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Rhee KE, Strong D. Should We "Wait and See"?: Change in Weight Status Among US Adolescents in the Population Assessment of Tobacco and Health Study. Child Obes 2023; 19:373-381. [PMID: 35960810 DOI: 10.1089/chi.2022.0079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Many parents and providers adopt a "wait and see" approach to obesity (OB) management. The goal of this study was to determine the likelihood that youth with overweight (OW) or OB would become normal weight over time. Methods: Data from the nationally representative Population Assessment of Tobacco and Health Study were used to examine the proportion of teens (aged 12-17 years) with OW/OB who tracked into a lower weight category over four waves of data collection (2013-2018). Analysis was restricted to those who completed all four waves of assessments (n = 10,086). Repeated-measures logistic regression models were used to describe the odds of having a BMI within the normal weight range at Waves 2-4, given an OW or obese weight status in the previous wave. Results: At Wave 1, 65% of the sample was normal weight, 18% had OW, and 17% had OB. By Wave 4, 24% had OW and 20% had OB. The adjusted odds of reporting a normal weight relative to OW/OB decreased by 13% each year. In Wave 4, only 2% [standard error (SE) 0.4%] of boys and 2% (SE 0.3%) of girls transitioned from OB to normal weight. For youth with OB in Wave 1, the probability of being in the normal weight category in Wave 2 was 0.04 (95% confidence interval 0.035-0.052), and decreased thereafter. Conclusion: Very few teens were able to return to normal weight once they developed OW/OB. Adopting a "wait and see" approach to OB management may be detrimental to a child's health.
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Affiliation(s)
- Kyung E Rhee
- Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | - David Strong
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
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2
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García-Blanco L, Berasaluce A, Romanos-Nanclares A, Martínez-González MÁ, Moreno-Galarraga L, Martín-Calvo N. Parental perception of child's weight, their attitudes towards child's dietary habits and the risk of obesity. World J Pediatr 2022; 18:482-489. [PMID: 35334044 PMCID: PMC9205829 DOI: 10.1007/s12519-022-00540-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The association between parental perception of child's weight and their attitudes towards his/her dietary habits has not been reported yet. This study aimed to assess the association between parental underestimation of child's weight and parental attitudes towards child's dietary habits. METHODS We conducted a cross-sectional analysis of SENDO cohort participants recruited between January 2015 and June 2020. All information was collected through online questionnaires completed by parents. We calculated crude and multivariable-adjusted odds ratio (OR) and 95% confidence intervals (CI) for unhealthy attitudes towards child's dietary habits associated with parental underestimation of child's weight. RESULTS Sixteen percent of children in the SENDO project had parents who underestimated their weight. Parents who underestimated their child's weight status were more likely to have unhealthy attitudes toward his/her dietary habits [OR 3.35; 95% CI (1.71-6.53)]. CONCLUSIONS Parental underestimation of child's weight was associated with unhealthy attitudes towards child's dietary habits. Pediatricians and public health practitioners should pay attention to the parental perception of child's weight to identify parents who underestimate it as an at-risk group in which to inquire about lifestyle and dietary habits.
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Affiliation(s)
- Lorena García-Blanco
- San Juan Primary Care Health Center, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain ,IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Arantxa Berasaluce
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain ,Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/ Irunlarrea 1, 31080 Pamplona, Spain
| | - Andrea Romanos-Nanclares
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain ,Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/ Irunlarrea 1, 31080 Pamplona, Spain
| | - Miguel Ángel Martínez-González
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain ,Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/ Irunlarrea 1, 31080 Pamplona, Spain ,Biomedical Research Centre Network On Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain ,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
| | - Laura Moreno-Galarraga
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain ,Department of Pediatrics, Complejo Hospitalario de Navarra B, Pamplona, Spain
| | - Nerea Martín-Calvo
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain. .,Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, C/ Irunlarrea 1, 31080, Pamplona, Spain. .,Biomedical Research Centre Network On Obesity and Nutrition (CIBERobn), Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain.
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Parents' perceptions and dissatisfaction with child silhouette: associated factors among 7-year-old children of the Generation XXI birth cohort. Eat Weight Disord 2021; 26:1595-1607. [PMID: 32772335 DOI: 10.1007/s40519-020-00953-0] [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: 03/23/2020] [Accepted: 06/30/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE We compared parent's perceived child's silhouette, and investigated predictors of their dissatisfaction. METHODS Participants were 4930 mother-child dyads enrolled at a Portuguese birth cohort. Parents' perceptions of child's current and desired silhouette was assessed and dissatisfaction with child's silhouette was defined as the discrepancy between these ratings (current-desired body). Multinomial logistic regressions, adjusted for potential confounders, were performed. RESULTS Mothers were more dissatisfied with child's silhouette, compared to fathers, in all weight categories. Mothers and fathers of girls were more dissatisfied, preferring thinner silhouettes (OR = 2.77, 95% CI 2.19; 3.51 and OR = 2.08, 95% CI 1.18; 3.66, respectively), compared to parents of boys. Lower birth weight increased maternal desire for a heavier child silhouette. Younger (< 20 years) and less educated (≤ 9 years of schooling) mothers were more dissatisfied with their child's silhouette, preferring heavier children (OR = 1.65, 95% CI 1.10; 2.48 and OR = 1.73, 95% CI 1.42; 2.09, respectively). Parents' own dissatisfaction was also associated with child's silhouette dissatisfaction. CONCLUSION Sociodemographic characteristics and parents' dissatisfaction with their own silhouette influenced their dissatisfaction with child's silhouette and should be considered when developing obesity interventions. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Hernandez RG, Garcia JT, Amankwah EK. A Look Back at Healthy Lifestyle Behavioral Patterns among School-Age Children: Are We Neglecting Healthy Weight for Overweight Kids? Child Obes 2020; 15:271-279. [PMID: 30920296 DOI: 10.1089/chi.2018.0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: To describe prevalence of healthy lifestyle behaviors (HLBs) between two school-age cohorts of racial-ethnically diverse children. Methods: Using two Early Childhood Longitudinal Study cohorts (ECLS-K 1999 and 2010), we compared percentage change in HLBs (sleep, physical activity, screen time, and family meals) by child weight groups and within racial-ethnic groups. Weight groups of interest included healthy weight (HW; BMI 5th-84th percentile), overweight (OW; ≥ 85th-94th), obese (OB; ≥ 95th-99th percentile), and severely obese (SO; ≥ 99th percentile). Results: OW children within the 2010 cohort reported greater percentage change (range: 2.0%-15.1% increase) in HLBs, whereas HW children demonstrated lower percentage change (range: -6.2% to 8.7% increase). OB and SO children showed significant lower percentage change in reducing screen time (range: -11.0% and -12.7%, respectively). HW Latino children demonstrated the least favorable trends with overall declines noted for 4/5 HLBs. Screen time was noted to have the greatest degree of favorable change (2%-14%) across weight groups, whereas adequate sleep duration demonstrated the lowest favorable percentage change (2%-2.8%). Conclusion: Fewer HW and OB children were participating in recommended HLBs compared with OW children in 2010. Recent health campaigns may have helped providers prioritize the identification and counseling of OW children, yet our data suggest that we may be neglecting the role of HLB counseling in OB and HW children. Continued analysis on the social determinants that impact HLBs in school-age and HW/OB minority children should inform how we can best tailor counseling and messages in the coming decades.
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Affiliation(s)
- Raquel G Hernandez
- 1 Department of Pediatrics Johns Hopkins University School of Medicine, Baltimore, MD.,2 Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | | | - Ernest K Amankwah
- 1 Department of Pediatrics Johns Hopkins University School of Medicine, Baltimore, MD.,2 Johns Hopkins All Children's Hospital, St. Petersburg, FL
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5
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Myers J, Werk LN, Hossain MJ, Lawless S. Quality Improvement Project to Promote Identification and Treatment of Children With Obesity Admitted to Hospital. Am J Med Qual 2020; 35:411-418. [PMID: 31941346 DOI: 10.1177/1062860619898534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Among children hospitalized for acute problems, comorbid obesity is commonly unaddressed. The objective was to improve identification and initial management of obesity among hospitalized children. In collaboration with nurses and dietitians, pediatric hospitalists of 2 children's hospitals conducted a quality improvement project to improve body mass index (BMI) documentation, obesity diagnosis, diet, and nutrition consultation through clinician education, development of computerized clinical decision-support system tools, and workflow modifications. Participants received monthly performance feedback. Among those with elevated BMI, diagnosis rose to 70.2%; a documented obesity diagnosis was associated with being 35 times more likely (P < .001) to receive at least 1 intervention while hospitalized. Participants reported an increase in skill in (27%), comfort with (27%), and knowledge of (33%) obesity management. Improvement in health care provider recognition and management of obesity in the inpatient setting is achievable. Additional work is needed to identify how best to sustain desired practice patterns.
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Affiliation(s)
- Joseph Myers
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Lloyd N Werk
- Nemours Children's Hospital, Orlando, FL.,University of Central Florida, Orlando, FL
| | | | - Stephen Lawless
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
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Garcia ML, Crespo NC, Behar AI, Talavera GA, Campbell N, Shadron LM, Elder JP. Examining Mexican-Heritage Mothers' Perceptions of Their Children's Weight: Comparison of Silhouette and Categorical Survey Methods. Child Obes 2020; 16:44-52. [PMID: 31556701 PMCID: PMC6931916 DOI: 10.1089/chi.2019.0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Failure to recognize children's overweight status by parents may contribute to children's risk for obesity. We examined two methods of measuring mothers' perceptions of children's weight and factors associated with weight perception inaccuracy. Methods: Cross-sectional analyses of clinical and self-report data from 287 Mexican-heritage mother-child dyads. Mothers identified their child's weight category using a scale (e.g., "normal/overweight/obese") and a visual silhouette scale (11 child gender-specific weight-varying images). Children's height and weight were measured to calculate body mass index (BMI). Chi-square tests examined associations between categorical, silhouette, and BMI percentile categories of children's weight. Bivariate logistic regression analyses examined factors associated with mothers' inaccuracy of their children's weight. Results: Only 13% of mothers accurately classified their child as obese using the categorical scale, while 78% accurately classified their child as obese using the silhouette scale. Mothers were more likely to underestimate their child's weight using BMI categories (62%) compared to using the silhouette scale (23%). Predictors of mothers' underestimation using the categorical method were child sex [female] (adjusted odds ratio [AOR] = 1.99; 95% CI: 1.02-3.86), child age [younger age] (AOR = 10.39; 95% CI: 4.16-25.92 for ages 5-6 years), and mother's weight status (overweight AOR = 2.99; 95% CI: 1.05-8.51; obese AOR = 5.19; 95% CI: 1.89-14.18). Child BMI was the only predictor of mothers' overestimation (AOR = 0.89; 95% CI: 0.85-0.94) using the silhouette method. Conclusions: Using silhouette scales to identify children's body weight may be a more accurate tool for clinicians and interventionists to activate parents' awareness of unhealthy weight in children compared to using traditional categorical weight-labeling methods.
