Overweight Parents Research Articles

Abstract 1368: Parenting considerations in the management of overweight and obese childhood ALL survivors.

Abstract BACKGROUND: Childhood acute lymphoblastic leukemia (ALL) survivors are at a higher risk for obesity and overweight than even the general pediatric population. Obesity risk has been linked to certain parenting (permissive and authoritarian) styles and to lack of parental support for weight-related behaviors. We thus sought to evaluate the potential contribution of parenting behaviors and styles to weight related issues and depression among overweight and obese children who have survived ALL. METHODS: Surveys on parenting styles, behaviors, communication styles, and parental support for weight management behaviors were performed by the primary parents of overweight and obese youth recruited for a clinical trial of a weight management program among childhood ALL survivors aged 8-18 years at three tertiary care pediatric institutions. In addition, the Childhood Depression Inventory was performed by the recruited children and baseline demographics from both children and parents were collected. Distribution and correlation analyses of survey results and collected baseline data were performed. RESULTS: Thirty five overweight (20%) and obese (80%) children recruited to date comprised 43% male, median (IQR) age of 13 (10,16) years, median BMI % of 98 (95,99)% and 89% Hispanic. The corresponding primary parent population consisted of 89% women, median age of 42 (38,48) years, median BMI of 33 (28,40) kg/m2 (60% obese, 26% overweight), and 89% Hispanic. While the majority (97%) of parents reported an authoritative parenting style, there were variations in the amount of permissive and dysfunctional parenting reported. Parenting verbosity in reaction to misbehavior was moderately associated with increased baseline child BMI percentile (r=0.37, p=0.03). Authoritarian parenting style moderately correlated with parental support for physical activity (specifically walking and biking) for the entire cohort (r=0.36, p=0.03). However, overall, parenting styles did not specifically correlate with support for weight management behaviors or with age and gender-matched child BMI percentiles. Parental over-reactivity correlated with higher child depression rating scores (r=0.35, p=0.04) while parental granting of autonomy was associated with lower depression rating scores (r=-0.35, p<0.04) in the cohort. DISCUSSION: We did not observe a preponderance of parenting styles associated with greater weight status in children among overweight and obese youth with ALL. However, specific parenting styles and behaviors were related to child weight status, parental weight management support, and depression ratings among overweight and obese ALL child survivors. These data confirm the important role of parents in weight management among young childhood ALL survivors. Citation Format: Jeannie S. Huang, Laura Terrones, Maria Chang, Lindsay Dillon. Parenting considerations in the management of overweight and obese childhood ALL survivors. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1368. doi:10.1158/1538-7445.AM2013-1368

Parental obesity and risk factors for cardiovascular disease among their offspring in mid-life: findings from the 1958 British Birth Cohort Study

Background:Few studies have investigated whether parental adiposity is associated with offspring cardiovascular health or the underlying pathways. Studying these associations may help to illuminate the paradox of increasing prevalence of obesity and declining trends in cardiovascular disease (CVD) mortality, which may be partially explained by beneficial adaptations to an obesogenic environment among people exposed to such environments from younger ages.Objective:To investigate associations between parental body mass index (BMI) and risk factors for CVD among their offspring in mid-life and to test whether associations of offspring BMI with CVD risk factors were modified by parental BMI.Methods:Data from parents and offspring in the 1958 British birth cohort were used (N=9328). Parental BMI was assessed when offspring were aged 11 years; offspring BMI, waist circumference and CVD risk factors (lipid levels, blood pressure, glycosylated haemoglobin (HbA1c) and inflammatory and haemostatic markers) were measured at 44–45 years.Results:Higher parental BMI was associated with less favourable levels of offspring risk factors for CVD. Most associations were maintained after adjustment for offspring lifestyle and socioeconomic factors but were largely abolished or reversed after adjustment for offspring adiposity. For some CVD risk factors, there was evidence of effect modification; the association between higher BMI and an adverse lipid profile among offspring was weaker if maternal BMI had been higher. Conversely, offspring BMI was more strongly associated with HbA1c if parental BMI had been higher.Conclusions:Intergenerational influences may be important in conferring the effect of high BMI on CVD risk among offspring.

