Authors and Disclosures
Michael O’Riordan
Michael O’Riordan is a journalist for Medscape. Before becoming a journalist for theheart.org, now part of the WebMD Professional Network, he worked for WebMD Canada. Michael studied at Queen’s University in Kingston and the University of Toronto and has a master’s degree in journalism from the University of British Columbia, where he specialized in medical reporting. He can be contacted at MORiordan@webmd.net.
From > Medscape Medical News > Heartwire
Data Mixed on Role of Parents and Caregivers in Combating Childhood Obesity
Michael O’Riordan
Posted: 1/27/2012
The evidence supporting increased involvement of parents and adult caregivers in reducing the weight of their obese children is “limited and inconsistent,” according to a new scientific statement from theAmerican Heart Association (AHA), although the experts say there are some parenting strategies that appear to be effective in getting children to alter unhealthy behaviors [1]. The statement is published online January 23, 2012 in Circulation.
For example, self-monitoring, which means focusing on a specific behavior, such as food consumption or physical activity, to raise awareness about the frequency in which the behavior occurs and positive reinforcement strategies tend to be most effective for eliciting changes that lead to weight loss.
“Involvement is a pretty broad term,” said Dr Myles Faith (University of North Carolina, Chapel Hill), the chair of the AHA writing committee on the role of parents in combating childhood obesity. “We wanted to know whether certain types of involvement or certain strategies were more effective than others, and when we looked at the literature there do appear to be some particular strategies that seem to be more effective, such as self-monitoring and praise.”
In previous studies, researchers have defined core behavior-change strategies to treat childhood obesity, including targeting specific behaviors, self-monitoring, goal setting, stimulus control, positive parenting strategies, and the promotion of self-efficacy and self-management skills. Faith told heartwire that for families with obese children trying to lose weight, there might be a tendency to see only where their children are struggling, such as with “failures” in losing weight. For parents, one of the most effective strategies is to start with one specific behavior, be aware of its role in contributing to overweight/obesity, and work toward changing it with positive reinforcement.
Inconsistent Data From Clinical Trials
In the AHA statement, Faith and colleagues reviewed data where researchers experimentally changed the degree or nature of parental/adult caregiver involvement in affecting the weight of children. Just two of 12 studies found significant short-term differences in child weight status among parents who were more actively involved. Of the 12 studies, just three reported long-term differences in weight loss. On the whole, the randomized, controlled clinical data “provide limited support for the notion that greater parental involvement with their children in treatment leads to stronger outcomes,” according to the AHA statement.
To heartwire , Faith said there are several reasons for the lack of benefit, including a statistical lack of power in the studies. In addition, he noted that parents of obese children who enroll in these clinical trials tend to be highly motivated and are likely to be involved in getting their children to lose weight already.
“Another reason I think is important is that involvement, again, is a very general, nonspecific term, and very few studies actually took out the microscope to see what parents actually do,” Faith said. “So the studies, from a measurement point of view, might not have been poised to look at specific behaviors. That might be why the studies have been unable to pick up any associations.”
In contrast to these studies, there is some evidence of benefit if parents or caregivers focus on changing core behavior strategies. For example, one study showed that reductions in child weight were achieved when parents planned meals, aimed to give few high-calorie snacks, and praised their children for good eating habits. They note that certain conditions in the parent-child relationship can also help increase the likelihood of children learning new behaviors, including but not limited to paying attention to the kids to increase positive behavior and being consistent.
Future Studies
In the statement, Faith and colleagues point out research gaps in the literature and emerging opportunities for study. They note that many parents of obese children do not perceive their kids to be obese and as a result are not usually inclined to make changes. Studies that help to understand accurate and inaccurate parental perceptions of childhood overweight/obesity would be welcomed, they state. In addition, they note there is a need for culturally tailored family-based treatments, as well as an understanding of how family risk and genetic discoveries can improve parental interventions. And finally, they note that TV viewing has to change because studies show that reductions in screen time can lower children’s weight.
“Childhood obesity is a result of many factors at all levels of society. This includes the individual level, such as family background and genetic predisposition, the family level, and also the community and societal level,” Faith said. “All of these particular levels are important–the family unit does not exist in a vacuum. Context is important. Strategies that are designed to combat childhood obesity are designed with all these different levels in mind.”
The AHA scientific statement on the role of parents and adult caregivers in combating childhood obesity also contains an appendix of obesity-treatment resources for professionals and parents.
