Low Recognition of Childhood Overweight and Disease Risk among Native‐American Caregivers^**

Abstract

ADAMS, ALEXANDRA K., RACHEL A. QUINN, AND RONALD J. PRINCE. Low recognition of childhood overweight and disease risk among Native-American caregivers. Obes Res. 2005;13:146 -152. Objectives: Pediatric obesity is a significant and increasing problem in Native-American communities. The aim of this study was to determine whether parents and other caregivers from three Wisconsin tribes recognized overweight children. We also assessed caregiver attributes associated with levels of concern for risk of future overweight and chronic disease. Research Methods and Procedures: Data were obtained from child health screenings and caregiver surveys. Participants included 366 kindergarten-through-second grade child-caregiver dyads. Children's BMI percentiles were calculated and compared with caregiver responses. We assessed the relationships between predictors of caregiver concern for health risk factors and recognition of overweight. Results: Twenty-six percent of children were overweight (Ն95th percentile), and 19% were at risk for being overweight (Ն85th to Ͻ95th percentile) using Centers for Disease Control standards. Caregivers recognized only 15.1% of overweight children. Factors predictive of child overweight recognition included a child BMI Ͼ99th percentile and grandmother as caregiver. Overall, caregivers were more concerned about diabetes and cardiovascular disease than obesity. Parents with diabetes and heart disease were more concerned than others about risk for these diseases; however, only diabetic parents made a connection between child weight status and future risk of obesity-related disease. Child sex, child age, and parental education level were not significant predictors for caregiver recognition of an overweight child. Discussion: Most caregivers did not recognize overweight children or associate excess weight with increased risk of disease. When designing community interventions, it is crucial to incorporate caregivers' attitudes and beliefs regarding childhood overweight and risk of future disease.

Parental perception and child's nutritional status

“…We found correlation between maternal verbal and visual evaluation of the child. Adams et al 24 compared perception rates of mothers and fathers and found that fathers less likely recognized overweight in their children 24 . However, maternal and paternal verbal assessments of child's weight status were correlated, and related to child's BMI in our study.…”

Social, economic and demographic correlates of overweight and obesity in primary-school children: preliminary data from the Healthy Growth Study

“…In a recent study, it was observed that food consumption in children was adjusted according to the stimuli induced by the food served by their caregivers or parents, instead of being regulated by the satiety and increased energy following the previously consumed meals (28) . In most cases, grandparents tend to believe that overweight signifies healthiness (29) or that young children may grow out of being overweight (30) . Another interpretation of this particular finding is probably based on the so-called 'post-World War II overfeeding syndrome' (31) referring to the post-war period in Greece when there was severely decreased accessibility to food.…”

The Role of Culture in the Context of School-Based BMI Screening

“…65 In a study of Native Americans living on reservations, only 15% of the obese children were perceived as overweight, and the children who were perceived as overweight had a mean BMI at Ͼ99th percentile. 60 Even some parents who had brought their child to a weightassessment clinic said that they were not especially concerned about their child's weight. 66 Similarly, very few of the parents who brought their obese child to be screened for a weightmanagement program thought that their child was very overweight, although 62% did say that their child was a little heavy.…”

“…Only studies conducted in the United States are listed, although a number of similar studies have been conducted outside the United States. [54][55][56][57][58] Some of the studies focused specifically on minority children, [59][60][61][62][63][64] whereas others included multiethnic samples. [65][66][67][68][69][70] Many researchers selected participants from within a fairly narrow age range (eg, 2-5 years, 4 -8 years), whereas a few included a broader age range.…”