How deep can we get our heads underground? – ctd.

Yesterday’s post was about doctors’ not talking to parents about their overweight children. But in the comments, I saw a usual response, namely that this finding isn’t important, because the parents already know their kids are overweight.

I wish.

My anecdotal experiences in clinic are conerning. I can’t tell you how many kids I see who are overweight, but whose parents tell me they won’t eat. But anecdotes aren’t data, and so let’s go to the literature. I’m just going to give you a sample. I’m also going to stick to the findings, so I encourage you to follow the links for the methods if you are interested. Emphasis will always be mine.

Here’s a good place to start: “Do parents accurately perceive their child’s weight status?

RESULTS: Misclassification occurred 25% of the time (95% confidence interval: 21.4-28.5). All parents of children with a BMI greater than or equal to the 95th percentile classified their child in a category other than “extremely overweight,” and 75% of children with a BMI from the 85th to less than the 95th percentile were misclassified as “about right” or “underweight.” Boys were more likely to be misclassified than were girls (29% vs 21%, P = .03).

CONCLUSIONS: The majority of parents of obese and overweight children underestimate their child’s weight status. Parents of boys are more likely to perceive their child’s weight incorrectly.

Not a single parent of an obese child thought their children was “extremely overweight”. Not one. Three-quarters of parents of overweight children thought their kids were just fine, or weighed too little.

Next up, “Parents underestimate their child`s overweight.

RESULTS: The prevalence of overweight (including obese) was 17.4% and 21.6% in 5- and 11-year-old children in this study. Only a few parents misclassified their normal weight children as overweight. By contrast, a majority of parents to the 5-year-old children and about half of the parentsto the 11-year-old children misclassified them as normal weight. Using waist circumference for body size classification did not improve parents’ performance. Mothers performed best when estimating own weight class.

CONCLUSIONS: A majority of parents fail to recognize overweight or obesity in their 5- and 11-year-old children. The underestimation of overweight may impair the motivation of the parents to adopt weight control.

Most parents think their overweight or obese children are normal weight. They need to be told!

Here’s “Underestimation of children’s weight status: views of parents in an urban community“.

RESULTS: 193 children were included (response rate 87%, 18 months-9 years, 70% black); 31% of parents underestimated their child’s weight status (46% of overweight children, 24% of normal weight). Parents of normal-weight children who underestimated were more likely to be concerned about their child’s weight (39% vs 2.9%, P < .001) than those who did not underestimate. Parents of overweight children who underestimated were less likely to be concerned about their child’s weight (7.7% vs 59%, P < .001) than those who recognized their children as overweight.

CONCLUSIONS: Many parents continue to underestimate their child’s weight status. These perceptions may present a barrier to the prevention of childhood obesity.

I could do this all day. Here’s “Parents’ perceptions of their child’s weight and health“.

RESULTS: Of the 223 children, 60% were <6 years old, 42% were male, 17% were black, 35% were Hispanic, 42% were white, and 7% were other; 19% were AROW [at risk for overweight], and 20% were overweight. Few parents (36%) identified their overweight or AROW child as “overweight” or “a little overweight” using words, but more (70%) selected a middle or heavier sketch. Among parents of overweight and AROW children, 18% recalled a doctor’s concern and 26% were worried about their child’s weight. If the overweight or AROW child was age > or =6 years, parents were more likely to identify their child as “overweight” or “a little overweight” using words, select a middle or heavier sketch, and to be worried. Parents of older children were more likely to be worried if they perceived their child as less active/slower than other children or recalled a doctor’s concern.

CONCLUSIONS: Few parents of overweight and AROW children recognized their child as overweight or were worried. Recognition of physical activity limitations and physicians’ concerns may heighten the parent’s level of concern. Sketches may be a useful tool to identify overweight children when measurements are not available.

So parents know what their kids look like, but they don’t think that’s “overweight” or a problem.

Here’s “Childhood obesity: do parents recognize this health risk?

RESULTS: Of the 83 parents surveyed, 23% (19/83) had overweight children (> or = 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 accuracy of their perceptions about their children’s weight. Only 10.5% of parents of overweight children (2/19) perceived their child’s weight accurately compared with 59.4% of other parents (38/64; p < 0.001). Parents of overweight children invariably underestimated 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 recognize that their child has a weight problem, pediatricians should develop strategies to help these parents correct their misperceptions.

I’m going to stop now, not because I’m out of studies, but because I’m hoping by now you’ve gotten the idea.

We have a problem here. We all seem to grasp that obesity and overweight are a real health issue, even in children. Unfortunately, we also seem unable to recognize the problem when it’s occurring in our own kids. I know this is hard to believe. But there’s a lot of evidence that it’s happening all the time. It’s compounded by the fact that most pediatricians don’t seem to be adequately pointing out the facts to their patients and families.

The first step is recognizing that we have a problem.


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