Isolation in a Sea of "Experts": Identifying the Parental Struggles Caring for Children With Early-Onset Obesity.

Abstract

Background: Severe early-onset childhood obesity is diagnosed by having a BMI >120% of the 95th percentile before age 5 years. Treatment for early-onset obesity is frequently unsuccessful. Prior studies have shown parents of children with obesity often face stigmatization and those who experience weight bias also experience poorer medical care. Home environment influences many risk factors, and parents are crucial for intervention. Research on the parental perspective of care is lacking and greater understanding could increase the effectiveness of treatment. We sought to understand the common stressors and obstacles parents encounter caring for a child with early-onset severe obesity. Methods: Parents of children with early-onset severe obesity participated in semistructured interviews. Interviews were digitally recorded, transcribed verbatim, coded, and analyzed using hybrid thematic analysis. Results: We identified a global theme of "Isolation in a sea of 'experts'," supported by three organizing themes: (i) Facing barriers at every turn; (ii) Carrying all the burdens; and (iii) Struggling to get their child seen as an individual. Within each organizing theme, subthemes emerged that highlighted the struggles that parents encountered. These included significant conflict with others when attempting to implement dietary changes (e.g., spouses, other children, and extended family), protecting their child's self-esteem, perceived weight bias from medical staff, lack of experienced obesity clinicians, lack of access to weight management services, and judgment from others (e.g., family, friends, and strangers). Conclusions: This study highlighted that many parents of children with early-onset severe obesity felt significant struggles, both internal and external. Understanding the barriers parents face when caring for their children is critical to improving relationships and medical care.