In a study of 104 children under treatment for type 2 diabetes at the Vanderbilt Eskind Pediatric Diabetes Clinic, the children and their parents were surveyed about their perceptions of the child's weight, dietary and exercise practices, as well as barriers to improving diet and exercise habits.
Quite often, both the children and their parents underestimated the child's weight status.
“You could argue the first step for overcoming obesity is recognition,” said Russell Rothman, M.D., assistant professor of Internal Medicine and Pediatrics at the Vanderbilt Center for Health Services Research, and senior author on the study in February's Diabetes Care.
“This is a group that is already getting treatment for type 2 diabetes, including education about exercise and nutrition. If anything, you might expect them to be more aware about weight issues. This should send up a red flag about how challenging it is to treat obesity in this population, if many of the parents and patients in this group don't even recognize the problem.”
The parents and children were surveyed by telephone and were asked, among other things, “do you think your child's/your weight is very overweight, slightly overweight, about right, slightly thin or very thin.”
While 87 percent of the children surveyed were obese by the most recent Centers for Disease Control and Prevention (CDC) standards, only 41 percent of parents, and 35 percent of the children reported themselves “very overweight.” Among parents who reported their child's weight as “about right,” 40 percent had children who actually were at or over the 95th percentile for weight and were considered obese by government standards.
Girls were more likely than boys to underestimate their weight, and parents underestimated their children's weight more often than the children did themselves. Additionally, those who underreported weight were more likely to report a poor diet and exercise than those who correctly reported their weight status. Those with misperceptions about weight also reported more barriers to better exercise and diet behaviors.
There have been other studies showing parents and children in the general population often don't accurately perceive weight. However, Rothman said this is the first study to examine weight perception among children with type 2 diabetes — a population that should already have been informed of their weight status and its contribution to diabetes from their health care providers.
“As health care providers we need to take a step back and realize these families need better guidance about understanding their weight status before we can convince them to make lifestyle changes to improve their health,” said Rothman, who also serves as director of the Vanderbilt Program on Effective Health Communication. “We need to do a better job as providers to work on shared communication, using more clear language, goal setting with families about key behavior changes, identifying barriers and setting realistic goals.”
Co-authors of the study include Ashley Cockrell Skinner, Ph.D., Morris Weinberger, Ph.D., Shelagh Mulvaney, Ph.D., and David Schlundt, Ph.D.
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