Weight-control behavior among obese children: association with family-related factors

The purpose of this study was to investigate the weight-control behavior of obese children, to understand parents' supervision and to explore related factors that influenced the weight-control behavior. A structured questionnaire was employed in this study. A random sample of 287 children and their parents was recruited from six elementary schools in Shihlin and Peitou districts of Taipei City. Criteria employed for recruitment of subjects were: third and fourth grade in elementary schools, and weight-for-length index > or = 1.2. RESULTS: Fifty-six percent of the obese children were mildly obese and eleven percent were severely obese. Ninety-seven percent of the subjects adopted weight-control behavior, the most frequent one being avoiding fried food. The exercise frequency and time duration consistency were generally insufficient. Twenty-seven percent of the obese children were not in the habit of exercising. Factors that influenced the execution of weight-control behavior by the obese children included obesity level, mother's education, family structure, socioeconomic status of the family, parents' perception of their children's weight, parents' concern, and supervision. Our study found that severely obese children attempted to lose weight with inappropriate methods. Children staying in foster families or with grandparents, or from families of low socioeconomic status, had poorer weight-control behavior. Children whose parents were more concerned about their weight problem tended to have better weight-control behavior. Therefore, it is important to assist the parents of obese children to confront the issue of obesity and help the children solve their weight problem. It is also important to help foster families with low income to make the most of social resources to reinforce the family function.     

Obesity in pre-school chldren: issuse and challenges for community based child health nurses

Childhood obesity is becoming a topical issue in both the health literature and the popular media and increasingly child health nurses are observing preschool children who appear to be disproportionately heavy for their height when plotted on standardized growth charts. In this paper literature related to childhood obesity in New Zealand and internationally is explored to identify current issues, and the implications of these issues for nurses in community based child health practice are discussed. Themes that emerged from the literature relate to the measurement of obesity, links between childhood and adult obesity and issues for families. A theme in the literature around maternal perception was of particular interest. Studies that investigated maternal perceptions of childhood obesity found that mothers identified their child as being overweight or obese only when it imposed limitations on physical activity or when the children were teased rather than by referring to individual growth graphs. The implications for nursing in the area of child health practice is discussed as nurses working in this area need an understanding of the complex and often emotive issues surrounding childhood obesity and an awareness of the reality of people's lives when devising health promotion strategies.     

Perceptions of school nurses regarding obesity in school-age children.

Obesity is epidemic in the nation's school-age population with African American and Hispanic children and adolescents specifically at risk. School nurses at elementary and middle public schools in the Missouri 8th Congressional District were surveyed regarding their perceptions of childhood obesity. School nurses supported preventive interventions and were knowledgeable of the risks of childhood obesity but were less accepting of treatment and counseling for obese children in the school setting. One third of the school nurses did not recommend treatment for weight loss, and half of the nurses provided overweight children with counseling and referral only when parents asked for help. Perceptions of school nurses regarding childhood obesity identified in this study included the following: (a) counseling for obesity is difficult, (b) parental support is lacking, and (c) competence in providing counseling is low. These perceptions are barriers to school nurses taking a more active role in the prevention and treatment of childhood obesity.     

Management of childhood constipation: parents' experiences

BACKGROUND: Constipation in childhood is common and places a burden on child health services. Whilst constipation can have a variety of causes, for most children it is usually non-organic and requires limited intervention. It has been suggested that health professionals can resent consultations for such a common problem, believing them to be inappropriate. However, they can underestimate the impact of this condition, leading to adverse clinical effects, as well as parental dissatisfaction. Little research has explored parents' experiences of consulting health professionals about the management of childhood constipation. AIM: To explore parents' experiences of consulting health professionals about management of childhood constipation and to use the findings to inform more effective therapeutic encounters when responding to parental concerns. METHODS: A phenomenological approach was adopted, using in-depth interviews with parents of 14 children receiving health interventions for constipation. FINDINGS: Six themes emerged from analysis including: 'enduring and extreme constipation', which reflected the substantial and sustained impact of the child's constipation; 'dismissed and fobbed off', which captured parents' feelings that their concerns were frequently dismissed by health professionals; 'asserting the need for action', a perception that they had reached a point at which they had to demand some intervention; and 'validation and acknowledgement', which reflected acknowledgment that, finally, their concerns for their child had been taken seriously and acted on. DISCUSSION: The findings indicate a failure by some health professionals to appreciate fully the significance of childhood constipation, thereby appearing to be unconcerned and insensitive to the needs of child and family. The impact of this is a potential loss of trust in health professionals by parents, which can then have implications for how they perceive and access health services for management of this common childhood problem. The findings offer an insight into parental experiences and indicate the need for a more sensitive approach during health consultations.     

