|Year : 2018 | Volume
| Issue : 1 | Page : 55-61
Perception about childhood obesity and overweight among parents and children
Lumchio L Murry
Lecturer, College of Nursing, AIIMS, New Delhi, India
|Date of Web Publication||11-Jun-2020|
Source of Support: None, Conflict of Interest: None
Childhood obesity is a serious public health problem and has reached epidemic proportions in most of the developed countries. India is not an exception to this trend. In this study, the perception about childhood obesity and overweight was assessed on a consecutive sample size of 105 obese and overweight children and their parents attending the out-patient department of tertiary hospital, using cross sectional design. A 10 item questionnaire developed by the researcher was used to collect data. The overall perception towards obesity and overweight was good in the majority (89.5%) of parents. Majority (85%) of obese and overweight children also showed good perception towards obesity. Recognition of obesity as a preventable health problem is paramount in the management of childhood obesity. Overweight and obesity in childhood and adolescence have substantial and adverse long-term consequences for physical health. It is major responsibility of health care personnel to identify obesity and overweight in children and to teach about its harmful effects inorder to prevent its consequences.
Keywords: obesity, childhood, parents, perception, overweight
|How to cite this article:|
Murry LL. Perception about childhood obesity and overweight among parents and children. Indian J Cont Nsg Edn 2018;19:55-61
| Introduction|| |
Childhood obesity is a serious public health problem and has reached epidemic proportions in most of the developed countries. Childhood and adolescent obesity have been increasing in most of the middle and high-income countries, and as with adult obesity, this is driven by increasingly obesogenic environments, especially the food environment (Swinburn, 2009). Obese children are at risk for many health problems that were once confined to the adult population. Childhood obesity is the leading cause of pediatric hypertension, and is associated with type II diabetes mellitus, increases the risk of coronary heart disease, increases stress on the weight-bearing joints, lowers self-esteem, affects relationships with peers, and also increases the risk of obesity in adulthood (Freeman- Fobbs, 2003; Gidding, Bao, Srinivasan, & Berenson, 1995; Must & Strauss, 1999). According to International Obesity Taskforce Report to World Health Organization (2004a), 10 % of children, or at least 155 million youngsters worldwide are overweight or obese. In the year 1998, the WHO designated obesity as a global epidemic.
Studies in India show prevalence rates of obesity ranging from 4.5 to 6.5 %country (Kumar, Mohanan, Kotian, Sajjan, & Kumar, 2008; Raj, Sundaram, Paul, Deepa, & Kumar, 2007). The prevalence of overweight among children was found to be 37.5 % in urban Delhi and 8 % in rural Haryana (Chadha, Gopinath, & Shekhawar, 1997).
Parents have a strong influence over their children’s lifestyles. But studies show that parents do not perceive their children as overweight even though they are above the normal weight for age. Mothers often believe that a heavy infant is a healthy infant and is a result of successful feeding and parenthood (Baughcum, Chamberlin, Deeks, Powers & Whitaker, 2000). Parents’ appropriate perception about their child’s obesity status can be a positive force in child obesity treatment (Dietz, 1993; Myers & Vargas, 2000). Content analysis of10 focus groups (average size = 7) and 18 follow- up interviews among parents of preschoolers living in Hartford, Connecticut (USA) revealed parents have a distorted, detached view on overweight in preschoolers, and did not include weight in their definition of health (Goodell, Pierce, Bravo, & Ferris, 2008). Parents of younger children were significantly more likely to underestimate differences in weight (65%), than parents of adolescents (51%) (West et al., 2008). Another cross sectional study among 355 pairs showed that children’s actual weight status (29.9% overweight or obese and 1.4% underweight) was different from their parents’ perceptions of their weight status (18.3% overweight or obese and 17.2% slightly underweight or underweight) (He & Evans, 2007). This shows that a large proportion of parents did not recognize that their children were overweight or obese. Studies on parental perception about childhood obesity in India are few and unreported. This study explores the perception of obese and overweight children and their parents towards childhood obesity.
| Objectives|| |
- To assess the parent’s perception about childhood obesity and overweight
- To assess children’s perception towards childhood obesity and overweight
- To find the association between perception of parents regarding obesity and overweight and the socio- demographic variables of child and parents
| Methods|| |
A cross sectional design was adopted for the study. Consecutive sampling technique was used to enroll 105 children from the age group of 6 years to 15 years and either of their parents. The study was conducted in the child health OPD of a tertiary care hospital in South India. Children aged 6 to 15 years, who were obese and overweight as determined by BMI for age percentiles, 2 to 20 years (Department of Health and Human Services, 2000), who attended child health OPD and one of the parent of the child irrespective of their weight at the time of inclusion were recruited for the study. After recruiting the subjects parental obesity was determined using BMI cut off rates for overweight - BMI of25 - 29.9 and obese - BMI greater than or equal to 30 (World Health Organization, 2004b).
