Earlier this week I attended an eye-opening overview of a Scientific Statement published and funded by the American Heart Association in January of this year. The lead author, Myles S. Faith PhD, associate professor, Gillings School of Global Public Health, University of North Carolina discussed how parents' behaviors impact (or not) the actions of obese children.
Much discussion fills the space in broadcast, print and online media about how parents need to model eating and exercise behaviors in order to help their obese children lose weight and get in shape. It is not quite that simple.
The study, "Evaluating Parents and Adult Caregivers as 'Agents of Change' for Treating Obese Children: Evidence for Parent Behavior Change Strategies and Research Gaps," begins by surveying a total of 939 pediatricians (22% of the total), pediatric nurse practitioners (31%) and registered dieticians (47%). The study found that 39% of pediatricians perceived themselves as having "low proficiency" in behavioral management strategies. Their topline was that many health professionals lacked the knowledge of core behavior change strategies to manage childhood obesity.
The statement also reported on another survey of 87 primary care pediatricians and nurse practitioners and found that just over one-quarter of them knew the definition of childhood obesity and only 9% knew how prevalent it is. While one could argue that it is not the role of a physician or nurse to teach parents about childhood obesity, who will lead the discussion with the parents? I was surprised to learn that in the first year of a baby's life, more than a third of this surveyed group never discussed fast food, television or candy with the parents.
Dr. Faith explained that simply having parents involved in the treatment does not necessarily yield improvement -- and parental intervention results have been mixed. Many factors, including smallish studies, impact of more vs. less motivated parents and, of course, whether one of more of the parents themselves are obese does have an influence.
President Obama has issued a President's Challenge and First Lady Michelle Obama has declared a war on child obesity, stating that the goal of the Let's Move Program is to reverse this situation in a decade. But as this study reports, "many parents of obese children do not perceive their children to be obese and therefore may not be inclined to make changes."
So what can we do?
This review does offer concrete solutions. First step is to identify specific behaviors to be changed -- both by the child and the parents. The more specific, the report notes, the more effective. Rather than using generalizations (eating healthier or exercising more) detailing the exact amount of calories or fat or the amount of time on an exercise bicycle works better.
Myles Faith underscored the importance of self-monitoring -- writing down or keeping track of behaviors including what and how much is eaten and physical activities as they occur. The result is that this activity raises the awareness before the activity begins, which can stimulate a change. In fact, they state that the more someone self-monitors, the more weight loss and the longer term weight loss. Choose My Plate offers a free terrific online self-monitoring tool.
Parents must also offer positive reinforcement and praise. The statement actually recommends that this is one of the strongest strategies; in addition to: spending time together, non-monetary prizes and nonfood rewards (more positive empowering strategies for parenting are available from the American Academy of Pediatrics).
It is time to stop pointing fingers and start all working together: at home, in schools and in our doctors' offices.
(Full disclosure: I also presented "Consumer Trends Influencing Purchase Behaviors in the Supermarket" at this conference without receiving any payment or reimbursement).
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