:10.1186/s12939-015-0187-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Pearce
- Population Policy and Practice, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Emeline Rougeaux
- Population Policy and Practice, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Catherine Law
- Population Policy and Practice, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
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Ek A, Chamberlain KL, Ejderhamn J, Fisher PA, Marcus C, Chamberlain P, Nowicka P. The More and Less Study: a randomized controlled trial testing different approaches to treat obesity in preschoolers. BMC Public Health 2015; 15:735. [PMID: 26231850 PMCID: PMC4522072 DOI: 10.1186/s12889-015-1912-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 06/08/2015] [Indexed: 01/13/2023] Open
Abstract
Background While obesity has been shown to be difficult to treat in school aged children and in adolescence, promising results have been detected for children who started treatment in early childhood. Yet knowledge on the effectiveness of structured early childhood obesity treatment programs is limited, preventing the widespread implementation of such programs. The main objective of this study is to evaluate the effectiveness of early treatment of childhood obesity with respect to treatment focus (parenting practices or lifestyle), length and intensity. The study will also examine the influence of gender, age, parental weight status, parenting practices, child behavior as well as parents’ socioeconomic status and child and parental psychosocial health on children’s weight status. Methods/design This is a parallel open label randomized controlled trial assessing two different behavioral treatment approaches offered in three conditions to families with children aged 4–6 years in Stockholm County, Sweden. Children (n = 180) identified as obese will be referred from primary child health care, school health care, and from outpatient pediatric clinics, and randomized to: 1) a standard treatment with focus on lifestyle, provided within the current healthcare system (n = 90); 2) a 10-session, 1.5 h/week group treatment with focus on parenting (n = 45); or 3) the same group treatment as 2) with additional follow-up sessions (n = 45). The primary study outcome is change in children’s body mass index standard deviation score (BMI SDS) one year post-baseline. Secondary outcomes include changes in children’s waist circumference, metabolic health, lifestyle patterns (Food Frequency Questionnaire), obesity-related child behaviors (Child Eating Behavior Questionnaire and Lifestyle Behavior Checklist, Problem Scale), parents’ general and feeding parenting practices (Communicating with Children and Child Feeding Questionnaire) and lifestyle-specific self-efficacy (Lifestyle Behavior Checklist, Confidence Scale), family functioning (Family Assessment Device), child and parental psychosocial health (Child Behavior Checklist and Beck’s Depression Inventory II). Discussion This study will facilitate a close examination of key components of treatment for obesity during early childhood and mechanisms of change. Results from this study will lead to better healthcare options for obesity treatment during early childhood and ultimately to the prevention of obesity later in life. Trial registration ClinicalTrials.gov NCT01792531 Registered February 14, 2013.
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Affiliation(s)
- Anna Ek
- Division of Pediatrics, B62, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 86, Stockholm, Sweden.
| | | | - Jan Ejderhamn
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
| | - Philip A Fisher
- Oregon Social Learning Center, Eugene, OR, USA. philf@uoregon.\edu.,University of Oregon, Eugene, OR, USA. philf@uoregon.\edu
| | - Claude Marcus
- Division of Pediatrics, B62, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 86, Stockholm, Sweden.
| | | | - Paulina Nowicka
- Division of Pediatrics, B62, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 86, Stockholm, Sweden.
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Bergström H, Haggård U, Norman Å, Sundblom E, Schäfer Elinder L, Nyberg G. Factors influencing the implementation of a school-based parental support programme to promote health-related behaviours--interviews with teachers and parents. BMC Public Health 2015; 15:541. [PMID: 26051650 PMCID: PMC4459678 DOI: 10.1186/s12889-015-1896-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 05/29/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The 'Healthy School Start' programme was developed to promote healthy dietary habits and physical activity, targeting parents of 6-year-old children in pre-school class. Knowledge of barriers and facilitators of implementation is crucial before introducing this kind of programme on a larger scale. The aim of this study was to explore the views of teachers and parents regarding factors influencing the implementation of a school-based parental support programme to promote physical activity and healthy diet. METHODS An inductive qualitative method was used to explore the experiences and views of teachers and parents involved in the programme. A group discussion was held with three teachers, and semi-structured interviews were conducted with 14 parents. Data were analysed using qualitative content analysis. RESULTS Clear communication on roles and responsibilities was identified as an overarching theme, emphasising the importance of clear information and well-functioning cooperation between project management, schools and parents when implementing the programme in a school setting. Five categories at a manifest level described aspects influencing the implementation: 1) 'The programme' underlining the importance of flexibility and feed-back; 2) 'the school' referring to management and work routines; 3) 'family conditions', implying various life situations; 4) 'group dynamics' dealing with attitudes among children and parents; and 5) 'the surrounding community' including accessibility and attitudes within society. CONCLUSIONS When implementing a parental support programme in a school setting it is important to facilitate communication and clearly define the division of responsibilities between project management, schools and parents. This emphasises the need for managerial support, and a professional prevention support system.
