The relationship between parent and child self-reported adherence and weight loss

OBJECTIVE: Better adherence to treatment strategies in family-based behavioral weight control programs may lead to greater weight reduction and improved weight maintenance in youth. This study assessed the influence of child and parent self-reported adherence to behavioral strategies on changes in 2-year child and parent percentage overweight. RESEARCH METHODS AND PROCEDURES: Participants included 8- to 12-year-old children in >or= 85th BMI percentile and their parents from 110 families taking part in two family-based randomized controlled weight control studies. This study examined whether self-reported adherence to behavioral strategies measured at 24 months increased prediction of child and parent percentage overweight change through 24-month follow-up after accounting for other factors that may influence weight change. RESULTS: Child adherence to weighing and to preplanning for celebrations where high-fat foods are served and parent adherence to praising the child and modeling healthy eating habits predicted 24-month child percentage overweight change (p<0.001). Child adherence to recording food and calories and parent adherence to modeling healthy eating habits predicted 24-month parent percentage overweight change (p<0.001). In hierarchical regression models, child weighing and preplanning and parent modeling were significant (p<0.01) incremental predictors (r2 of 24.8%) of 24-month child percentage overweight. Child recording and parent modeling were significant (p<0.01) incremental predictors (r2 of 14%) of parent 24-month percentage overweight change. DISCUSSION: Child and parent adherence to specific components of family-based behavioral weight control treatment are independent predictors of long-term child and parent percentage overweight change.     

The influence of parenting change on pediatric weight control

OBJECTIVE: Parenting style was examined as a predictor of weight loss maintenance in behavioral family-based pediatric obesity treatment. RESEARCH METHODS AND PROCEDURES: Fifty obese children who participated in a behavioral family-based pediatric obesity treatment were studied. Hierarchical regression tested the incremental effect of baseline parenting and parenting during treatment on children's percentage overweight change over 12 months, beyond demographics and adherence to targeted behaviors. RESULTS: Children's percentage overweight significantly decreased at 6 (-16.3) and 12 (-11.1) months. Adherence to program goals significantly increased variance accounted for in the regression model by 10.8%, whereas adding baseline father acceptance and change in father acceptance accounted for another 20.5%. The overall model accounted for 40.6% of the variance in pediatric weight control. ANOVA showed significantly greater percentage overweight decrease from baseline for youth with fathers who increased their acceptance vs. those who decreased acceptance at 6 (-19.8 vs. -14.6) and 12 (-17.4 vs. -8.1) months. DISCUSSION: Youth who perceive an increase in father acceptance after treatment had better changes in percentage overweight over 12 months than youth with lower ratings of father acceptance. Future directions include examining how other parenting dimensions impact pediatric obesity treatment outcome and how parental acceptance can be enhanced to improve child weight control.     

Resting metabolic rate in lean and obese children: relationship to child and parent weight and percent-overweight change

Two studies were conducted to assess differences in metabolic rate as a function of child weight (study I); and the interaction of child and parent weight (study II). In both studies obese children had higher resting metabolic rates (RMRs) than lean children (p less than 0.05). Child weight accounted for 72 and 78% of the variance in RMR in studies 1 and 2, respectively. Including parental weight did not improve the prediction of RMR. After 6 mo of treatment, obese children decreased percent overweight, whereas lean children showed no change (p less than 0.01). RMR in both groups remained unchanged after 6 mo. These results indicate that the RMR is higher in obese than in lean children, that changes in percent overweight that result from increases in height and no change in weight do not decrease RMR over 6 mo, and parent weight does not improve the prediction of child RMR.     

Increasing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity

OBJECTIVE: The goal of this study was to evaluate the effect of a parent-focused behavioral intervention on parent and child eating changes and on percentage of overweight changes in families that contain at least one obese parent and a non-obese child. RESEARCH METHODS AND PROCEDURES: Families with obese parents and non-obese children were randomized to groups in which parents were provided a comprehensive behavioral weight-control program and were encouraged to increase fruit and vegetable intake or decrease intake of high-fat/high-sugar foods. Child materials targeted the same dietary changes as their parents without caloric restriction. RESULTS: Changes over 1 year showed that treatment influenced targeted parent and child fruit and vegetable intake and high-fat/high-sugar intake, with the Increase Fruit and Vegetable group also decreasing their consumption of high-fat/high-sugar foods. Parents in the increased fruit and vegetable group showed significantly greater decreases in percentage of overweight than parents in the decreased high-fat/high-sugar group. DISCUSSION: These results suggest that focusing on increasing intake of healthy foods may be a useful approach for nutritional change in obese parents and their children.     