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Affiliation(s)
- Melawhy L. Garcia
- Department of Health Science, Center for Latino Community Health, Evaluation, and Leadership Training, California State University Long Beach, Long Beach, CA.,Address correspondence to: Melawhy L. Garcia, MPH, PhD, Department of Health Science, California State University Long Beach, 1250 Bellflower Boulevard, HHS2-115, Long Beach, CA 90840
| | - Noe C. Crespo
- School of Public Health, Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
| | - Alma I. Behar
- School of Public Health, Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
| | - Gregory A. Talavera
- Department of Psychology, South Bay Latino Research Center, San Diego State University, Chula Vista, CA
| | - Nadia Campbell
- Sponsored Research Administration, San Diego State University Research Foundation, San Diego, CA
| | - Lisa M. Shadron
- Sponsored Research Administration, San Diego State University Research Foundation, San Diego, CA
| | - John P. Elder
- School of Public Health, Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
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7
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The Relationship Between Body Mass Index in Children and Insurance Type, Parental Eating Concern, Asthma, and Allergies. J Pediatr Health Care 2019; 33:e29-e37. [PMID: 31447014 DOI: 10.1016/j.pedhc.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/29/2019] [Accepted: 06/02/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Trust for America's Health reported rising levels of obesity contributed to increased disease rates and health care costs (Levi et al., 2013). Factors associated with overweight and obesity rates include lower socioeconomic status, public insurance, and increased chronic disease rates. METHODS Body mass index percentile, health insurance, parental eating concern, asthma, and allergy information were evaluated from a dataset of 870 de-identified health assessment records. RESULTS Among overweight/obese children, we found significant differences in children insured by Medicaid (26%) versus commercial insurance (15.9%), children with asthma (22.1%) versus children without asthma (14.8%), and children with known allergies (7.8%) versus children without known allergies (16.7%). The difference between children with parental eating concerns (3.7%) and children without (18.1%) was nearly significant. DISCUSSION The associations depicted can assist pediatric providers in recognizing risk factors for overweight/obesity among their patients. Combating obesity in childhood can improve health outcomes.
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8
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Conlon BA, Mcginn AP, Isasi CR, Mossavar-Rahmani Y, Lounsbury DW, Ginsberg MS, Diamantis PM, Groisman-Perelstein AE, Wylie-Rosett J. Home Environment Factors and Health Behaviors of Low-income, Overweight, and Obese Youth. Am J Health Behav 2019; 43:420-436. [PMID: 30808480 DOI: 10.5993/ajhb.43.2.17] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives: Home environment may influence children's health behaviors associated with obesity. In this study, we examined home environment factors associated with diet and physical activity behaviors of overweight or obese youth. Methods: We analyzed baseline data from child and parent/caregiver dyads enrolled in an urban family weight management program. Multivariable logistic regression examined how home environment (parenting practices, family meal habits, and home availability of fruits/vegetables, sugar-sweetened beverages (SSBs), screen media, and physical activity resources) are related to children's intake of fruit, vegetables, and SSBs, and moderate-vigorous physical activity and sedentary time (ST) after adjusting for potential confounders. Results: Children were more likely to consume fruit if their families frequently ate meals together and infrequently watched TV during meals, and more likely to consume vegetables with high fruit/vegetable availability and low SSB availability. Children were more likely to engage in ST if parents practiced monitoring and frequently watched TV during meals. Conclusions: Overweight or obese children appear to have healthier habits if their families eat meals together without watching TV and if healthy food choices are available in the home. Encouraging parents to focus these practices may promote healthier body weight in children.
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Affiliation(s)
- Beth A. Conlon
- Postgraduate Student, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY;,
| | - Aileen P. Mcginn
- Associate Professor, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
| | - Carmen R. Isasi
- Associate Professor, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
| | - Yasmin Mossavar-Rahmani
- Associate Professor, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
| | - David W. Lounsbury
- Assistant Professor, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
| | - Mindy S. Ginsberg
- Senior Associate, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
| | - Pamela M. Diamantis
- Attending Physician, Department of Pediatrics, Children's Health Services Jacobi Medical Center, Bronx, NY
| | | | - Judith Wylie-Rosett
- Professor, Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY
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9
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Sastre LR, Matson S, Gruber KJ, Haldeman L. A qualitative study examining medical provider advice, barriers, and perceived effectiveness in addressing childhood obesity to patients and families from a low-income community health clinic. SAGE Open Med 2019; 7:2050312119834117. [PMID: 30834116 PMCID: PMC6396046 DOI: 10.1177/2050312119834117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/05/2019] [Indexed: 11/18/2022] Open
Abstract
Objective: To examine medical provider (n = 16) perceptions in addressing and managing pediatric obesity with a diverse, low-income patient population. Methods: Semi-structured audio-recorded interviews were performed at three pediatric clinics. Transcripts were reviewed using content analysis and consensus was reached among authors for themes. Themes were grouped into categories including: (1) initiation of weight discussions, (2) advice and perceived effectiveness, and (3) barriers. Results: Most providers reported being comfortable addressing weight and use a variety of methods to initiate conversations; however, many challenges were reported, which include limited time and parent misperceptions of child’s weight. A broad range of lifestyle advice was utilized, but preference to discuss physical activity over nutrition was reported. Conclusion: Results suggest that successful management of children’s weight involves addressing issues at both the parent and the provider levels. Improved nutrition resources or training for providers is suggested; however, time must also be available for individualized counseling. Incorporation of registered dietitians may also reduce the burden.
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Affiliation(s)
- Lauren R Sastre
- Department of Nutrition Science, East Carolina University, Greenville, NC, USA
| | - Stephanie Matson
- Department of Human Nutrition, Winthrop University, Rock Hill, SC, USA
| | - Kenneth J Gruber
- Center for Youth, Family and Community Partnerships, The University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Lauren Haldeman
- Department of Nutrition, The University of North Carolina at Greensboro, Greensboro, NC, USA
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10
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Brown CL, Perrin EM. Obesity Prevention and Treatment in Primary Care. Acad Pediatr 2018; 18:736-745. [PMID: 29852268 DOI: 10.1016/j.acap.2018.05.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 04/30/2018] [Accepted: 05/12/2018] [Indexed: 12/22/2022]
Abstract
Despite extensive public health and clinical interventions, obesity rates remain high, and evidence-based preventive strategies are elusive. Many consensus guidelines suggest that providers should screen all children after age 2 years for obesity by measuring height and weight, calculating body mass index (BMI), and sensitively communicating weight status in the context of health to the family at each visit. However, preventive counseling should begin in infancy and focus on healthy feeding, activity, and family lifestyle behaviors. For children with overweight or obesity, the American Academy of Pediatrics outlines 4 stages of treatment: 1) Primary care providers should offer "prevention plus," the use of motivational interviewing to achieve healthy lifestyle modifications in family behaviors or environments; 2) children requiring the next level of obesity treatment, structured weight management, need additional support beyond the primary care provider (such as a dietitian, physical therapist, or mental health counselor) and more structured goal setting with the team, including providers adept at weight management counseling; 3) children with severe obesity and motivated families may benefit from referral to a comprehensive multidisciplinary intervention, such as an obesity treatment clinic; and 4) tertiary care interventions are provided in a multidisciplinary pediatric obesity treatment clinic with standard clinical protocols for evaluation of interventions, including medications and surgery. Although it is certainly a challenge for providers to fit in all the desired prevention and treatment counseling during preventive health visits, by beginning to provide anticipatory guidance at birth, providers can respond to parents' questions, add to parents' knowledge base, and partner with parents and children and adolescents to help them grow up healthy. This is especially important in an increasingly toxic food environment with numerous incentives and messages to eat unhealthfully, barriers to appropriate physical activity, and concomitant stigma about obesity. Focusing on key nutrition and physical activity habits and establishing these healthy behaviors at an early age will allow children to develop a healthy growth trajectory. However, much more work is needed to determine the best evidence-based practices for providers to counsel families on improving target behaviors, environmental modifications, and parenting skills and to decrease abundant disparities in obesity prevalence and treatment.
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Affiliation(s)
- Callie L Brown
- Department of Pediatrics and Department of Epidemiology and Prevention (Dr Brown), Wake Forest School of Medicine, Winston-Salem, NC; Department of Pediatrics and Duke Center for Childhood Obesity Research (Dr Perrin), Duke University School of Medicine, Durham, NC.
| | - Eliana M Perrin
- Department of Pediatrics and Department of Epidemiology and Prevention (Dr Brown), Wake Forest School of Medicine, Winston-Salem, NC; Department of Pediatrics and Duke Center for Childhood Obesity Research (Dr Perrin), Duke University School of Medicine, Durham, NC
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11
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Queally M, Doherty E, Matvienko-Sikar K, Toomey E, Cullinan J, Harrington JM, Kearney PM. Do mothers accurately identify their child's overweight/obesity status during early childhood? Evidence from a nationally representative cohort study. Int J Behav Nutr Phys Act 2018; 15:56. [PMID: 29921288 PMCID: PMC6006594 DOI: 10.1186/s12966-018-0688-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 06/04/2018] [Indexed: 12/22/2022] Open
Abstract
Background Maternal recognition of overweight/obesity during early childhood is a key determinant in achieving healthy weight status in children. The aim of this study is to 1) investigate maternal perceptions of their child weight, focusing on whether or not mothers accurately identify if their child is overweight or obese at three years old and five years old; 2) identify the factors influencing maternal misperceptions regarding their child’s weight at three years old and five years old, 3) ascertain if a failure to recognize overweight/obesity at three years old is associated with the likelihood of doing so at five years old. Methods Using two waves of the longitudinal Growing Up in Ireland study data regarding child, maternal, and household characteristics as well as healthcare access and utilization variables were obtained for mothers when their children are three and five years old respectively. Multivariate logistic analysis was used to examine the factors associated with mothers inaccurately perceiving their child to be of normal weight status when the child is in fact either clinically overweight or obese. Results In wave 2, 22% of mothers failed to accurately identify their child to be overweight or obese. This inaccuracy decreased to 18% in wave 3. A failure of mothers to identify their child’s overweight/obesity was more likely to occur if the child was a girl (OR: 1.25) (OR: 1.37), had a higher birth weight (OR:1.00), if the mother was obese (OR: 1.50), (OR: 1.72) or working (OR:1.25) (OR:1.16) in wave 2 and wave 3, respectively. Other factors affecting the odds of misperceiving child’s weight include gestation age, income and urban living. Conclusion These findings suggest that mothers of overweight or obese three and five year olds show poor awareness of their child’s weight status. Both child and mother characteristics play a role in influencing this awareness. Mothers unable to accurately identify their child’s overweight or obesity status at three years old are likely to do again when the child is five years old. This study highlights the need for increased support to help improve mothers’ understanding of healthy body size in preschool aged children.
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Affiliation(s)
- Michelle Queally
- Discipline of Economics, JE Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland.
| | - Edel Doherty
- Discipline of Economics, JE Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland
| | | | - Elaine Toomey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - John Cullinan
- Discipline of Economics, JE Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland
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Katzow M, Homel P, Rhee K. Factors Associated With Documentation of Obesity in the Inpatient Setting. Hosp Pediatr 2017; 7:731-738. [PMID: 29183918 PMCID: PMC5703768 DOI: 10.1542/hpeds.2017-0100] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Childhood obesity is rarely identified in hospitalized pediatric patients despite the high prevalence of obesity and potential for associated morbidity. The purpose of this study was to identify specific patient characteristics associated with the documentation of obesity and related weight management recommendations in the inpatient setting. METHODS Retrospective chart review was conducted on all pediatric patients ages 2 to 18 years old and discharged between January 1, 2012, and December 31, 2014, to determine the following: (1) if obesity was noted in the clinical documentation of those with a BMI ≥95th percentile; and (2) if those with documented obesity had evidence of an obesity-specific management plan. Using χ2 and multivariable logistic regression, we determined patient characteristics associated with the documentation of obesity and presence of a management plan. RESULTS Only 26% (214 of 809) of inpatients with obesity had documentation of weight status. The odds of obesity documentation were higher in patients with comorbid cholelithiasis, severe obesity, and older age. Of those with obesity documentation, 23% (49 of 214) had an obesity management plan. Comorbid sleep apnea and admission to a surgical service with a pediatric hospital medicine consult were significantly associated with the presence of an obesity management plan. CONCLUSIONS Increased efforts are necessary to improve obesity diagnosis and management in younger children who have not yet developed comorbidities. Additionally, the role of pediatric hospitalists as consultants for surgical patients should be further explored as a tool for addressing obesity during inpatient hospitalization.