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Affiliation(s)
- Helena Bergström
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, 171 29, Solna, Sweden. .,Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
| | - Ulrika Haggård
- National Board of Forensic Medicine, Box 4044, Huddinge, Sweden.
| | - Åsa Norman
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
| | - Elinor Sundblom
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, 171 29, Solna, Sweden.
| | - Liselotte Schäfer Elinder
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, 171 29, Solna, Sweden. .,Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
| | - Gisela Nyberg
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, 171 29, Solna, Sweden. .,Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
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Santos-Beneit G, Sotos-Prieto M, Pocock S, Juliana Redondo, Fuster V, Peñalvo JL. Asociación entre antropometría y presión arterial alta en una muestra representativa de preescolares de Madrid. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.05.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Jeffery AN, Metcalf BS, Hosking J, Mostazir MBA, Voss LD, Wilkin TJ. Awareness of body weight by mothers and their children: repeated measures in a single cohort (EarlyBird 64). Child Care Health Dev 2015; 41:434-42. [PMID: 24912623 DOI: 10.1111/cch.12167] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mothers often do not realize when their child is overweight. We aimed to compare mothers' perceptions of children's weight before and during puberty, and to explore factors at 7 years predicting recognition of overweight at 16 years. METHODS Mothers of 237 children (136 boys) from the EarlyBird study estimated their own weight category and that of their child aged 7 years and 16 years. The children estimated their own weight category at 16 years. Annual measures: body mass index standard deviation score (BMIsds), per cent fat, physical activity. Pubertal development assessed by age at peak height velocity (APHV). MATERNAL MEASURES: BMI, education, socio-economic status. RESULTS At 7 years 21% of girls and 16% of boys were overweight or obese, rising to 27% and 22% respectively at 16 years. The accuracy of the mother's perception of her child's weight category improved from 44% at 7 years to 74% at 16 years, but they were less able to judge overweight in sons than daughters. The mothers' level of concern about overweight was greater for girls than boys, and increased for girls (52% mothers of overweight/obese girls were worried at 7 years, 62% at 16 years), but remained static in the boys (42% vs. 39%). Over 80% of the youngsters realized when they were overweight, but 25% normal-weight girls also classed themselves as overweight. Only BMI predicted a mother's ability to correctly perceive her child's weight. Neither her awareness, nor concern, about the child's weight at 7 years had any impact on the trajectory of the child's BMI from 7 years to 16 years. CONCLUSIONS Parents are central to any successful weight reduction programme in their children, but will not engage while they remain ignorant of the problem. Crucially, any concern mothers may have about their child's excess weight at 7 years appears to have no impact on subsequent weight change.