Reducing Pediatric Overweight: Nurse-Delivered Motivational Interviewing in Primary Care

The purpose of this study was to test the Let's Go 5-2-1-0 program delivered through motivational interviewing by nurses with 4-18-year-old overweight children and parents in primary care (PC). A quasi-experimental design allocated 60 control families to standard clinical care (SCC) and 70 families to SCC plus the 5-2-1-0 intervention. Drop-out rates were 9 and 35% at 6 months and 25 and 41% at 12 months, respectively for control and intervention participants. BMI percentile trended (p = .057) toward decline (M change = -3.0 versus -1.5) for intervention children at 6 months (n = 52 control, 44 intervention), and nonsignificantly (p = 0.14) for both groups (43 control, 40 intervention) at 12 months (controls -1.9, intervention -4.6). Intervention effects were found for self-reported daily fruit/vegetable consumption, physical activity, and screen time. Satisfaction was high. Further study of the PC nursing intervention is warranted.

Adherence to behavioral targets and treatment attendance during a pediatric weight control trial

Better weight loss outcomes are achieved in adults and youth who adhere to obesity treatment regimens (i.e., session attendance and prescribed changes in weight control behaviors). However, more research is needed regarding children's adherence to a range of behaviors relevant for weight maintenance over long-term follow-up. Overweight children (N = 101, aged 7-12 years), along with an overweight parent, participated in a 20-week family-based behavioral weight loss treatment (FBT) and were then assigned to either a behaviorally focused or socially focused 16-week weight maintenance treatment (MT). Treatment attendance and child and parent adherence (i.e., reported use of skills targeted within treatment) were examined in relation to child percent overweight change from baseline to post-FBT, post-MT, and 2-year follow-up. Higher attendance predicted better child weight outcomes at post-MT, but not at 2-year follow-up. Adherence to self-regulatory skills/goal-setting skills predicted child weight outcomes at 2-year follow-up among the behaviorally focused MT group. Future research is needed to examine mediators of change within family-based weight control interventions, including behavioral and socially based targets. Incorporating self-regulatory weight maintenance skills into a comprehensive MT may maximize children's sustained weight control.

Web-Based Family Intervention for Overweight Children: A Pilot Study

Research has shown the efficacy of family-based behavioral interventions for overweight children, but a major difficulty is access to effective treatment programs. The objective of this study was to develop and test the initial feasibility and efficacy of a web-based family program for overweight 8- to 12-year-old children. A website was created using concepts from effective family-based behavioral programs and input from focus groups with overweight children, parents, and pediatricians. The website provided information about obesity and healthy lifestyles, assessment of dietary and physical activity habits, interactive dietary and physical activity games, and instruction in goal-setting and monitoring of goals. Children selected a dietary and physical activity goal and a daily step goal with pedometers. Feasibility and pilot testing over 4 weeks was conducted with 24 overweight children referred by a physician. Outcomes were z-BMI, healthy eating and physical activity, and intrinsic motivation and self-efficacy for weight control. Mean number of logins over the study period was 11.4 for the study sample. Eighteen families (75%) returned for the follow-up assessment. Pre-post analyses for these participants showed improvements in intrinsic motivation, (p=0.05), self-efficacy (p=0.025), physical activity (p=0.005), and healthy lifestyle behaviors (p=0.001). Comparisons between high and low users of the program indicated that high users reduced their BMI while low users increased their BMI over time (p=0.02); high users also improved their dietary intake relative to low users (p=0.04). Consumer satisfaction ratings were high. These pilot findings suggest this is a feasible approach for treatment of overweight children and that children who used the web program frequently improved their BMI and dietary intake.

