Advances in ISSN: 2378-3168AOWMC

Obesity, Weight Management & Control
Review Article
Volume 3 Issue 3 - 2015
Childhood Obesity and Parental Health Literacy
Ray Marks1,2*
1Department of Health & Behavioral Sciences, City University of New York, USA
2Department of Health and Behavior Studies, Columbia University, USA
Received:July 29, 2015 | Published: October 14, 2015
*Corresponding author: Ray Marks, Department of Health & Behavioral Sciences, City University of New York, and Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, USA, Tel: 212-678-3445; Email: ,
Citation: Marks R (2015) Childhood Obesity and Parental Health Literacy. Adv Obes Weight Manag Control 3(3): 00055. DOI: 10.15406/aowmc.2015.03.00055

Abstract

Recent data have indicated that having a high body mass index poses immense health risks to children, and adolescents. This review describes the recent research on childhood obesity-an epidemic of global proportions- and parental health literacy. Based on the available information, it provides guidelines for public health professionals interested in preventing or reducing overweight in youth and obesity in adults. To this end, English language peer reviewed publications and data reporting on the topics of overweight, obesity and health literacy were reviewed to specifically examine the interrelationship of these factors. Findings reveal childhood obesity is an ongoing widespread health concern, where intervening to prevent the onset of obesity should start in the formative years. It is concluded that such strategies should be grounded upon fostering accurate parental perceptions about the condition, as well as efforts to help parents with low health literacy to detect and intervene upon this condition.

Keywords: Childhood obesity; Health literacy; Parents; Perceptions; Prevention

Introduction

Childhood overweight is an unrelenting public health challenge that shows few signs of abating [1-5]. Moreover, regardless of where the research is conducted, additional research shows many preventable diseases are associated with the early onset of obesity, and this risk increases incrementally as the magnitude of an individual's obesity level increases. Nonetheless, given that current campaigns designed to minimize this burdensome public health have made very little major impact to date, it appears important to continue to examine what else needs to be done to combat this problem.

One emerging body of promising research shows that parents, who have great influence over their children’s health practices may repeatedly misperceive either the importance of childhood overweight or the presence of childhood overweight or both. Another body of literature shows that being health literate is an important element of health related behaviors that may be undermining public health attempts to ameliorate childhood obesity, especially among groups with low levels of educational attainment.

This brief examines the concept of health literacy, the possible role of health literacy in mediating overweight problems in children, and how this knowledge might be applied to enhance present preventive efforts. Also included in this review are recent data stressing the importance of fostering accurate parental perceptions as well as knowledge about their children's actual body weight status, as well as their vulnerability to becoming overweight and its detrimental long term outcomes. All types of research was deemed acceptable as this line of research is in its infancy. The results of the search strategy used when applying the key terms health literacy and childhood obesity is shown in Table 1. Other data published between 2014 and 2015 that discussed parental weight perceptions in the context of childhood obesity were sought, carefully read, and summarized (Table 2).

Data Base

Number of References

Number of Appropriate References

Cinahl

3

1

PUBMED

35

5

Scopus

51

5

Web of Science

40

6

Table 1: Number of Resources Available on Topic 2000-2015.

Ref. Source

Findings

Suggestions

[15]

Results of 6 caregiver studies showed more than 70% of cases underestimated their child’s weight status

Perceptions are a risk factor for childhood obesity

[16]

Among parents, 25.2% underestimated and 1.1% overestimated their child's weight

Strategies to prevent obesity should take health literacy levels into account

[17]

While parents and grandparents were aware of their preschoolers' growth chart percentiles, these measures did not translate into recognition of children's overweight or obesity. The participants spoke of obesity as a problem that may affect the children in the future, but not at present.

Clinicians should discuss overweight issues among their clients in charge of preschoolers

[18]

Parents of 3-12 year olds reported inaccurate height and weight data, or underestimated degree overweight

Parents need to be able to report weight issues accurately where present.

[19]

Most participants found growth charts and the term "BMI" confusing.

Linking body weight and its health association is valuable for motivating parents with overweight kids towards action

[20]

Overweight or obese parents and parents of boys were more likely to underestimate the actual weight status of their children.

Obesity underestimation is a possible risk factor for childhood obesity

[21]

The majority (79.8%) of preschoolers who were classified as overweight using BMI percentile were perceived as non-overweight by the parent in the first 2 years-of-life.