Comparison of Program Costs for Parent-Only and Family-Based Interventions for Pediatric Obesity in Medically Underserved Rural Settings

ABSTRACT:  Purpose: To compare the costs of parent-only and family-based group interventions for childhood obesity delivered through Cooperative Extension Services in rural communities. Methods: Ninety-three overweight or obese children (aged 8 to 14 years) and their parent(s) participated in this randomized controlled trial, which included a 4-month intervention and 6-month follow-up. Families were randomized to either a behavioral family-based intervention (n = 33), a behavioral parent-only intervention (n = 34), or a waitlist control condition (n = 26). Only program costs data for the parent-only and family-based programs are reported here (n = 67). Assessments were completed at baseline, post-treatment (month 4) and follow-up (month 10). The primary outcome measures were total program costs and cost per child for the parent-only and family interventions. Findings: Twenty-six families in the parent-only intervention and 24 families in the family intervention completed all 3 assessments. As reported previously, both intervention programs led to significantly greater decreases in weight status relative to the control condition at month 10 follow-up. There was no significant difference in weight status change between the parent-only and family interventions. Total program costs for the parent-only and family interventions were $13,546 and $20,928, respectively. Total cost per child for the parent-only and family interventions were $521 and $872, respectively. Conclusions: Parent-only interventions may be a cost-effective alternative treatment for pediatric obesity, especially for families in medically underserved settings.     

Influence of Behavioral and Environmental Factors on the Development of Obesity in Three-year-old Children —A Case-Control Study Based on Toyama Study—

Obesity in children seems to be a risk factor for chronic diseases in adulthood. From the viewpoint of preventive medicine, factors influencing the development of obese children should be removed early in life. The purpose of this study was to the elucidate relationship between obesity in 3-year-old children and both behavioral and environmental factors by conducting a case-control study. Subjects were selected from the Toyama study. Matched-pair comparisons were performed between obese children whose Kaup’s index was 18 or more (N=117) and control children (N=234) . Multivariate stepwised logistic regression analysis also applied to assess influence of confounding factors. The results indicated that the following 6 factors significantly influenced the development of obese 3-year-old children in exact Fisher’s method analysis (p<0.05): person other than the mother responsible for taking care of the child, short sleep duration (9 hours or less), physical inactivity, eating snacks irregularly, overweight father (BMI≥24), and overweight mother (BMI≥24). For both sexes, after adjusting for confounders by multivariate stepwise logistic analysis, overweight mother (OR 2.54, 95 % CI 1.64-3.95), birth overweight (birth weight≥3,500g; OR 1.76, 95 % CI 1.15-2.69), the mother not responsible for taking care of the child (OR 1.65, 95% CI 1.10-2.48), overweight father (OR 1.62, 95%CI 1.09-2.40), eating snacks irregularly (OR 1.56, 95% CI 1.04-2.33), and gender (female;OR 0.51, 95% CI 0.34-0.77) had significant relationships with obesity in childhood. For boys, overweight mother (OR 2.53, 95 % CI 1.47-4.35), birth overweight (OR 2.03, 95%CI 1.22-3.39), eating snacks irregularly (OR 1.94, 95 %CI 1.19-3.18), and birth month (36-41 months; OR 0.47, 95 % CI 0.23-0.96) had significant relationships. For girls, overweight mother (OR 2.62, 1.28-5.35), and short sleep duration (OR 2.24, 1.11-4.52) had significant relationships. In neither Fisher’s exact method nor multivariate logistic models, time to wake up, bedtime, duration of playing outdoors, regularity of meals, care about salty food, or frequency of eating snacks had significant relations with obesity in 3-year-old children (p<0.05).     

Perception of eating and exercise in children as a function of child and parent weight status

The present study assessed the effects of child body weight (obese/lean) and familial loading for obesity (two obese parents/two lean parents) on the psychophysics of sweetness, fatness and exercise workloads, as well as subjective ratings of foods varying in sugar and fat and activities varying in energy expenditure. Children were measured in a baseline state and at 6 months after the obese children had participated in a family-based behavioral weight control program. No differences between obese and lean children in perceptual ratings were observed. However, offspring of obese or lean parents differed on intensity rating, food palatability and activity enjoyment ratings. Intensity ratings for sweetness in offspring of obese parents was increased, with a similar trend for intensity ratings for fatness. Offspring of obese parents rated all foods and activities with lower palatability and enjoyment ratings than offspring of lean parents. After a 6 month family-based behavioral weight loss treatment, obese children had significant decreases in percent overweight while lean children remained stable. Changes in the pattern of food ratings were observed for the obese children, with a reduction in liking for foods high in fat and/or sugar, and an increase in ratings for food slower in fat and sugar. The effects of parental obesity on food and exercise intensity ratings and hedonic ratings were maintained. Overall, these results suggest parental weight influences behavioral factors related to obesity in children.     