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Affiliation(s)
- Michelle Katzow
- Department of Pediatrics, New York University School of Medicine, New York, New York;
- Department of Pediatrics, Maimonides Infants & Children's Hospital, Brooklyn, New York
| | - Peter Homel
- Office of Research Administration, Maimonides Medical Center, Brooklyn, New York; and
| | - Kyung Rhee
- University of California, San Diego, San Diego, California
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Bentley F, Swift JA, Cook R, Redsell SA. "I would rather be told than not know" - A qualitative study exploring parental views on identifying the future risk of childhood overweight and obesity during infancy. BMC Public Health 2017; 17:684. [PMID: 28851331 PMCID: PMC5576317 DOI: 10.1186/s12889-017-4684-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 08/16/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Risk assessment tools provide an opportunity to prevent childhood overweight and obesity through early identification and intervention to influence infant feeding practices. Engaging parents of infants is paramount for success however; the literature suggests there is uncertainty surrounding the use of such tools with concerns about stigmatisation, labelling and expressions of parental guilt. This study explores parents' views on identifying future risk of childhood overweight and obesity during infancy and communicating risk to parents. METHODS Semi-structured qualitative interviews were conducted with 23 parents and inductive, interpretive and thematic analysis performed. RESULTS Three main themes emerged from the data: 1) Identification of infant overweight and obesity risk. Parents were hesitant about health professionals identifying infant overweight as believed they would recognise this for themselves, in addition parents feared judgement from health professionals. Identification of future obesity risk during infancy was viewed positively however the use of a non-judgemental communication style was viewed as imperative. 2) Consequences of infant overweight. Parents expressed immediate anxieties about the impact of excess weight on infant ability to start walking. Parents were aware of the progressive nature of childhood obesity however, did not view overweight as a significant problem until the infant could walk as viewed this as a point when any excess weight would be lost due to increased energy expenditure. 3) Parental attributions of causality, responsibility, and control. Parents articulated a high level of personal responsibility for preventing and controlling overweight during infancy, which translated into self-blame. Parents attributed infant overweight to overfeeding however articulated a reluctance to modify infant feeding practices prior to weaning. CONCLUSION This is the first study to explore the use of obesity risk tools in clinical practice, the findings suggest that identification, and communication of future overweight and obesity risk is acceptable to parents of infants. Despite this positive response, findings suggest that parents' acceptance to identification of risk and implementation of behaviour change is time specific. The apparent level of parental responsibility, fear of judgement and self-blame also highlights the importance of health professionals approach to personalised risk communication so feelings of self-blame are negated and stigmatisation avoided.
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Affiliation(s)
- Faye Bentley
- Anglia Ruskin University, Cambridge, United Kingdom
| | - Judy Anne Swift
- Behavioural Nutrition, University of Nottingham, Nottingham, United Kingdom
| | - Rachel Cook
- Department of Psychology, Anglia Ruskin University, Cambridge, United Kingdom
| | - Sarah A Redsell
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Cambridge, United Kingdom
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Wong MS, Showell NN, Bleich SN, Gudzune KA, Chan KS. The association between parent-reported provider communication quality and child obesity status: Variation by parent obesity and child race/ethnicity. PATIENT EDUCATION AND COUNSELING 2017; 100:1588-1597. [PMID: 28318844 PMCID: PMC5478425 DOI: 10.1016/j.pec.2017.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine the association between healthcare provider communication quality and child obesity status, and the role of parent obesity and child race/ethnicity regarding this association. METHODS We conducted a cross-sectional secondary data analysis with the 2011-2013 Medical Expenditures Panel Survey of parents with children ages 6-12 (n=5390). We used multivariable logistic regression to examine the association of parent-reported healthcare provider communication quality (explaining well, listening carefully, showing respect, and spending enough time) with child obesity status, and effect modification by parent obesity and child race/ethnicity. RESULTS Parents of obese children were more likely to report that their child's healthcare provider listened carefully (OR=1.41, p=0.002) and spent enough time (OR=1.33, p=0.022) than parents of non-obese children. Non-obese parents of obese children experienced better communication in the domains of listening carefully (p<0.001) and spending enough time (p=0.007). Parents of obese non-Hispanic Asian children and non-Hispanic Black children were more likely to report that providers explained things well (p=0.043) and listened carefully (p=0.012), respectively. CONCLUSION Parents of obese children experienced better communication if parents were non-obese or children were non-Hispanic Black or Asian. PRACTICE IMPLICATIONS Healthcare providers should ensure effective communication with obese parents of obese children.
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Affiliation(s)
- Michelle S Wong
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA.
| | - Nakiya N Showell
- Division of General Pediatrics & Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sara N Bleich
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Kimberly A Gudzune
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, USA; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kitty S Chan
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA
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Northrup AA, Smaldone A. Maternal Attitudes, Normative Beliefs, and Subjective Norms of Mothers of 2- and 3-Year-Old Children. J Pediatr Health Care 2017; 31:262-274. [PMID: 27745978 DOI: 10.1016/j.pedhc.2016.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 08/26/2016] [Accepted: 08/30/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This exploratory study examined maternal attitudes, normative beliefs, subjective norms, and meal selection behaviors of mothers of 2- and 3-year-old children. METHODS Guided by the Theory of Reasoned Action, we had mothers complete three surveys, two interviews, and a feeding simulation exercise. Data were analyzed using descriptive and bivariate statistics and multivariate linear regression. RESULTS A total of 31 mothers (50% Latino, 34% Black, 46.9% ≤ high school education, 31.3% poor health literacy) of 32 children (37.5% overweight/obese) participated in this study. Maternal normative beliefs (knowledge of U.S. Department of Agriculture recommendations) did not reflect actual U.S. Department of Agriculture recommendations. Collectively, regression models explained 13% (dairy) to 51% (vegetables) of the variance in behavioral intent, with normative belief an independent predictor in all models except grain and dairy. DISCUSSION Meal selection behaviors, on average, were predicted by poor knowledge of U.S. Department of Agriculture recommendations. Dietary guidance appropriate to health literacy level should be incorporated into well-child visits.
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Sugiyama T, Horino M, Inoue K, Kobayashi Y, Shapiro MF, McCarthy WJ. Trends of Child's Weight Perception by Children, Parents, and Healthcare Professionals during the Time of Terminology Change in Childhood Obesity in the United States, 2005-2014. Child Obes 2016; 12:463-473. [PMID: 27710015 PMCID: PMC5107670 DOI: 10.1089/chi.2016.0128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the changes on self- and parental weight perceptions and parental communication with healthcare professionals (HCPs) in the United States during the mid-2000s period when the terminology changed for classifications of childhood obesity/overweight. METHODS A repeated cross-sectional study was conducted with 6799 children aged 8-15 years with the National Health and Nutrition Examination Survey 2005-2014. BMI was calculated from objectively measured heights and weights, and children were classified as normal/underweight, overweight or obese, using the new terminology. Children reported their own weight status. Parents reported their child's weight status and reported how HCPs described their children's weight status. Logistic regressions were used to investigate changes in weight perceptions among overweight/obese children themselves and their parents and parental communication with HCPs about children's overweight/obesity status during the time of the terminology change. RESULTS The proportion of parents told by HCPs about children's weight status increased for overweight children [6.8% in 2005-2006 to 18.8% in 2013-2014, p for trend (ptrend = 0.02)], and marginally increased between 2005-2006 (37.1%) and 2007-2008 (45.4%) for obese children (p = 0.09). However, parental perceptions for obese/overweight children did not change. Also, obese children's weight perception did not change, and the proportion of overweight children who perceived their weight status accurately declined in 2005-2012 (25.9%-16.4%, ptrend = 0.02). CONCLUSIONS Although the terminology change about childhood obesity/overweight was associated with increased communication about child's weight status by HCPs, the accuracy of weight perceptions among obese/overweight children or their parents did not improve or declined.
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Affiliation(s)
- Takehiro Sugiyama
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Masako Horino
- UCLA Center for Cancer Prevention and Control Research, Los Angeles, CA
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Kaori Inoue
- Department of Endocrinology and Metabolism, the Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan
| | - Yasuki Kobayashi
- Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Martin F. Shapiro
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
- Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - William J. McCarthy
- UCLA Center for Cancer Prevention and Control Research, Los Angeles, CA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
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McDonald SW, Ginez HK, Vinturache AE, Tough SC. Maternal perceptions of underweight and overweight for 6-8 years olds from a Canadian cohort: reporting weights, concerns and conversations with healthcare providers. BMJ Open 2016; 6:e012094. [PMID: 27798005 PMCID: PMC5073603 DOI: 10.1136/bmjopen-2016-012094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The majority of mothers do not correctly identify their child's weight status. The reasons for the misperception are not well understood. This study's objective was to describe maternal perceptions of their child's body mass index (BMI) and maternal report of weight concerns raised by a health professional. DESIGN Prospective, community-based cohort. PARTICIPANTS Data were collected in 2010 from 450 mothers previously included in a longitudinal birth cohort. Mothers of children aged 6-8 years reported their child's anthropometric measures and were surveyed concerning their opinion about their child's weight. They were also asked if a healthcare provider raised any concerns regarding their child's body weight. Child BMI was categorised according to the WHO Growth Charts adapted for Canada. Descriptive statistics and bivariate analyses were used to evaluate mothers' ability to correctly identify their children's body habitus. RESULTS 74% of children had a healthy BMI, 10% were underweight, 9% were overweight and 7% were obese. 80%, 89% and 62% of mothers with underweight, overweight and obese children, respectively, believed that their child was at the right weight. The proportion of mothers who recalled a health professional raising concerns about their child being underweight, overweight, and obese was low (12.5%). CONCLUSIONS The majority of mothers with children at unhealthy weights misclassified and normalised their child's weight status, and they did not recall a health professional raising concerns regarding their child's weight. The highest rates of child body weight misclassification occurred in overweight children. This suggests that there are missed opportunities for healthcare professionals to improve knowledge exchange and early interventions to assist parents to recognise and support healthy weights for their children.