Parent weight perceptions in the first 2 years of life may heighten risk for obesity/overweight + unhealthy diets that can be modified

[22]

There is a major discrepancy between the child's measured BMI and their parent's perception of their child's weight category.

Managing children’s weight should start with education of parents

Table 2: Publications on topic of childhood obesity and parental perceptions.

Results

Health literacy

Derived from the field of education, the term ‘health literacy,’ has been deemed by researchers in the field to represent literacy skills related to vocabulary, materials, and directives employed in health care settings [6]. Health numeracy, defined as those “skills needed to understand quantitative health information” [7] is another important component within the realm of health literacy and one found lacking in a substantive proportion of adults worldwide [8], especially among those with low incomes and low educational levels. Since adults with either limited literacy, or limited numeracy skills or both are likely to have limited ability to carry out desirable health practices, and may be completely unaware of the need to do so, they may have a strong negative influence on others under their care. They may not only be unaware of the risks of their guardians, but may hold beliefs that are not borne out by facts, they may also not understand facts, or messages needed to prevent adverse health outcomes.

Huizinga et al. [9] recount that in 2003, the National Assessment of Adult Literacy (NAAL) found that approximately 90 million Americans have basic or below basic literacy skills and that 110 million have basic or poor quantitative (numeracy) skills. These findings were independently associated with having a poor understanding of health information, poor health behaviors, and poor clinical outcomes. In the context of nutrition and obesity, low health literacy/numeracy was associated with worse knowledge about breastfeeding, difficulty understanding food labels and portion sizes and higher body mass index (BMI) in adults. This group recounts that Surgeon General Richard Carmona not only acknowledged that health literacy was a major problem in the United States, but that he recognized that low health literacy was potentially a strong explanatory factor related to the proliferating obesity problem.

A more recent cross-sectional study by Yin et al. [10] did indeed find eleven percent of parents of 2-month old children had low health literacy. In addition, low parental health literacy was associated with certain obesogenic infant care behaviors. The findings included reports of parents feeding their children more formula than breast milk if they were low health literate, they fed their child as soon as it cried. The authors suggested these behaviors and others may serve as modifiable targets for low health literacy-focused interventions to help reduce childhood obesity.

Garret [11] who reported results from logistic regression analyses demonstrated that the parent's health literacy level was a significant predictor of the accuracy of their perceptions regarding their child's body weight (p<.05). However, the parent's concern regarding child weight and perceived level of efficacy did not significantly predict the accuracy of their perceptions. Content analyses revealed that parents are often uncertain how to define healthy or unhealthy body weights in children. Parents in the study often relied on subjective observations to determine the appropriateness of child body weight, but many were open to counseling and education from medical professionals, Internet resources, and other objective sources.

Chari et al. [12] conducted an anonymous survey among English speaking parents. They found the odds for obesity in children increased with low health literacy scores of the parents. Cha et al. [13] too who found obesogenic infant care behaviours may increase childhood obesity, and predict obesity and related health risks in adulthood reported poor parental health literacy predicted poor child health outcomes, including childhood obesity.

Cluss et al. [14] measured nutrition knowledge of parents of Medicaid-insured obese children using a simple health literacy tool. Although health literacy was not specifically examined, this group found the parents' understanding of food's nutritional value is variable, and those who were black, had less education, and very low income had poorer nutrition knowledge than others with better education.

One reason why poor health literacy may impact childhood obesity rates is the impact of poor understanding of a health issue on the caregiver’s perceptions of related health risks. Unsurprisingly Tomlkins et al. [15] who conducted a 2006-2012 systematic review-and found an underestimation of obesity ranging from 13.3 to 100 % of parents of overweight children found parental health literacy was one of the factors that affected accuracy of parental perceptions. Related findings are shown in Table 2 and show the consistent misinterpretation of childhood obesity by caregivers.

Discussion

Despite the limited number of research articles on this topic, parental health literacy is clearly a significant factor that can contribute inadvertently to the obesity epidemic, as well as its solutions. As outlined by Huizing et al. [9] who discussed the prevention of early childhood obesity, interventions to foster health literacy concerning childhood obesity and its causes and solutions among parents might be extremely helpful in this regard, given the link between the extent of this skill and accuracy of their child’s weight perception [11]. In particular, tailored efforts that target the parent or caregiver’s comprehension and application levels, plus their numeracy skill level are potentially helpful. In addition, the material should be culturally relevant. For example, information for Latino parents and their children should contain information about healthy food choices from commonly consumed food from their culture. Parents also need practical tools that they can use to aid in the interpretation of food labels and in meal planning. They also need aids to understand the proper caloric intake and body composition of small children.

