Primary Care of Overweight Children: The Importance of Parent Weight and Attitudes about Overweight: A MetroNet Study

Methods

Results

The mean age of the children accompanying the parent respondents was 11.6 years and 51.5% of the children were female. Parental reports of the child'srace were as follows: 54.8% white, 31.9% black, and 13.3% other (see Table 1).

Data on the child'sweight status was obtained from 141 of the 171 parent respondents. Based on parents’ responses, we calculated 67 children with a BMI ≥ 85th percentile. Younger age was associated with overweight status, with children ages 5 to 13 years more likely to be overweight than those 14 years or older. Parents reported that 55.5% of mothers were overweight; maternal overweight was associated with child overweight (P = .02). Respondents were less likely to provide weight status information for fathers (n = 32 missing); however, for the data reported, 77.0% (107/139) of fathers were overweight. Father overweight status was also associated with child overweight (P = .06).

We examined the association of child weight status with parental perception of the child'sweight. Almost all (72/73 or 98.6%) parents with a child of normal weight indicated their child was not overweight. However only 42.4% (28/66) of parents with an overweight child indicated their child was overweight (P < .001).

We hypothesized that the overweight parents would be more likely to indicate their overweight child was not overweight. We had insufficient numbers for a valid χ² test that combined both parents, which we believe resulted from limited variance with the fathers’ weight status variable. Among the 42 overweight mothers with overweight children, 20 (47.6%) did not think the child was overweight whereas 22 (52.4%) thought that the overweight child (BMI > 85%) was indeed overweight (P = .04).

Discussion

The parents in our study tended to say that their overweight child was not overweight, with slightly less than half of all parents correctly recognizing their child'soverweight status. In addition, child overweight was associated with parental overweight. These findings highlight the family context of weight problems, especially among younger children, and suggest that child obesity interventions should optimally focus on physician–parent partnerships.⁴

Physicians might first advise parents of overweight children about the risks of obesity-related problems that can harm the child'shealth. Then they can act as change agents² and offer family-based interventions that are designed for primary care providers⁵ and which include health education and efforts to change misunderstandings of healthy weight for children.

In addition, resources are recommended for physicians to identify those parents ready to make changes for overweight children and to identify families that are likely to benefit from physician-led interventions.⁶ Other suggestions are to consider using published guidelines for family interventions as reviewed by Snethen et al⁷ or proposed by O’Brien et al⁸ and Epstein.⁹ Among families where the child is overweight and particularly among families where both parents and children are overweight, the family unit is the elemental focal point for reducing the prevalence of childhood obesity and encouraging healthy eating. This can be a most important role for primary care physicians who seek to be change agents.²