Childhood Obesity: Role of Parents and Parenting

There are no doubt rare cases of childhood obesity that occur due to genetic, psychological, or other biological factors that are specific to just the kid and do not apply to anyone else in the family.

In the vast majority of cases, however, familial or other factors resulting in childhood excess weight gain, affect more than just the kid.

An excellent review and Scientific Statement on the role of targeting parents as ‘agents of change’ for treating obese children was just released by the American Heart Association and published in CIRCULATION.

The paper evaluates the strength of evidence that particular parenting strategies can leverage behavior change and reduce positive energy balance in obese youth.

As may be expected, the evidence is inconsistent.

“For example, only 17% of the intervention studies reported differential improvements in child overweight as a function of parental involvement in treatment. On the other hand, greater parental adherence with core behavior change strategies predicted better child weight outcomes after 2 and 5 years in some studies.”

The authors identify a number of important research gaps, including the assessment of refined parenting phenotypes, cultural tailoring of interventions, examination of family relationships, and incorporation of new technologies.

Interestingly, the release of this statement coincides with the publication of a paper by Laurie Miller Brotman and colleagues from the New York University School of Medicine in the journal PEDIATRICS, suggesting that interventions aimed at generally improving parenting skills may reduce obesity risk in high-risk minority youth.

The study included 186 minority youth at risk for behavior problems who enrolled in long-term follow-up studies after random assignment to family intervention or control condition at age 4. Follow-up Study 1 included 40 girls at familial risk for behavior problems; Follow-up Study 2 included 146 boys and girls at risk for behavior problems based on teacher ratings.

Importantly, the family intervention aimed to promote effective parenting and prevent behavior problems during early childhood and did not not focus on physical health or attempt to specifically modify diets or physical activity.

After five years (Study 1) and 3 years (Study 2), the kids randomized to intervention had significantly lower BMI compared to controls with lower rates of obesity (BMI ≥95th percentile) among intervention girls and boys. These changes in body weight were associated with improvements in physical and sedentary activity, blood pressure, and diet.

Thus, as the authors point out, simply improving parenting skills without specifically focusing on messages pertaining to diet or activity may significantly reduce the risk of obesity him high-risk kids.

Obviously, these findings should not simply be used to promote a ‘blame the parents’ attitude or instigate a ‘witch hunt’ on parents of overweight or obese kids.

Rather, I believe that these data should serve as a reminder that many parents today face parenting challenges that may be unique to today’s family environment with fewer kids, working parents, ’empowered’ and ‘opinionated’ offspring, and lack of extended family support and role models.

Providing this support to parents may not only benefit weight management but also improve the emotional and physical health of our youth.

Remember, it takes a village to raise a child.

AMS
Hamburg, Germany

Faith MS, Van Horn L, Appel LJ, Burke LE, Carson JA, Franch HA, Jakicic JM, Kral TV, Odoms-Young A, Wansink B, Wylie-Rosett J, & on behalf of the American Heart Association Nutrition and Obesity Committees of the Council on Nutrition, Physical Activity and Metabolism, Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing (2012). Evaluating Parents and Adult Caregivers as “Agents of Change” for Treating Obese Children: Evidence for Parent Behavior Change Strategies and Research Gaps: A Scientific Statement From the American Heart Association. Circulation PMID: 22271754

Brotman, L., Dawson-McClure, S., Huang, K., Theise, R., Kamboukos, D., Wang, J., Petkova, E., & Ogedegbe, G. (2012). Early Childhood Family Intervention and Long-term Obesity Prevention Among High-risk Minority Youth PEDIATRICS DOI: 10.1542/peds.2011-1568