White et al. [23] who reported on the Growing Right Onto Wellness (GROW) trial, a childhood obesity prevention study targeting a low health literate population stated the modules for this curriculum are appropriate for persons with low health literacy. Promotion of health literacy in general in the public may further benefit efforts to minimize the childhood obesity epidemic [24], as many parents may tend to be unaware of their child’s overweight problem [18].

Sanders et al. [25] noted children who become overweight by age 2 years have significantly greater risks of long-term health problems, and children in low-income communities, where rates of low adult literacy are highest, are at increased risk of developing obesity and that health literacy may be a critical modifiable factor for reducing child health problems, and others among this group. The Greenlight Intervention Study to assess the effectiveness of a low-literacy, primary-care intervention on the reduction of early childhood obesity may be helpful in this respect.

Velardo & Drummond [26] stated that health literacy, which relates to the acquisition, understanding and application of health information, has become an increasingly important public health issue, particularly where parents and children are concerned, and must be assessed and intervened upon accordingly at the earliest point in time. Cha et al. [13] further stated nurses should routinely assess parent health literacy and provide appropriate support to prevent obesogenic infant care behaviors. The same approach by other providers is strongly indicated as well. Future research in this realm would undoubtedly be helpful, as might work to evaluate parent educational programs tailored to health literacy level and effectiveness on reducing obesogenic care behaviors,

Since overweight children are also more likely to become obese adults, and are at greater risk for adult health problems than those who are of normal weight, the role of low health literate parents in reducing this risk should receive more attention. As was observed by the small number of related publications on this topic, the overlap between parental misperceptions, and childhood obesity, and health literacy warrants more attention, especially if parents with inaccurate perceptions of their child’s health status are likely to ignore appropriate health messages as discussed by Aljunaibi et al. [27]. It seems reasonable to assume that increased obesity-related knowledge, may translate into heightened motivation to make family changes related to body weight and health [28], while distorted maternal parental perception leads to excess weight being perceived as normal [29]. Being a young mother and having a daughter may raise the risk of underestimation [30]. Hence preventive programs should include effort to increase the mother’s or caregiver’s weight status perception [30]. Jones [31] who found parents misidentified if their children were overweight or obese, found parents did not understand, use or trust clinical measures, thus often remaining detached from the issue. They stressed the importance of improving parental recognition of childhood overweight as well as engagement in its management. As reiterated by Chaperro [32] if parents fail to recognize their overweight child is overweight, they will be less inclined to recognize the importance of applying targeted obesity programs to their family. Wen & Hui [33] concluded that the accurate classification of children’s weights by parents could help prevent childhood obesity. However, lack of education and role modeling [34] are barriers to prevention that need to be overcome.

Parents may specifically not realize:

  1. Soft drinks can be as dangerous and habit forming as cigarettes;
  2. Getting children to move is as important as their cognitive development; and
  3. Teaching them to respect about how media usage and viewing influences obesity risks is important.

They may also not realize that their own behaviors can be noticed and readily modeled, and that they can influence better health choices through their own actions in the community, and home settings. They themselves might therefore benefit from some form of education in this regard.

Parents can also help youth to develop life skills, skills for making effective judgments and choices, as well as offering supportive and safe environments that make the healthier choice the easier choice. If given the opportunity, children can learn about what creates health. What are the most important health determinants of chronic non-communicable diseases and how to practice positive health behaviors at all times. Sleep patterns, which can favor the onset of obesity inadvertently, can be mediated by parents, and should be optimized, and regulated, and efforts to improve parent’s overall health literacy may be highly fruitful, especially if parents do not understand, use or trust clinical measures of overweight, but alternative approaches that rely on extreme cases [31] and commonly underestimate weight of overweight or obese children as outlined by Regber et al. in a study of eight countries in Europe [35] and Musaad et al. [36] in an American based study where 93% were not perceived as overweight or obese by the parent. Despite limitations to this study and others, more research using well designed controlled prospective trials among different target groups is clearly indicated given the compelling data that has emerged to date.