Impact of parental BMI on the manifestation of overweight 5–7 year old children

Summary Background There is an increase in the prevalence of overweight and obese children. Genetic and environmental factors are contributing factors but the influence of parental nutritional state on early manifestation of overweight is not well characterised. Aim of the study To systematically investigate the impact of parental BMI on the manifestation of overweight in 5 to 7 year old children. Methods Cross-sectional study (as a part of the Kiel Obesity Prevention Study [KOPS]) of 3306 children aged 5–7 years and their parents. The nutritional state of the children (BMI, triceps skinfold, fat mass, prevalence of overweight) was investigated in subgroups differing with respect to parental BMI. Results BMI of the children was significantly correlated with parental BMI (r = 0.272, p < 0.01). Children's BMI showed closer associations with maternal than with paternal BMI (r = 0.254 vs. 0.159, p < 0.01). A multivariate regression analysis showed that parental BMI explained 7.6 % of the variance in children's BMI. OR for overweight was elevated in children with at least one overweight parent (overweight mother: OR 2.9 (boys)/3.1 (girls); overweight father: OR 1.8 (boys)/2.4 (girls). OR was highest for children with two obese parents (OR 7.6 (boys)/6.3 (girls). Children with one obese parent were more frequently overweight than children with one overweight parent. Conclusions Parental BMI showed only a weak correlation with the BMI of their children. However, children's risk of becoming overweight increased with parental overweight and obesity. Thus, familial disposition has to be taken into account to identify risk groups for preventive measures. Received: 5 February 2002, Accepted: 2 May 2002     

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.     

Influence factors on the development of obesity in 3-year-old children based on the Toyama study

BACKGROUND: Obesity in childhood increases the risk of obesity in adulthood. Obesity in adulthood is a risk factor for chronic diseases such as hypertension and atherosclerosis. Therefore, it is important to eliminate factors influencing the development of obesity in children from the viewpoint of preventive medicine. The purpose of this study is to elucidate the relationship between obesity and lifestyle in 3-year-old children in a case-control study. METHODS: Subjects were selected from the Toyama study at health checkups for 3-year-old children which are done routinely by local governments in Japan on all children of that age. A special questionnaire consisting of items on lifestyle and environmental factors of the children and past histories of parents was distributed to the Toyama study participants beforehand and was collected at the checkup. Matched-pair comparisons were performed between obese children whose body mass index was 18 or more (N = 427) and control children (N = 854) matched by sex and birth month. Multivariate stepwise conditional logistic regression analysis was also applied to assess the influence of confounding factors. RESULTS: The following six factors significantly influenced the development of obese 3-year-old children using the Mantel-Haenszel method: the mother's job, limited playtime outdoors (1 hour or less), snacking irregularity, an overweight father (body mass index >/= 24), an overweight mother (body mass index >/= 24), and overweight at birth (birth weight >/= 3,500 g). An overweight mother or father, limited playtime outdoors, overweight at birth, and snacking irregularity were significantly related to obesity in 3-year-old children after adjusting for confounding factors by multivariate stepwise conditional logistic regression analysis. CONCLUSIONS: We have suggested several factors influencing the development of obesity in 3-year-old Japanese children: parental overweight and overweight at birth as host factors, physical inactivity and snacking irregularity as behavioral factors, the mother's job as an environmental factor.     

Child and parent factors that influence psychological problems in obese children

This study assessed the influence of child and parental obesity and parental psychiatric symptoms on psychological problems in obese 8-11-year-old children. Child psychological problems were measured using the Child Behavior Checklist/4-18, whereas adult psychiatric symptoms were measured using the Cornell Medical Index. Multiple linear regression analyses showed parental psychiatric symptoms were related to child psychological problems for six of eight problem behavior scales. Child obesity made no independent contribution to child psychological problems, and parental obesity was related to child problems on only one scale. The most prevalent problems were Anxiety/Depression for 15% of the boys and Social Problems for 20% of the boys and 12.8% of the girls. These results suggest a broader conceptualization of factors that influence behavior problems of obese children than their degree of obesity. © 1994 by John Wiley & Sons, Inc.     

