RESUMEN
OBJECTIVE: To determine whether a 2-year family-based intervention using frequent contact and limited expert involvement was effective in reducing excessive weight compared with usual care. METHODS: Two hundred and six overweight and obese (BMI ≥85th percentile) children aged 4 to 8 years were randomized to usual care (UC) or tailored package (TP) sessions at university research rooms. UC families received personalized feedback and generalized advice regarding healthy lifestyles at baseline and 6 months. TP families attended a single multidisciplinary session to develop specific goals suitable for each family, then met with a mentor each month for 12 months, and every third month for another 12 months to discuss progress and provide support. Outcome measurements (anthropometry, questionnaires, dietary intake, accelerometry) were obtained at 0, 12, and 24 months. RESULTS: BMI at 24 months was significantly lower in TP compared with UC children (difference, 95% confidence interval: -0.34, -0.65 to -0.02), as was BMI z score (-0.12, -0.20 to -0.04) and waist circumference (-1.5, -2.5 to -0.5 cm). TP children consumed more fruit and vegetables (P = .038) and fewer noncore foods (P = .020) than UC children, and fewer noncore foods were available in the home (P = .002). TP children were also more physically active (P = .035). No differences in parental feeding practices, parenting, quality of life, child sleep, or behavior were observed. CONCLUSIONS: Frequent, low-dose support was effective for reducing excessive weight in predominantly mild to moderately overweight children over a 2-year period. Such initiatives could feasibly be incorporated into primary care.
Asunto(s)
Familia , Obesidad Infantil/terapia , Medicina de Precisión , Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , Factores de TiempoRESUMEN
OBJECTIVE: To determine what factors are associated with parental motivation to change body weight in overweight children. DESIGN: Cross-sectional study. SETTING: Dunedin, New Zealand. SUBJECTS: Two hundred and seventy-one children aged 4-8 years, recruited in primary and secondary care, were identified as overweight (BMI ≥ 85th percentile) after screening. Parents completed questionnaires on demographics; motivation to improve diet, physical activity and weight; perception and concern about weight; parenting; and social desirability, prior to being informed that their child was overweight. Additional measures of physical activity (accelerometry), dietary intake and child behaviour (questionnaire) were obtained after feedback. RESULTS: Although all children were overweight, only 42% of parents perceived their child to be so, with 36% indicating any concern. Very few parents (n 25, 8%) were actively trying to change the child's weight. Greater motivation to change weight was observed for girls compared with boys (P = 0.001), despite no sex difference in BMI Z-score (P = 0.374). Motivation was not associated with most demographic variables, social desirability, dietary intake, parenting or child behaviour. Increased motivation to change the child's weight was observed for heavier children (P < 0.001), those who were less physically active (P = 0.002) and more sedentary (P < 0.001), and in parents who were more concerned about their child's weight (P < 0.001) or who used greater food restriction (P < 0.001). CONCLUSIONS: Low levels of parental motivation to change overweight in young children highlight the urgent need to determine how best to improve motivation to initiate change.
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Actitud Frente a la Salud , Índice de Masa Corporal , Motivación , Sobrepeso , Responsabilidad Parental , Padres , Obesidad Infantil , Peso Corporal , Niño , Preescolar , Estudios Transversales , Ejercicio Físico , Femenino , Humanos , Masculino , Nueva Zelanda , Sobrepeso/terapia , Obesidad Infantil/prevención & control , Percepción , Factores Sexuales , Encuestas y CuestionariosRESUMEN
OBJECTIVES: As parents of young children are often unaware their child is overweight, screening provides the opportunity to inform parents and provide the impetus for behaviour change. We aimed to determine if parents could recall and understand the information they received about their overweight child after weight screening. DESIGN: Randomised controlled trial of different methods of feedback. SETTING: Participants were recruited through primary and secondary care but appointments took place at a University research clinic. PARTICIPANTS AND INTERVENTION: 1093 children aged 4-8â years were screened. Only overweight children (n=271, 24.7%) are included in this study. Parents of overweight children were randomised to receive feedback regarding their child's weight using best practice care (BPC) or motivational interviewing (MI) at face-to-face interviews typically lasting 20-40â min. 244 (90%) parents participated in a follow-up interview 2â weeks later to assess recall and understanding of information from the feedback session. PRIMARY AND SECONDARY OUTCOME MEASURES: Interviews were audio-taped and transcribed verbatim before coding for amount and accuracy of recall. Scores were calculated for total recall and sub-categories of interest. RESULTS: Overall, 39% of the information was recalled (mean score 6.3 from possible score of 16). Parents given feedback via BPC recalled more than those in the MI group (difference in total score 0.48; 95% CI 0.05 to 0.92). Although 94% of parents were able to correctly recall their child's weight status, fewer than 10 parents could accurately describe what the measurements meant. Maternal education (0.81; 0.25 to 1.37) and parental ratings of how useful they found the information (0.19; 0.04 to 0.35) were significant predictors of recall score in multivariate analyses. CONCLUSIONS: While parents remember that their child's body mass index is higher than recommended, they are unable to remember much of the information and advice provided about the result. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry ACTRN12609000749202.