Parental disconnect between perceived and actual weight status of children: A metasynthesis of the current research

Purpose: Obesity is one of the most common chronic diseases in childhood. Many studies offer a variety of explanations for the alarming increase in childhood obesity; however, none discuss why an apparent disconnect exists in parental perceptions of their child's weight status. The purpose of this article was to review the current research literature on parental perceptions about their children's weight.
Data source: The articles included in this review were retrieved through a literature search using PubMed. Key words used to obtain relevant articles include childhood obesity , childhood overweight , and parental perception .
Conclusions: Several studies looked at parental perceptions of childhood obesity generated from the United Kingdom, Australia, Italy, and the United States. Universally, parents were more likely to misperceive their child's weight. This was especially true for parents who were themselves overweight.
Implications for practice: If parents do not recognize their child as at risk for overweight or overweight, they cannot intervene to diminish the risk factors for pediatric obesity and its related complications. More research is needed to identify why this phenomenon occurs. Only then can effective interventions be initiated.     

A randomized clinical trial of the effects of parent mentors on early childhood obesity: Study design and baseline data

BackgroundFew effective community-based interventions exist for early childhood obesity. Parent mentors have been successful as an intervention for other conditions, but have not been used in childhood obesity. We designed an intervention for early childhood obesity using parent mentors and a positive outlier approach to assess potential efficacy, feasibility, and acceptability.MethodsThis trial enrolled obese (≥ 95th BMI percentile for age and gender) 2–5-year-old children in a Head Start program and their parents, with allocation to either parent mentors trained in positively deviant behaviors regarding childhood obesity, or community health workers delivering health education on obesity-related behaviors. The primary outcome is body mass index z-score change at the six-month follow-up assessment. Secondary outcomes include feeding behaviors and practices, health-related quality of life, dietary intake, and participation levels.ResultsWe enrolled three parent mentors and 60 parent–child dyads. The population is 100% Hispanic; 44% of parents speak Spanish as their primary language and 45% were not high-school graduates. Children had a reported median vegetable and fruit intake of 0.3 and 1.1 cups per day, respectively, at baseline, and a median daily screen time of three hours. There was no intergroup difference in quality-of-life scores at baseline. Retention has been high, at 90% in three months.ConclusionsIn this randomized trial of the effects of parent mentors on early childhood obesity, parent–child dyads from an underserved, Hispanic population were successfully enrolled through a partnership with a Head Start organization, with a high retention rate.     

Exploring Relationships Among Maternal BMI,Family Factors,and Concern for Child's Weight

PROBLEM: In an effort to better understand child obesity, this study examined the association between family living location, family function, mother's body mass index (BMI), and mothers' attitudes and behaviors concerning child feeding. Recent research on obesity has shown there is limited information on family influence and parental perceptions and attitudes. METHODS: A cross-sectional analysis was performed on data from 47 mothers of school-aged children. FINDINGS: Urban African-American mothers had higher BMIs and were significantly more concerned about their child's weight status than rural white mothers. Additionally, maternal BMI was associated with the total number of individuals in the household. CONCLUSION: Results suggest the importance in understanding the family and community and its influence on childhood obesity. Armed with knowledge about family factors and parents' beliefs and perceptions, nurses can develop interventions that can assist families and communities to focus on healthy children feeding and weight management.     

Latina mothers' beliefs and practices related to weight status, feeding, and the development of child overweight

ABSTRACT Objective: To examine maternal beliefs and practices related to weight status, child feeding, and child overweight in the Latino culture that may contribute to the rising rates of overweight among preschool Latino children in the United States. Design and Sample: This 2‐phase qualitative study relies on data obtained in 6 focus groups with a total of 31 primarily Spanish‐speaking, low‐income mothers, followed by 20 individual, in‐depth interviews with women participating in a health promotion educational program. Measures: Child‐feeding beliefs, practices, and weight status perceptions were elicited. Results: The findings indicated that most respondents reported personal struggles with weight gain, particularly during and after pregnancy, and were concerned that their children would become obese. Although subjects understood the health and social consequences related to overweight, many discussed the pressures of familial and cultural influences endorsing a “chubby child.” Conclusions: Education and interventions that incorporate “culturally mediated” pathways to address mothers' feeding practices are essential for the prevention and control of childhood overweight among low‐income Latinos. Nurses should be aware of the social and cultural influences on Latina mothers' beliefs and practices related to weight status and feeding practices and address these in their education approaches to prevent childhood overweight and obesity with this population group.     

