Is parental control over children's eating associated with childhood obesity? Results from a population-based sample of third graders

OBJECTIVE: Identifying parental behaviors that influence childhood obesity is critical for the development of effective prevention and treatment programs. Findings from a prior laboratory study suggest that parents who impose control over their children's eating may interfere with their children's ability to regulate intake, potentially resulting in overweight. These findings have been widely endorsed; however, the direct relationship between parental control of children's intake and their children's degree of overweight has not been shown in a generalized sample. RESEARCH METHODS AND PROCEDURES: This study surveyed 792 third-grade children with diverse ethnic and socioeconomic backgrounds from 13 public elementary schools. Parental control over children's intake was assessed through telephone interviews using a state-of-the-art instrument, and children were measured for height, weight, and triceps skinfold thickness. RESULTS: Counter to the hypothesis, parental control over children's intake was inversely associated with overweight in girls, as measured by body mass index, r = -0.12, p < 0.05, and triceps skinfolds, r = -0.11, p < 0.05. This weak relationship became only marginally significant when controlling for parents' perceptions of their own weight, level of household education, and children's age. No relationship between parental control of children's intake and their children's degree of overweight was found in boys. DISCUSSION: Previous observations of the influence of parental control over children's intake in middle-class white families did not generalize to 8- to 9-year-olds in families with diverse socioeconomic and ethnic backgrounds. The present findings reveal a more complex relationship between parental behaviors and children's weight status.     

Childhood obesity among Puerto Rican children: discrepancies between child's and parent's perception of weight status

Public concern about childhood obesity and associated health problems calls for the identification of modifiable factors that could halt this epidemic. Parental perceptions of their children's weight status could be associated to how parents influence children's eating patterns. We aimed to identify the perceptions Puerto Rican parents have of their children's weight and children's own perceptions of weight status as compared to real weight. A cross sectional survey was performed in a representative sample of 1st-6th grade students. Only half of the children correctly identified their weight, and only 62.4% of the parents correctly classified their children's weight. Most obese/overweight children did not perceive themselves as such. Almost half of obese/overweight children were identified by the parents as normal weight while over half of the underweight children were perceived by their parents at normal weight. More girls than boys perceived themselves as obese/overweight and more parents of girls than of boys perceived them as such. Higher-educated parents were better at recognizing overweight/obesity among their children compared to less-educated parents. This study suggests an influence of parents' SES characteristics on their perceptions of children's weight status as well as on children's own perceptions of their weight status.     

Accuracy of maternal reports of pre-schoolers' weights and heights as estimates of BMI values

BACKGROUND: Data is lacking on the reliability of weight and height for young children as reported by parents participating in population-based studies. We analysed the accuracy of parental reports of children's weights and heights as estimates of body mass index, and evaluated the factors associated with the misclassification of overweight and obese children. METHODS: Analyses were conducted on a population-based birth cohort of 1549 4-year-old children from the province of Québec (Canada) in 2002. Mothers reported weights and heights for the children as part of the regular annual data collection. Within the following 3 months, children's weights and heights were measured at home as part of a nutrition survey. RESULTS: This study indicates that mothers overestimate their children's weight more than their height, resulting in an overestimation of overweight children of more than 3% in the studied population. Only 58% of the children were reported as overweight/obese with reported values. Maternal misreporting is more important for boys than girls, and for low socioeconomic status children compared with high socioeconomic status children. CONCLUSIONS: Research on the prevalence of overweight and obesity has often used self-reported measures of height and weight to estimate BMI. However, the results emphasize the importance of collecting measured data in childhood studies of overweight and obesity at the population level.     

Determinants of Childhood Obesity and Association with Maternal Perceptions of Their Children's Weight Status: The “GENESIS” Study

Prevention of early childhood obesity requires a clear understanding of its determinants. This study examined perinatal, parental, and lifestyle determinants of childhood obesity and how these factors are associated with maternal misperceptions of their children's weight status. The current work presents a cross-sectional analysis of 2,374 children, age 1 to 5 years, living in Greece (April 2003 to July 2004). The 2000 Centers for Disease Control and Prevention growth charts were used to classify children as overweight (≥85th and <95th body mass index [BMI]-for-age percentile for children older than 24 months) and obese (≥95th weight-for-length percentile for children younger than 24 months and ≥95th BMI-for-age percentile for children older than 24 months). Maternal perceptions about their children's weight status were assessed via interviews with the mothers. Early infancy growth data were obtained from pediatric medical records. The present study showed that the prevalence of overweight and obesity was 16.2% and 17.5%, respectively. Each unit increase of maternal and paternal BMI significantly increased the likelihood of childhood obesity by a factor of 1.03 (95% confidence interval [CI]: 1.01 to 1.07) and 1.15 (95% CI: 1.10 to 1.20), respectively. Furthermore, children with a rapid weight gain in infancy were 1.9 (95% CI: 1.3 to 2.7) times more likely to be overweight and 1.5 (95% CI: 1.2 to 1.9) times more likely to have their weight status underestimated by their mother. In conclusion, rapid infancy weight gain and higher parental BMI were the main determinants of obesity in preschool years. Maternal underestimation of children's weight status was more likely for children with rapid weight gain in infancy.     

