A Primer on Early Childhood Obesity and Parental Influence

Eric A. Hodges

Disclosures

Pediatr Nurs. 2003;29(1) 

In This Article

Abstract and Introduction

Childhood obesity is a common health problem facing U.S. children with an increasing prevalence particularly in certain populations. Recognizing obesity in children is a clinical determination with specific measures that can indicate potential future associated health problems, but parental perception of overweight and/or obesity is influenced by other conditions. This primer offers a brief synopsis of parental influence in the etiology of early childhood obesity beginning with parameters of obesity and how it is operationalized through measurement. The importance of parental perceptions of their children relative to obesity and eating are discussed, and how parents influence the development of childhood eating behaviors or physical activity are considered.

Recent public health concern about obesity and how it contributes to a variety of health conditions has led to the establishment of national goals to improve our understanding of these links (U.S. Department of Health, 2000) and to recognize that weight-related behaviors begin in childhood ("Surgeon General's Call to Action," 2001). Not surprisingly, early childhood obesity is a problem of increasing prevalence in the U.S. (Mei et al., 1998; Ogden et al., 1997; Strauss & Pollack, 2001). Among U.S. low-income preschool children between 1983 and 1995, an increase from 18.6% to 21.6% was noted at the 85th percentile cutoff point, and an increase from 8.5% to 10.2% was noted at the 95th percentile cutoff (Mei et al., 1998). Strauss and Pollack (2001) reported that overweight increased steadily among African American children, in particular, after adjusting for confounding variables. What becomes clinically relevant for pediatric nurses is that obesity is not a benign condition, but carries both physical and psychologic sequelae associated with hypertension, dyslipidemia, hyperinsulinemia, orthopedic problems, social rejection, and low self-esteem (Dunn & Evers, 1996; Freedman, Dietz, Srinivasan, & Berenson, 1999). Freedman and colleagues (1999) found that among 5-to 17-year-olds, children above the 95th percentile for weight were (a) more than twice as likely to have elevated total cholesterol, (b) more than twice as likely to have elevated diastolic blood pressures, (c) 4.5 times as likely to have elevated systolic blood pressures, and (d) 12.6 times as likely to have fasting hyperinsulinemia compared to peers below the 85th percentile.

Childhood obesity is a health condition that has a tendency to continue into adulthood. In a recent study to assess the link between childhood obesity and the risk of obesity in adulthood, it was found that the risk odds ratio ranged from 1.3 for obesity at 1 or 2 years old to 17.5 for obesity at 15 to 17 years old (Whitaker, Wright, Pepe, Seidel, & Dietz, 1997). The trajectory of overweight from infancy to childhood was made clear by the recent finding that rapid weight gain in the first 4 months of life was associated with increased risk of overweight at 7 years old (Stettler, Zemel, Kumanyika, & Stallings, 2001). This clinical trajectory was further emphasized by a recent finding that 77 % of children (N= 2617) with a body mass index (BMI) greater than the 95th percentile remained obese as adults (Freedman, Khan, Dietz, Srinivasan, & Berenson, 2001).

Childhood obesity is thought to occur through the interplay of multiple influences. In a recent review of literature, Keller and Stevens (1996) identified these influences as prenatal, genetic, familial, and environmental. Parents are likely to be influential in the genesis of early childhood obesity prenatally, genetically, and through familial influences. Further, they supply and shape a large majority of the environ-mental influences for infants and young children. The importance of familial and environmental influence is underscored with recognition that childhood is a critical period for shaping the dietary and life-style behaviors that can have implications for adult heart disease risk (Cunnane, 1993).

The purpose of this paper is to provide a brief synopsis of parental influence in the etiology of early childhood obesity beginning with parameters of obesity and how it is operationalized through measurement. The importance of parental perceptions of their children relative to obesity and eating are discussed, and how parents influence the development of childhood eating behaviors or physical activity are considered. Finally, implications for nursing practice are considered.

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