Clustering of diet, physical activity and overweight in parents and offspring in South India

Although there are some studies on familial clustering of metabolic risk factors, there are few on clustering of diet and physical activity. The aim of this study was to identify the extent of familial clustering of weight status, diet and physical activity in urban and rural families in South India. Anthropometric, dietary and physical activity data were obtained for 325 offspring aged 8-21 years and both their parents from urban and rural South India. However, 294 single offspring and their parents were used for analysis. Body mass index (BMI) was computed and individuals categorized as normal, underweight and overweight/obese. Diet was assessed using food frequency questionnaires and physical activity using physical activity questionnaires. Offspring BMI correlated significantly (P<0.001) with the BMIs of both parents (r=0.35, P<0.001). Percent protein, carbohydrate, total fat and saturated fat intakes were significantly correlated (P<0.001) between offspring and parents. Offspring physical activity level (PAL) correlated significantly with the mother (r=0.26, P<0.001), but not the father. A two-step cluster analysis revealed two distinct clusters: obesogenic and nonobesogenic. The obesogenic cluster, which consisted of 83% of families with at least one parent or offspring overweight, had significantly higher intakes of fat, saturated fat and higher sedentary activity levels but lower carbohydrate intakes and sleep duration (all P<0.001) among both offspring and parents. Diet, physical activity and BMI of children, adolescents and young adults in India is associated with parental behavior. Health promotion aimed at reducing obesity in these groups should address familial issues.

Obesity in adolescence is associated with perinatal risk factors, parental BMI and sociodemographic characteristics

To record the prevalence of overweight and obesity in primary-school children in relation to perinatal risk factors, parental body mass index and sociodemographics. A sample of 2294 schoolchildren aged 9-13 years was examined in municipalities from four Greek counties. Weight and height were measured using standard procedures, whereas international thresholds were used for the definition of overweight and obesity. Perinatal and parental data were also recorded via standardized questionnaires. The prevalence of overweight and obesity was 30.5% and 11.6%, respectively, with a higher prevalence of obesity in boys compared with girls (13.7% vs 9.5%, P<0.02). Maternal smoking at pregnancy (odds ratio (OR) 1.37; 95% confidence interval (CI) 1.05-1.98), rapid infant weight gain (OR 1.69; 95% CI 1.20-2.38), paternal and maternal obesity (OR 2.25; 95% CI 1.45-3.48 and OR 2.14; 95% CI 1.28-3.60) were found to significantly increase the odds of children's obesity (apart from overweight), whereas Greek nationality (OR 1.06; 95% CI 1.01-1.39) was found to significantly increase only the odds of children's overweight. Maternal pre-pregnancy obesity (OR 2.15; 95% CI 1.27-3.70) and introduction of solid foods at weaning later than 5 months of life (OR 1.60; 95% CI 1.02-2.51) were also found to increase the likelihood of childhood obesity. On the contrary, children having older fathers (OR 0.55; 95% CI 0.37-0.80) or more educated mothers (OR 0.57; 95% CI 0.36-0.90) were less likely to be obese. The current study identified certain perinatal factors (that is, maternal pre-pregnancy obesity, maternal smoking at pregnancy, rapid infant weight gain and late introduction of solid foods at weaning) and parental characteristics (that is, younger fathers, Greek nationality, less educated and overweight parents) as important risk factors for children's overweight and obesity, indicating the multifactorial nature of their etiology and the need to extend our understanding beyond positive energy equilibrium.

Identification of distinct body mass index trajectories in Australian children

Recent studies have identified distinct trajectories of obesity development in children, but more research is required to further explore these trajectories. Several socio-demographic variables such as parental education and obesity are associated with these trajectories. This study further demonstrates that there are distinct trajectories of body mass index in children. The use of raw body mass index values is more sensitive to changes in body composition compared with body mass index categories (e.g. lean vs. overweight). Hence the present results provide a more detailed insight into development patterns of obesity. The socio-demographic predictors of the trajectories offer potential avenues for future obesity interventions. A limited number of studies have demonstrated that there may be distinct developmental trajectories of obesity during childhood. To identify distinct trajectories of body mass index (BMI) in a large sample of Australian children. Participants included 4601 children aged 4-5 years at baseline, who were followed up at ages 6-7 years, 8-9 years and 10-11 years. Height and weight were measured at each of these time points, and used to calculate BMI. Growth Mixture Modelling was used to identify the presence of distinct BMI trajectories. Four distinct trajectories were identified (i) High Risk Overweight; (ii) Early Onset Overweight; (iii) Later Onset Overweight and (iv) Healthy Weight. Further analyses indicated that factors such as parental overweight, parent education, parent smoking and child birth weight were significant predictors of these trajectories. These findings indicate that different patterns of BMI development exist in children, which may require tailored interventions.