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Affiliation(s)
- Sheila W McDonald
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Population, Public, and Aboriginal Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Heather K Ginez
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Angela E Vinturache
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Bocca G, Corpeleijn E, Broens J, Stolk RP, Sauer PJ. Dutch healthcare professionals inadequately perceived if three- and four-year-old preschool children were overweight. Acta Paediatr 2016; 105:1198-203. [PMID: 26676368 DOI: 10.1111/apa.13314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/11/2015] [Indexed: 11/29/2022]
Abstract
AIM We studied whether healthcare professionals adequately perceived if preschool children were overweight and whether this was influenced by their own body mass index (BMI). METHODS We sent 716 Dutch healthcare professionals questionnaires containing seven pictures and seven sketches of three- and four-year-old children showing body weights from underweight to morbidly obese. The professionals rated the pictures on a five-point scale from too heavy to too light and chose the sketch that they felt best depicted the child's body shape. They also reported their own height and weight and their BMI was calculated. RESULTS Of the 716 questionnaires, 346 (48.3%) were returned with complete information and analysed. Healthcare professionals mostly chose sketches that showed children as being lighter than they really were. Depending on their own BMI group, the overweight child was perceived as having a normal weight by 74-79% of the healthcare professionals. The obese children were rated correctly by 44-52% of the professionals, but 14-15% said their weight was normal. The morbidly obese child was adequately assessed by 93-98% of the professionals. CONCLUSION Healthcare professionals inadequately perceived whether three- and four-year-old children were overweight and this may have hindered early interventions, leading to overweight children becoming overweight adolescents.
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Affiliation(s)
- Gianni Bocca
- Department of Paediatrics; Beatrix Children's Hospital; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Jasper Broens
- Department of Paediatrics; Beatrix Children's Hospital; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Ronald P. Stolk
- Department of Epidemiology; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
| | - Pieter J. Sauer
- Department of Paediatrics; Beatrix Children's Hospital; University of Groningen; University Medical Center Groningen; Groningen The Netherlands
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Armstrong SC, Skinner AC. Defining "Success" in Childhood Obesity Interventions in Primary Care. Pediatrics 2016; 138:peds.2016-2497. [PMID: 27621411 DOI: 10.1542/peds.2016-2497] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 12/30/2022] Open
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Duarte LS, Fujimori E, Minagawa Toriyama AT, Palombo CNT, Borges ALV, Kurihayashi AY. Brazilian Maternal Weight Perception and Satisfaction With Toddler Body Size: A Study in Primary Health Care. J Pediatr Nurs 2016; 31:490-7. [PMID: 27132799 DOI: 10.1016/j.pedn.2016.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 03/15/2016] [Accepted: 03/31/2016] [Indexed: 11/15/2022]
Abstract
UNLABELLED Maternal perception and satisfaction with child's weight status are important to detect early and to successfully treat the extremes in weight, especially during early childhood, when the child is more dependent on maternal care. OBJECTIVES To assess the inaccuracy of maternal perception of toddler body size and its associated factors and to analyze maternal dissatisfaction with toddler body size. METHODS Cross-sectional study with 135 mother-toddler dyads attending Primary Health Care Facilities, São Paulo, Brazil. Children's actual weight status was classified using body mass index-for-age. Inaccuracy and dissatisfaction were assessed using an image scale. We used logistic regression to identify the factors associated with inaccuracy of maternal perception of toddler body size. RESULTS Inaccuracy in maternal perception was observed in 34.8% of participants. Mothers of excessive weight children were more likely to have inaccurate perceptions (OR=4.6; 95% CI 2.0-10.7), and mothers of children who attended well-child care were less likely to have inaccurate perceptions (OR=0.3, 95% CI 0.1-0.9). More than half of mothers (52.6%) were dissatisfied with their toddler's size and desired a larger child (75.0% of mothers of underweight children, 25.0% of mothers whose children were at risk for overweight and 23.0% of mothers of overweight children). CONCLUSION The majority of mothers were inaccurate in their perception and was dissatisfied with their toddler's body size. Maternal inaccuracy and dissatisfaction differed by the weight status of the toddler. Attendance at well-child visits was an effective way to decrease maternal inaccuracy, which reinforces the importance of the influence of health professionals.
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Affiliation(s)
- Luciane Simões Duarte
- Public Health Nursing Department of University of São Paulo School of Nursing, Brazil.
| | - Elizabeth Fujimori
- Public Health Nursing Department of University of São Paulo School of Nursing, Brazil
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Abstract
Guided by the social cognitive theory, this randomized controlled trial tested the “Make a Move,” a provider-led intervention for Head Start parents aimed to produce changes in the outcomes of knowledge, attitude, and behavior of physical activity and healthy eating. Participants were parents of children ages 3–5 years enrolled in a Head Start program. Participants completed a 57-item questionnaire at baseline and postintervention. The Wilcoxon rank-sum test revealed a statistically significant difference between the intervention and control groups in scores on knowledge of healthy eating ( z = 1.99, p = .05), attitude of physical activity ( z = 2.71, p < .01), and behavior of physical activity ( z = 2.03, p = .04). Ten participants (77%) completed all four intervention sessions. This study provided new insights into the relationship of a provider-led intervention with respect to knowledge, attitude, and behaviors in healthy eating and physical activity.
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Affiliation(s)
- Kimberly Nerud
- Nursing Department, Health Science Center, University of South Dakota, Sioux Falls, SD, USA
| | - Haifa (Abou). Samra
- Nursing Department, Health Science Center, University of South Dakota, Sioux Falls, SD, USA
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Karunanayake CP, Rennie DC, Hildebrand C, Lawson JA, Hagel L, Dosman JA, Pahwa P. Actual Body Weight and the Parent's Perspective of Child's Body Weight among Rural Canadian Children. CHILDREN-BASEL 2016; 3:children3030013. [PMID: 27527235 PMCID: PMC5039473 DOI: 10.3390/children3030013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 07/22/2016] [Accepted: 07/28/2016] [Indexed: 01/04/2023]
Abstract
The prevalence of being overweight during childhood continues to increase in the USA and Canada and children living in rural areas are more at risk than their urban counterparts. The objectives of this study were to evaluate how well the parent’s perception of their child’s weight status correlated with objectively measured weight status among a group of rural children and to identify predictors of inaccurate parental perceptions of child’s weight status. Participants were children from the Saskatchewan Rural Health Study conducted in 2010. Self-administered questionnaires were distributed through rural schools to parents of children in grades one to eight. Parents reported their child’s height and weight and rated their child’s weight status (underweight, just about the right weight, or overweight). Standardized body mass index (BMI) categories were calculated for clinically measured height and weight and for parental report of height and weight for 584 children. Logistic regression analysis was performed to identify predictors of misclassification of the parent’s perception of child’s weight status adjusting for potential confounders. Clinically measured overweight was much higher (26.5%) compared to parental perceived overweight (7.9%). The misclassification of the child’s BMI was more likely to occur if the child was a boy (odds ratio (OR) = 1.58) or non-Caucasian (OR = 2.03). Overweight was high in this group of rural children and parental perception of weight status underestimated the actual weight status of overweight school-age children. Parental reporting of child weight status has implications for public health policy and prevention strategies. Future research should focus on assessing longitudinal effects of parental misperceptions of child’s weight status.
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Affiliation(s)
- Chandima P. Karunanayake
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Box 23, 104, Clinic Place, Saskatoon, SK S7N 2Z4, Canada; (D.C.R.); (C.H.); (J.A.L.); (L.H.); (J.A.D.); (P.P.);
- Correspondence: ; Tel.: +306-966-1647
| | - Donna C. Rennie
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Box 23, 104, Clinic Place, Saskatoon, SK S7N 2Z4, Canada; (D.C.R.); (C.H.); (J.A.L.); (L.H.); (J.A.D.); (P.P.);
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada
| | - Carole Hildebrand
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Box 23, 104, Clinic Place, Saskatoon, SK S7N 2Z4, Canada; (D.C.R.); (C.H.); (J.A.L.); (L.H.); (J.A.D.); (P.P.);
| | - Joshua A. Lawson
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Box 23, 104, Clinic Place, Saskatoon, SK S7N 2Z4, Canada; (D.C.R.); (C.H.); (J.A.L.); (L.H.); (J.A.D.); (P.P.);
- Department of Medicine, College of Medicine, University of Saskatchewan, 5D40 Health Sciences Building, Box 19, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada
| | - Louise Hagel
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Box 23, 104, Clinic Place, Saskatoon, SK S7N 2Z4, Canada; (D.C.R.); (C.H.); (J.A.L.); (L.H.); (J.A.D.); (P.P.);
| | - James A. Dosman
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Box 23, 104, Clinic Place, Saskatoon, SK S7N 2Z4, Canada; (D.C.R.); (C.H.); (J.A.L.); (L.H.); (J.A.D.); (P.P.);
- Department of Medicine, College of Medicine, University of Saskatchewan, 5D40 Health Sciences Building, Box 19, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada
| | - Punam Pahwa
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Box 23, 104, Clinic Place, Saskatoon, SK S7N 2Z4, Canada; (D.C.R.); (C.H.); (J.A.L.); (L.H.); (J.A.D.); (P.P.);
- Department of Community Health and Epidemiology, University of Saskatchewan, Health Science Building, 104, Clinic Place, Saskatoon, SK S7N 5E5, Canada
| | - the Saskatchewan Rural Health Study Team
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Box 23, 104, Clinic Place, Saskatoon, SK S7N 2Z4, Canada; (D.C.R.); (C.H.); (J.A.L.); (L.H.); (J.A.D.); (P.P.);
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Redsell SA, Weng S, Swift JA, Nathan D, Glazebrook C. Validation, Optimal Threshold Determination, and Clinical Utility of the Infant Risk of Overweight Checklist for Early Prevention of Child Overweight. Child Obes 2016; 12:202-9. [PMID: 27093465 PMCID: PMC5118965 DOI: 10.1089/chi.2015.0246] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Previous research has demonstrated the predictive validity of the Infant Risk of Overweight Checklist (IROC). This study further establishes the predictive accuracy of the IROC using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) and examines the optimal threshold for determining high risk of childhood overweight. METHODS Using the IROC algorithm, we calculated the risk of being overweight, based on International Obesity Task Force criteria, in the first year of life for 980 children in the ALSPAC cohort at 5 years. Discrimination was assessed by the area under the receiver operating curve (AUC c-statistic). Net reclassification index (NRI) was calculated for risk thresholds ranging from 2.5% to 30%, which determine cutoffs for identifying infants at risk of becoming overweight. RESULTS At 5 years of age, 12.3% of boys and 19.6% of girls were categorized overweight. Discrimination (AUC c-statistic) ranged from 0.67 (95% confidence interval [CI], 0.62-0.72) when risk scores were calculated directly to 0.93 (95% CI, 0.88-0.98) when the algorithm was recalibrated and missing values of the risk factor algorithm were imputed. The NRI showed that there were positive gains in reclassification using risk thresholds from 5% to 20%, with the maximum NRI being at 10%. CONCLUSIONS This study confirms that the IROC has moderately good validity for assessing overweight risk in infants and offers an optimal threshold for determining high risk. The IROC algorithm has been imbedded into a computer program for Proactive Assessment of Obesity Risk during Infancy, which facilitates early overweight prevention through communication of risk to parents.
