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 Researchers found that addressing parents’ beliefs about themselves
and their kids, and encouraging doctors to talk about the importance
of physical activity could remove important obstacles to obese
childrens’ weight loss.
“We thought about doing this study because when we worked with
families to try to engage them in weight loss, we noticed
differences in parent’s readiness to change dietary behaviors versus
physical activity behaviors,” said Dr. Kyung Rhee, who was at Brown
University in Providence, Rhode Island, when she led the study.
“They weren’t always ready to do both – some families were ready to
do one versus the other, but when you’re really trying to engage in
weight loss, it’s important to engage in both,” said Rhee, a
pediatrician at the University of California, San Diego.
For the study, published in the Journal of the Academy of Nutrition
and Dietetics, Rhee and her colleagues surveyed the parents of 202
overweight and obese children who attended a Providence obesity
clinic from November 2008 to August 2009.
The surveys assessed the readiness of parents to make behavioral
changes around their children’s eating patterns and exercises
habits. Parents were also asked about their own weight and health,
and their perceptions of their child’s health.
Many of the children had the pre-diabetes condition known as
impaired glucose tolerance or had high cholesterol levels, but 31
percent of parents thought their child’s health was excellent and 28
percent didn’t believe their child’s weight was a health problem.
The researchers were interested in where parents fell along a
spectrum of readiness to make changes according to a psychology
theory about how people transform their behaviors, such as quitting
smoking or losing weight, and what factors influenced the parents’
willingness to change.
Based on the survey responses, they divided parents into three
categories, including those in the precontemplation/contemplation
stage, who had not made behavior changes and weren’t planning to
make any for their child within the next six months.
The second category was made up of parents who had made a few
changes or planned to make changes during the next month and were
considered to be in the preparation stage of change.
Parents who had made changes more than once a week for at least a
month were considered to be in the action/maintenance stage,
indicating they were the most ready to act to address their child’s
weight problem.
With regard to helping their children make dietary changes, about 17
percent of parents were in the precontemplation/contemplation stage,
21 percent were in the preparation stage and 61 percent were in the
action/maintenance stage.
When it came to physical activity changes, however, 41 percent of
parents were in the precontemplation/contemplation stage, 18 percent
were in the preparation stage and about 41 percent were in the
action/maintenance stage.
The study team noted that children of parents in the
action/maintenance stage for diet were already eating less fast food
and more fruits and vegetables compared to other kids. Those whose
parents were in the action/maintenance stage for physical activity
were already more active than their peers.
When the researchers looked at factors linked to the parents’
readiness to make changes, they found that parents who believed
their own weight was a health problem were less ready to make
changes to their children’s diets.
They also discovered that parents with older children were less
likely to be in the action/maintenance stage for physical activity.
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Rhee pointed out that this survey was done among parents whose kids
were going through an obesity and endocrine clinic. “And even in
that setting only 60 percent were ready to make dietary changes and
only 40 percent were ready to make physical activity changes,” she
said.
“So I think if you were to do this in a population of non-treatment
seeking families, I’d be afraid that the readiness levels would be a
lot lower, which I think speaks to the difficulty of what we’re
trying to do to get people to lose weight,” she said.
The parents indicated that a doctor’s recommendation for making
dietary changes was influential, Rhee and her colleagues note in
their report. That suggests doctors could also play bigger role in
helping parents find ways to improve a child’s physical activity
levels, they write.
The researchers also speculate that parents who think their own
weight is a health problem may feel frustrated or overwhelmed by
past failures to lose weight themselves. And that parents of older
children may feel they have less control over the child’s eating and
activity levels during the day than they would with a younger child.
Rhee told Reuters Health the study results indicate that
pediatricians should consider talking to parents about their own
weight history and feelings about trying to change their own dietary
behaviors.
“Overall I think the notion of stages of change has great
applicability representing a way to tap into levels of motivation
and action,” Kenneth Gruber told Reuters Health in an email.
“I think the article addresses a very important topic and highlights
issues that need more attention,” said Gruber, a research
psychologist with the Center for Youth, Family and Community
Partnerships at the University of North Carolina Greensboro, who was
not involved in the study.
Because the study looked at only one point in time, he cautioned, it
doesn’t show whether or how parents progressed from one stage to
another or if the changes made were always positive.
Gruber said that people in the contemplative stage usually will at
least try to become more active – but many factors including success
of the effort, adequate resources to support the effort and being
able to control the outcomes of the effort come into play.
“For example, a parent may want his/her child to be more physically
active, but live in an unsafe neighborhood and have little free time
to take the child to safe play venues,” Gruber said.
He added that he was pleased the authors noted the importance of
doctor-parent child weight discussions.
“This is an issue that deserves more attention because primary care
physicians are reluctant to talk with parents and children about
weight issues,” he said.
SOURCE: http://bit.ly/UeUpXz Journal of the Academy of Nutrition and
Dietetics, online June 23, 2014.
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