Évaluation de la personnalité, de la motivation au changement et des facteurs familiaux présents chez des jeunes suivis pour obésité

The aim of this study is to describe the psychological factors among young people treated for obesity and their parents. 63 families whose children (from 8 to 18 years old) are treated for weight problems have answered questions about the personality and the advantages/disadvantages of a healthy diet and regular exercise. Parents provided information on a scale of anxiety–depression, and on social demographic details. Young people have expressed their feelings of perceived competence, ability and motivation in the areas of nutrition and physical activity across different scales. A semi-structured interview was conducted with 13 families. Motivation and feeling of perceived competence in young people are high despite the important disadvantages to having a healthy diet. They have high scores in all dimensions of personality and there are correlations with the scores of perceived competence. Parents seem to be an important model from a personal hygiene point of view; however, no statistical relationship could be demonstrated with being overweight, anxiety or depression parents.

Efficacy of Family-Based Weight Control Program for Preschool Children in Primary Care

To test the efficacy of an innovative family-based intervention for overweight preschool-aged children and overweight parents conducted in the primary care setting. Children with BMI ≥ 85th percentile and an overweight parent were randomized to intervention or information control (IC). Trained staff delivered dietary and physical/sedentary activities education to parents over 6 months (10 group meetings and 8 calls). Parents in the intervention received also behavioral modification. An intention-to-treat analysis was performed by using mixed analysis of variance models to test changes in child percent over BMI (%OBMI) and z-BMI and to explore potential moderators of group differences in treatment response. Ninety-six of 105 randomized families started the program: 46 children (31 girls/15 boys) in the intervention and 50 (33 girls/17 boys) in the IC, with 33 and 39 mothers and 13 and 11 fathers in intervention and IC, respectively. Baseline characteristics did not differ between groups. Children in the intervention group had greater %OBMI and z-BMI decreases at 3 and 6 months compared with those assigned to IC (P < .0021). A greater BMI reduction over time was also observed in parents in the intervention compared with parents assigned to IC (P < .0001). Child %OBMI and parent BMI changes were correlated (r = .31; P = .003). Children with greater baseline %OBMI were more likely to have a greater %OBMI decrease over time (P = .02). Concurrently targeting preschool-aged overweight youth and their overweight parents for behavioral weight control in a primary care setting reduced child %OBMI and parent BMI, with parent and child weight changes correlating.

Parents' Awareness of Their Fifth Graders' Weight Status in Rural South Dakota

The Parent Awareness Questionnaire (PAQ) was used to survey parents of fifth graders in 5 rural South Dakota schools on the perception of their own and their children's weight. The PAQ responses were compared with anthropometric assessments. Thirty-six percent of the children were overweight or obese. Correct weight status assessments were made by 19% of mothers and 23% of fathers of overweight children and 0% of mothers and 13% of fathers of obese children, whereas the remainder underassessed their children's weight. Parents of overweight and obese children were largely unconcerned and unaware of their children's true weight status.

Attributable Risks for Childhood Overweight: Evidence for Limited Effectiveness of Prevention

Calculation of attributable risks (ARs) of childhood overweight to estimate effectiveness of prevention strategies. We used pooled data of 4 population-based German studies including 34240 children and adolescents aged 3 to 18 years to calculate the impact of familial, social, "early life", and lifestyle factors on overweight. ARs (joint for all determinants as well as partial risks) were calculated. The prevalence of childhood overweight was 13.4%. Successfully tackling all determinants can reduce overweight by 77.7% (ie, from 13.4% to 3.0%; = joint AR) with partial effects of treating parental overweight (42.5%); improving social status (14.3%); reducing media time to <1 hour per day (11.4%); and not smoking during pregnancy, low weight gain during pregnancy, and breastfeeding (together 9.5%), respectively. Improving all preventable risk factors (ie, early life factors and lifestyle) the effect is 9.2%. Media time has the strongest effect. The determinants identified explained 78% of the prevalence of overweight. Taking into account the partial ARs, the effectiveness of lifestyle interventions to prevent overweight in children is limited. Our data argue in favor of interventions aimed at families and social environments, with a major focus on promoting a lower screen time and computer use in children.