Exploring the Relationship Between Parental Concern and the Management of Childhood Obesity

Parental concern about child weight has been identified as a factor in parental monitoring and regulation of child diet. However, little is known about factors that influence parental concern or about how concern may influence parent management of child physical activity. The objectives of the current study were to identify the factors associated with parental concern about child weight and determine if parental concern is associated with specific actions to improve diet and increase physical activity. A stratified random sample of 1,500 parents of children in kindergarten, 2nd, 4th, 5th, 7th, and 9th grade were interviewed. Interviews addressed: (a) child and parent physical activity, (b) child and family nutrition, (c) child and parent BMI weight category, (d) interactions with health care providers, (e) parent obesity knowledge, (f) school assessment of BMI, and (g) parent perception of and concern about child weight. Child gender, weight status, and parent perception of child weight were significant predictors of parental concern. Parents were significantly more likely to report concern if their child was female, they believed their child to be overweight/obese, or their child was overweight/obese as indicated by BMI percentile. Concerned parents were significantly more likely to limit child screen time, take steps to improve child diet, and increase child physical activity than were parents who reported no concern. Treatment and prevention efforts should emphasize parental concern and awareness about child weight by providing accurate feedback on child weight status and education regarding the health risks associated with childhood overweight and obesity. Schools can play an important role in this process through the incorporation of BMI screenings.     

Parental influence on obesity in Northern Plains American Indian youth

Little is known regarding American Indian (AI) parental influence on children's diet and physical activity (PA), or if this influence is associated with childhood weight. We compared AI parents' diet, PA, and support for these behaviors with the child's body mass index. Scores for parental support of positive PA and diet were higher among parents of overweight/obese children. Parent PA and nutrition behaviors were in a similar, but not significant, direction with respect to child body mass index. Findings suggest that future research is needed to determine what parental, societal, or community variables influence AI children to engage in healthy eating and PA, especially if they are overweight or obese, and the age at which these variables would have the most impact on these behaviors.     

Parent's socioeconomic status,adolescents' disposable income,and adolescents' smoking status in Massachusetts

OBJECTIVES: This study examined the association between parental socioeconomic status (SES) and adolescent smoking. METHODS: We conducted telephone interviews with a probability sample of 1308 Massachusetts adolescents aged 12 to 17 years. We used multiple-variable-adjusted logistic regression models. RESULTS: The risk of adolescent smoking increased by 28% with each step down in parental education and increased by 30% for each step down in parental household income. These associations persisted after adjustment for age, sex, race/ethnicity, and adolescent disposable income. Parental smoking status was a mediator of these associations. CONCLUSIONS: Parental SES is inversely associated with adolescent smoking. Parental smoking is a mediator but does not fully explain the association.     

Children at high risk for overweight: a classification and regression trees analysis approach

OBJECTIVE: Early identification of children at high risk for childhood overweight is a major challenge in fighting the obesity epidemic. We tried to identify the most powerful set of combined predictors for childhood overweight at school entry. RESEARCH METHODS AND PROCEDURES: A classification and regression trees analysis on risk factors for childhood overweight in 4289 children 5 to 6 years of age participating in the obligatory school entry health examination 2001/2002 in Bavaria, Germany, was performed. Parental questionnaires asked for children's weight at birth and 2 years, breastfeeding history, maternal smoking in pregnancy, parental education, parental overweight/obesity, nationality, and number of older siblings. Overweight was defined according to sex- and age-specific BMI cut-points proposed by the International Obesity Task Force. RESULTS: Prevalence of overweight was 11% among the entire study population. Although high early weight gain >10,000 grams was found in about one-half of the overweight children, its positive predictive value reached only 25%, indicating that one of four children with a high early weight gain is overweight at school entry. The best reliable set of predictors included high early weight gain and obese parents and accounted for a likelihood ratio of 3.6, with a corresponding positive predictive value of 40%, and was found in 4% of all children. DISCUSSION: A combination of predictors available at 2 years of age could improve predictability of overweight at school entry. However, corresponding low positive predictive values indicate a precision of the prediction that might be insufficient for targeting intervention programs for identified high-risk children.     

