Physicians, low-income mothers define 'overweight' differently, says University of Chicago study

April 30, 2001

To prevent obesity in young children, health professionals may need to focus more on improving general parenting skills and less on discussing growth charts with low-income mothers, according to a study presented today by researchers at the University of Chicago Hospitals.

"Mothers and health professionals do not view the term "overweight" in the same way," said Anjali Jain, MD, lead author of the study and instructor of pediatrics at the University of Chicago.

"While physicians emphasize growth chart guidelines to define children as overweight, mothers are concerned about other factors, such as if a child fits into age-appropriate clothing or if the child is physically active," she said. "The result is an unresolved disagreement over what is an appropriate, healthy weight for the child."

Researchers found that low-income mothers in general distrusted and disliked the standard growth charts used by health professionals to assess a child's weight, which may cause a major barrier in addressing a child's immediate and future weight concerns.

"Parents looked at the charts as a 'bunch of kids out there, but not my child,'" said Jain.

The study included mothers of 18 children enrolled in the clinic of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) at the Children's Hospital Medical Center in Cincinnati. Researchers recruited biological mothers of two to five year-old children who were defined as "at-risk" for later obesity. WIC is a federally funded program that provides supplemental food and nutrition counseling to women and their young children living in households with an income below 185 percent of the federal poverty line.

Although 15 of the 18 children were considered overweight using the National Center for Health Statistics (NCHS) growth charts, mothers of only 10 of the children labeled their child as "a little" or "very" overweight, the study says. Moreover, only two of the 15 mothers said they worried about their child's present weight, and only five of the 15 mothers said they were concerned about their child's future weight.

Researchers found that mothers became worried about their children's weight if the youngsters were inactive or teased by other children, regardless of the children's rank on the growth chart.

In fact, these mothers considered inactivity and low self-esteem as the two most critical outcomes of being overweight. "Mothers suggested that being overweight caused inactivity, rather than the other way around," said Jain.

The study also found several other beliefs that may promote obesity. For example, study participants felt that heredity played a major role in a child's becoming overweight, and they felt helpless because of it. During the focus group sessions, mothers made comments such as: "She's destined to be just like me" or "When you got a fat gene, you got a fat gene, and there's nothing you can do about it."

"Obesity is more prevalent than ever," Jain said. "But genetic factors alone do not explain how many children are overweight in this country."

Study participants mentioned the challenges of providing a consistent environment for their children, often because different caretakers offer conflicting messages.

"If a mother provides only healthy foods in reasonable quantities, but a grandmother then says 'feed the child,' and the father also gives a different message, it's not surprising that the mother feels no control," said Jain. "The child seeks the parent who is most lenient, defeating the mother's efforts to provide a healthy diet for her child."

Researchers also noticed that food was used to reward children or to encourage good behavior. Jain said physicians may need to help parents set limits, learn when to say no, and reward children with time and attention and without food. Helping mothers enhance their parenting skills may allow them to impose more structure and control on their child's eating and activity and reduce the risks of obesity, researchers speculated.

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