Supporting parents of preschool children in adopting a healthy lifestyle.

BackgroundChildhood obesity is a public health epidemic. In Canada 21.5% of children aged 2–5 are overweight, with psychological and physical consequences for the child and economic consequences for society. Parents often do not view their children as overweight. One way to prevent overweight is to adopt a healthy lifestyle (HL). Nurses with direct access to young families could assess overweight and support parents in adopting HL. But what is the best way to support them if they do not view their child as overweight? A better understanding of parents’ representation of children’s overweight might guide the development of solutions tailored to their needs.Methods/designThis study uses an action research design, a participatory approach mobilizing all stakeholders around a problem to be solved. The general objective is to identify, with nurses working with families, ways to promote HL among parents of preschoolers. Specific objectives are to: 1) describe the prevalence of overweight in preschoolers at vaccination time; 2) describe the representation of overweight and HL, as reported by preschoolers’ parents; 3) explore the views of nurses working with young families regarding possible solutions that could become a clinical tool to promote HL; and 4) try to identify a direction concerning the proposed strategies that could be used by nurses working with this population. First, an epidemiological study will be conducted in vaccination clinics: 288 4–5-year-olds will be weighed and measured. Next, semi-structured interviews will be conducted with 20 parents to describe their representation of HL and their child’s weight. Based on the results from these two steps, by means of a focus group nurses will identify possible strategies to the problem. Finally, focus groups of parents, then nurses and finally experts will give their opinions of these strategies in order to find a direction for these strategies. Descriptive and correlational statistical analyses will be done on the quantitative survey data using SPSS. Qualitative data will be analyzed using Huberman and Miles’ (2003) approach. NVivo will be used for the analysis and data management.DiscussionThe anticipated benefits of this rigorous approach will be to identify and develop potential intervention strategies in partnership with preschoolers’ parents and produce a clinical tool reflecting the views of parents and nurses working with preschoolers’ parents.

Parental Attitudes Toward Obesity and Overweight Screening and Communication for Hospitalized Children

Many studies have evaluated BMI screening, communication, and follow-up recommendations in the outpatient setting. However, few studies have examined parental attitudes toward using the inpatient setting as a time to screen and counsel families regarding their child's BMI. We sought to study parental attitudes about overweight and obesity screening in the inpatient setting. Parents (N= 101) of children aged 2 to 18 years admitted to a general pediatric hospital or surgical service were queried regarding their attitudes about screening and counseling for overweight and obesity. Children's age, gender, height, weight, and diagnosis codes were extracted from electronic medical records and billing databases. BMI was calculated, plotted, and categorized according to standard Centers for Disease Control and Prevention growth charts and expert recommendation. Fourteen percent of children in the study were overweight, and 17% were obese. Parents of overweight and obese children underestimated their child's weight status 68% of the time. The majority believed admitted children should always have their BMI calculated. Almost all parents (90%) indicated that their inpatient physician should inform them if their child were overweight or obese and that primary care providers should be informed of the results of BMI screening. Parents of children admitted to the hospital believed their children should have their BMI screened. If their child was overweight or obese, parents believed they should be informed, and counseling should be initiated. These findings support using the inpatient time to screen and communicate BMI.

Comparison of the biochemical, anthropometric and body composition variables between adolescents from 10 to 13 years old and their parents.