Trajectories of Overweight Among US School Children: A Focus on Social and Economic Characteristics

Much of the research examining the patterns, timing, and socioeconomic characteristics of child overweight has been limited by the lack of longitudinal nationally representative data with sufficiently large or diverse samples. We used the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K), a nationally representative sample of US kindergartners, to identify three distinct patterns of weight gain from kindergarten through eighth grade. The largest group (boys: 59%, girls: 55%) was characterized as having consistently normal weight whereby BMI percentile remained below the 85th percentile. The remaining children (boys: 41%, girls: 45%) fell either into a class characterized as always overweight/at risk of overweight (boys: 27%, girls: 25%) or gradually becoming overweight/at risk for overweight (boys: 15%, girls 20%). We found some evidence that the relationship between socioeconomic status and children’s health may operate differently across gender. Among girls, low parental income and education were both significant risk factors for the gradual onset of overweight after beginning Kindergarten. Parental income or changes in parental income were not related to boys’ risk of developing overweight after entering Kindergarten; only parents’ education. We found that while children of immigrants display higher levels of overweight/at risk for overweight at each grade level, the children of immigrant parents who have had less exposure to the US were more likely to experience early and sustained overweight throughout elementary and middle school, particularly among boys. High rates of overweight as early as kindergarten, combined with race/ethnic differences suggest that interventions should focus on pre-school children’s environments.     

Family-Based Treatment for Pediatric Overweight: Parental Weight Loss as a Predictor of Children's Treatment Success

This study examined the relative influence of nutrition and exercise education, behavioral therapy, and parental weight loss on children's weight-related treatment outcomes. Participants included 65 children and their parents who were participating in an evidence-based multicomponential pediatric overweight intervention program. After accounting for age and sex, children's attendance at group treatment and change in health knowledge predicted 9.7% and 5.8% of the variance in children's weight change, respectively. However, the single greatest predictor of change in children's body mass index was parent weight loss, which accounted for 18.8% of the variance in the model. Findings suggest that although nutrition-exercise education and group therapy are beneficial, parental weight loss best predicts children's treatment outcomes.     

Association of reduction in parental overweight with reduction in children's overweight with a 3-year follow-up

BACKGROUND: Parental overweight has been reported to be a risk factor predicting obesity of their children. However, the effect of changes in parental overweight on the changes in children's overweight is not yet characterized. METHODS: Six hundred five children of 9-10 years underwent physical examinations and a survey concerning parents' body mass index (BMI) with a 3-year follow-up. RESULTS: In families where both parents' BMI was above 25 at baseline, when either parents' BMI decreased to less than 25 kg/m(2), children improved their adiposity, atherosclerosis index (AI), and systolic blood pressure (SBP). No such improvement was observed in children both of whose parents maintained BMI > or =25 kg/m(2). CONCLUSIONS: Improving parental overweight possibly reduced the risk of overweight in their children. Changes in parental overweight status were associated with changes in overweight status of their children.     

An empirical analysis of consumers’ attitudes toward pharmacies’ advertising

This study investigates current attitudes and opinions toward pharmacies’ advertising. The purposes of this study were to determine (a) consumers’ attitudes toward advertising by pharmacies and (b) whether age, race, income, marital status, occupation, education, sex, and number of children in household of the consumer accounted for any significant difference in attitudes toward pharmacies that advertise. The intent was to discover information that would be useful to pharmacies in planning marketing strategies and improving the quality of their advertising. The study seems to confirm the belief of many pharmacies that advertising and marketing clearly have a place in the future of pharmacists’ services.     

Television watching and frequency of family meals are predictive of overweight onset and persistence in a national sample of school-aged children

