Piloting a Community-Based, Culturally Adapted Health Promotion Program for Children with Autism Spectrum Disorder and Developmental Disabilities in First-Generation Korean Immigrant Families

Children with autism spectrum disorder and developmental disabilities (ASD/DD) face barriers to participation in health promotion programs due to the lack of available and/or affordable programs and trained staff at recreation centers. Children with ASD/DD in Korean immigrant families are one of the most underserved minority groups due to language, racial/ethnic discrimination, and stigma and shame within their own ethnic community. However, little research is available on development, implementation, and evaluation of a culturally adapted community health promotion program in this population. The purpose of this study is to assess effectiveness of a pilot program for children with ASD/DD from first-generation Korean immigrant families. The pilot study used a quantitative, quasiexperimental design (one-group design with pre- and posttest) following a seven-week health promotion program. We recruited 15 children with ASD/DD, ages nine through 16, from first-generation Korean immigrant families. The findings of the study suggest that the pilot program was effective in gaining nutrition knowledge and increasing physical involvement among participants. Given the fact that Asian immigrants are a fast-growing population and that nearly 75 percent of them were born abroad, development and evaluation of a community-based, culturally adapted health promotion program is urgently needed.

Underestimation of overweight weight status in children and adolescents aged 0-19 years: A systematic review and meta-analysis

BACKGROUND

Perceptions of children's weight status may be important in obesity prevention and treatment.

AIMS

This review identifies the prevalence of the underestimation of overweight status in children by parents/main carers, children, and healthcare professionals (HCP). The review critically synthesized both quantitative and qualitative evidence to explore the factors associated with this underestimation. The diverse methods used to assess this phenomenon are reported.

METHODS

Pooled effect sizes were calculated using random-effects model. Published studies, up to 2020, were accessed using the following search engines: CINAHL, EMBASE, PUBMED, and Psych-Info and including the "Cited by" and "Related Articles" functions. Hand-searching was used to retrieve further articles. Publication language and location had no bearing on the nature of the included studies.

RESULTS

A total of 91 articles were included. In the quantitative studies, 55% (95% CI 49%-61%) of caregivers underestimated their child's level of overweight and obesity using a verbal scale and 47% (95% CI 36%-55%) using visual scales. Of the children studied, 34% (95% CI 25%-43%) underestimated their own level of overweight and obesity using both scales. In (n = 3) articles, HCPs reflected this misperception, but limited studies prevented meta-analysis. Underestimation was associated with the child's age, gender, BMI and parental weight status, ethnicity and education. In the qualitative studies, parents/main carers of children with overweight and obesity described their child's weight in terms other than overweight, for example, "big boned," "thick," and "solid."

CONCLUSION

The results confirm the prevalence of underestimation of child overweight status across international studies. Understanding the factors which lead to this inaccuracy may help to improve communication within the therapeutic triad and facilitate the recognition and management of children's overweight status.

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

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

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

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

Parental misperceptions of children's underweight status: a meta-analysis

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.

Parental underestimates of child weight: a meta-analysis

BACKGROUND AND OBJECTIVE

Parental perceptions of their children's weight play an important role in obesity prevention and treatment. The objective of this study was to determine the proportion of parents worldwide who underestimate their children's weight and moderators of such misperceptions.

METHODS

Original studies published to January 2013 were chosen through literature searches in PUBMED, PSYCHINFO, and CINAHL databases. References of retrieved articles were also searched for relevant studies. Studies were published in English and assessed parental perceptions of children's weight and then compared perceptions to recognized standards for defining overweight based on anthropometric measures. Data were extracted on study-level constructs, child- and parent-characteristics, procedural characteristics, and parental underestimates separately for normal-weight and overweight/obese samples. Pooled effect sizes were calculated using random-effects models and adjusted for publication bias. Moderators were explored using mixed-effect models.

RESULTS

A total of 69 articles (representing 78 samples; n = 15,791) were included in the overweight/obese meta-analysis. Adjusted effect sizes revealed that 50.7% (95% confidence interval 31.1%-70.2%) of parents underestimate their overweight/obese children's weight. Significant moderators of this effect included child's age and BMI. A total of 52 articles (representing 59 samples; n = 64,895) were included in the normal-weight meta-analysis. Pooled effect sizes indicated that 14.3% (95% confidence interval 11.7%-17.4%) of parents underestimate their children's normal-weight status. Significant moderators of this effect included child gender, parent weight, and the method (visual versus nonvisual) in which perception was assessed.

CONCLUSIONS

Half of parents underestimated their children's overweight/obese status and a significant minority underestimated children's normal weight. Pediatricians are well positioned to make efforts to remedy parental underestimates and promote adoption of healthy habits.

Parental factors associated with obesity in children with disability: a systematic review

The current literature on obesity in typically developing children shows that the family context, and specifically the way parents parent their children are major determinants of childhood obesity. The influence of these factors on obesity in children with disability, however, remains unclear. A systematic review of the literature was undertaken to identify the parental and parenting risk factors associated with obesity in children and adolescents with disability. Articles were identified through Medline, Academic Search Complete, PsycINFO, ProQuest, ISI, CINAHL, Cochrane and Scopus databases. There was no restriction on publication dates. The inclusion criteria were empirical papers that tested associations between parental and parenting risk factors and obesity in children and adolescents with intellectual and other developmental disabilities. Only 11 studies met the selection criteria and subsequently included in this review. Results suggest that obesity in children and adolescents with disability may be associated with socioeconomic status; parents' body mass index, perception and attitude towards their children's weight and physical activity; and levels of activity in both parents and children. Firm conclusions about these associations cannot be reached, however, due to mixed findings and methodological limitations of the studies. Recommendations for future research are provided.

The prevalence and determinants of overweight and obesity among French youths and adults with intellectual disabilities attending special education schools

This study examines the prevalence of overweight and obesity and a panel of potential determinants among French youths and adults with an intellectual disability (ID). The sample used consisted of 1120 youths and adults with an ID, from 5 to 28 years old, attending a French special education school. The results indicated that 19.8% of the participants with an ID are classified as overweight and 8.6% as obese. Multivariate logistic regression analyses revealed that there are nearly three times more girls/women classified as overweight than boys/men. Additionally, they showed that there are nearly two times more participants from southern France classified as overweight than from northern France, and that the risk of being classified as overweight significantly increases with seniority in the school. Next, the interaction effects observed indicated first that there are nearly two times more boys/men on psychotropic medication classified as overweight than boys/men not on psychotropic medication. Second, they revealed that the odds of being classified as overweight for boys/men not on psychotropic medication are 47% lower than for girls/women not on psychotropic medication. Third, they indicated that there are nearly two times more boys/men from southern France classified as obese than boys/men from northern France. Fourth, they showed that the odds of being classified as obese for boys/men from northern France are 52% lower than for girls/women from northern France. In conclusion, these results should be viewed as preliminary and need to be replicated since, to our knowledge, this study is the first one to examine this topic while simultaneously controlling for all of the potential determinants and relying on a sample of youths and adults.