Socio-demographic data like, age, gender, birth order, educational status, area of living, dietary pattern, parental age, gender, education, income and occupation were collected. Socio-economic status was determined by the Kuppuswamy’s scale (Mishra & Singh, 2003). Perception towards obesity was assessed using a researcher developed questionnaire containing 10 items each, with dichotomous options, for parents and children. Each item was a positive or negative statement related to their child’s obesity status and the parents were expected to answer yes or no denoting whether they agreed or disagreed to the statements. Each correct answer was given a score of one and each incorrect answer was given a score of zero. The content validity of the questionnaires was checked by subjecting it to analysis by experts in the field. Questions with Item Content Validity Index (I-CVI) of less than 0.80 were removed from the questionnaire. The Scale Content Validity Index (S-CVI) was 1.0. The feasibility of the study was determined during the pilot study. A score of 60% and above was considered as good perception.
The study was approved by Dissertation Committee and Ethics Committee of the college and permission was obtained from nursing and medical Heads of Departments of respective areas. Informed consent was taken from children and their parents. To recruit subjects for the study, children were weighed with minimal clothing and without footwear. Height was measured by placing the child against a firm, straight wall on which a calibrated measuring tape was mounted, barefooted and the heels, buttocks, shoulders, and occipital prominence touching the wall and the BMI was calculated. The study included 105 children who were overweight or obese.
The questionnaire on parental perception was given to the parents. The questionnaire on child’s perception was administered to children of 10 years and above.
| Results|| |
Socio-demographic data and perception towards childhood obesity and overweight was analyzed using descriptive statistics.
[Table 1] shows the demographic profile of the participants. The majority of children were from the age group of 6 to 12 years (schoolers). The mean age was 10 years. Males comprised 59%. In the birth order, single child status was a majority (55%). Among the parents, there were 50 fathers and 55 mothers who participated in the study. Among parents 37% were obese and 39% were overweight.
|Table 1: Distribution of Children and Parents according to Socio-demographic Variables|
Click here to view
[Table 2] shows the analysis of the questions on parental perception towards obesity and overweight. The overall perception about obesity was good in 89% of parents and 85% of children. Majority of the parents rightly perceived obesity as a health problem (84.8%). They also agreed that their children were overweight (78.1%) and that an overweight child will have problems when they become older (90.5%). Majority (86.7%) of parents disagreed that a fat child is a healthy child. Forty four percentage of parents reported that they feel embarrassed in social gatherings due to their child’s overweight status whereas 58.1% of the parents reported that they were not worried about the child’s overweight. Most of the parents (92.4%) felt that their child needed support and encouragement to reduce weight.
A total of 47 children (above 10 years) filled the questionnaire on perception of obesity. [Table 3] presents the analysis of child’s perception towards obesity and overweight. Most of the children (70.2%) reported that obesity is a health problem. Eighty seven percent admitted that they were overweight. Majority of them (87.2%) were also aware about the risk of health problems due to obesity when they become older and that exercise and diet control is necessary to lose weight (87.2%). However, a majority (91.5%) of the children perceived a fat child as a healthy child. Sixty two percent of the children also felt embarrassed among friends and relatives due to their weight status. Majority of the children (91.5%) also perceived a need for support and encouragement from their parents to lose weight.