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Affiliation(s)
- A N Jeffery
- Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
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Large proportions of overweight and obese children, as well as their parents, underestimate children’s weight status across Europe. The ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) project. Public Health Nutr 2015; 18:2183-90. [DOI: 10.1017/s136898001400305x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo investigate the magnitude and country-specific differences in underestimation of children’s weight status by children and their parents in Europe and to further explore its associations with family characteristics and sociodemographic factors.DesignChildren’s weight and height were objectively measured. Parental anthropometric and sociodemographic data were self-reported. Children and their parents were asked to comment on children’s weight status based on five-point Likert-type scales, ranging from ‘I am much too thin’ to ‘I am much too fat’ (children) and ‘My child’s weight is way too little’ to ‘My child’s weight is way too much’ (parents). These data were combined with children’s actual weight status, in order to assess underestimation of children’s weight status by children themselves and by their parents, respectively. Chi-square tests and multilevel logistic regression analyses were conducted to examine the aims of the current study.SettingEight European countries participating in the ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) project.SubjectsA school-based survey among 6113 children aged 10–12 years and their parents.ResultsIn the total sample, 42·9 % of overweight/obese children and 27·6 % of parents of overweight/obese children underestimated their and their children’s weight status, respectively. A higher likelihood for this underestimation of weight status by children and their parents was observed in Eastern and Southern compared with Central/Northern countries. Overweight or obese parents (OR=1·81; 95 % CI 1·39, 2·35 and OR=1·78, 95 % CI 1·22, 2·60), parents of boys (OR=1·32; 95 % CI 1·05, 1·67) and children from overweight/obese (OR=1·60; 95 % CI 1·29, 1·98 and OR=1·76; 95 % CI 1·29, 2·41) or unemployed parents (OR=1·53; 95 % CI 1·22, 1·92) were more likely to underestimate children’s weight status.ConclusionsChildren of overweight or obese parents, those from Eastern and Southern Europe, boys, younger children and children with unemployed parents were more likely to underestimate their actual weight status. Overweight or obese parents and parents of boys were more likely to underestimate the actual weight status of their children. In obesity prevention such underestimation may be a barrier for behavioural change.
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Eli K, Howell K, Fisher PA, Nowicka P. "A little on the heavy side": a qualitative analysis of parents' and grandparents' perceptions of preschoolers' body weights. BMJ Open 2014; 4:e006609. [PMID: 25500371 PMCID: PMC4265138 DOI: 10.1136/bmjopen-2014-006609] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Parents' difficulties in perceiving children's weight status accurately pose a barrier for family-based obesity interventions; however, the factors underlying weight misinterpretation still need to be identified. This study's objective was to examine parents and grandparents' perceptions of preschoolers' body sizes. Interview questions also explored perceptions of parental responsibility for childhood obesity and appropriate contexts in which to discuss preschoolers' weights. DESIGN Semistructured interviews, which were videotaped, transcribed and analysed qualitatively. SETTING Eugene and the Springfield metropolitan area, Oregon, USA PARTICIPANTS: Families of children aged 3-5 years were recruited in February-May 2011 through advertisements about the study, published in the job seekers' sections of a classified website (Craigslist) and in a local newspaper. 49 participants (22 parents and 27 grandparents, 70% women, 60% with overweight/obesity) from 16 low-income families of children aged 3-5 years (50% girls, 56% with overweight/obesity) were interviewed. RESULTS There are important gaps between clinical definitions and lay perceptions of childhood obesity. While parents and grandparents were aware of their preschoolers' growth chart percentiles, these measures did not translate into recognition of children's overweight or obesity. The participants spoke of obesity as a problem that may affect the children in the future, but not at present. Participants identified childhood obesity as being transmitted from one generation to the next, and stigmatised it as resulting from 'lazy' parenting. Parents and grandparents avoided discussing the children's weights with each other and with the children themselves. CONCLUSIONS The results suggest that clinicians should clearly communicate with parents and grandparents about the meaning and appearance of obesity in early childhood, as well as counteract the social stigma attached to obesity, in order to improve the effectiveness of family-based interventions to manage obesity in early childhood.