Childhood obesity: nurses' role in addressing the epidemic

Obesity is a significant long-term health problem that is common among children and adolescents in Western countries. Being overweight or obese (extremely overweight) can contribute to type 2 diabetes in childhood and increase the risk of cardiovascular disease in adulthood. Primary prevention of obesity prevents the development of serious secondary complications in adulthood. Nurses can help parents and children by providing nutritional advice and, through weight management programmes, offer strategies for decreasing caloric intake and increasing physical activity. Nurses' actions should always take a whole-family approach because it is challenging for obese children to alter their dietary or physical habits if not supported by their families. Nurses should work with all members of the multidisciplinary team in addressing childhood obesity as it is a major health issue with long-term mobidities.     

Prevalence and risk factors of excess weight in school children in West Greece

The present study estimated the prevalence of childhood obesity and identified risk factors in 10–13 year old children. A cross‐sectional study was conducted, including 200 children and their parents, in seven randomly‐selected primary schools across Patras, Greece. Height, weight, and waist circumference were measured, and self‐reported information was collected via face‐to‐face interviews. Body mass index was calculated for the children and their parents. The effect of risk factors on overweight and obesity was analyzed using regression analysis. The prevalence of overweight and obesity was 32% and 10.5%, respectively. The odds of being overweight/obese increased in children whose parents had a lower educational level and/or higher body mass index. Fewer daily meals and more time spent in front of the television and/or on the computer were significantly associated with obesity in 10–13 year old children. The prevalence of excess weight in primary school children in Patras is of concern, especially for boys. Children's nutritional habits, leisure activities, and parental characteristics influence their somatometric characteristics. These findings highlight the need for future weight loss interventions targeted at this population.     

Childhood overweight: parental perceptions and readiness for change.

Although the national health crisis of childhood obesity is a well-documented problem, few if any clinical interventions have had success in curbing its growth. In fact, childhood obesity, along with its associated morbidities, continues to climb even in the face of increased awareness. Research shows that factors contributing to obesity are almost entirely modifiable on some level. Furthermore, specific behavior changes have been shown to result in positive outcomes, yet these changes have not been widely implemented by practitioners, families, or individuals. The transtheoretical model of health behavior change offers insight into assessing individuals and targeting interventions for behavior change. This article focuses on guiding school nurses to assess parents of school-age children at risk for obesity for readiness for health behavior change, then choosing parent-focused interventions based on their stage of readiness for change.     

The experience of stress in parents of children hospitalized with long-term disabilities

This paper discusses parents' perceptions of their stress when their children are hospitalized with long-term disabilities. The study used a qualitative method. Data were collected with 40 parents through in-hospital interviews, and were analysed using the method of constant, comparative analysis. Parents' own interpretation of their stress experience is considered in relation to their perception of their role. The data suggest that the hospitalization of a child requires parents to make changes in their usual parenting role. In describing the nature of the changes required, parents identified the need to understand the illness experience; become familiar with the hospital environment; adapt to their changing relationship with the child and other family members; and negotiate with health professionals about their child's care. Verbatim accounts are used in this paper to illustrate parents' interpretations of their hospital experience. Parents perceive their role in their hospitalized child's care differently than health professionals do, and it would appear that much parental stress is attributable to the 'space' between health care workers' understanding of parents' experience, and parents' own comprehension. If nurses understood parents' own perception of their hospital-related stress better, more effective nursing care could be developed. Further research is needed in this important area.     

Parents' beliefs about children and gun safety

This study sought to determine parents' beliefs about children and gun safety. A survey was sent to 230 parents of elementary age children addressing their beliefs about firearm storage, firearm safety training for children, and whether or not their child would handle a gun. Findings are based on the 82 returned surveys. Parents believed safe firearm storage was important to protect children. Only 22% of parents reported having a firearm in their home. However, of those reporting a firearm in the home, 85% did not practice safe gun storage despite reporting they believed it was important. These findings are supported by other studies that have found that parents have unrealistic perceptions about how their child will respond when a firearm is encountered. The only predictor of parents' incorrect perceptions about firearm safety training was the item "children will be safe if taught." This parental misperception provides further evidence that parents have unrealistic attitudes about children and guns.     