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Affiliation(s)
- Sarah A. Redsell
- Faculty of Health, Social Care, and Education, Anglia Ruskin University, Cambridge, United Kingdom
| | - Stephen Weng
- School of Medicine, Division of Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Judy A. Swift
- Faculty of Science, University of Nottingham, Sutton Bonington, United Kingdom
| | - Dilip Nathan
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, United Kingdom
| | - Cris Glazebrook
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
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Gauthier KI, Gance-Cleveland B. Hispanic parents' perceptions of their preschool children's weight status. J SPEC PEDIATR NURS 2016; 21:84-93. [PMID: 27079822 DOI: 10.1111/jspn.12143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/18/2016] [Accepted: 03/04/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to examine the accuracy of Hispanic parents' perceptions of their preschool children's weight status. DESIGN AND METHODS A cross-sectional descriptive design with Hispanic parent-child dyads (n = 83) from a Head Start setting was used to compare parents' perceptions of their children's weight status with their 2- to 5-year-old children's body mass index (BMI) and weight categories. Methods included a word choice from five response options, and varying body size silhouettes presented in a linear fashion and a random circular pattern. Parents' perceptions were compared with the children's BMI, and in relationship to parents' demographic characteristics and BMI. RESULTS Approximately half of parents underestimated their child's weight status, and overweight/obese parents tended to underestimate their overweight/obese children's weight status. PRACTICE IMPLICATIONS Eliciting parent perception of their child's weight is one way providers can engage in obesity prevention dialogue.
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Affiliation(s)
- Kristine I Gauthier
- Assistant Professor, University of Colorado, Anschutz Medical Campus, College of Nursing
| | - Bonnie Gance-Cleveland
- Professor, University of Colorado, Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
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Bucher Della Torre S, Dudley-Martin F, Kruseman M. 'Croque&bouge': A feasible and acceptable programme for obesity prevention in preschoolers at risk and their parents. SAGE Open Med 2016; 3:2050312115574365. [PMID: 26770769 PMCID: PMC4679228 DOI: 10.1177/2050312115574365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 01/27/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To conceptualize and pilot test a programme of three workshops aiming to prevent the development of overweight in susceptible preschool children. METHODS Three workshops were conducted, targeting both parents and children. The curriculum for parents included discussions on feeding responsibilities, healthy eating, taste development, neophobia and physical activity recommendations. Children participated in various play activities with fruits and vegetables and read stories about hunger and satiety feelings. Recruitment was organized through paediatricians and child-care centres. Evaluation of the programme focused on feasibility, adequacy for children's age, parents' perception of impact and, for children, change of the ability to recognize and willingness to taste fruits and vegetables. RESULTS A total of 21 children and one of their parents participated in the programme. The programme was found to be feasible and adequate for the targeted community. Parents reported perceiving a positive impact of the intervention; however, this finding was not statistically significant. The major difficulty was identifying and recruiting families and engaging the parents in a discussion about weight. CONCLUSIONS This short programme aiming to improve parents' ability to offer healthy environment and promote healthy eating behaviour was feasible and acceptable for families with young children. When developing and implementing such programmes, close collaboration with paediatricians and other health providers should be sought in order to identify and reach children at risk of obesity and their family.
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Affiliation(s)
- Sophie Bucher Della Torre
- Nutrition and Dietetics Department, School of Health Professions - Geneva (HEdS-GE), University of Applied Sciences Western Switzerland (HES-SO), Carouge, Switzerland
| | - Fiona Dudley-Martin
- Nutrition and Dietetics Department, School of Health Professions - Geneva (HEdS-GE), University of Applied Sciences Western Switzerland (HES-SO), Carouge, Switzerland
| | - Maaike Kruseman
- Nutrition and Dietetics Department, School of Health Professions - Geneva (HEdS-GE), University of Applied Sciences Western Switzerland (HES-SO), Carouge, Switzerland
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Brown CL, Pesch MH, Perrin EM, Appugliese DP, Miller AL, Rosenblum K, Lumeng JC. Maternal Concern for Child Undereating. Acad Pediatr 2016; 16:777-782. [PMID: 27354196 PMCID: PMC5077664 DOI: 10.1016/j.acap.2016.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/02/2016] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe features of maternal concern for her child undereating; examine maternal and child correlates of maternal concern for undereating; and determine whether maternal concern for undereating is associated with feeding practices. METHODS This was a cross-sectional analysis of an observational study with 286 mother-child dyads (mean child age, 71 months). Maternal concern for undereating was assessed using a semistructured interview. Mothers completed questionnaires to assess picky eating, food neophobia, and feeding practices. Feeding practices were further assessed using videotaped mealtime observations. Logistic regression was used to assess the association of maternal and child characteristics with maternal concern for undereating. Regression was used to assess the association of maternal concern for undereating with feeding practices, controlling for covariates. RESULTS Over a third of mothers (36.5%) expressed concern that their child does not eat enough. Correlates of concern for undereating included child body mass index z-score (BMIz; odds ratio [OR] = 0.58; 95% confidence interval [CI], 0.43-0.77) and picky eating (OR = 2.41; 95% CI, 1.26-4.59). Maternal concern for undereating was associated with greater reported pressure to eat (relative risk [RR] = 1.97; 95% CI, 1.55-2.50), greater observed bribery (OR = 2.63; 95% CI, 1.50-4.60), and higher observed pressure (OR = 1.90; 95% CI, 1.08-3.36) during mealtimes. CONCLUSIONS Mothers of children who are picky eaters and have a lower BMIz are more likely to be concerned that their children do not eat enough, and maternal concern for undereating is associated with pressuring and bribing children to eat. Pediatricians might address maternal concern for undereating by advising feeding practices that do not involve pressure and bribery, particularly among healthy weight children.
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Affiliation(s)
- Callie L. Brown
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Megan H. Pesch
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Eliana M. Perrin
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | | | - Alison L. Miller
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan,Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Katherine Rosenblum
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Julie C. Lumeng
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan,Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan,Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
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Hernandez RG, Garcia J, Thompson DA. Racial-Ethnic Differences in Parental Body Image Perceptions of Preschoolers: Implications for Engaging Minority Parents in Weight-Related Discussions. Clin Pediatr (Phila) 2015; 54:1293-6. [PMID: 25609097 PMCID: PMC5094183 DOI: 10.1177/0009922814566933] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Parental misperception of minority preschoolers’ body image remains a major barrier to obesity prevention. Differences in child body image perception between Latino and African-American parents may inform etiologies to obesity disparities. Using pooled data from studies implementing validated child body sketches, frequency of parental misperception in these two populations are analyzed and associations with provider commentary and parental acculturation reported. Two convenience samples were utilized (Latino parents: n=73, African-American parents: n=150). Over half of Latino parents (58%) compared to 5% of African-American parents misperceived their obese child as lighter than a healthy weight (p=.002). In contrast to our prior study, provider commentary was not associated with reduced risk of misperception in Latino parents. Misperception occurred most frequently in mild-moderately acculturated Latino parents. Increased rates of misperception and limitations on the potential role of the provider commentary indicate a critical need to better strategize communication with low-income, moderately acculturated Latino parents.
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Affiliation(s)
- Raquel G. Hernandez
- All Children’s Hospital, Johns Hopkins Medicine St. Petersburg Florida,Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore MD
| | - Janelle Garcia
- All Children’s Hospital, Johns Hopkins Medicine St. Petersburg Florida
| | - Darcy A. Thompson
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO
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Upperman C, Palmieri P, Lin H, Flores G, Turer CB. What do parents want for their children who are overweight when visiting the paediatrician? Obes Sci Pract 2015; 1:33-40. [PMID: 28580163 PMCID: PMC5450825 DOI: 10.1002/osp4.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective The objective of this study was to determine whether parental preferences regarding primary care weight‐management strategies differ by child age, gender, overweight severity, race/ethnicity or parental agreement that their child is overweight. Methods A survey was administered to parents of 2‐ to 18‐year‐old children who are overweight at an academic primary‐care clinic regarding perception of child overweight, helpful/harmfulness of having the child present during weight discussions, and dietary‐advice preferences. Multivariable analyses examined factors associated with preferred weight‐management strategies, after adjustment for parent/child characteristics. Results Eighty‐three per cent of parents agreed that a child's presence during weight discussions is helpful/very helpful, 74% that paediatricians should prescribe specific diets, and 55% preferred specific vs. general dietary advice only (N = 219). In multivariable analyses, characteristics associated with helpfulness of child presence included older child age (vs. 2–5 year olds, 6–11 year olds: odds ratio [OR], 4.6; 95% CI, 1.3–16; 12‐ to 18‐year‐olds: OR, 23; 95% CI, 4–136), male gender (OR, 5.0; 95% CI, 1.7–10) and obesity (vs. overweight: OR, 2.8; 95% CI, 1.7–12). Characteristics associated with preferring specific diets included Latino race/ethnicity (OR, 5.3; 95% CI, 3–12), older age (vs. 2–5 year olds, 6–11 year olds: OR, 2.8; 95% CI, 1.1–7; 12–18 year olds: OR, 3.7; 95% CI, 1.5–10) and agreement that the child is overweight (OR, 2.3; 95% CI, 1.1–5) and, for specific dietary advice, older age (vs. 2–5 year olds: OR, 2.3; 95% CI, 1.1–5) and agreement that the child is overweight (OR, 2.1; 95% CI, 1.2–4). Conclusions Findings suggest that weight‐management strategies tailored to child age, gender, overweight severity, race/ethnicity and parental agreement that their child is overweight may prove useful in improving child weight status.
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Affiliation(s)
- C. Upperman
- School of Medicine; UT Southwestern Medical Center; Dallas TX USA
| | - P. Palmieri
- Department of Pediatrics; UT Southwestern and Children's Medical Center; Dallas TX USA
| | - H. Lin
- Department of Pediatrics; UT Southwestern Medical Center; Dallas TX USA
| | - G. Flores
- Department of Pediatrics; UT Southwestern and Children's Medical Center; Dallas TX USA
| | - C. B. Turer
- Department of Pediatrics; UT Southwestern and Children's Medical Center; Dallas TX USA
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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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Natale R, Uhlhorn SB, Lopez-Mitnik G, Camejo S, Englebert N, Delamater AM, Messiah SE. Caregiver’s Country of Birth Is a Significant Determinant of Accurate Perception of Preschool-Age Children’s Weight. HEALTH EDUCATION & BEHAVIOR 2015; 43:191-200. [DOI: 10.1177/1090198115599395] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. One in four preschool-age children in the United States are currently overweight or obese. Previous studies have shown that caregivers of this age group often have difficulty accurately recognizing their child’s weight status. The purpose of this study was to examine factors associated with accurate/inaccurate perception of child body mass index (BMI) among a multicultural sample of caregivers who were predominantly low-income and foreign-born. Methods. A total of 980 caregivers (72% Hispanic, 71% born outside of the United States) of preschool-age children ( N = 1,105) were asked if their child was normal weight, overweight, or obese. Answers were compared to actual child BMI percentile category via chi-square analysis. Logistic regression analysis was performed to assess predictors of accurate perception of child BMI percentile category. Results. More than one third of preschoolers were either overweight (18.4%) or obese (16.5%). The majority (92%) of caregivers of an overweight/obese child inaccurately perceived that their child was in a normal BMI category. Overall, foreign-born caregivers were significantly less likely to accurately perceive their child’s BMI percentile category versus U.S.-born caregivers (odds ratio [OR] = 0.65, 95% confidence interval [CI] = 0.48-0.88). Specifically, those born in South America (OR = 0.59, 95% CI = 0.36-0.98), Central America/Mexico (OR = 0.59, 95% CI = 0.41-0.85), and Caribbean Hispanic nations (OR = 0.54, 95% CI = 0.35-0.83) were significantly less likely to accurately perceive their child’s BMI category versus U.S.-born caregivers. Conclusions. The results of this study suggest that foreign-born caregivers of U.S. preschool-age overweight/obese children in particular do not accurately perceive their child’s BMI status. Health care professionals serving foreign-born caregivers may consider additional culturally appropriate healthy weight counseling for these families.