The present study had the objective of comparing the lipid profile, nutritional status and body composition of adolescents and their parents. A cross-sectional study was conducted with 120 adolescents from 10 to 13 years old, public schools students from the city of Viçosa, Minas Gerais, Brazil and their respective biological parents (104 mothers and 82 fathers). Data was collected regarding weight, height, waist and hip circumference, body fat, triglycerides, total and fraction cholesterol. Besides, taking the skinfold measurements (bicipital, tricipital, subscapular and suprailiac) of the adolescents; and evaluation of sexual maturity, excluding those that were in stage 1 according to Tanner. The statistical treatment includes descriptive analysis, the use of the Student's t-test, Mann Whitney, and Pearson and Spearman correlation. An Odds Ratio was conducted with a confidence interval of 95%, considering p < 0.05 significant. A positive and significant correlation was seen for weight, BMI and total cholesterol between father and son; for all the variables, except body fat and wait/hip ratio between father and daughter; for weight and height between mother and son and BMI between mother and daughter. Adolescents that had both parents with hypertriglyceridemia, with inadequacies of LDL or HDL presented, respectively 19, 20 and 4 times more chances of presenting the same alterations. This study confirmed differences in the anthropometric measurements, body composition and lipid profile between children of overweight, eutrophic and underweight parents, as well as greater chance for the adolescent to present an altered lipid profile when the parents also have presented that alteration.

Dietary intake in a randomized-controlled pilot of NOURISH: A parent intervention for overweight children

ObjectiveNOURISH is a community-based treatment program for parents of overweight and obese children (ages 6–11, BMI≥85th percentile). This study examined the impact of Nourishing Our Understanding of Role modeling to Improve Support and Health on child and parent dietary intake, secondary trial outcomes. MethodsIn Virginia from 2008 to 2009, this randomized controlled pilot was implemented and dietary assessment of parents and children conducted at baseline, post-test, and 6-month follow-up. Parents (85% female, 62% African American, mean BMI=34.1±9.1) were randomized into intervention (n=46) or control (n=50) groups. Children's (mean age=8.6±1.5) mean Body Mass Index percentile was 98.1±2.6. Parents completed 24-hour dietary records for themselves and their child(ren). Repeated measures analyses assessed treatment effects over time. T-tests evaluated within-group changes from baseline to post-test and to follow-up, using a modified intent-to-treat approach. ResultsBoth groups reported significant dietary changes, with few treatment effects found. For parents in NOURISH, significant improvements were found in intakes of total kilocalories/day, grams/day of carbohydrates and sugar, and percent calories from protein (p<0.05). Among control group children, significant improvements in total kilocalories/day and grams/day of carbohydrates and sugar were found (p<0.05). ConclusionsAmong parents who self-select into a childhood obesity program, minimal intervention can elicit short-term dietary changes comparable to those of a structured intervention.

‘I know it's wrong, but . . .’: a qualitative investigation of low‐income parents' feelings of guilt about their child‐feeding practices

In the developed world, child overweight and obesity rates are highest among the disadvantaged. This has resulted in calls for more research with low socio-economic families to better understand their experiences with disadvantage and how they might lead to poorer weight outcomes. The present study, conducted in Australia, adopted a qualitative approach to investigate the factors affecting low socio-economic parents' child-feeding practices. Methods used to collect data were introspections, interviews and focus groups. In total, 37 parents of overweight or obese children aged between 5 and 9 years took part in the 6-month study. Guilt emerged as an emotion that parents regularly experienced when allowing their children to consume too much food or foods high in fat, salt and/or sugar. Parents attributed their guilt-inducing child-feeding practices to both external and internal factors. Time scarcity and cost were factors that were primarily characterized by an external locus of control. The factors characterized by an internal locus of control were fear of their children experiencing hunger, the perceived need to secure their children's affection through the provision of treat foods, perceptions of their ability to balance their children's diets across eating situations and perceived laziness. Recommendations are provided for addressing guilt-inducing child-feeding practices.

Impaired parent-reported health-related quality of life of underweight and obese children at elementary school entry.

