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Children 10–18 years

Overcome misconceptions about weight for better family health

Obese boy in poolDespite the proliferation of information linking a healthy diet with weight control the rates of obesity continue to grow.

Currently 35.7% adults and 17% of children in USA are obese and in New Zealand 31% and 11% respectively. 1,2

If current research is to be believed, obesity is becoming so common we no longer “see” it.1

One in three children are unaware they are obese*

Approximately 30% of children aged 8-15 yrs misperceive their weight status, according to a new analysis of data from the National Health and Nutrition Examination Survey 2005-2012 1 The study carried out by Dr Sarafrazi and colleagues in Maryland came up with the following key findings:

Gender:

Boys were affected more than girls with 81% of overweight boys (48% obese) and 71% overweight girls (36% obese) believing that they were the “right weight”.

Age:

Weight misperception was highest amongst younger children 8-11yrs (33%) compared to adolescents 12-15yrs (27%)

Income:

Low income families (32.5%) compared to higher income (26.3%) misperceived their weight the most.

Ethnicity:

Around 34% of Mexican Americans and 34% non-Hispanic black children 8-15yrs misperceived their weights compared to 27.7% white non-Hispanic children.

Dr Sarafrazi’s team has estimated that 9.1million children in USA have an inaccurate understanding of their own weight.

Adults also misperceive obesity

Looks can be deceiving

Commenting on the National survey Dr Prout Medical Director of the bariatric program at The Children’s Hospital in Philadelphia, Pennsylvania suggest paediatricians should pay more attention to the actual numbers associated with obesity and talk with families so that action can be taken.

Dr Prout noted that 70% of paediatricians got obesity status wrong when they just look at a child “we can’t go  based upon how people look” she recently reported to Medscape Medical News.3

Parents need the facts

A separate study in The Miami Children’s Hospital found that 25% of parents under estimated their children’s weight status. The researcher’s reported that parents often thought that their child had glandular problems or would “grow out” of the extra weight that they carried.4

Parents are role models for their children

The Miami researchers also observed that parents were often overweight themselves and suggested that when children grow up surrounded by overweight or obese people they are more likely to think that this is normal. “That they come from a big, happy family”4.

Overestimating weight also has its dangers.

The researchers in Miami found that the odds of trying to lose weight was ten times higher in those who overestimated their weight than those who under estimated it.

Unfortunately when children over-estimate their body weight this can lead to impaired perception of body image and a vulnerability to the development of eating disorders. 4,5

Parents who do recognise weight issues are affecting their children could be forgiven for feeling caught in a “weight trap” fearing that any intervention may make the problem worse.
Either way weight issues cannot be ignored because:

Obesity

In all age groups if left untreated obesity can lead to the development of other diseases such as coronary heart disease, diabetes, bone abnormalities, hypertension, respiratory disorders, gallstones, asthma and sleep disorders. 1

Eating disorders

These also endangers health, altering hormone levels, growth, bone development, energy levels, heart, lung and mental functioning. There is also a high rate of drug and alcohol abuse associated with eating disorders and even premature death 5

Defining weight categories

What defines obesity? Concern is often expressed about the accuracy and appropriateness of measurements used to determine weight categories 6

Children’s Growth Rates

CDC growth charts are useful when measuring the development of children during a time when body composition, height and weight are changing rapidly.7

Weight Status Category Percentile Range
Underweight Less than the 5th percentile
Healthy weight 5th percentile to less than the 85th percentile
Overweight 85th to less than the 95th percentile
Obese Equal to or greater than the 95th percentile

Waist circumference

This is also useful for measuring changes in abdominal growth in children under 12years.

Body Mass Index

BMI is a tool used the world over to measure older children and adults because it is quick to use, practical and convenient. However BMI may not correspond to the same fat composition or muscularity in different populations, partly due to different body proportions.