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Affiliation(s)
- Ruby Natale
- University of Miami Miller School of Medicine, Miami, FL, USA
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Welsh JA, Nelson JM, Walsh S, Sealer H, Palmer W, Vos MB. Brief training in patient-centered counseling for healthy weight management increases counseling self-efficacy and goal setting among pediatric primary care providers: results of a pilot program. Clin Pediatr (Phila) 2015; 54:425-9. [PMID: 25336443 DOI: 10.1177/0009922814553432] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND We hypothesized that training in patient-centered counseling would improve self-efficacy and quality of weight management-related counseling provided by pediatric primary care physicians (PCPs). METHODS A total of 36 PCPs attended a brief (2-hour) training and consented to participate in an evaluation. Training impact was assessed using self-administered, pretraining and posttraining surveys and a review of patient charts from prior to and from 6 and 12 months after training for a random subsample of 19 PCPs (10 charts/timepoint per PCP). RESULTS Self-reported effectiveness at obesity prevention and treatment increased from 16.7% to 44.4% (P = .01) and from 19.4% to 55.6% (P < .001), respectively. Self-efficacy in counseling and motivating patients increased from 44.4% to 80.6% (P < .001) and 27.8% to 63.9% (P < .001), respectively. Goal documentation increased from 3.9% to 16.4% and 57.9% at 6 months and 12 months posttraining, respectively. CONCLUSIONS Brief training in patient-centered counseling appears to increase self-efficacy and the frequency and quality of weight-related counseling provided by PCPs.
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Affiliation(s)
- Jean A Welsh
- Children's Healthcare of Atlanta, Atlanta, GA, USA Emory University School of Medicine, Atlanta, GA, USA Nutrition and Health Sciences PhD Program, Emory University, Atlanta, GA, USA
| | | | - Stephanie Walsh
- Children's Healthcare of Atlanta, Atlanta, GA, USA Emory University School of Medicine, Atlanta, GA, USA
| | - Holly Sealer
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Wendy Palmer
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Miriam B Vos
- Children's Healthcare of Atlanta, Atlanta, GA, USA Emory University School of Medicine, Atlanta, GA, USA Nutrition and Health Sciences PhD Program, Emory University, Atlanta, GA, USA
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Nelson JM, Vos MB, Walsh SM, O'Brien LA, Welsh JA. Weight management-related assessment and counseling by primary care providers in an area of high childhood obesity prevalence: current practices and areas of opportunity. Child Obes 2015; 11:194-201. [PMID: 25585234 PMCID: PMC4382824 DOI: 10.1089/chi.2014.0052] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Childhood obesity in Georgia exceeds the national rate. The state's pediatric primary care providers (PCPs) are well positioned to support behavior change, but little is known about provider perceptions and practices regarding this role. PURPOSE The aim of this study was to assess and compare weight-management-related counseling perceptions and practices among Georgia's PCPs. METHODS In 2012-2013, 656 PCPs (265 pediatricians, 143 family practice physicians [FPs], and 248 nurse practitioners/physician assistants [NP/PAs]) completed a survey regarding weight-management-related practices at well-child visits before their voluntary participation in a free training on patient-centered counseling and child weight management. Data were analyzed in 2014. Likert scales were used to quantify responses from 1 (strongly disagree or never) to 5 (strongly agree or always). Responses of 4 and 5 responses were combined to denote agreement or usual practice. Chi-squared analyses tested for independent associations between pediatricians and others. Statistical significance was determined using two-sided tests and p value <0.05. RESULTS The majority of PCPs assessed fruit and vegetable intake (83%) and physical activity (78%), but pediatricians were more likely than FPs and NP/PAs to assess beverage intake (96% vs. 82-87%; p≤0.002) and screen time (86% vs. 74-75%; p≤0.003). Pediatricians were also more likely to counsel patients on lifestyle changes (88% vs. 71%; p<0.001) and to track progress (50% vs. 35-39%; p<0.05). Though all PCPs agreed that goal setting is an effective motivator (88%) and that behavior change increases with provider encouragement (85%), fewer were confident in their ability to counsel (72%). CONCLUSIONS Our results show that many PCPS in Georgia, particularly pediatricians, have incorporated weight management counseling into their practice; however, important opportunities to strengthen these efforts by targeting known high-risk behaviors remain.
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Affiliation(s)
| | - Miriam B. Vos
- Wellness Department, Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Nutrition and Health Sciences Program, Graduate School of Biological and Biomedical Sciences, Emory University, Atlanta, GA
| | - Stephanie M. Walsh
- Wellness Department, Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | | | - Jean A. Welsh
- Wellness Department, Children's Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Nutrition and Health Sciences Program, Graduate School of Biological and Biomedical Sciences, Emory University, Atlanta, GA
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Childhood Obesity Perceptions Among African American Caregivers in a Rural Georgia Community: A Mixed Methods Approach. J Community Health 2014; 40:367-78. [DOI: 10.1007/s10900-014-9945-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Black MM, Hager ER. Commentary: Pediatric obesity: systems science strategies for prevention. J Pediatr Psychol 2014; 38:1044-50. [PMID: 24013965 DOI: 10.1093/jpepsy/jst071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Pediatric obesity is a major public health problem that undermines the physical and mental health of children and increases their risk for adult obesity and other chronic illnesses. Although health care providers, including pediatric psychologists, have implemented prevention programs, effects have been minimal, with no solid evidence of sustainable programs. METHODS A systems science framework that incorporates the multiple interacting factors that influence pediatric obesity may be useful in guiding prevention. RESULTS The National Prevention Strategy provides recommendations that can be incorporated into systems science designs, including (1) Healthy and Safe Environments, (2) Clinical and Community Preventive Services, (3) Empowering People, and (4) Elimination of Health Disparities. In addition, our recommendation is that future obesity prevention programs target early in life (pre-pregnancy through toddlerhood) and use multilevel multidisciplinary designs. CONCLUSIONS The benefits of preventing pediatric obesity extend from the health and well-being of individual children to the economic security of the nation.
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Helton JJ, Liechty JM. Obesity prevalence among youth investigated for maltreatment in the United States. CHILD ABUSE & NEGLECT 2014; 38:768-775. [PMID: 24035366 DOI: 10.1016/j.chiabu.2013.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 08/09/2013] [Accepted: 08/16/2013] [Indexed: 06/02/2023]
Abstract
The objective of this study is to determine the prevalence and correlates of obesity among youth investigated for maltreatment in the United States. Participants were drawn from the National Survey of Child and Adolescent Well-Being II, a national probability study of 5,873 children aged birth to 17 years under investigation for maltreatment in 2008. From child weight reported by caregivers, we estimated obesity (weight-for-age ≥95th percentile) prevalence among children aged 2 through 17 (n=2,948). Sex-specific logistic regression models by developmental age were used to identify obesity risk factors, including child age, race/ethnicity, and maltreatment type. Obesity prevalence was 25.4% and was higher among boys than girls (30.0% vs. 20.8%). African American adolescent boys had a lower risk for obesity than white boys (OR=0.28, 95% CI [0.08, 0.94]). Compared with girls aged 2-5 with a neglect allegation, girls with a sexual abuse allegation were at greater risk for obesity (OR=3.54, 95% CI [1.01, 12.41]). Compared with adolescent boys with a neglect allegation, boys with a physical abuse allegation had a lower risk for obesity (OR=0.24, 95% CI [0.06, 0.99]). Adolescent girls with a prior family history of investigation were at greater risk for obesity than those without a history of investigation (OR=3.97, 95% CI [1.58, 10.02]). Youth investigated for maltreatment have high obesity rates compared with national peers. Opportunities to modify and evaluate related child welfare policies and health care practices should be pursued.
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Affiliation(s)
- Jesse J Helton
- School of Social Work and Children and Family Research Center, University of Illinois, Urbana, IL, USA
| | - Janet M Liechty
- School of Social Work and College of Medicine, University of Illinois, Urbana, IL, USA
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Abstract
BACKGROUND AND OBJECTIVE Parental perceptions of their children's weight play an important role in obesity prevention and treatment. The objective of this study was to determine the proportion of parents worldwide who underestimate their children's weight and moderators of such misperceptions. METHODS Original studies published to January 2013 were chosen through literature searches in PUBMED, PSYCHINFO, and CINAHL databases. References of retrieved articles were also searched for relevant studies. Studies were published in English and assessed parental perceptions of children's weight and then compared perceptions to recognized standards for defining overweight based on anthropometric measures. Data were extracted on study-level constructs, child- and parent-characteristics, procedural characteristics, and parental underestimates separately for normal-weight and overweight/obese samples. Pooled effect sizes were calculated using random-effects models and adjusted for publication bias. Moderators were explored using mixed-effect models. RESULTS A total of 69 articles (representing 78 samples; n = 15,791) were included in the overweight/obese meta-analysis. Adjusted effect sizes revealed that 50.7% (95% confidence interval 31.1%-70.2%) of parents underestimate their overweight/obese children's weight. Significant moderators of this effect included child's age and BMI. A total of 52 articles (representing 59 samples; n = 64,895) were included in the normal-weight meta-analysis. Pooled effect sizes indicated that 14.3% (95% confidence interval 11.7%-17.4%) of parents underestimate their children's normal-weight status. Significant moderators of this effect included child gender, parent weight, and the method (visual versus nonvisual) in which perception was assessed. CONCLUSIONS Half of parents underestimated their children's overweight/obese status and a significant minority underestimated children's normal weight. Pediatricians are well positioned to make efforts to remedy parental underestimates and promote adoption of healthy habits.
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Affiliation(s)
- Alyssa Lundahl
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska
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Correlates of parental misperception of their child's weight status: the 'be active, eat right' study. PLoS One 2014; 9:e88931. [PMID: 24551191 PMCID: PMC3925202 DOI: 10.1371/journal.pone.0088931] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 01/14/2014] [Indexed: 12/02/2022] Open
Abstract
Objective This study reported on correlates of parental perception of their child’s weight status. Associations between parental misperception (i.e., underestimation of the child’s weight) and parental intention to improve their child’s overweight-related health behaviors and their child meeting guidelines regarding these behaviors were also investigated. Methods Baseline data from the population-based ‘Be active, eat right study’ were used. The population for analysis consisted of 630 overweight and 153 obese five year-old children and their parents. Questionnaires were used to measure parental perception of the child’s weight status, correlates of misperception (i.e., child age, child gender, child BMI, parental age, parental gender, parental country of birth, parental educational level and parental weight status), overweight-related health behaviors (i.e., child playing outside, having breakfast, drinking sweet beverages, and watching TV), and parental intention to improve these behaviors. Height and weight were measured using standardized protocols. Multivariable logistic regression analyses were performed. Results In total, 44.40% of the parents misperceived their child’s weight status. Parental misperception was associated with lower child BMI, the parent being the father, a foreign parental country of birth, and a lower parental education level (p<0.05). Parental misperception was not associated with parental intention to improve child overweight-related health behavior, nor with child meeting the guidelines of these behaviors. Discussion This study showed that almost half of the parents with an overweight or obese child misperceived their child’s weight status. A correct parental perception may be a small stepping-stone in improving the health of overweight and obese children.
