Transcript Public Perceptions of Causes of Childhood Obesity

Public Perceptions of Causes
of Childhood Obesity
Parental responsibility
Modern technology and media
Over-consumption of unhealthy foods
Children’s lack of knowledge and
motivation
Physical activity environment
Lack of healthy food
Lack of physical activity
Genes
Individual Responsibility
…
International Journal of Obesity, Hardus, 2003
Environment
Individual Choice/Environment
Time
7:00 am
10:00
am
Meal
Breakfast
Food/
Drink
waffles
syrup
Juice
Sugar
60
Noon
2:00 pm 4:00 pm 5:00 pm
6:30 pm
Reward Lunch
B-day
Party
MD
Check
up
Dinner
Fundraiser
candy
threw out
sandwich;
juice drink
& twix bar
Cupcake;
juice
drink
lollipop
McDs ¼
pounder
cheese,
md fries
lg coke
Cookies
24
28
48
12
86
20
278 g
grams
Fat
grams
7
8
8
8
0
52
2
85 g
SocioEcological Web and
Childhood Obesity
Public Policy Factors
Community Factors
Institutional Factors
Interpersonal
Factors
Individual
SocioEcological Web
Influencing Childhood Obesity
Individual (individual choice & responsibility)

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Dietary intake, physical activity, sedentary
behavior
Influenced by knowledge,attitudes, beliefs, skills
Interpersonal

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Families, friends, peers
Provide social identity, support and role definition
Institutional

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Schools, local sporting institutions
Rules, regulations, policies that constrain or
encourage particular behaviors
SocioEcological Web
Influencing Childhood Obesity
Families
Community
Formal or informal local networks and
norms
 Resources that encourage or discourage
healthy eating and physical activity

Public Policy

Local, state and federal policies or laws
that regulate or effect eating practices and
exercise habits
Families
Powerful and complex fields of influence
embedded in a multi-layered
environment
Characteristics
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Foods available at home
Food/meal routines – feeding styles
Family members’ weight status and diet
Attitudes towards weight individuals’ weight status
Encouragement of physical activity
Rules regarding TV use
Families, continued
Changes in home environment
Increased use of fast foods and home
replacement meals (1987-2.6 billion sales;
1992 –5.7 billion sales)
 1965 – 30% of food $ spent away from
home; 1998 increased to 47%

(Bowers, D.E., Food Review January-April 2000:23-29, Jekanowski, M.D. Food
Review January-April 1999:32-34, Jekanowksi, M.D., Food Review January-April
1999:11-16)
Parent-Child Eating Styles
Parents shape children’s eating style

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Foods available
Parent feeding styles
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Mothers report > use of restrictive practices
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restriction of intake (restrict child’s access to unhealthy
foods)
pressure to eat (pressure child to eat more food, typically
healthy foods)
With increased mothers’ own weight/eating concerns
With increased perception of daughters’ risk for weight
problem
Mothers report > use of pressure to eat

With increased perception of daughter as underweight
Francis, Appetite, 2001
Potential Adverse Effects
Result is to focus child away from internal
cues regarding hunger and satiety
Parent assumes responsibility of initiating or
terminating eating
Potential to compromise child internal
awareness of hunger/fullness and appropriate
responses
Limitations – white well educated sample of
mothers and 5 yo daughters (n=196
Francis, Appetite, 2001
Long Term Effects of Parental
Restrictive Feeding Styles
Assessment of 5-7 yo girls intake of palatable foods
after a standardized lunch
Girls with large intakes of snack foods in the absence
of hunger were 4.6 times more likely to be overweight
at 5 and 7 years of age
For each unit of increase in parents’ reported
restrictive feeding styles at 5 y, girls were 2.1 times as
likely to eat in absence of hunger at age 7 (even after
controlling for BMI and hunger related eating at age 5)
About 50% girls reported negative self evaluation after
eating; such report linked to perceptions of being
restricted from such foods
Fisher, American Journal of Clinical Nutrition, 2002
Attitudes, Practices & Concerns
Re: Child Feeding and Weight
Need to tailor interventions based on attitudes,
practices and concerns
Build on mothers goals to provide good nutrition
while balancing convenience, variety and cost
Provide strategies to overcome stress associated
with providing meals
Focus parents on encouraging child-based
hunger/fullness cues and appropriate responses
Recognize differences in cultural perceptions of
overweight and facilitate recognition of unhealthy
weights
Sherry, JADA, 2004
Parent’s Perceptions Re:
Children’s Weight
3 focus groups (n=18; 13 black, 5 white); WIC
participants

Mothers don’t use reported anthropometrics to
assess weight, instead use reported teasing and
limitations on exercise; if active with good appetite
not considered overweight; overweight children
described as “thick or solid”; genes considered
cause independent of environment; emotionally
difficult to deny or limit foods
Parent’s Perceptions Re:
Children’s Weight
Cross sectional survey of 622 WIC
participants with children 2-5 years