There was no significant association between parental perception with selected socio-demographic variables (see [Table 4]). Contrary to this in a study done by Aljunaibi, Abdulle and Nagelkerke (2013) parental perceptions of their children being overweight or obese were associated with the child’s actual BMI.
|Table 4: Association of Parental Perception with Socio-demographic variables|
Click here to view
| Discussion|| |
Parents’ perceptions about their children regarding obesity have been widely studied in the western countries. Obesity related issues are gaining attention in India as well. In this study, the overall perception of parents towards obesity and overweight has been shown to be generally good. A majority of parents perceived their child to be overweight. A similar study done by Rich et al. (2005) in which in-depth interviews were conducted with 76 caregivers whose children were obese also found that 89% regarded their child as overweight. Findings in another study reported that 61.9% of parents of obese children perceived their children to be having normal weight (Aljunaibi et al., 2013). In this study, most of the parents regarded obesity as a health problem (84.8%). This is supported by Rhee, De Lago, Arscott-Mills, Mehta and Davis (2005) in their study with 151 parents of obese children. They found that 70% of the parents regarded obesity as a health problem. In another study parents perceived that obese children will have heart disease later (Myers & Vargas, 2000). In the current study also parents (90.5%) reported that an overweight child will have health problems when older. The above findings indicate that both parents and children are aware that obesity can cause serious health issues. Majority of them agreed that their children need exercise and diet control to reduce weight. Parents who felt embarrassed in social gatherings due to their children’s weight status was 41.9%. They agreed that the child needs their encouragement and support to lose weight (92.4%). These findings are encouraging because it shows that parents are concerned about their child being obese and overweight and thus they are more likely to take preventive action towards obesity if an obesity prevention intervention is planned.
Opinion was divided about whether obesity has hereditary influence (45.7% vs 54.3%). This may be because the exogenous factors in the development of obesity were more prominent. Another disheartening finding was that only 54.3% of the parents reported parental obesity as having an influence on their child’s’ weight status whereas there is evidence that parental obesity is the strongest predictor of childhood obesity (Whitaker, Wright, Pepe, Seidel, & Dietz, 1997: Christoffel & Ariza, 1998: Strauss & Knight, 1999). If parents have distorted perception and knowledge about obesity they may not approach health care members for appropriate intervention at the right time (Suzanne et al., 2008). These findings indicate that parents need to be educated about their obesity status and its influence on child’s weight.
Studies done to identify prevalence of obesity in children show that in 2010 estimated combined prevalence of childhood overweight and obesity was 19.3 % which also showed a significant increase from the earlier prevalence of 16.3 % reported in 2001-2005 (Ranjani et al., 2016). In this study children aged ten years and above were assessed for their perception towards obesity and overweight. The overall perception score was encouraging in 85% of children. Most of the children reported that obesity is a health problem and agreed that they were overweight. This acceptance and good perception is a vital motivating factor in prevention or treatment of obesity. The children’s perception that exercise and diet influence weight and overweight and lead to health problems provides a positive starting point for obesity control interventions. The wrong perception that a fat child is a healthy child might have been passed on by the adults in the family and society.
In India where parents force children to eat large meals to stay healthy without considering the healthy life style such as exercise and outdoor activities can influence their child’s perception lifelong. This suggests that these children are not really aware of the harmful implications of childhood obesity and do not have a clear understanding of the meaning of “healthy”. Although self-esteem was not measured specifically, 62 % of the children felt embarrassed among friends and relatives due to their overweight status. Shin and Shin (2007) also found that obese children have significantly lower self-esteem and higher level of depressive symptoms. Most of the children (53.2%) in this study believed that childhood obesity will not cause obesity during adulthood . Literature however suggests that childhood obesity is a known precursor to obesity and other non-communicable diseases in adulthood (Ranjani et al., 2016). Leibel, Rosenbaum and Hirsch (1995) pointed out that 90 to 95% of obese/overweight people who appropriately lose weight subsequently regain it. With this strong evidence it is imperative that children and parents need to be taught about preventing obesity. Similar to their parents, most of the children (61.7%) believed that obesity is not hereditary.
| Conclusion|| |
This study aimed to assess the perception towards childhood obesity among obese and overweight children and their parents. Childhood obesity contributes to increased morbidity and mortality. There needs to be a shift in focus from under nutrition to overweight in children. Health care approaches to combat overweight in children also need to be put in place. It is the prime duty of parents and every health personnel to recognize the burden and act towards preventing childhood obesity and overweight.