Do parent–child acculturation gaps affect early adolescent Latino alcohol use? A study of the probability and extent of use

The literature has been mixed regarding how parent–child relationships are affected by the acculturation process and how this process relates to alcohol use among Latino youth. The mixed results may be due to, at least, two factors: First, staggered migration in which one or both parents arrive to the new country and then send for the children may lead to faster acculturation in parents than in children for some families. Second, acculturation may have different effects depending on which aspects of alcohol use are being examined. This study addresses the first factor by testing for a curvilinear trend in the acculturation-alcohol use relationship and the second by modeling past year alcohol use as a zero inflated negative binomial distribution. Additionally, this study examined the unique and mediation effects of parent–child acculturation discrepancies (gap), mother involvement in children’s schooling, father involvement in children’s schooling, and effective parenting on youth alcohol use during the last 12 months, measured as the probability of using and the extent of use. Direct paths from parent–child acculturation discrepancy to alcohol use, and mediated paths through mother involvement, father involvement, and effective parenting were also tested. Only father involvement fully mediated the path from parent–child acculturation discrepancies to the probability of alcohol use. None of the variables examined mediated the path from parent–child acculturation discrepancies to the extent of alcohol use. Effective parenting was unrelated to acculturation discrepancies; however, it maintained a significant direct effect on the probability of youth alcohol use and the extent of use after controlling for mother and father involvement. Implications for prevention strategies are discussed.     

Primary care of overweight children: the importance of parent weight and attitudes about overweight: a MetroNet study.

PURPOSE: The purpose of this study was to identify the association of parents' weight and attitude about their child's weight with the child's body mass index (BMI) status. DESIGN: Cross-sectional, clinic-based study in a practice-based research network. METHODS: One hundred seventy-one parents or adults accompanying children aged 5 to 17 years to a primary care visit in 4 family medicine centers completed a questionnaire. Parent/adult overweight status and attitudes were compared with child overweight status. RESULTS: Forty-eight percent of children were overweight or obese (BMI >or= the 85th percentile) as were 56% of mothers and 77% of fathers (BMI >or= 25 kg/m(2)). Child and parent overweight were significantly associated, as were mother overweight and beliefs about child overweight status. Children aged 5 to 13 years were more likely to be overweight than those aged >or=14 years. CONCLUSIONS: Parents of overweight children are often overweight and many do not recognize that their children are overweight. Suggestions are made for primary care physicians to engage parents of overweight children in family weight control efforts.     

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.     

Is family‐based behavioral weight control appropriate for severe pediatric obesity?

OBJECTIVE: Although the efficacy of family-based behavioral treatment for moderate pediatric obesity has been well established, few studies have focused on the treatment of severe obesity. We sought to evaluate the acceptability and feasibility of a family-based intervention for severely obese children. METHOD: Twenty-four families with children aged 8-12 years who were > or =160% of their ideal body weight participated in a 10-12-session behavioral intervention. Participants were weighed and their heights measured at the start of each treatment session and during a follow-up visit 4-13 (M = 7.8) months posttreatment. Children also completed measures of depressive symptoms and anxiety at pretreatment, posttreatment, and follow-up, and eating attitudes were assessed at pretreatment and follow-up. RESULTS: One third of the families did not complete treatment. However, children who completed the program lost a significant amount of weight and reported significant improvements in depression, anxiety, and eating attitudes that were maintained over time. DISCUSSION: A short-term, family-based behavioral intervention was successful in moderating weight gain for most children and had positive effects on children's mood and eating disorder symptoms. Future randomized, controlled trials of longer interventions are necessary to determine the success of this approach.     

The Impact of Childhood Hypothalamic/Chiasmatic Brain Tumors on Child Adjustment and Family Functioning

The relation between the adjustment of children treated for hypothalamic/chiasmatic brain tumors and family functioning was examined. Participants were 29 children, ages 7 to 17 years, who were off treatment at least 6 months, and their mothers and fathers. Child adjustment was compared with 29 same-age survivors of other brain tumors and a normative sample. Results support the presence of increased behavior problems and decreased social and academic competence in these particular brain tumor survivors compared with the normative sample. They did not differ significantly from other brain tumor survivors based on mother ratings. Decreased competence and increased emotional and behavioral problems were related significantly to child, mother, and father reports of poorer family functioning. Older age at diagnosis, less perceived change in child due to tumor and treatment, and regular education placement were related to higher child competence and better behavior but not to family functioning. These findings highlight the need for working with families to provide resources and skills in dealing with the social and behavioral changes that result from brain tumors and their treatment.     