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45% low education (30% moms obese; 19%
children overweight)
55% high education (17% moms obese; 14%
children overweight)
79% of mothers failed to perceive overweight
children as overweight; almost all accurately
perceive their own weight
Among 99 moms with overweight children, low
maternal education associated with misperception
after controlling for income, maternal obesity, age,
smoking and child’s age, race and gender
Baughcum, Pediatrics, 2000
Media – Influences Families
Conflicting messages

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Healthy-weight children shown in advertisements
negative stereotypes of overweight children
among many segments of the population –
including health care professionals

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Unhealthy, academically unsuccessful, socially inept,
unhygienic and lazy (Hill, Int J Obesity 1995, Teachman,
Int J Obesity 2001)
Promotion/Advertisement of energy dense foods
in all venues (TV, schools, community sites,
Internet
Calories 110
Fat 2 g
Sugar 1 g
Fiber 3 g
Calories 110
Fat 1 g
Sugar 6 g
Fiber 3 g
Calories 120
Fat 1 g
Sugar 14 g
Fiber 0 g
Are Cocoa Puffs
really part of a
healthy breakfast?
Media Literacy Activities
35 parents with children participating in Head
Start programs; 4 week media literacy program
(compared to 4 week food safety educational
placebo to control for “attention”); pre-post
evaluation
4 week curriculum: advertising techniques,
children’s perceptions of ads, comparing food
label information to claims, role playing dealing
with children’s requests
Improved parents’ understanding of TV
advertising (p<.001), attitudes about TV ads
(p,>001), self-efficacy (p<.001), TV mediation
behaviors (p<.001), and ability to read food
labels (p<.001)
Hindin, JADA, 2004
Family-Based Interventions
Goals

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Build parental/family support
Create supportive home environment
Epstein’s review of randomised controlled family-based
interventions: “most pediatric obesity interventions are
marked by small changes in relative weight or adiposity
and substantial relapse”.
Example: program with dietary counseling,
encouragement to exercise, and family tx for 14-18
months resulted in smaller increase in BMI than no tx
controls (1.1 vs 2.8 kg/m2 @ 1 yr fu); drop out
substantial
Epstein, Pediatrics, 1998; Isreal, J Ped Psy, 1994
Family-Based Interventions
•Continue to research
family-based
interventions
AND
•Implement in the
context of the
socioecological model
•Saturate communities
with multidisciplinary
teams
•Ex: Heart Links
Project
•Quality (research based)
•Quanity based on
internal hunger/fullness
Hunger-Fullness Scaling
Monday
Pla
Breakfast
n
Hung
er/Fu
Lunch
Dinner
Snack
Reali
ty
llnes
s
Com
men
ts
0
5
10
Starving
Comfortable
Stuffed
SocioEcological Framework for
Interventions
Public Policy Factors
Community Factors
Institutional Factors
Interpersonal
Factors
Individual
Resource
http://www.stonybrook.edu/heartlinks/
NYSDOH Healthy Heart Program
Dept. Family Medicine
Stony Brook University
Year
www.cspinet.org
Sugar Content of Popular Foods
FOOD
TSP
“% Daily Value”
Snickers bar, 2.1 oz.
5¾
58
TastyKake Honey Bun, 3¼ oz.
6
60
Lowfat fruit-flavored yogurt, 8 oz. 7
70
Pepsi, 12 oz.
10¼
103
Pancake syrup, ¼ cup
10¼
103
Hostess Lemon Fruit Pie, 4½ oz.
Strawberry Passion Awareness
Fruitopia, 20 oz.
11½
115
17¾
178
Sources: Manufacturers, USDA, CSPI analyses and/or estimates.
Center for Science in the Public Interest, August, 1999
Obesity and Mortality
Tobacco Use
Poor Diet and
Physical Inactivity
1990
1990
2000
2000
% of all 19%
18.1%
14%
16.6%
deaths
# deaths 400,000 435,000 300,000 400,000
If this trend continues, obesity will become the leading cause
of death by 2005, killing 500,000 people per year.
CDC 3/04
Yoplait Go-Gurt Cherry &
Strawberry Assorted Yogurt
Nutrition Facts
Serv. Size 1 tube (64g;about 2 oz)
Servings 8
Amount Per Serving
Calories 70
Calories From Fat 15
% Daily Value *
Total Fat 2g
3%
Saturated Fat 1g
5%
Cholesterol 5mg
2%
Sodium 40mg
2%
Potassium 125mg
3%
Total Carbohydrate 11g
4%
Dietary Fiber 0g
0%
Sugars 10g
Protein 2g
Yoplait Go-Gurt Cherry &
Strawberry Assorted Yogurt
Nutrition Facts
Serv. Size 1 container (227g; 6 oz)
Servings 1
Amount Per Serving
Calories 160
Calories From Fat 0
% Daily Value *
Total Fat 0g
0%
Saturated Fat 0g
0%
Cholesterol 0mg
0%
Sodium 130mg
5%
Potassium 125mg
3%
Total Carbohydrate 30g
10%
Dietary Fiber 1g
3%
Sugars 29g
Protein 8g