Conflicts of Interest: The author has declared no conflicts of interest.
| References|| |
Aljunaibi, A., Abdulle, A., & Nagelkerke, N. (2013). Parental weight perceptions: A cause for concern in the prevention and management of childhood obesity in the United Arab Emirates. Plos ONE
, (3), doi: 10.1371/journal.pone.0059923
Baughcum, A.E., Chamberlin, C.M., Deeks, C.M., Powers, S.W., & Whitaker, R. C. (2000). Maternal perceptions of overweight preschool children. Pediatrics
, 106, 13801386.
Chadha, S.L., Gopinath,N., & Shekhawar,S. (1997). Urban- rural differences in the prevalence of coronary heart disease and its risk factors in Delhi. Bulletin WHO
, 5, 3138.
Christoffel, K.K., & Ariza, A. (1998). The epidemiology of overweight in children: Relevance for clinical care. Pediatrics
, 101(1), 103-105.
Dietz, W.H. (1993). Therapeutic strategies in childhood obesity. Hormone Research, 39
Freeman-Fobbs, P. (2003). Feeding our children to death: The tragedy of childhood overweight in America. Journal of the National Medical Association
Gidding, S.S., Bao, W., Srinivasan, S. S., & Berenson, G.S. (1995). Effects of secular trends in obesity on coronary risk factors in children: The Bogalusa heart study. Journal of Pediatrics
, 27, 868-873.
Goodell, L. S., Pierce, M. B., Bravo, C. M., & Ferris, A.M.(2008). Parental perceptions of overweight during early childhood. Quality Health Research, 18
He, M., & Evans, A. (2007). Are parents aware that their children are overweight or obese? Do they care?. Canadian Family Physician
, 53(9), 1493-97.
Kumar, H.N.H., Mohanan, P., Kotian, S., Sajjan, B.S., Kumar, S. G. (2008). Prevalence of overweight and obesity among preschool children in semi urban South India. Indian Pediatrics
Leibel, R. L., Rosenbaum, M., & Hirsch, J. (1995). Changes in energy expenditure resulting from altered body weight. New England Journal of Medicine, 332
Mishra, D., & Singh, H.P. (2003). Kuppuswamy’s socioeconomic scale- A revision. Indian Journal of Pediatrics
, 70, 273-274.
Must, A., & Strauss, R.S. (1999). Risk and consequences of childhood and adolescent overweight. International Journal of Obesity and Related Metabolic Disorders
, 23, S2-S11.
Myers, S., & Vargas, Z. (2000). Parental perception of the preschool obese child. Pediatric Nursing
, 26(1), 23-30.
Raj, M., Sundaram, K.R., Paul, M., Deepa, A.S., & Kumar, R.K. (2007). Obesity in Indian children: Time trends and relationship with hypertension. National Medical Journal of India
, 20(6), 288-93.
Ranjani, H., Mehreen, T. S., Pradeepa, R., Anjana, R. M., Garg, R., Anand, K., & Mohan, V. (2016). Epidemiology of childhood overweight & obesity in India: A systematic review. The Indian Journal of Medical Research
, 143(2), 160.
Rhee, K.E., De Lago, C.W., Arscott-Mills, T., Mehta, S.D., & Davis, R.K. (2005). Factors associated with parental readiness to make changes for overweight children. Pediatrics
, 116, 94-101.
Rich, S.S., DiMarco, N.M., Huettig, C., Essery, E.V., Anderson, E., & Sanborn, C.F. (2005). Perceptions of health status and play activities in parents of overweight Hispanic toddlers and preschoolers. Family Community Health
, 28, 130-141.
Shin, N.Y., & Shin, M.S. (2007). Body dissatisfaction. Self- esteem and depression in obese Korean children. Journal of Pediatrics
, 152(4), 502-06.
Strauss, R.S., & Knight, J.K. (1999). Influence of the home environment on the development of obesity in children. Pediatrics, 103
Swinburn, B. (2009). Obesity prevention in children and adolescents. Psychiatric Clinic, North America
, 18(1), 209-23.
West, D.S., Raczynski, J.M., Phillips, M.M., Bursac, Z., Heath, Gauss, C., Montgomery, B.E. (2008). Parental recognition of overweight in school-age children. Obesity
, 16(3), 630-6.
Whitaker, R., Wright, J., Pepe, M., & Dietz, W. (1997). Predicting obesity in young adulthood from childhood and parental obesity. The New England Journal oj Medicine
, 337(13), 869-73.
World Health Organisation. (2004b). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet
[Table 1], [Table 2], [Table 3], [Table 4]