OBJECTIVE: To identify eating and activity factors associated with school-aged children's onset of overweight and persistent overweight. DESIGN: Data were gathered at four time points between kindergarten entry and spring of third grade. Children were directly weighed and measured and categorized as not overweight (<95th percentile of body mass index) or overweight (> or =95th percentile body mass index); parents were interviewed by telephone or in person. SUBJECTS/SETTING: Subjects were participants in the Early Childhood Longitudinal Study-Kindergarten Cohort, a nationally representative sample of children who entered kindergarten during 1998-1999. Children who weighed <2,000 g at birth, received therapeutic services before kindergarten, skipped or repeated a grade, or without complete height and weight data were excluded, resulting in 8,459 participants. Children with intermittent overweight were not examined (n=459); analyses addressed 8,000 children. MAIN OUTCOME MEASURES: Three mutually exclusive groups of children were identified: never overweight, overweight onset, and persistent overweight. STATISTICAL ANALYSES PERFORMED: Multilevel, multivariate logistic regression analyses estimated the effects of eating and activity factors on the odds of overweight onset and persistent overweight above child sex, race, and family socioeconomic status. RESULTS: Children who watched more television (odds ratio [OR] 1.02) and ate fewer family meals (OR 1.08) were more likely to be overweight for the first time at spring semester of third grade. Children who watched more television (OR 1.03), ate fewer family meals (OR 1.08), and lived in neighborhoods perceived by parents as less safe for outdoor play (OR 1.32) were more likely to be persistently overweight. Child aerobic exercise and opportunities for activity were not associated with a greater likelihood of weight problems. CONCLUSIONS: This study supports theories regarding the contributions of television watching, family meals, and neighborhood safety to childhood weight status. When working with families to prevent and treat childhood weight problems, food and nutrition professionals should attend to children's time spent with screen media, the frequency of family mealtimes, and parents' perceptions of neighborhood safety for children's outdoor play.     

Predictors and outcomes of household food insecurity among inner city families with preschool children in Vancouver

OBJECTIVES: The purposes of this study were to measure household food security and to determine its association with potential predictor variables related to household and community environments, as well as the relationship between household food insecurity and preschool children's nutritional status. METHODS: In this cross-sectional study, household food security was measured in a convenience sample of households (n=142) with children aged 2-5 years in Vancouver in March 2004. We assessed the association between environmental predictors and household food security status, adjusted for household income. Indicators of children's nutrition were compared between categories of household food security. RESULTS: Household food insecurity was associated with indicators of suboptimal health status in preschoolers. After controlling for household income, parents with less access to food of reasonable quality, fewer kitchen appliances and a lower rating of their cooking skills had greater odds of experiencing household food insecurity. IMPLICATIONS: Our study results support the need to test interventions involving collaborative efforts among government, social planners and public health practitioners to remove barriers to food security for families. Multiple measures, including opportunities to gain practical food skills and household resources that enable convenient preparation of nutrient-dense foods, could be examined. Our findings suggest the need for improved selection and quality at existing small stores and an increase in the number of food outlets in low-income neighbourhoods.     

Food insecurity is highly prevalent and predicts underweight but not overweight in adults and school children from Bogotá, Colombia

The aims of this study were to determine the sociodemographic and dietary correlates of household and child food insecurity in Bogotá, Colombia and to examine whether food insecurity is a risk factor for underweight or overweight in this population. We analyzed data from 2359 families with 2526 children 5-12 y of age who completed a cross-sectional survey conducted in 2006. The survey was representative of low- and middle-income families who had children enrolled in the public primary school system of Bogotá. We used a 16-item food insecurity scale, modified from the United States Household Food Security Survey Module, assessed children's dietary intake with a FFQ, and measured their height and weight. Mothers' anthropometry was obtained through self-report. We estimated adjusted prevalence ratios and 95% CI from binomial regression models. Household food insecurity with hunger and child food insecurity were each positively associated with maternal age, parity, and single parent status and inversely related to mean household income and number of home assets. Animal protein and snack food intake were inversely related to child food insecurity. In multivariate analyses, food-insecure children were 3 times more likely to be underweight than food-secure children (95% CI = 1.6, 5.4; P = 0.0007). Hunger in the household was significantly associated with maternal underweight. Food insecurity was not related to child stunting, child overweight, or maternal overweight. The prevalence of food insecurity in Bogotá is high and related to poverty. Food insecurity does not necessarily predict overweight in countries undergoing the nutrition transition.     

Socioeconomic Status and Overweight: A Population-Based Cross-Sectional Study of Japanese Children and Adolescents

Background

Socioeconomic status (SES) as a determinant of obesity has received scant attention in Japan. This study examined the association between SES and overweight among Japanese children and adolescents.

Methods

Cross-sectional analyses of a representative sample of Japanese children (6–11 years: n = 397) and adolescents (12–18 years: n = 397) were performed, with measured heights and weights from the 2010 National Health and Nutrition Examination Survey and the 2010 Comprehensive Survey of Living Conditions. Overweight, including obesity, was defined by International Obesity Task Force cut-offs. SES indicators included household income, equivalent household expenditure, parental educational attainment, and parental occupational class.