Conclusion

The current findings suggest that health literacy is a potentially unrecognized obesity determinant due to its impact on parental views about child weight loss strategies and health information-seeking preferences, as well as health knowledge, in general. Leighty et al. [37] have consequently suggested that pediatric weight loss advice to parents should include both an assessment of parent attitudes, as well as their knowledge about child weight control and that they should help parents to access reliable sources of child weight control information. Garrett-Wright [38] who studied perceptions of parents among preschoolers in the context of obesity, indicated that assessing parental perceptions of preschool children’s body weight could help providers to better comprehend how parents view their children and could thus lead to more efficient suitably tailored educational interventions in the future. In addition, they suggested parental health literacy might hold the key to providing high-quality family-centered care. Providing such care is imperative as indicated by a recent expose in the New York Times that showed a considerable lack of parental understanding about childhood overweight issues [39]. Approaches that should be tested in future work might include some of the above mentioned ideas, plus efforts by parents to counteract the unhealthy influence of television on diet, including nutrition education, media literacy education to teach children to defend against unwanted influence; and reduced exposure to unhealthy messages [40]. Basic research that examines the correlates examined in this brief and the importance of providing parents with cogent information and skills should also be examined.

References

  1. Department of Health (2014) Obesity as a major public health threat. New York, USA.
  2. Centers for Disease Control and Prevention (2014) Body Mass Index.
  3. Harvard School of Public Health (2014) Obesity trends.
  4. Centers for Disease Control and Prevention (2012) Trends in the prevalence of extreme obesity among US preschool-aged children living in low-income families, 1998-2010. JAMA 308(24): 2563-2565.
  5. National Heart Lung and Blood Institute (2014) Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults: The Evidence Report. pp. 228.
  6. Rudd RE, Moeykens BA, Colton TC (1999) Health and Literacy. A Review of Medical and Public Health Literature. New York, USA.
  7. Ancker JS, Kaufman D (2007) Rethinking health numeracy: A multidisciplinary literature review. J Am Med Inform Assoc 14(6): 713-721.
  8. Smith SG, Wolf MS, von Wagner C (2010) Socioeconomic status, statistical confidence and patient-provider communication: An analysis of the Health Information National Trends Survey (HINTS 2007). J Health Comm 15(Suppl 3): 169-185.
  9. Huizinga MM, Pont S, Rothman RL, Perrin E, Sanders L, et al. (2008) ABC's and 123's: Parental Literacy, Numeracy and Childhood Obesity. Obes Manag 4(3): 98-103.
  10. Yin HS, Sanders LM, Rothman RL, Shustak R, Eden SK, et al. (2014) Parent health literacy and "obesogenic" feeding and physical activity-related infant care behaviors. J Pediatr. 164(3): 577-583.
  11. Garrett D (2008) Parental Perceptions of Overweight in Toddlers and Preschool Children [e-book]. Vanderbilt University. CINAHL, Ipswich, England.
  12. Chari R, Warsh J, Ketterer T, Hossain J, Sharif I et al. (2014) Association between health literacy and child and adolescent obesity. Patient Educ Couns 94(1): 61-66.
  13. Cha E, Besse JL (2015) Low parent health literacy is associated with 'obesogenic' infant care behaviours. Evid Based Nurs 18(2): 46.
  14. Cluss PA, Ewing L, King WC, Reis EC, Dodd JL, et al. (2013) Nutrition knowledge of low-income parents of obese children. Transl Behav Med 3(2): 218-225.
  15. Tompkins CL, Seablom M, Brock DW (2015) Parental perception of child's body weight: a systematic review. J Child and Fam Studies. 24:1384-1391.  
  16. Chen HY, Lemon SC, Pagoto SL, Barton BA, Lapane KL, et al. (2014) Personal and parental weight misperception and self-reported attempted weight loss in US children and adolescents, National Health and Nutrition Examination Survey, 2007-2008 and 2009-2010. Prev Chronic Dis 11: 140132.