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Cloutier MM, Lucuara-Revelo P, Wakefield DB, Gorin AA. My Weight Ruler: a simple and effective tool to enhance parental understanding of child weight status. Prev Med 2013; 57:550-4. [PMID: 23872428 DOI: 10.1016/j.ypmed.2013.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 07/08/2013] [Accepted: 07/09/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare caregiver identification and understanding of body mass index percentile (BMI%) using the CDC Growth Chart and a newly adapted BMI ruler ("My Weight Ruler"). METHOD Between October 2009 and March 2010, eight focus groups with 27 low-income, minority caregivers with children 2-4 years of age were conducted to choose a meaningful tool to explain child weight status. A within-subject experiment comparing identification and interpretation of 2 BMI% plots (50th and 97th%) using the CDC Growth Chart and the selected tool was performed in February 2012 with 251 primary caregivers of children 2-4 years in a primary care clinic. RESULTS Caregivers chose the "BMI Ruler" a tool used in Arkansas, recommended culturally-responsive descriptors of weight status and renamed it "My Weight Ruler". 92% of caregivers reported having previously been explained the CDC Growth Chart; 37% correctly identified both plots. In contrast, 92% of caregivers correctly identified both plots on the My Weight Ruler and many interpreted the 97th% plot as a health risk and need to change behavior. CONCLUSION My Weight Ruler is a simple, easily understood tool of weight status for low-income, minority primary caregivers and could enhance parental knowledge and understanding of child weight status.
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Affiliation(s)
- Michelle M Cloutier
- Department of Pediatrics, University of Connecticut Health Care Center, 263 Farmington Avenue, Farmington, CT 06030, USA; Children's Center for Community Research, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA.
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Rossen LM, Tarasenko YN, Branum AM, Simon AE, Schoendorf KC. Abdominal adiposity and caregiver recall of healthcare provider identification of child overweight in the United States, 2001-2010. Child Obes 2013; 9:418-26. [PMID: 24028562 PMCID: PMC4655875 DOI: 10.1089/chi.2013.0051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND A minority of overweight or obese children are identified as such by a healthcare provider (HCP). The aim of this study was to examine characteristics of caregiver-reported HCP identification of overweight or obesity and whether it is associated with children's waist circumference (WC). METHODS This was an observational study using a nationally representative sample of 14,694 children (2-15 years of age) from the 2001-2010 National Health and Nutrition Examination Survey. Proxy respondents (i.e., caregivers) for 4906 overweight or obese (BMI≥85th percentile) children reported whether an HCP had ever told them that their child was overweight. Multi-variable logistic regression analyses were used to examine associations between reported HCP identification of overweight and child sociodemographic and anthropometric characteristics. RESULTS Over 75% of caregivers of overweight or obese children did not recall being notified of their child's weight status by an HCP, though this proportion has decreased over the past decade. A significant WC by weight status interaction indicated abdominal adiposity was positively associated with reported HCP identification for obese children, but not for overweight children. CONCLUSIONS Lower levels of reported HCP identification were observed for overweight children, compared to obese children; among obese children, those with lower levels of abdominal adiposity were less likely to be identified as overweight by an HCP, according to caregivers. Reasons for this finding remain unclear. Providers may be relying on a child's appearance, rather than universally screening all patients for overweight. Additionally, a variety of parent and provider characteristics may influence weight-related communications and caregiver recall of such information.
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Affiliation(s)
- Lauren M. Rossen
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Yelena N. Tarasenko
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD,Department of Health Policy and Management and the Department of Epidemiology, Georgia Southern University, Jiann-Ping Hsu College of Public Health, Statesboro, GA
| | - Amy M. Branum
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Alan E. Simon
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Kenneth C. Schoendorf
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
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Weng SF, Redsell SA, Nathan D, Swift JA, Yang M, Glazebrook C. Estimating overweight risk in childhood from predictors during infancy. Pediatrics 2013; 132:e414-21. [PMID: 23858427 DOI: 10.1542/peds.2012-3858] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The aim of this study was to develop and validate a risk score algorithm for childhood overweight based on a prediction model in infants. METHODS Analysis was conducted by using the UK Millennium Cohort Study. The cohort was divided randomly by using 80% of the sample for derivation of the risk algorithm and 20% of the sample for validation. Stepwise logistic regression determined a prediction model for childhood overweight at 3 years defined by the International Obesity Task Force criteria. Predictive metrics R(2), area under the receiver operating curve (AUROC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS Seven predictors were found to be significantly associated with overweight at 3 years in a mutually adjusted predictor model: gender, birth weight, weight gain, maternal prepregnancy BMI, paternal BMI, maternal smoking in pregnancy, and breastfeeding status. Risk scores ranged from 0 to 59 corresponding to a predicted risk from 4.1% to 73.8%. The model revealed moderately good predictive ability in both the derivation cohort (R(2) = 0.92, AUROC = 0.721, sensitivity = 0.699, specificity = 0.679, PPV = 38%, NPV = 87%) and validation cohort (R(2) = 0.84, AUROC = 0.755, sensitivity = 0.769, specificity = 0.665, PPV = 37%, NPV = 89%). CONCLUSIONS Using a prediction algorithm to identify at-risk infants could reduce levels of child overweight and obesity by enabling health professionals to target prevention more effectively. Further research needs to evaluate the clinical validity, feasibility, and acceptability of communicating this risk.
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Affiliation(s)
- Stephen F Weng
- Division of Psychiatry, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham NG7 2TU, United Kingdom
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41
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Jay M, Stepney C, Wijetunga NA, Akinrinade G, Dorsey K, Bruzzese JM. Accuracy of weight perception among urban early adolescents with uncontrolled asthma and their caregivers. Ann Behav Med 2013; 45:239-48. [PMID: 23355113 PMCID: PMC3602231 DOI: 10.1007/s12160-012-9452-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Obesity is associated with poor asthma outcomes; weight loss improves such outcomes. Inaccurate recognition of obesity may impede weight control. PURPOSE We examined perception of weight by early adolescents with uncontrolled asthma and their caregivers, and tested the relationship between medical visit frequency and accuracy of perceived weight status. METHODS A total of 373 adolescents and their caregivers reported the adolescent's height/weight and weight perception; caregivers reported healthcare utilization. We measured height/weight. Logistic regression modeled accuracy of weight perception. RESULTS A total of 43.7 % of the overweight/obese adolescents and caregivers accurately perceived weight status. BMI percentile [odds ratio (OR) = 1.19, confidence interval (CI) = 1.10-1.28] and total medical visits (OR = 1.18, CI = 1.05-1.33) were associated with higher accuracy in caregivers. Total medical visits (OR = 0.84, CI = 0.74-0.96) was associated with lower accuracy in adolescents. CONCLUSIONS Accurate perception of weight status was poor for overweight adolescents with uncontrolled asthma and their caregivers. Frequent medical visits were associated with improved caregivers' but not adolescents' perceptions.
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Affiliation(s)
- Melanie Jay
- NYU School of Medicine, Division of General Internal Medicine, New York, NY
| | | | - N. Ari Wijetunga
- Albert Einstein College of Medicine, Yeshiva University, Bronx, NY
| | - Grace Akinrinade
- NYU School of Medicine, Dept. of Child and Adolescent Psychiatry, New York, NY
| | - Karen Dorsey
- Yale University, School of Medicine, Dept. of Pediatrics, New Haven, CT
| | - Jean-Marie Bruzzese
- NYU School of Medicine, Dept. of Child and Adolescent Psychiatry, New York, NY
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Stracciolini A, Myer GD, Faigenbaum AD. Exercise-deficit disorder in children: are we ready to make this diagnosis? PHYSICIAN SPORTSMED 2013; 41:94-101. [PMID: 23445864 DOI: 10.3810/psm.2013.02.2003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Primary care physicians, particularly pediatricians, are expected to promote physical activity and prescribe exercise to patients. Unfortunately, many health care professionals do not have adequate skills or experience in this area, making exercise intervention logistically and psychologically challenging. Exercise-deficit disorder (EDD), which is a new term to the literature, is defined as reduced levels of moderate-to-vigorous physical activity, inconsistent with public health recommendations. Physicians are in a unique position to identify children who are deficient in exercise and initiate prevention strategies. To aid physicians in the diagnosis and treatment of children with EDD, we propose integrating exercise assessment into primary care practice, and, when appropriate, referral to a pediatric exercise specialist. This approach should ensure adequate development of muscle strength and motor skills that are required for successful physical activity participation. The timely identification of children with EDD is essential in preventing resistance to intervention. Connecting pediatric health care professionals with pediatric exercise specialists, culminating in an established professional collaborative system, is critical for promoting healthy behaviors throughout childhood and adolescence.
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Gee S, Chin D, Ackerson L, Woo D, Howell A. Prevalence of childhood and adolescent overweight and obesity from 2003 to 2010 in an integrated health care delivery system. J Obes 2013; 2013:417907. [PMID: 23970960 PMCID: PMC3732626 DOI: 10.1155/2013/417907] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 05/13/2013] [Accepted: 06/27/2013] [Indexed: 12/17/2022] Open
Abstract
An observational study of the Kaiser Permanente Northern California (KPNC) BMI coding distributions was conducted to ascertain the trends in overweight and obesity prevalence among KPNC members aged 2-19 between the periods of 2003-2005 and 2009-2010. A decrease in the prevalence of overweight (-11.1% change) and obesity (-3.6% change) and an increase in the prevalence of healthy weight (+2.7% change) were demonstrated. Children aged 2-5 had the greatest improvement in obesity prevalence (-11.5% change). Adolescents aged 12-19 were the only age group to not show a decrease in obesity prevalence. Of the racial and ethnic groups, Hispanics/Latinos had the highest prevalence of obesity across all age groups. The KPNC prevalence of overweight and obesity compares favorably to external benchmarks, although differences in methodologies limit our ability to draw conclusions. Physician counseling as well as weight management programs and sociodemographic factors may have contributed to the overall improvements in BMI in the KPNC population. Physician training, practice tools, automated BMI reminders and performance feedback improved the frequency and quality of physician counseling. BMI screening and counseling at urgent visits, in addition to well-child care visits, increased the reach and dose of physician counseling.
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Affiliation(s)
- Scott Gee
- Prevention & Health Information, Regional Health Education, The Permanente Medical Group, Inc., 1950 Franklin Street, 13th Floor, Oakland, CA 94612, USA.
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44
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Rietmeijer‐Mentink M, Paulis WD, van Middelkoop M, Bindels PJ, van der Wouden JC. Difference between parental perception and actual weight status of children: a systematic review. MATERNAL & CHILD NUTRITION 2013; 9:3-22. [PMID: 23020552 PMCID: PMC6860751 DOI: 10.1111/j.1740-8709.2012.00462.x] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
An increasing number of children worldwide are overweight, and the first step in treating obesity is to identify overweight. However, do parents recognise overweight in their child and which factors influence parental perception? The aim of the present review is to systematically study differences between parental perception and the actual weight status of children. Medline, EMbase, CINAHL and PsychINFO were searched. After screening 2497 abstracts and 106 full texts, two reviewers independently scored the methodological quality of 51 articles (covering 35 103 children), which fulfilled the inclusion criteria. The primary outcome parameters were sensitivity and specificity of parental perception for actual weight status of their child. The methodological quality of the studies ranged from poor to excellent. Pooled results showed that according to objective criteria 11 530 children were overweight; of these, 7191 (62.4%) were incorrectly perceived as having normal weight by their parents. The misperception of overweight children is higher in parents with children aged 2-6 years compared with parents of older children. Sensitivity (correct perception of overweight) of the studies ranged from 0.04 to 0.89, while specificity (correct perception of normal weight) ranged from 0.86 to 1.00. There were no significant differences in sensitivity or specificity for different cut-off points for overweight, or between newer and older studies. Therefore we can conclude that parents are likely to misperceive the weight status of their overweight child, especially in children aged 2-6 years. Because appropriate treatment starts with the correct perception of overweight, health care professionals should be aware of the frequent parental misperception of the overweight status of their children.