Asunto(s)
Tamizaje Masivo/métodos , Recuerdo Mental , Padres/educación , Obesidad Infantil , Adulto , Índice de Masa Corporal , Peso Corporal , Niño , Preescolar , Retroalimentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Entrevista Motivacional , Padres/psicología , Obesidad Infantil/diagnóstico , Obesidad Infantil/prevención & control , Proyectos de InvestigaciónRESUMEN
AIM: To determine whether a single session of motivational interviewing (MI) for feedback of a child's overweight status promotes engagement in treatment following screening. METHODS: One thousand ninety-three children aged 4-8 years were recruited through primary and secondary care to attend health screening, including assessment of parenting practices and motivation (questionnaire). Families with normal-weight children were informed about their child's weight but had no further involvement. Parents of overweight (body mass index ≥ 85th percentile) children (n = 271) were randomised to receive weight feedback via MI or best practice care (BPC) using a traffic light concept to indicate degree of health risk. Follow-up interviews were held 2 weeks later to examine intervention uptake, changes to motivation and behaviour, and parental response to feedback. RESULTS: Recruitment into the intervention was high (76%) and not altered by feedback condition (percentage difference 6.6 (95% confidence interval -2.9, 16.0). High scores on the Health Care Climate Questionnaire (rating of the interviewer) indicated satisfaction with how the information was provided to parents. No differences were observed in multiple indicators of harm. However, self-determined motivation for healthy life-styles was significantly higher in the MI condition at follow-up (0.18: 0.00, 0.35), after only a single session of MI. CONCLUSIONS: MI and BPC were both successful in encouraging parents to participate in a family-based intervention, with MI offering little significant benefit over BPC. A traffic light approach to weight feedback is a suitable way of providing sensitive information to parents not expecting such news.
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Índice de Masa Corporal , Retroalimentación Psicológica , Entrevista Motivacional/métodos , Padres/educación , Obesidad Infantil/prevención & control , Adulto , Peso Corporal , Niño , Preescolar , Femenino , Humanos , Estilo de Vida , Modelos Logísticos , Masculino , Análisis Multivariante , Nueva Zelanda , Relaciones Padres-Hijo , Padres/psicología , Atención Primaria de Salud/métodos , Sensibilidad y Especificidad , Pérdida de PesoRESUMEN
OBJECTIVES: To determine what factors drive participation in a family-based weight management program for 4- to 8-year-old children following screening for overweight or obesity. STUDY DESIGN: Children (n = 1093) attended a comprehensive screening appointment where parents completed questionnaires on demographics, motivation for healthy lifestyles, feeding practices, and beliefs about child size, prior to feedback about the child's weight. Parents of overweight or obese children (body mass index ≥85th percentile) attended a follow-up interview to assess reactions to feedback and willingness to participate in a 2-year intervention. RESULTS: A total of 271 (24.8%) children were overweight or obese with 197 (72.7%) agreeing to the intervention. Socioeconomic status differed in intervention participants (n = 197) compared with non-participants (n = 74), whereas no differences were observed in parental feeding practices, ineffective parenting practices, or self-determined forms of motivation. However, fewer non-participating parents believed their child to be overweight (23% vs 49%, P < .001) or were concerned about it (16% vs 43%, P < .001), despite children having an average body mass index approximating the 95th percentile. Non-participating parents did not expect their child to be overweight (P = .002) and rated receiving this information as less useful (P = .008) than participating parents. CONCLUSION: Preconceptions about child weight and reactions to feedback determined intervention uptake more than parenting or motivation for health. Many parents agreed to participate in the intervention despite not viewing their child as overweight.
