English Parents and Children Respond Positively to Weight Feedback

Posted Sep 26, 2008.By Heidi Splete

Parents were receptive to feedback from physicians about their children's weights-even if the child was overweight-and this feedback had no significant negative impact on the parents or the children, based on results from questionnaires given to more than 500 English parents and children.

Previous research has shown that many parents of overweight children are unaware that their children are considered overweight. Appropriate feedback about a child's weight may encourage parents to help children reach healthy weights, Chloe Grimmett and her colleagues at University College, London wrote in the September issue of Pediatrics(2008:122:e682-8).

But any feedback about weight must be given with consideration for cultural sensitivity surrounding weight and awareness of the potential for psychological stress, the researchers noted. The National Child Measurement Programme in the United Kingdom was introduced in 2005 to monitor childhood obesity, but the program provides weight feedback to parents only on request.

To determine the acceptability of weight feedback, the investigators reviewed questionnaires from 358 children and 287 parents 6 weeks before and 4 weeks after they received feedback from a physician about the child's weight. The children were selected from two age groups, which included children aged 6-7 years and children aged 10-11 years.

Trained researchers measured the weight of each child in kg to the nearest 0.1 kg using a portable electronic scale. Each child's height was measured to the nearest 0.1 cm. The measurements were taken privately with each child.

The children were categorized as overweight if they were in the 91st-97th percentiles, and they were categorized as very overweight if they were in the 98th percentile or higher for body mass index for their age.

Parents received personalized letters from the researchers that contained both qualitative and quantitative data about the child's weight, along with simple advice for promoting physical activity and following a healthy diet. The letters used neutral language that did not imply parental responsibility for the child's weight. The advice was presented in a nonjudgmental manner appropriate for children of all weights.

Before the feedback, 61% of the parents of overweight children identified their child's weight as "about right," while 39% identified their child as overweight. After the feedback, 49% of the parents identified their child as overweight, but this change was not statistically significant.

But significantly more parents of overweight children, compared with healthy weight children, reported making dietary changes (49% vs. 12%) and changes in physical activity (48% vs. 10%) for their children after learning their child's weight status.

Children's self-esteem was unchanged among the 6- to 7-year-olds after the feedback, compared with before the feedback, but self-esteem improved significantly after the feedback among healthy weight 10- to 11-year-olds. Self-esteem measures were essentially unchanged among the overweight 10- to 11-year-olds.

In addition, reports of dietary restraint in the older age group decreased significantly among healthy weight children after the feedback, compared with before the feedback, but no such change was seen among the overweight children. There were no changes in dietary restraint before and after feedback in either weight category in the younger-age group.

Of note, the overweight children reported no significant increases in teasing from other children after the feedback, compared with before the feedback in either age group.

Overall, 66% of parents in the study wanted regular feedback on their child's weight, with no differences between parents of overweight vs. healthy weight children.

"The results were broadly reassuring within this sample of families who had opted into a weight feedback program," Ms. Grimmett and her colleagues noted. "Interestingly, 30% of parents who continued to describe their overweight child as healthy weight reported making lifestyle changes after feedback, which could indicate a positive reaction to the feedback despite rejection of the weight status label."

The study was limited by a lack of randomization and by a lower percentage of overweight children than the national average in England, the researchers noted.

Future studies are needed to identify the best ways to provide weight feedback and to provide support for families who are ready to make lifestyle changes, they added.

The researchers stated that they had no financial conflicts.