PurposeExamine the health-related quality of life of 5–6-year-old underweight, overweight and obese children.MethodsOur cross-sectional study included 3,227 parent–child dyads from the “Be active, eat right” study. Parents completed questionnaires regarding child and parental characteristics. Health-related quality of life of the child was measured using the Child Health Questionnaire Parent Form 28. Children were classified normal weight, overweight, obese, severely obese, and underweight according to the international age and gender BMI cutoff points. Bootstrap analyses were performed for general linear models corrected for potential confounding variables.ResultsSeverely obese children (β, −2.60; 95 % CI, −4.80 to −0.57, p < 0.01) and underweight children (β, −1.11; 95 % CI, −1.85 to −0.39, p < 0.01) had lower parent-reported scores on the physical summary scale. On the physical functioning profile scale parents of overweight and severely obese children also reported statistically significant lower scores (p < 0.05 and p < 0.01, respectively).There were no significant differences regarding the psychosocial summary scale scores between the different weight categories.ConclusionUnderweight and overweight children experience impaired health-related quality of life on the physical functioning domain. Physicians, teachers and parents should be aware of the possible negative impact on health-related quality of life in underweight and overweight 5–6-year-old children.Electronic supplementary materialThe online version of this article (doi:10.1007/s11136-012-0211-x) contains supplementary material, which is available to authorized users.

Multi-level influences on childhood obesity in Sweden: societal factors, parental determinants and child’s lifestyle

Swedish school children living in rural areas and in areas with low education are at excess risk of becoming overweight. This study examines influences of societal and individual characteristics (children and their parents) on prevalence of overweight and obesity, in a national sample of 7-9-year-old children. Anthropometric and lifestyle data were collected in a nationally representative sample of 3636 Swedish children. Overweight and obesity (International Obesity Task Force (IOTF)) data were analyzed in relation to lifestyle factors, parental weight, education and breast-feeding. The prevalence of overweight was 15.6% including 2.6% obese. Urbanization level and parental characteristics (weight status and education) were related to risk of overweight. Overall less favorable lifestyle characteristics were observed in rural areas and for children of low/medium educated mothers. Boys had greater risk of obesity in semi-urban and rural areas but this was not true for girls. For children's overweight, the living area effect was attenuated in multivariate analysis, while there was an association with origin of parents, high parental weight and medium maternal education. For obesity, the living area effect remained in boys while having two non-Nordic parents predicted obesity in girls. Parental weight status was associated with obesity in both girls and boys. Individual and societal factors influence children's weight status, and parental weight status is a strong determinant. Including overweight and obese parents in future health promoting interventions could be a strategy to prevent children from becoming overweight, but identifying those parents may prove difficult. To ensure reaching children with the greatest needs, targeting high risk areas might be a more effective approach.

The majority of parents of overweight and very overweight children underestimate their child's weight status and weight-related health risk

Aims The aim of this study was to explore parents9 perceptions of their child9s weight status and weight-related health risks. Methods The UK National Child Measurement Programme (NCMP) measures the height and weight of every child aged 5/6 and 10/11. Parents of children in the NCMP across five PCTs completed questionnaires prior to their child9s measurement. Parents classified their child9s current weight status into one of four categories (underweight, healthy weight, overweight or very overweight) and these classifications were compared to NCMP classifications using logistic regression with robust standard errors to account for clustering. Results A total of 3050 parents completed the questionnaire. Over 99% of parents of healthy weight children correctly identified their child9s weight status, compared to 12% of parents with overweight children and less than 1% of parents with very overweight children. Parents of overweight and very overweight children were less likely to correctly identify their child9s weight status in children aged 5/6 years (OR: 5.25, 95% CI: 2.36-11.71), in boys (OR: 2.97, 95% CI: 1.43-6.18) and in very overweight children (OR: 32.9, 95% CI: 4.5-240.8). Correct classification was not associated with ethnicity, parental education or family history of obesity. The majority of parents with overweight and very overweight children (73%) reported general knowledge of health risks associated with childhood overweight. However, when applying this knowledge to their own child, only 22% identified their child9s weight as a health risk. Among these parents, the odds of failing to identify a health risk in their child were higher in parents of overweight children than very overweight children (OR: 4.74, 95% CI 2.96-7.58) and in parents of children aged 5/6 (OR: 4.20, 95% CI: 2.56-6.90). There was no association between health risk perception and family history of disease or parental BMI. Conclusions The majority of parents of overweight and very overweight children underestimate their child9s weight status and associated health risk. Parents of younger children, boys and very overweight children were more likely to incorrectly classify their child9s weight and fail to identify their child9s weight as a health risk. This study highlights the need to address parental misperceptions as an important step to tackling overweight children.