Child/Adolescent Health

Studies examine pediatricians' and parents' attitudes toward childhood obesity

Watching television has been shown to be clearly associated with children becoming obese, and pediatricians feel they have little success in treating children's obesity, according to a new study. Overweight children are more likely to live in poverty and suffer from chronic medical and emotional conditions, factors likely to increase parental aggravation. While some have linked negative parental attitudes and behaviors with overeating by children, parental aggravation is not linked to this problem, concludes a second study.

Both studies were supported by the Agency for Healthcare Research and Quality (HS13901) and led by Sarah E. Barlow, M.D., M.P.H., of St. Louis University. They are described here.

Barlow, S.E., Richert, M., and Baker, E.A. (2007). "Putting context in the statistics: Paediatricians' experiences discussing obesity during office visits." Child: Care, Health and Development 33(4), pp. 416-423.

Despite following obesity treatment recommendations, pediatricians feel they have little success treating children's obesity. In interviews with eight pediatricians from diverse practices, the researchers asked them how they identify, treat, and might improve office-based treatment for obesity.

The pediatricians felt that they identified most overweight children, and primarily with weight and height charts, not the body mass index (BMI). They followed recommendations to emphasize to children and their families the health problems of obesity, advised simple behavior changes for the entire household, and adapted messages to individual families. Sometimes, they also took extra time to discuss obesity. Despite this, they often considered their efforts futile and found almost no success. The pediatricians cited several family barriers that may have impeded their success in this area. For example, many families had poor home environments, whose pressing needs crowded out time to prepare food and exercise. Other families were not committed to fighting their child's obesity, with some simply accepting that weight problems were intrinsic to the family. The successful patients typically came to the pediatric office already motivated.

Thus, promoting pediatrician compliance with recommendations will not reduce childhood obesity. Instead, improving patient motivation prior to visits and new handouts, such as a list of healthy snacks or exercises that could be done in the house, may be more effective, conclude the authors.

Barlow, S.E. and Chang, J-J. (2007). "Is parental aggravation associated with childhood overweight? An analysis of the national survey of children's health 2003." Acta Paediatrica 96, pp. 1360-1364, 2007.

This study did not link parental aggravation with a child being overweight. The researchers compared parents' aggravation with their child with the child's body mass index (BMI), based on parental responses to the National Health Survey of Children's Health. Parents were considered aggravated by their child when they responded "usually" or "often" to any of three items during the last month:

1. On average, they felt their child was much harder to care for than other children.
2. They were bothered a lot by their child's behavior.
3. They felt angry with their child.

About 9 percent of parents reported being aggravated with their child. When parents reported aggravation, the children more often had a BMI of 95th percentile or greater (overweight). Overweight children were also older, more often black, and had lower income and education status than those who weren't overweight. More overweight than normal weight children also had problem behaviors, socioemotional difficulties, a chronic medical condition, and watched more hours of television per day.

Thus, higher BMI was associated with many characteristics likely to make parenting more demanding and aggravation with children more likely. However, after controlling for these characteristics, parental aggravation was not linked to additional risk of a child's high BMI.

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