Comparisons between paternal and maternal involvement with sons: early to middle childhood

This study compared father–son and mother–son involvement in two-parent families from early to middle childhood. Ninety-four families were recruited for a three-year follow-up study that began when the children were four years old. At each time point, in comparison to mothers, fathers were less accessible to their son on weekdays, and spent more one-on-one time with their son on weekend days. Across the three-year period, differences were evident in patterns of father–son and mother–son participation in play and learning activities. Results revealed that parent–child conversations were a rich source of parental involvement during middle childhood with many boys having frequent conversations on a range of topics with both parents: covering shared activities and interests, relationships, daily activities, or involving cognitive stimulation. Findings highlight the importance of obtaining data from both fathers and mothers to provide insight into patterns of continuity and change in parental involvement over time.     

Influence of Play and Temperament on the Young Child's Response to Pain

The relation between the adjustment of children treated for hypothalamic/chiasmatic brain tumors and family functioning was examined. Participants were 29 children, ages 7 to 17 years, who were off treatment at least 6 months, and their mothers and fathers. Child adjustment was compared with 29 same-age survivors of other brain tumors and a normative sample. Results support the presence of increased behavior problems and decreased social and academic competence in these particular brain tumor survivors compared with the normative sample. They did not differ significantly from other brain tumor survivors based on mother ratings. Decreased competence and increased emotional and behavioral problems were related significantly to child, mother, and father reports of poorer family functioning. Older age at diagnosis, less perceived change in child due to tumor and treatment, and regular education placement were related to higher child competence and better behavior but not to family functioning. These findings highlight the need for working with families to provide resources and skills in dealing with the social and behavioral changes that result from brain tumors and their treatment.     

Parental Perception of Child Bodyweight and Health Among Mexican-American Children with Acanthosis Nigricans

Acanthosis nigricans (AN) is a cutaneous marker associated with elevated risk of type 2 diabetes. This study assesses mother–father differences in perception of child’s bodyweight and health by Mexican-American parents with AN-positive children. The study used medical records in conjunction with survey data collected between 2011 and 2012 for 309 Mexican-American children with AN in South Texas. Multivariate logit models were estimated to assess mother–father differences in perception of child bodyweight and health controlling for selected child- and parent-level covariates. About 91 % of the children in the sample were obese and 6.5 % were overweight. One fifth of mothers and 38.5 % of fathers in the sample expressed no concern of their children’s bodyweight. After adjusting for selected explanatory variables at both the child and parent level, the odds for fathers, relative to mothers, to be concerned about child’s bodyweight were 82 % lower (OR = 0.18, p < 0.05). Similar findings also hold for parental awareness of child’s AN (OR = 0.19, p < 0.05). Among Mexican-American families with AN-positive children, the lack of concern over child’s bodyweight, unawareness of AN, and misconception of child’s health on the part of many parents, especially of fathers, constitutes a challenge to diabetes prevention. Health education programs targeting Mexican-American families with AN-positive children might be more cost effective to consider mother–father differences in perception of child health and bodyweight.     

A cost-analysis of adopting a healthful diet in a family-based obesity treatment program

OBJECTIVE: To assess dietary costs during a family-based pediatric obesity intervention. DESIGN: Families were randomized to one of two groups. Dietary and cost data were collected from a parent or child using three 24-hour recalls: at baseline, 6 months, and 12 months. SUBJECTS: Thirty-one families with an obese 8- to 12-year-old child entered treatment, with complete dietary data provided from 20 families. INTERVENTION: The 20-week behavior modification intervention emphasized increasing diet nutrient-density. Families attended group and individual sessions or group sessions. MAIN OUTCOME MEASURES: Energy intake; percent of energy from protein, fat, and carbohydrate; servings and percent servings from food groups classified by nutrient density; and daily food costs. STATISTICAL ANALYSES PERFORMED: Mixed analyses of variance, with group as the between-subject factor, and time as the within-subject factor. RESULTS: No significant effect of group was found in any analyses. Significant decreases in percent overweight were observed at 6 and 12 months for children (-10.0+/-8.7 and -8.0+/-10.3, respectively) (mean+/-standard deviation) and parents (-6.7+/-10.3 and -5.3+/-14.1). Energy intake for parents and children combined significantly decreased from baseline (1,881+/-462) to 6 months (1,412+/-284), and 1 year (1,338+/-444). Servings from low-nutrient-dense foods significantly decreased from baseline (34.7+/-16.2) to 6 months (16.0+/-8.6) and 1 year (18.6+/-9.2), causing a significant increase in diet nutrient density. Dietary cost did not change at 6 months, but significantly decreased from baseline to 1 year ($6.77+/-2.41 to $5.04+/-1.80). Cost per 1,000 kcal did not significantly change. APPLICATIONS/CONCLUSIONS: Adopting a lower-energy, nutrient-dense diet did not increase dietary costs over time. Consequently, cost should not be a barrier in the adoption of a healthful diet.