  17. Eli K, Howell K, Fisher PA, Nowicka P (2014) "A little on the heavy side": a qualitative analysis of parents' and grandparents' perceptions of preschoolers' body weights. BMJ Open. 4(12): e006609.  
  18. Gordon NP, Mellor RG (2015) Accuracy of parent-reported information for estimating prevalence of overweight and obesity in race-ethnically pediatric clinic population aged 3-12. Pediatr 15: 5.
  19. Knierim SD, Rahm AK, Haemer M, Raghunath S, Martin C, et al. (2015) Latino parents' perceptions of weight terminology used in pediatric weight counseling. Acad Pediatr 15(2): 210-217.
  20. Manios Y, Moschonis G, Karatzi K, Androutsos O, Chinapaw M, et al. (2015) Large proportions of overweight and obese children, as well as their parents, underestimate children's weight status across Europe. The ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) project. Public Health Nutr 18(12): 2183-2190.
  21. Musaad SM, Donovan SM, Fiese BH, STRONG Kids Research Team (2015) Parental perception of child weight in the first two years-of-life: a potential link between infant feeding and preschoolers' diet. Appetite 91: 90-100.
  22. Spargo M, Mellis C (2014) Childhood obesity and parental perceptions in a rural Australian population: a pilot study. J Paediatr Child Health 50(2): 131-134.
  23. White RO, Thompson JR, Rothman RL, McDougald Scott AM, Heerman WJ, et al. (2013) A health literate approach to the prevention of childhood overweight and obesity. Patient Educ Couns 93(3): 612-618.
  24. Feng A, Wang L, Chen X, Liu X, Li L, et al. (2015) Developmental origins of health and disease (DOHaD): Implications for health and nutritional issues among rural children in China. Biosci Trends. 9(2): 82-87.
  25. Sanders LM, Perrin EM, Yin HS, Bronaugh A, Rothman RL (2014) "Greenlight study": a controlled trial of low-literacy, early childhood obesity prevention. Pediatrics 133(6): e1724-1737.
  26. Velardo S, Drummond M (2013) Understanding parental health literacy and food related parenting practices. Hlth Sociol Rev 22(2): 137-150.
  27. Aljunaibi A, Abdulle A, Nagelkerke N (2013) Parental weight perceptions: a cause for concern in the prevention and management of childhood obesity in the United Arab Emirates. PLoS One 8(3): e59923.
  28. Mareno N (2014) Parental perception of child weight: a concept analysis. J Adv Nurs 70(1): 34-45.
  29. Camargo AP, Barros Filho Ade A, Antonio MÂ, Giglio JS (2013) [The non perception of obesity can be an obstacle to the role of mothers in taking care of their children]. Cien Saude Colet 18(2): 323-333.
  30. Souto-Gallardo MC, Jiménez-Cruz A, Bacardí-Gascón M (2011) Parents perception of weight status of Mexican preschool children using different tools. Arch Latinoam Nutr 61(4): 382-388.
  31. Jones AR, Parkinson KN, Drewett RF, Hyland RM, Pearce MS, et al. (2011) Parental perceptions of weight status in children: the Gateshead Millennium Study. Int J Obes 35(7): 953-962.
  32. Chaparro MP, Langellier BA, Kim LP, Whaley SE (2011) Predictors of accurate maternal perception of their preschool child's weight status among Hispanic WIC participants. Obesity 19(10): 2026-2030.
  33. Wen X, Hui SS (2011) Chinese parents' perceptions of their children's weights and their relationship to parenting behaviours. Child Care Health Dev 37(3): 343-351.
  34. Sosa ET (2012) Mexican American mothers' perceptions of childhood obesity: a theory-guided systematic literature review. Health Educ Behav 39(4): 396-404.
  35. Regber S, Novak M, Eiben G, Bammann K, De Henauw S, et al. (2013) Parental perceptions of and concerns about child's body weight in eight European countries--the IDEFICS study. Pediatr Obes 8(2): 118-129.
  36. Musaad SM, Paige KN, Teran-Garcia M, Donovan SM, Fiese BH (2013) Childhood overweight/obesity and pediatric asthma: the role of parental perception of child weight status. Nutrients 5(9): 3713-3729.
  37. Liechty JM, Saltzman JA, Musaad SM (2015) Health literacy and parent attitudes about weight control for children. Appetite 91: 200-208.
  38. Garrett-Wright D (2011) Parental perception of preschool child body weight. J Pediatr Nurs 26(5): 435-445.
  39. Hughes D (2015) Parents not recognising obesity in their own children.
  40. Harris JL, Bargh JA (2009) Television viewing and unhealthy diet: implications for children and media interventions. Health Commun 24(7): 660-673.
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