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Affiliation(s)
| | - Winifred D. Paulis
- Department of General PracticeErasmus MCUniversity Medical CenterRotterdamThe Netherlands
| | | | - Patrick J.E. Bindels
- Department of General PracticeErasmus MCUniversity Medical CenterRotterdamThe Netherlands
| | - Johannes C. van der Wouden
- Department of General PracticeErasmus MCUniversity Medical CenterRotterdamThe Netherlands
- Department of General Practice and Elderly Care MedicineEMGO Institute for Health and Care ResearchVU University Medical CenterAmsterdamThe Netherlands
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45
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Hager ER, Candelaria M, Latta LW, Hurley KM, Wang Y, Caulfield LE, Black MM. Maternal perceptions of toddler body size: accuracy and satisfaction differ by toddler weight status. ACTA ACUST UNITED AC 2012; 166:417-22. [PMID: 22566540 DOI: 10.1001/archpediatrics.2011.1900] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To examine (1) accuracy of maternal perceptions of toddler body size; (2) factors associated with accuracy of toddler body size; and (3) how maternal satisfaction relates to accuracy/toddler body size. DESIGN Cross-sectional. SETTING Low-income community sample from suburban Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)/urban pediatric clinics. PARTICIPANTS Two hundred eighty-one mother-toddler dyads (toddlers: 54.1% male; mean age, 20.2 months; 70.8% African American; 8.5% underweight [<15th weight-for-length percentile]; and 29.2% overweight [≥85th weight-for-length percentile]). MAIN EXPOSURE Measured anthropometry (mother/toddler) and demographics. OUTCOME MEASURE Validated toddler silhouette scale (accuracy and satisfaction). RESULTS Nearly 70% of mothers were inaccurate in assessing their toddler's body size. Compared with mothers of healthy-weight toddlers, mothers of underweight toddlers were 9.13 times more likely to be accurate (95% CI, 2.94-28.36) and mothers of overweight toddlers were 87% less likely to be accurate (95% CI, 0.05-0.33); accuracy did not differ by toddler age, sex, or race or mother's education or weight status. More than 70% of all mothers and 81.7% of mothers of overweight toddlers were satisfied with their toddler's body size. Accurate mothers of underweight toddlers were less likely to be satisfied than accurate mothers of healthy-weight toddlers (30.0% vs 76.8%; P < .001). CONCLUSIONS Mothers of overweight toddlers had inaccurate perceptions of their toddler's body size and were highly satisfied, suggesting a view of heavy toddlers as normative. Mothers of underweight toddlers had accurate perceptions yet were dissatisfied, suggesting recognition of their child as outside the norm. Because inaccurate perceptions begin early in toddlerhood, pediatric providers should help improve families' understanding of healthy body size. Future studies should examine how satisfaction and accuracy relate to parenting behaviors.
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Affiliation(s)
- Erin R Hager
- Division of Growth and Nutrition, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
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46
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Liang L, Meyerhoefer C, Wang J. Obesity counseling by pediatric health professionals: an assessment using nationally representative data. Pediatrics 2012; 130:67-77. [PMID: 22665411 DOI: 10.1542/peds.2011-0596] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Examine the rate of screening for adolescent overweight and obesity by pediatric health care professionals and the provision of advice on healthy eating and physical activity. METHODS Our sample contains adolescents 11 to 17 years old (6911 girls and 6970 boys) from the 2001-2007 Medical Expenditure Panel Survey who reported having at least 1 health provider visit in the previous 12 months. Using logistic regression, we investigated factors associated with whether parents reported that their children were weighed and measured and whether they or their children received counseling on their eating habits and physical activity. All models were estimated separately by gender. RESULTS Forty-seven percent of girls and 44% of boys who visited a health provider were advised to eat healthy, and 36% of boys and girls were advised to exercise more. Obese boys and girls were both more likely to be advised to eat healthy (odds ratio [OR] = 2.10, P < .001 and OR = 1.70, P < .001) and exercise more (OR = 2.37, P < .001 and OR = 1.90, P < .001) than adolescents who have normal weight. However, overweight boys and girls were counseled at a much lower rate than those who were obese. Adolescents who were more likely to receive such advice lived in the northeast, were from higher-income households, had parents with at least some college education, and had a usual source of medical care. CONCLUSIONS Greater efforts should be made to incorporate guidelines on childhood obesity screening and counseling into clinical practice.
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Affiliation(s)
- Lan Liang
- Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland 20850, USA.
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47
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Hernandez RG, Thompson DA, Cheng TL, Serwint JR. Early-childhood obesity: how do low-income parents of preschoolers rank known risk factors? Clin Pediatr (Phila) 2012; 51:663-70. [PMID: 22496175 DOI: 10.1177/0009922812440841] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine parental rankings of known factors related to early-childhood obesity and compare reports between parents of healthy weight and overweight children. METHODS Parents of 2- to 5-year-old children seeking well-child care ranked card-sort statements including risks, barriers, and motivating factors for achieving a healthy weight child. Frequencies and means of ranked factors are reported and compared. RESULTS Of the 150 participants, few parents (7.4%) considered low levels of physical activity a top risk factor compared with other known risks. Inability to control the food choices of alternate caregivers was the greatest perceived barrier to achieving a healthy child weight (34%). There were no differences in rankings by child weight groups. CONCLUSION Low-income parents of preschoolers are aware of high-risk feeding behaviors, but few recognize the risk of inactivity in their young child. Innovations that promote adequate physical activity and engage influential caregivers during counseling are necessary.
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Affiliation(s)
- Raquel G Hernandez
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Bradford K, Kihlstrom M, Pointer I, Skinner AC, Slivka P, Perrin EM. Parental attitudes toward obesity and overweight screening and communication for hospitalized children. Hosp Pediatr 2012; 2:126-132. [PMID: 24319916 DOI: 10.1542/hpeds.2011-0036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Many studies have evaluated BMI screening, communication, and follow-up recommendations in the outpatient setting. However, few studies have examined parental attitudes toward using the inpatient setting as a time to screen and counsel families regarding their child's BMI. We sought to study parental attitudes about overweight and obesity screening in the inpatient setting. METHODS Parents (N= 101) of children aged 2 to 18 years admitted to a general pediatric hospital or surgical service were queried regarding their attitudes about screening and counseling for overweight and obesity. Children's age, gender, height, weight, and diagnosis codes were extracted from electronic medical records and billing databases. BMI was calculated, plotted, and categorized according to standard Centers for Disease Control and Prevention growth charts and expert recommendation. RESULTS Fourteen percent of children in the study were overweight, and 17% were obese. Parents of overweight and obese children underestimated their child's weight status 68% of the time. The majority believed admitted children should always have their BMI calculated. Almost all parents (90%) indicated that their inpatient physician should inform them if their child were overweight or obese and that primary care providers should be informed of the results of BMI screening. CONCLUSIONS Parents of children admitted to the hospital believed their children should have their BMI screened. If their child was overweight or obese, parents believed they should be informed, and counseling should be initiated. These findings support using the inpatient time to screen and communicate BMI.
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Affiliation(s)
- Kathleen Bradford
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7229, USA.
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Warschburger P, Kröller K. "Childhood overweight and obesity: maternal perceptions of the time for engaging in child weight management". BMC Public Health 2012; 12:295. [PMID: 22520114 PMCID: PMC3488478 DOI: 10.1186/1471-2458-12-295] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 04/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasing awareness of the impact of parental risk perception on the weight course of the child and the parent's readiness to engage in preventive efforts, but only less is known about factors related to the parental perception of the right time for the implementation of preventive activities. The aim of this study was to examine parental perceptions of the appropriate time to engage in child weight management strategies, and the factors associated with different weight points at which mothers recognize the need for preventive actions. METHODS 352 mothers with children aged 2-10 years took part in the study. We assessed mothers' perceptions of the actual and preferred weight status of their child, their ability to identify overweight and knowledge of its associated health risks, as well as perceptions of the right time for action to prevent overweight in their child. A regression analysis was conducted to examine whether demographic and weight related factors as well as the maternal general risk perception were associated with recognizing the need to implement prevention strategies. RESULTS Although most of the parents considered a BMI in the 75th to 90th percentile a valid reason to engage in the prevention of overweight, 19% of the mothers were not willing to engage in prevention until their child reached the 97th percentile. Whereas the child's sex and the identification of an elevated BMI were significant predictors for parents' recognition of the 75th percentile as right point to engage in prevention efforts, an inability to recognize physical health risks associated with overweight silhouettes emerged as a significant factor predicting which parents would delay prevention efforts until a child's BMI reached the 97th percentile. CONCLUSION Parental misperceptions of overweight and associated health risks constitute unfavorable conditions for preventive actions. Feedback on the health risks associated with overweight could help increase maternal readiness for change.
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Affiliation(s)
- Petra Warschburger
- Department of Psychology, University of Potsdam, Karl-Liebknecht-Str, 24/25, 14476, Potsdam, Germany.
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Faith MS, Van Horn L, Appel LJ, Burke LE, Carson JAS, Franch HA, Jakicic JM, Kral TV, Odoms-Young A, Wansink B, Wylie-Rosett J. Evaluating Parents and Adult Caregivers as “Agents of Change” for Treating Obese Children: Evidence for Parent Behavior Change Strategies and Research Gaps. Circulation 2012; 125:1186-207. [DOI: 10.1161/cir.0b013e31824607ee] [Citation(s) in RCA: 187] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This scientific statement addresses parents and adult caregivers (PACs) as “agents of change” for obese children, evaluating the strength of evidence that particular parenting strategies can leverage behavior change and reduce positive energy balance in obese youth. The statement has 3 specific aims. The first is to review core behavior change strategies for PACs as used in family-based treatment programs and to provide a resource list. The second is to evaluate the strength of evidence that greater parental “involvement” in treatment is associated with better reductions in child overweight. The third is to identify research gaps and new opportunities for the field. This review yielded limited and inconsistent evidence from randomized controlled clinical trials that greater PAC involvement necessarily is associated with better child outcomes. For example, only 17% of the intervention studies reported differential improvements in child overweight as a function of parental involvement in treatment. On the other hand, greater parental adherence with core behavior change strategies predicted better child weight outcomes after 2 and 5 years in some studies. Thus, the literature lacks conclusive evidence that one particular parenting strategy or approach causally is superior to others in which children have a greater focus in treatment. A number of research gaps were identified, including the assessment of refined parenting phenotypes, cultural tailoring of interventions, examination of family relationships, and incorporation of new technologies. A conceptual model is proposed to stimulate research identifying the determinants of PAC feeding and physical activity parenting practices, the results of which may inform new treatments. The statement addresses the need for innovative research to advance the scope and potency of PAC treatments for childhood obesity.
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