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Toolkit Helps Parents Recognize a Child’s Risk of Obesity

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Some simple interventions used by pediatricians were enough to change a parent’s perspective about a child’s being overweight or obese, and change the parent’s behaviors at home to reduce those risks.
Researchers confirmed previous reports that parents of overweight or obese children do not recognize their child’s weight problem. But this time, by arming pediatricians with a “toolkit,” an easily used chart and a series of questions and suggestions, the researchers addressed several problems.

“Doctors often don’t have time to discuss overweight; they don’t have the tools to do it; and many aren’t confident that they’re going to make a difference in their patients’ lives,” said Eliana Perrin, lead author of the study.

“Also, parents don’t recognize weight problems or don’t know how to make things better, and even if they do, there are often barriers to healthier eating or more activity for these families,” says Perrin.

As First Lady Michelle Obama‘s “Let’s Move!” campaign aims to reduce childhood obesity – almost one-third of young people are overweight – two leading questions are how to affect that change and if it can be successful.

Perrin’s study is likely the first evidence that a parent’s assessment of their child’s weight can be changed. Her study also showed improved dietary behaviors in children and reduced time playing video games or watching television, called “screen time.”

“We found something we can do to help stem the obesity epidemic,” says Perrin, whose previous research in childhood obesity has shown that using a body mass index, or BMI, chart color-coded like a traffic light helps parents understand the often confounding measurement.

Perrin’s research group trained pediatric resident physicians on how to use the color-coded BMI chart and a revision of a questionnaire called “Starting the Conversation,” originally designed by Alice Ammerman, a co-author on the study. The STC gives health care providers a snapshot of potential red flags to help counsel patients as well as tips to implement change.

Parents were asked about their children’s weight status and discussions about weight in the doctor’s office. The Starting the Conversation form used in this study was revised by Perrin and asked parents about non-healthy eating habits – frequency of sugary snacks, sugar-sweetened beverages and eating out at restaurants, as well as activity and screen time. It also asked about the parent’s readiness to change. The pediatrics residents were instructed to show parents their children’s weight status in a color-coded BMI chart and were taught to use the parents’ responses to the questionnaire to engage the parents in discussions about healthier eating behaviors and activities.

Researchers enrolled 115 children ages 4 to 12 who were covered by Medicaid or the State Health Insurance Program and repeated the Starting the Conversation questionnaire as well as questions about weight status at one-month and three-month follow-up appointments.

The study showed the most significant improvement in dietary changes among children who were overweight. At follow up, they were more likely than healthy-weight children to drink lower-fat milk and showed the largest reduction in the frequency of eating out. But overall, children improved fruit and vegetable consumption, decreased sweetened beverages and unhealthy snacks, drank lower-fat milk more and reduced screen time.

In the initial visit, all of the parents of healthy-weight children accurately perceived their child’s weight. However, only 57 percent of overweight children’s parents did so at baseline. That improved significantly to 74 percent at three month follow up.

BMI was measured and tracked and a few children became more overweight, while more reached healthier weights but no significant improvements in weight status were noted in this short study, Perrin says. “The research has to be replicated and expanded, and it must determine if improvements in parental perception of children’s weight motivates families to improve behavior and, ultimately, leads to healthier weight over time,” she says.

“Everyone’s talking about BMI and we have a lot of studies to show that parents do not see their overweight children as overweight. That often does not sink in with parents,” Perrin says. “This is the first time we’ve seen a changed perspective from parents. We hope that parents who know their children are overweight will be empowered to help them achieve healthier lifestyles that can last a lifetime.”

Source: Elements4Health

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Health Alert

Being Fat Starts Early

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When you think of a 3-year-old, the words “obese” and “overweight” probably do not come to mind.
But this may be the age when many children’s problems with weight begin, according to a new study published in the American Journal of Public Health. The study by Rachel Kimbro and her colleagues at the University of Wisconsin in Madison looked at nearly 2,300 urban low-income families.
They found that 35 percent of the 3-year-olds studied were overweight or obese. In addition, Hispanic children were twice as likely as either black or white children to be overweight or obese, suggesting ethnic differences play a big part in childhood obesity.
“There are very few studies of obesity in children this young,” said Gary Foster, director of the obesity research center at Temple University School of Medicine. “This study is very important.”
Foster said the study addresses some of the factors that put children at risk for obesity at such a young age. “We have known for a long time that obesity is disproportionately related to income,” he said. “The poorer you are, the more likely that you are obese.”

Among the other child obesity risk factors suggested by the study are high birth weight, taking a bottle to bed and whether or not a child’s mother is obese.

But researchers were not able to fully explain all of the differences. For example, the differences in childhood obesity rates between racial groups could not be entirely blamed on economic status, overall health or parenting habits, the study said.

No Need for Alarm, Some Experts Say
Other experts argue that the study results are not new and just confirm previous data.
“The finding that we can identify different prevalence rate of obesity in different ethnic groups is not particularly surprising,” said Dr. Darwin Deen, professor of family and social medicine at the Albert Einstein College of Medicine in New York. “It correlates well with other data that have shown the same thing.
“The bigger question is whether 3-year-olds in certain ethnic groups are more likely to remain obese as they get older.”

While the idea of overweight and obese 3-year-olds is a concern, experts said a majority of children who are overweight at this age outgrow it.

“The 3 to 5 age group is not predictive of being obese as an adult,” said Deen. “It’s more the older group such as adolescents [that predicts adult obesity].”

But while parents should not necessarily be alarmed if their child is on the heavy side, they should realize the need to change the way they are feeding their child.

Many Parents Overfeed Their Children
“The bottom line is that you can’t become overweight without an energy imbalance,” said Foster. “And the easiest way is by an imbalance on the intake side.
“It’s much easier to increase intake by 500 calories than it is to increase your activity by that much.”
Foster said the study findings suggest parents should pay more attention to both the quantity and the quality of food they feed their kids.

And at the earliest ages, breast-feeding seems to be of utmost importance.
“Breast-feeding is extraordinarily important,” Deen said. “It’s one of the things that plays an important role in preventing obesity.
“This does not mean that most formula-fed babies will become obese or that formula shouldn’t be used, but breast-feeding is sort of tailor-made for the child.”
Monitoring the child’s calorie intake, whether from breast milk or formula, is also important to maintain a healthy weight.
Deen explained that while the study also raises some important concerns about racial differences, it does not change the overall approach to obesity.
“What we are talking about are moderate prevalence rate differences among different ethnic groups,” he said. “I don’t think it helps me much as a practitioner if I know that one group of my patients has more obesity than another group.
“When I have a patient in front of me, my advice about healthy choices remains the same, regardless of what their race is.”
Deen added that as rates of childhood obesity rise, changing kids’ behavior towards food will become more and more crucial.

“I think we need to worry because there clearly is an epidemic of childhood obesity in the country,” said Deen.
The take-home message from this study should be that what we do with children, even in the early years of life, has an impact on their future.”

Source:ABC News