Parents are more likely to underestimate their preschool children's weight when pediatricians do not tell them their children are overweight or gaining weight too fast, a study by the University of South Florida and Johns Hopkins University reports.
The study, published online earlier this month in Clinical Pediatrics, suggests pediatricians should not hesitate to wield their influence in helping parents identify overweight children. These children are at risk of developing serious and costly health problems once reserved for adults, like Type II diabetes and heart disease.
"When it comes to younger children, pediatricians tend to shy away from discussing and making recommendations about weight," said lead author Raquel Hernandez, MD, MPH, assistant professor of pediatrics at USF Health.
"That's unfortunate, because even a child as young as 2 years old with a body mass index indicative of obesity is at high risk of becoming an obese adult," said Dr. Hernandez, who initiated the study while she was a fellow in general academic pediatrics at Johns Hopkins. "As much as we'd like to think that chubby, smiling toddler will outgrow the excess weight, it's just not likely to happen with today's overabundance of food and societal influences toward heavier size."
The American Academy of Pediatrics recommends using body mass index (BMI), an indicator of body fatness calculated from height and weight, to screen for overweight and obesity in children, beginning at age 2. Children are considered overweight if they fall in the 85th to 94th percentiles of the BMI growth charts, and deemed obese if they are in the 95th percentile or higher.
This USF-Johns Hopkins study was the first to look at parents' perception of an ideal or healthy-weigh image in preschoolers -- children ages 2 to 5. From July 2008 to April 2009, the researchers interviewed 150 parents of preschoolers during well-child visits to an academic-based clinic. Among their findings:
• The absence of a pediatrician's comment was the strongest predictor that a parent of an overweight or obese child would misclassify their child's body image. These parents reported that their own child's current weight was the same or lighter than that of a healthy-weight preschooler.
• Among all respondents, less than 8 percent recalled ever being told by their pediatrician that their child was gaining weight too fast or overweight. A larger proportion of parents with overweight or obese children reported hearing this from a pediatrician -- 10 percent and 30 percent, respectively.
• While nearly one in three preschoolers in the study was overweight or obese, 83 percent of all parents reported their children as "about the right weight." More than half the parents of obese children cited their child was "about the right weight."
• Parents of overweight preschoolers were much more likely to underestimate their children's weight (89.6 percent) than parents of obese children (45.5 percent). In fact, 20 percent of these parents indicated that an image heavier than their child's reflected a healthy preschooler.
Dr. Hernandez said physicians may hesitate to bring up a young child's weight because they don't want to risk offending the parent. Adding to their reluctance may be the lack of specific clinical testing recommendations (blood sugar, cholesterol, etc.) and practical lifestyle guidelines for overweight and obese children ages 2 to 5, she said. "As a pediatrician, you may ask yourself. 'Do I really want to get into talking about a child's weight with the parent who hasn't asked about it, and if I do, what do I have to offer?'"
Yet, the advice of pediatricians matters more than they may think. Parents in the study overwhelmingly reported that they would value a pediatrician's advice about a child's weight problem over that of family members or friends.
Pediatricians have an important opportunity to make a difference in preventing obesity by intervening early, Dr. Hernandez said, before children's nutritional and exercise habits are set and when it's easier for them to lose weight.
"Weight is part of early childhood growth and development that should be on a parent's radar screen," Dr. Hernandez said. "Even when it's an uncomfortable subject, pediatricians need to raise the issues of long-term health risk, nutrition and behavioral changes with parents whose children are overweight or obese -- because clearly they will listen to us."
- R. G. Hernandez, T. L. Cheng, J. R. Serwint. Parents' Healthy Weight Perceptions and Preferences Regarding Obesity Counseling in Preschoolers: Pediatricians Matter. Clinical Pediatrics, 2010; DOI: 10.1177/0009922810368288
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