我国11城市3～6岁儿童单纯肥胖症危险因素分析

目的 探索我国城市3 ～6 岁儿童生活方式和饮食习惯与肥胖的关系,为制订儿童肥胖干预策略提供依据.方法 采用分层整群抽样,分别从成都、济南、深圳、沈阳、上海、重庆、郑州、西安、长沙、青岛和海口11 个城市中随机抽取3 个城区,每个城区随机抽取幼儿园6 所,所有在园儿童进行体格测量,以WHO 的身高标准体重加2 个标准差作为肥胖判断标准.将调查中确诊的单纯肥胖症儿童与同性别、同年龄、同班级的正常体重儿童进行1∶2配对后,对所有肥胖儿童和配对的正常体重儿童进行家长自填问卷调查,回收的完整调查问卷中2218 份肥胖问卷和5380 份正常体重问卷,分别作为本研究的肥胖组和对照组.结果 单因素和多因素Logistic 回归分析结果显示,高出生体重(OR ＝1.48)、母亲受教育程度低(OR ＝1.20)、父母超重(OR ＝1.55、OR ＝1.81)、每周食用甜饮料≥3 次(OR ＝1.34)、食欲好(OR ＝4.07)、进食速度快(OR ＝2.77)、4 个月前非纯母乳喂养(OR ＝1.71)为儿童肥胖发生的危险因素;分别有45.6%和84.9%的肥胖儿童家长对儿童体型和肥胖对健康危害的认识做出不正确的评价和存在错误认识;分别有53.4%、43.3%和51.2%的肥胖儿童家长有鼓励进食、食物奖励和不限制零食的行为.结论 3 ～6 岁儿童肥胖的发生与家庭养育环境密切相关,喂养方式、饮食习惯和错误的育儿观念是儿童肥胖发生的主要危险因素.     

Design of the FRESH study: A randomized controlled trial of a parent-only and parent–child family-based treatment for childhood obesity

Approximately 1 out of 3 children in the United States is overweight or obese. Family-based treatment (FBT) is considered the gold-standard treatment for childhood obesity, but FBT is both staff and cost intensive. Therefore, we developed the FRESH (Family, Responsibility, Education, Support, & Health) study to evaluate the effectiveness of intervening with parents, without child involvement, to facilitate and improve the child's weight status. Targeting parents directly in the treatment of childhood obesity could be a promising approach that is developmentally appropriate for grade-school age children, highly scalable, and may be more cost effective to administer. The current paper describes the FRESH study which was designed to compare the effectiveness of parent-based therapy for pediatric obesity (PBT) to a parent and child (FBT) program for childhood obesity. We assessed weight, diet, physical activity, and parenting, as well as cost-effectiveness, at baseline, post-treatment, and at 6- and 18-month follow-ups. Currently, all participants have been recruited and completed assessment visits, and the initial stages of data analysis are underway. Ultimately, by evaluating a PBT model, we hope to optimize available child obesity treatments and improve their translation into clinical settings.     

Childhood fevers: developing an evidence-based anticipatory guidance tool for parents

Misconceptions about childhood fevers heighten parents' concerns leading to frequent use of health care services. Designing, piloting, and evaluating nursing interventions to demystify parents' phobia of fevers are imperative. An evidence-based fever anticipatory guidance tool was designed to assist parents by: dispelling misconceptions, teaching proper care of their febrile child and appropriate use of antipyretics, and providing a list of serious signs that warrant medical attention. Concepts of the Health Belief Model (HBM) are applied to parent behavior to promote a greater understanding of their actions in the face of childhood fever. Informing consumers with accurate and consistent information has direct implications for changing practice in the hospital and community.     

Review of Childhood Obesity: From Epidemiology,Etiology, and Comorbidities to Clinical Assessment and Treatment

Childhood obesity has emerged as an important public health problem in the United States and other countries in the world. Currently 1 in 3 children in the United States is afflicted with overweight or obesity. The increasing prevalence of childhood obesity is associated with emergence of comorbidities previously considered to be “adult” diseases including type 2 diabetes mellitus, hypertension, nonalcoholic fatty liver disease, obstructive sleep apnea, and dyslipidemia. The most common cause of obesity in children is a positive energy balance due to caloric intake in excess of caloric expenditure combined with a genetic predisposition for weight gain. Most obese children do not have an underlying endocrine or single genetic cause for their weight gain. Evaluation of children with obesity is aimed at determining the cause of weight gain and assessing for comorbidities resulting from excess weight. Family-based lifestyle interventions, including dietary modifications and increased physical activity, are the cornerstone of weight management in children. A staged approach to pediatric weight management is recommended with consideration of the age of the child, severity of obesity, and presence of obesity-related comorbidities in determining the initial stage of treatment. Lifestyle interventions have shown only modest effect on weight loss, particularly in children with severe obesity. There is limited information on the efficacy and safety of medications for weight loss in children. Bariatric surgery has been found to be effective in decreasing excess weight and improving comorbidities in adolescents with severe obesity. However, there are limited data on the long-term efficacy and safety of bariatric surgery in adolescents. For this comprehensive review, the literature was scanned from 1994 to 2016 using PubMed using the following search terms: childhood obesity, pediatric obesity, childhood overweight, bariatric surgery, and adolescents.