A Summary of BMI Grading

Classification BMI(kg/m²)
Underweight <18.5
Normal weight 18.5-24.99
Overweight > 25
Obese > 30

The health risks associated with increasing BMI are continuous but the interpretation of BMI grading in relation to risk may differ for different populations. In The New Zealand Guidelines for Weight Management in Adults the recommended BMI cut-off points are 20,25,30 kg/m² for cardiovascular and diabetes risk assessment (as indicators of healthy, overweight and obese respectively), as related to increasing risk of comorbidities. 8

Waist to hip circumference

This measures abdominal adiposity. Measurement is taken horizontally and midway between the last rib and top of the hip bone. Cut-off points in measurement of 102cm or greater in men and 88cm or greater in women are identified as the indication for cardiovascular and diabetes risk assessment. 8

Misconceptions can be changed

So, if we do recognise that there is a problem should we talk to our children or partner about their weight or just leave it and hope the problem solves its self?
That really seems to depend on whether we think that the person/child has a good sense of self-esteem and in particular self- efficacy. What’s the difference?

Self esteem

This is a persons feeling of self-worth

Self-efficacy(SE)

This pertains to a sense of control that a person has over their environment and behaviour. SE influences the effort a person puts into changing risk behaviours and persistence to achieve goals despite barriers and set-backs that may undermine their level of motivation. Proposed in 1997 as Social cognitive theory  Psychologist Albert Bandara postulated that people with high self-efficacy who believe they can perform are more likely to view difficult tasks as something to be mastered rather than something to be avoided 9

 The Pros: Research supporting the SE approach has found that raising a child’s self- efficacy can not only help weight issues but can also help an array of health related behaviours. Improving such things as smoking, physical activity, weight control, condom use, dental hygiene, seat belt use, AIDS prevention, breast examination etc 6,10

The Cons: In some cases research cautions that raising awareness of obesity in those who underestimate their problem may undermine self-efficacy by creating a barrier to engaging in a health behaviour such as for example exercise. “I’m too heavy to exercise” could be given as one reason for their inactivity 6

Research has looked into the weight perception and self- efficacy of 1210 obese children aged 12-15yrs. They found stronger self-reported involvement in health behaviours such as physical activity, healthy diet, ability to achieve a healthy diet, overall healthy lifestyle amongst children who under estimated their weight compared to those with accurate weight perception. However the researchers did note a major limitation with the study was that the under estimators were self-reporting and were lighter at the start than those with accurate perception.6

Taking action to reduce obesity

It’s a family affair

Also as a community we can all play our part to:

  • Not isolate the obese adult or child
  • Focus on health and lifestyle as a family.
  • Work to provide a healthy diet and increase exercise for everyone.
  • Ideally build a child’s sense of worth and self-efficacy when they are young so that they feel empowered to tackle their health problems as they get older. For “late starters” recognise that it is never to late to feel valued and that maintaining self efficacy requires effort and re-appraisal throughout life.
  • If helping others, concentrate on portraying positive health messages as focusing on risk factors and threats can lead to negative self-perception 6
  • Young people are motivated by interventions that are enjoyable, competitive and provide the opportunity for socialization so make it fun 6
  • If weight concerns are creating other health issues such as diabetes, asthma, fatigue, hypertension or orthopaedic problems  then consult a Dietitian without delay.

Misperceptions hamper progress

Getting to the heart of how we develop misperceptions 11, may, when applied to weight, also help adults and children develop a healthier outlook. So consider how misperceptions usually come about?