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Obesidad/terapia , Cooperación del Paciente/estadística & datos numéricos , Peso Corporal , Niño , Preescolar , Femenino , Humanos , Masculino , Tamizaje Masivo , Motivación , Sobrepeso/terapia , Responsabilidad ParentalRESUMEN
How parents feed their children may impact on their weight and eating behaviours, both now and in the future. The Comprehensive Feeding Practices Questionnaire (CFPQ) proposes to measure parental feeding practices and was originally developed using 12 factors in relatively small, homogenous samples. In contrast the present study used a large, diverse sample (n=1013) of children aged 4-8years. A confirmatory factor analysis showed that the original 12-factor model was not a good fit and that several factors were strongly inter-correlated. A subsequent exploratory factor analysis yielded five scales of interest: Healthy Eating Guidance, Monitoring, Parent Pressure, Restriction and Child Control. These scales were largely supported by further analyses in these data. Parents who were concerned about their child being overweight reported more Healthy Eating Guidance and Restriction and less Parent Pressure, whereas parents concerned about their child being underweight used more Parent Pressure and less Healthy Eating Guidance. Parents who rated a healthy diet for their child as very important undertook more Healthy Eating Guidance and Monitoring of food intake and less Child Control. These five factors from the CFPQ provide a well-supported and useful set of feeding practices that could be applicable to a wide variety of population groups.
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Dieta , Conducta Alimentaria , Obesidad , Relaciones Padres-Hijo , Responsabilidad Parental , Encuestas y Cuestionarios/normas , Delgadez , Actitud Frente a la Salud , Control de la Conducta , Niño , Ingestión de Energía , Análisis Factorial , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Modelos Estadísticos , PadresRESUMEN
BACKGROUND: Because parental recognition of overweight in young children is poor, we need to determine how best to inform parents that their child is overweight in a way that enhances their acceptance and supports motivation for positive change. This study will assess 1) whether weight feedback delivered using motivational interviewing increases parental acceptance of their child's weight status and enhances motivation for behaviour change, and 2) whether a family-based individualised lifestyle intervention, delivered primarily by a MInT mentor with limited support from "expert" consultants in psychology, nutrition and physical activity, can improve weight outcomes after 12 and 24 months in young overweight children, compared with usual care. METHODS/DESIGN: 1500 children aged 4-8 years will be screened for overweight (height, weight, waist, blood pressure, body composition). Parents will complete questionnaires on feeding practices, physical activity, diet, parenting, motivation for healthy lifestyles, and demographics. Parents of children classified as overweight (BMI > or = CDC 85th) will receive feedback about the results using Motivational interviewing or Usual care. Parental responses to feedback will be assessed two weeks later and participants will be invited into the intervention. Additional baseline measurements (accelerometry, diet, quality of life, child behaviour) will be collected and families will be randomised to Tailored package or Usual care. Parents in the Usual care condition will meet once with an advisor who will offer general advice regarding healthy eating and activity. Parents in the Tailored package condition will attend a single session with an "expert team" (MInT mentor, dietitian, physical activity advisor, clinical psychologist) to identify current challenges for the family, develop tailored goals for change, and plan behavioural strategies that best suit each family. The mentor will continue to provide support to the family via telephone and in-person consultations, decreasing in frequency over the two-year intervention. Outcome measures will be obtained at baseline, 12 and 24 months. DISCUSSION: This trial offers a unique opportunity to identify effective ways of providing feedback to parents about their child's weight status and to assess the efficacy of a supportive, individualised early intervention to improve weight outcomes in young children. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12609000749202.