Obesity Paper

Childhood Obesity: Do Parents Recognize This Health Risk? Debra Etelson,* Donald A. Brand,*† Patricia A. Patrick,‡ and Anushree Shirali§ Abstract ETELSON, DEBRA, DONALD A. BRAND, PATRICIA A. PATRICK, AND ANUS HREE SHI RALI. Chi ldh ood obesi ty: do paren ts recog nize this healt h risk? Obes Res. 2003;11:1362–1368. Objective: This study examined parents’ understanding of excess weight as a health risk, knowledge of healthy eating habits, and recognition of obesity in their children. Research Methods and Procedures: An anonymous ques- tionnaire was distributed during well-care visits involving children 4 to 8 years of age at a pediatric faculty practice. Parents indicated their level of concern about excess weight and oth er famili ar hea lth ris ks usi ng a fou r-p oin t Lik ert scale, answered mul tipl e-choic e ques tions conc erni ng healthy eating patterns, and communicated their percep- tions about thei r chi ld’s weight using a visual analog scale. A parent’ s perception was conside red “accurate” if it deviated from the child’s growth chart percentile by 30 points. Results: Of the 83 pare nt s surveyed, 23% (19/83) had overweight children ( 95th percentile of age- and gender- specific BMI growth charts). These parents did not differ from other parents in their level of concern about excess weight as a health risk or in their knowledge of healthy eating patterns, but the two groups of parents did differ in the acc ura cy of the ir per ceptio ns about the ir chi ldr en’ s weight. Only 10.5% of parents of overweight children (2/ 19) perceived their child’s weight accurately compared with 59. 4% of other par ents (38/64; p 0.001 ). Paren ts of overweight chil dren invariably under estimated their children’s weight. The median difference between their perception and the growth chart percentile was 45 points. Discussion: Given that most parents of overweight children fail to rec ognize that the ir child has a wei ght pro ble m, pediatricians should develop strategies to help these parents correct their misperceptions. Key words: child, body weight, caregivers, weight perception, health-risk appraisal Introduction Obesity is now considered to be the most prevalent nu- tritional disease of children and adolescents in the United States (1). An estimated 15% of 6- to 11-year-old children are overweight (i.e., they fall at or above the 95th percentile of BMI for their age and sex) (2). Exces sive weight duri ng child hood stems from several interacting factors, including poor diet and exercise habits. Dietary preferences and physical activity patterns are prob- ably shaped early in childhood, influenced by parental prac- tices and familial environment (3,4). It follows that obesity prevention programs, to be successful, will require parental participation (5). Such participation, in turn, will depend on parents’ ability to recognize that their child is overweight, to understand that obesity puts the child at risk for associated short-term and long-term health problems, and to provide hea lth y, bal anc ed mea ls tha t wil l hel p the ir chi ld los e weight. Parents do not typically consult growth charts to deter- mine whether a chil d is overweigh t. Instead, they notic e when a child becomes inactive or suffers from teasing by other chi ldr en. Parents may tend to def ine obesi ty as a condition accompanied by severe physical impairment, es- pecially compromised mobility. They may also believe that a child’s size is inherited and that the child will eventually shed excess weight with age (6). Whereas we know that parental participation is vital for successful obesity treatment programs (7,8), we know less about how wel l par ent s rec ogn ize obe sit y in the ir own children. Before instructing parents about dietary and exercise regimens, clinicians must first verify that parents know when they have a child with a weight problem and why they Received for review March 3, 2003. Accepted in final form September 9, 2003. *Department of Pediatrics, †Department of Medicine, ‡Primary Care Research Unit, and §School of Medicine, New York Medical College, Valhalla, New York. Address correspondence to Debra Etelson, Department of Pediatrics, New York Medical College, Munger Pavilion, 3rd Floor, Valhalla, NY 10595. E-mail: debra_etelson@nymc.edu Copyright © 2003 NAASO 1362 OBESITY RESEARCH Vol. 1 1 No. 11 November 2003

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Obesity Paper