1
Used with permission
PARENTAL RECOGNITION OF
OVERWEIGHT AND OBESITY IN PREADOLESCENTS: A PROCESS OF DISCOVERY
Jennifer Laurent, PhD, FNP-BC
U i
University
i off Vermont
V
[email protected]
2
Financial Disclosures: None
3
BACKGROUND
 1/3 of pre-adolescents and adolescents are overweight.
 16% are clinically obese.
 Quantitative
Q
i i studies
di clearly
l
l demonstrate
d
a clear
l
“disconnect”
“di
”
between actual child weight and parental perceived weight in
overweight/obesity children across SES, gender, race, and
sex.
o
o
o
o
Boutelle et al, 2004
Parry et al., 2008
Jones et al., 2011
and many more!
 Affected youth are ARF MetSyn,
MetSyn OA
OA, DMT2
DMT2, premature CHD and
more… (Dietz & Robinson, 2005; Franks et al., 2010; Lobstein & Jackson-Leach, 2006)
4
PURPOSE
The purpose of this study was
to explore how parents gained
this awareness & describe the
i fl
influential
i l factors
f
involved
i
l d in
i
acquiring this knowledge.
5
METHODS
 This study is an expanded focus from a larger grounded theory study that
explored how parents promoted health for their overweight/obese prepre
adolescent (Laurent, 2010).
 Strauss and Corbin’s
Corbin s model (1998) of grounded theory guided data
collection, analysis, and interpretation of the findings.
 Data were g
generated and analyzed
y
from the q
question,, “How did y
you come
to realize your pre-adolescent was overweight or obese?”
 All participants were recruited for the Northeast, U.S.
 Interview were 30-90 minutes and were audio recorded.
 This study received IRB approval.
STUDY
GS
FINDINGS
Parent participants, n=17
o
o
o
o
All identified as Caucasian.
12 mothers,
h
4 ffathers,
h
& 1 grandmother.
d
h
9 were obese, 3 overweight, 5 normal weight.
Wide variation in SES
Children, n=13
o
o
o
o
All were obese save 2 who were overweight.
overweight
9 were white, 4 bi-racial.
The majority were pre-pubertal.
5 boys & 8 girls
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CONCEPTS
Compared
C
d
to Others
Predisposition
HCP
DISCOVERY
Turning
Point
Husky
H
k
Build
8
“He’s husky looking.” (Karen)
“A girl with curves.” (Peggy)
“Chunky monkey.” (Anna)
“Big
Big boned
boned” (Serena)
“We were out on the bike path and I looked over and he looked
almost like he had a lump on his side. And I’m like, what the
h k’ that
heck’s
h – and
d realized
li d it
i was love
l
handles
h dl or whatever
h
–
stupid name. So that’s sort of where I was kind of aware of it,
but well, is it baby fat?” (Barb)
Concept: Husky Build
9
“Some people have a genetic makeup where they can eat
anything they want and their metabolism is just different.”
(Tom)
“I mean both my husband and I were short, pudgy kids.”
(Kammie)
“Y can see hi
“You
his whole
h l b
body
d is
i like
lik my husband’s.”
h b d’ ” (Sharyl)
(Sh
l)
“She’s very, very similar in that her [biologic] mom was only
y daughter]
g
] is now. And
about that much taller than what [[my
like I said, from the time we knew her, [her biological mother]
never was thin. She fluctuated from being chubby to being fat,
or overweight.” (Charlie)
“The whole family has a problem with it.” (Kathy)
Concept: Predisposition
10
“I’m heavy. She’s insane, out of control. And then we have the
little one who still weighs like 40 pounds.
pounds She
She’ss little skinny
Minnie. Okay. I have polar opposite children here.” (Sara)
“He has a lot of friends who are just, you know, 14 and skinny
as a rail, and they eat anything they want”. (Cate)
“He will have two pieces [of pizza] tops. I mean the amount, it
seems like the amount of food he eats is so much less and his,
his
his activities is about the same, you know, I try to compare
with other boys his age and, but yet…he’s still overweight.”
(Sharyl)
Concept: Compared to Others
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“There was some correlation [of weight gain] or relation to
what’s been going on with regards to behavior issues at school
[the last one or two years].” (Alex)
“It was the summer my mom died. He gained fourteen pounds
that summer.” (Sharyl)
“Sixth
“Si
h grade
d was rough
h on h
her down
d
there
h
[at
[ middle
iddl school]…
h l]
in a social way.” (Julie)
Concept: Turning Point
12
“I have to say this is the first year I was kind of impressed that
the doctor’s
doctor s office was so blunt about it.
it You know,
know certainly
I’ve had concerns before and they haven’t kind of supported
me.” (Kylie)
“She said in front of my daughter – her exact words – You are
very obese. You are very obese. And then she pulled out the
chart. They had the height and the weight and all that, and
told Nina she was very obese.
obese Very fat and needed to lose a
tremendous amount of weight.” (Joyce)
“Heavier than according to what she should be.” (Julie)
Concept: Healthcare Provider
HCP
Discovery
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P
Parents
t appear tto acceptt that
th t overweight
i ht or obesity
b it might
i ht
be the “given” phenotype for their pre-adolescent
 Parents do not rely
y on their p
pre-adolescents body
y shape
p as a
marker for being overweight or obese.
 There appears to be a stressful event or “turning point”
which parents relate to the onset of weight gain.
gain
 Parents use a comparative analysis to judge their preadolescents weight.
 The healthcare provider plays a crucial role in the discovery
process.
Discussion of Findings
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 The new normal? (Rose, 1985)
 Anticipatory guidance may be warranted in times of
household stress.
 The importance of the HCP-pre-adolescent/family
relationship in the discovery process.
process
 Importance of yearly well child exams.
Implications
16
 The process of discovery was not the
overarching aim of the primary study.
 Retrospective account of predominantly
white mothers from Northeastern U.S.
US
Limitations
17
 Examining the role of household stress
and healthy behaviors during the
formative years of adolescence.
 How to enhance the discovery process for
parents before pre-adolescent overweight
or obesity is achieved.
Future Directions
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L
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