  • Faulty perceptions of reality: it is best to get the facts first. See your doctor regularly and call us for a nutritional assessment and action plan if you need to make changes.
  • Self- defeating beliefs: If you think negatively from the start i.e” I’m overweight, diets don’t work so won’t help my child” you overlook potential for change. Restrictive diets don’t work but other methods can. It is important to think “how can we” rather than “we can’t because”
  • Limiting concepts-  Don’t be hampered by past failings or labels. Keep an open mind and raise your sights to new goals as a family.
  • Unhealthy attitudes – it’s easy to tune into the negative things, particularly when the media tends to focus on this each day. Instead find your talents and eat healthier so that you have the energy to do what you are good at.
  • Unrealistic thinking– while it is important to have dreams it is also important to live in the real world. So set small goals at the start because as you achieve them your confidence will grow
  • .Impaired judgement- sometimes our emotions can get in the way of our progress. In a busy day it is easier to move along the path of least resistance. This is when it can be helpful to have the support of a mentor, friend or family member who thinks logically and encourage you to make healthier decisions and “stay on track”.

Building self efficacy

There are a number of ways that parents can help their children (and themselves) to raise self-efficacy enough to achieve better health.

  • Teach children that mostly effort not luck brings results
  • Notice how other children of the same age achieve things even when the task is hard
  • Persuasion from trusted coaches, teaches and friends that focuses on the strengths the child already has e.g.” You are good at problem solving so I know that you can find a creative solution”
  • Keep emotions and moods positive.
  • Teach children how to set goals, make them achievable and within an appropriate time frame. To do this though it is also important to put in regular checks of progress and encouragement along the way.
  • Celebrate successes
  • Make praise specific. “ I was so proud you won today. Your kicking was a lot more accurate and you really helped your team in the line-out .”
  • Help children to link their strengths to their goals. E.g.”The same effort, time and commitment that made you good at maths can also help you to change your weight and get fitter”.

If you, or a family member has misconceptions about weight which are holding up progress towards achieving a healthier lifestyle, then contact us we would love to help.


More articles by Lea that may help:

References

1 Sarafrazi N, Hughes JP, Borrud L, et al. Perception of weight status in U.S. children and adolescents aged 8–15 years, 2005–2012. NCHS data brief, no 158. Hyattsville, MD: National Center for Health Statistics. 2014.http://www.cdc.gov/nchs/data/databriefs/db158.htm

2. New Zealand Ministry of Health Obesity data and stats 2012/13  http://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/obesity-data-and-stats

3. Pullin C.  One third of children misperceive their weight status July 23,2014  http://www.medscape.com/viewarticle/828743

4. Han-Yang Chen, M.S., department of quantitative health sciences, University of Massachusetts Medical School, Worcester, Mass.; David Katz, M.D., M.P.H., director, Yale University Prevention Research Center, New Haven, Conn.; William Muinos, M.D., director, weight management program, Miami Children’s Hospital; July 31, 2014, Preventing Chronic Disease

5. Harring HA, Montgomery K, Hardin J. Preceptions of body weight, weight management strategies, and depressive symptoms among US college students. J Am Coll Health 2010;59(1):43-50 Http://www.ncbi.nlm.nih.gov/pubmed/20670928

6  Thunfors P, Hanlon A, Collins B Weight Status Misperception and the health behaviors of obese adolescents ISPUB.com http://ispub.com/IJPN/13/1/11452

7. CDC Centre for Disease Control and Prevention. Healthy weight is not a diet, it’s a lifestyle http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html
8. New Zealand guidelines for weight management in Adults and New Zealand guidelines for weight management in children and young people, Ministry of Health 2009.

9 Bandura A , Self-efficacy: Toward a Unifying Theory of Behavioral Change, Psychological Review 1977, Vol. 84, No. 2, 191-215

10.Luszczynska A and Schwarzer R 2005 The role of self efficacy in health self-regulation

11.Palmer O Why Misconceptions Occur: 11 Reasons & One Remedy. http://oceanpalmer.com/2012/02/why-misconceptions-occur-11-reasons-one-remedy/

 

 

About the author View all

Lea Stening

Lea is one of New Zealand’s leading paediatric dietitians and also specialises in Sports Nutrition. She has specialised in Paediatric Nutrition for 31 years and in 1985 was the first paediatric dietitian to enter private practice in New Zealand. Lea helps families through her private consultations, public lectures, newspaper and magazine articles as well as television and radio interviews. Read more »

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