Results

Overweight prevalence was 12.3% in children and 9.1% in adolescents. Adolescents living in middle-income households were more likely to be overweight than those living in high-income households (OR 2.26, 95% CI, 1.01–5.67) after adjustment for age, sex, and parental weight status. Similarly, adolescents living in households with low expenditure levels were more likely to be overweight than those living in households with high expenditure levels (OR 3.40, 95% CI, 1.20–9.60). In contrast, no significant association was observed among children.

Conclusions

Our results indicated that low household economic status was associated with being overweight, independent of parental weight status, among Japanese adolescents.Key words: socioeconomic status, overweight, children, adolescent, Japan     

An empirical analysis of consumers' attitudes toward optometrist advertising

The purposes of this study were to determine: (a) consumers' attitudes toward advertising by optometrists and (b) whether city of residence, occupation, age, sex, race, marital status, number of children in household, total family household income and education accounted for any significant differences in consumer attitudes toward optometrists that advertise. Information obtained from this study could be used by optometrists to plan and improve the quality of their advertising.     

家长参与对儿童用眼行为的影响

  目的  分析家长参与和儿童良好用眼行为形成的相关性,为更精准的近视防控提供理论依据。  方法  通过整群抽样的方法,于2021年4—5月,选择温州市鹿城区3所学校2 726名小学生及其家长。通过眼部测量和问卷调查收集儿童眼部参数、儿童用眼行为、家长特征和家长参与情况。  结果  家庭经济水平、家长学历程度、家长是否近视与家长参与行为有关(P值均 < 0.05)。儿童近视风险较低与家长总是/经常参与睡眠和户外活动行为管理有关(P值均 < 0.01)。家长总是/经常参与儿童用眼行为管理对儿童平均每天视屏时间＜2 h(OR=1.95,95%CI=1.31~2.90)、每天户外活动时间＞2 h(OR=0.78,95%CI=0.65~0.93)、每天睡眠时间＞8 h(OR=0.52,95%CI=0.40~0.68)、每天持续读写时间＜1 h(OR=1.33,95%CI=1.30~1.56)、读写时距离桌面距离＞30 cm(OR=0.57,95%CI=0.34~0.95)影响均有统计学意义(P值均＜0.05)。  结论  家长参与性高可帮助儿童养成良好的用眼习惯并降低近视患病率。自身患有近视的家长参与度更高,且家长参与度与家庭总收入和家长文化程度呈正相关。     

Race/ethnicity, life-course socioeconomic position, and body weight trajectories over 34 years: the Alameda County Study

OBJECTIVES: We investigated whether race differences in weight gain over 34 years were because of socioeconomic position (SEP) and psychosocial and behavioral factors (physical activity, cigarette smoking, alcohol consumption, depression, marital status, number of children). We used a life-course approach to SEP with 4 measures of SEP (childhood SEP, education, occupation, income) and a cumulative measure of SEP. METHODS: We used mixed models and data collected from the Alameda County Study to examine the association between race and weight change slopes and baseline weight in men (n=1186) and women (n=1375) aged 17 to 40 years at baseline (in 1965). RESULTS: All subjects gained weight over time. African American women weighed 4.96 kg (P < .001) more at baseline and gained 0.10 kg/year (P = .043) more weight than White women. Black men weighed 2.41 kg (P = .006) more at baseline but did not gain more weight than White men. The association of race with weight gain in women was largely because of cumulative SEP score. CONCLUSIONS: Interventions to prevent overweight and obesity should begin early in life and target the socioeconomically disadvantaged.     

Parental feeding practices and socioeconomic status are associated with child adiposity in a multi-ethnic sample of children

Parental feeding practices have been associated with children’s weight status, but results have been inconsistent across populations. Research is needed to elucidate the relationship between parental feeding practices and adiposity in diverse populations. The present study tested if: (1) parental feeding practices differed by race/ethnicity, (2) parental pressure to eat and parental restriction were associated with adiposity levels, and (3) to investigate the relationship between parental feeding practices and/or child adiposity with socioeconomic status (SES). Structural equations modeling was conducted to test the model in 267 children aged 7-12 years self-identified as African American (AA), European American (EA), or Hispanic American (HA) from economically diverse backgrounds. Dual energy X-ray absorptiometry and computed tomography scanning were used to determine body composition and abdominal fat distribution, respectively. Parental restriction was a significant predictor of child adiposity while parental pressure to eat had an inverse relationship with child adiposity. HA parents reported significantly higher levels of restriction and pressure to eat, whereas EA parents reported the lowest. SES was positively associated with child adiposity and inversely related to parental restriction and pressure to eat. Thus, parental feeding practices differ across racial/ethnic groups and SES and may contribute to population differences in child adiposity.