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Affiliation(s)
- Karin Eli
- Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK
| | - Kyndal Howell
- Department of Psychology, University of Oregon, Eugene, USA
| | | | - Paulina Nowicka
- Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK
- Unit of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Santos-Beneit G, Sotos-Prieto M, Pocock S, Redondo J, Fuster V, Peñalvo JL. Association between anthropometry and high blood pressure in a representative sample of preschoolers in madrid. ACTA ACUST UNITED AC 2014; 68:477-84. [PMID: 25487220 DOI: 10.1016/j.rec.2014.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 05/21/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Program SI! is a multi-level, school-based intervention for the promotion of cardiovascular health from early childhood. The aim of this paper is to characterize the prevalence of obesity and high blood pressure in the preschoolers enrolled in the study, and to compare various criteria for classifying obesity. METHODS The study was a cluster-randomized controlled intervention trial including 24 state schools in Madrid (Spain). Weight, height, triceps and subscapular skinfold thicknesses, waist circumference, and systolic and diastolic blood pressure were measured in 2011 children (1009 boys and 1002 girls) aged 3 to 5 years (3.7 [0.9]). Body mass index and blood pressure were classified by corresponding task force criteria. Obesity was studied by 6 different criteria. Associations of body mass index, body weight, body fat, and waist circumference on blood pressure were examined, and the risk of high blood pressure in relation to tertiles of body mass index was calculated. RESULTS The prevalence of obesity according to the International Obesity Task Force varied from 2% at age 3 to 8% at age 5, and the overall prevalence of high blood pressure (≥ 90th percentile) was 20%. Sex- and age-specific criteria for obesity showed better agreement with the reference than a single generalized cutoff. The risk of high blood pressure was higher for the highest tertile of body mass index distribution. CONCLUSIONS The highest prevalence of obesity and high blood pressure was found among older children. The classification of obesity in children was more accurate using sex- and age-specific cutoffs.
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Affiliation(s)
- Gloria Santos-Beneit
- Área de Epidemiología y Genética de Poblaciones, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Fundación SHE, Barcelona, Spain.
| | - Mercedes Sotos-Prieto
- Área de Epidemiología y Genética de Poblaciones, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Fundación SHE, Barcelona, Spain
| | - Stuart Pocock
- Área de Epidemiología y Genética de Poblaciones, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Valentín Fuster
- Área de Epidemiología y Genética de Poblaciones, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Department of Cardiology, Mount Sinai School of Medicine, New York, United States
| | - José L Peñalvo
- Área de Epidemiología y Genética de Poblaciones, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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Rebholz CE, Chinapaw MJM, van Stralen MM, Bere E, Bringolf B, De Bourdeaudhuij I, Jan N, Kovacs E, Maes L, Manios Y, Moreno L, Singh AS, Brug J, te Velde SJ. Agreement between parent and child report on parental practices regarding dietary, physical activity and sedentary behaviours: the ENERGY cross-sectional survey. BMC Public Health 2014; 14:918. [PMID: 25190541 PMCID: PMC4169834 DOI: 10.1186/1471-2458-14-918] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 07/29/2014] [Indexed: 12/14/2022] Open
Abstract
Background Parents and their parenting practices play an important role in shaping their children’s environment and energy-balance related behaviours (EBRBs). Measurement of parenting practices can be parent- or child-informed, however not much is known about agreement between parent and child perspectives. This study aimed to assess agreement between parent and child reports on parental practices regarding EBRBs across different countries in Europe and to identify correlates of agreement. Methods Within the ENERGY-project, a cross-sectional survey was conducted among 10–12 year old children and their parents in eight European countries. Both children and parents filled in a questionnaire on 14 parental practices regarding five different EBRBs (i.e. soft drink, fruit juice and breakfast consumption, sports activity and watching TV) and socio-demographic characteristics. Children’s anthropometric measurements were taken at school. We calculated percentages of agreement between children and their parents and weighted kappa statistics (for ordinal variables) per practice and country and assessed factors associated with agreement using multilevel linear regression. Results Reports of 6425 children and their parents were available for analysis. Overall mean agreement between parent and child reports was 43% and varied little among countries. The lowest agreement was found for questions assessing joint parent–child activities, such as sports (27%; Kappa (κ) = 0.14) or watching TV (30%;κ = 0.17), and for parental allowance of the child to have soft drinks (32%;κ = 0.24) or fruit juices (32%;κ = 0.19), or to watch TV (27%;κ = 0.17). Having breakfast products available at home or having a TV in the child’s bedroom were the only practices with moderate to good agreement (>60%;κ = 0.06 and 0.77, respectively). In general, agreement was lower for boys, younger children, younger parents, parents with less than 14 years of education, single parents, parents with a higher self-reported body mass index and parents who perceived their child to be underweight. Conclusions Parents and children perceive parental practices regarding dietary, physical activity and sedentary behaviours differently in all parts of Europe, with considerable variation across specific practices and countries. Therefore, future studies should assess both, parents and children’s view on parental practices. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-918) contains supplementary material, which is available to authorized users.
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Affiliation(s)
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- EMGO Institute for Health and Care Research and the Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
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