Questionnaire on obesity in children
Obesity cut-offs as derived from parental perceptions: cross-sectional a black, minhae park, john gregson, catherine l falconer, billy white, anthony s kessel, sonia saxena, russell m viner and sanjay a blackdepartment of non-communicable disease epidemiology;find this author on google scholarfind this author on pubmedsearch for this author on this siteminhae parkdepartment of non-communicable disease epidemiology;find this author on google scholarfind this author on pubmedsearch for this author on this sitejohn gregsondepartment of non-communicable disease epidemiology;find this author on google scholarfind this author on pubmedsearch for this author on this sitecatherine l falconerschool of oral and dental sciences, university of bristol, this author on google scholarfind this author on pubmedsearch for this author on this sitebilly whitedepartment of general and adolescent paediatrics, institute of child health, university college london, this author on google scholarfind this author on pubmedsearch for this author on this siteanthony s kesselfaculty of public health and policy, london school of hygiene & tropical medicine, this author on google scholarfind this author on pubmedsearch for this author on this sitesonia saxenadepartment of primary care and public health, imperial college london, this author on google scholarfind this author on pubmedsearch for this author on this siterussell m vinerdepartment of general and adolescent paediatrics, institute of child health, university college london, this author on google scholarfind this author on pubmedsearch for this author on this sitesanjay kinradepartment of non-communicable disease epidemiology;find this author on google scholarfind this author on pubmedsearch for this author on this efigures & datainfoeletters ctbackground overweight children are at an increased risk of premature mortality and disease in adulthood. Parental perceptions and clinical definitions of child obesity differ, which may lessen the effectiveness of interventions to address obesity in the home setting. The extent to which parental and objective weight status cut-offs diverge has not been to compare parental perceived and objectively derived assessment of underweight, healthy weight, and overweight in english children, and to identify sociodemographic characteristics that predict parental under- or overestimation of a child’s weight and setting cross-sectional questionnaire completed by parents linked with objective measurement of height and weight by school nurses, in english children from five regions aged 4–5 and 10–11 years parental derived cut-offs for under- and overweight were derived from a multinomial model of parental classification of their own child’s weight status against school nurse measured body mass index (bmi) s measured bmi centile was matched with parent classification of weight status in 2976 children. Parents become more likely to classify their children as underweight when they are at the 0. Clinical and parental classifications of obesity are divergent at extremes of the weight mass indexchildcross-sectional studiesfemalehumansmaleobesityparentspreschoolprimary careintroductionthe prevalence of childhood obesity has increased significantly in recent years. Overweight children and adolescents are at an increased risk of cardiometabolic disease and premature mortality in adulthood. 7 the lack of accurate parental perception of a child’s weight status may limit the effectiveness of interventions aimed at primary prevention of child obesity. National child measurement programme (ncmp) measures the heights and weights of all children in reception (age 4–5 years) and year 6 (aged 10–11 years) at state schools in england. Local authorities are encouraged to provide written weight status feedback to the children’s parents, as well as telephone or in-person feedback to children that are overweight. Obesity cut-offs represent points where the deviation in bmi from a reference population of british children, collected between 1978 and 1990, is assumed extreme enough to infer membership of a different weight status group. As parents may be less likely to act if they do not perceive their child’s overweight as a problem, quantification of the discrepancy between perceived weight status by the parent and objectively measured weight status may help to explore the potential impact of parental weight misclassification on effectiveness of public health interventions aimed at reducing the prevalence of child is study aimed to:Compare parental-perceived and objectively-derived assessment of underweight, healthy weight, or overweight; andidentify socidemographic characteristics that predict parental under- or overestimation of a child’s weight this fits inparental perceptions and clinical definitions of child obesity are known to diverge; however, the extent of the discrepancy has not been documented. Parents of all children enrolled in the ncmp in the 2010–2011 school year across the following five primary care trusts (pcts) were invited to participate: redbridge, islington, west essex, bath and north east somerset (year 6 only), and sandwell (reception only). Questionnaires were distributed to parents on the day of the child’s ncmp measurement but before they received weight feedback. Was used for all sin total, 3397 parents responded to the questionnaire (response rate 15% of all children in the five pcts). Of these, 139 parents did not complete the question asking about their child’s weight status, and 282 children were not present on pct records. Categorisation of children’s weight status by national child measurement programme (ncmp)-measurement against parent-reported ad figureopen in new tabdownload powerpointfigure 2. Distribution of body mass index centiles in 2976 children, with bars colour coded by parent-reported weight status within each distribution of bmi centiles was skewed, with 20% of children in the highest decile (figure 2).
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Predictors of a parent incorrectly classifying their child’s weight statusdiscussionsummarychild bmi centile cut-offs were modelled based on parent-reported weight status, and it was found that parents become more likely to classify their children as underweight when they are at the 0. Although there is concern over using bmi weight status cut-offs for adiposity at an individual level,15 pragmatically, the >98th centile bmi cutoff has moderate sensitivity (71%) and high specificity (98%) relative to clinically measured impedance,15 limiting the number of children being falsely identified as very overweight. As such, it cannot be concluded if the cutoffs reported are specific to parents, or also present in subjective assessments by health study was limited by the low number of parents with very overweight children classifying their children as very overweight, meaning both overweight and very overweight were collapsed into a single overweight category. Data on parental weight perceptions were collected by postal low response rate for the questionnaire introduces the potential for non-response bias: responders to the questionnaire were more likely to be from white ethnic groups and less deprived than the target population (table 2). Although no substantial changes were seen in the modelled cut-offs stratifying for age and sex, these analyses were underpowered because of small numbers of parents identifying their children as underweight and this table:view inlineview popuptable 2. 10 in contrast to a literature review of 52 studies that found parents were more likely to misclassify children aged 2–6 years than older children,6 this study found that older children (10–11-year-olds) were more likely to be misclassified than younger children (5–6 years). In a recent survey of parents with children aged 4–16 years in liverpool, parental beliefs and attitudes about childhood obesity differed significantly by ethnicity, but this study did not compare parental perceptions with children’s measured weight status. A cochrane review of interventions for preventing child obesity identified parental support to enact healthy lifestyle changes at home as a promising strategy for weight reduction. Although bmi cut-offs in childhood can be considered arbitrary in some ways (because they are based on population norms rather than specified health risks associated with them), childhood overweight and obesity have been shown to predict adult weight status and the health problems associated with excess weight in adulthood. 3,5 the parents of some children who are most at risk of health consequences of being overweight, including south asian boys, appear from these study findings to be least able to detect weight problems in their child. If parents are unable to accurately classify their own child’s weight, they may not be willing or motivated to enact changes to the child’s environment that promote healthy weight study has demonstrated the extreme divergence between clinical and parental classifications of obesity. This discrepancy in perceived weight status is important for policy makers and clinicians to consider in their approaches to obesity prevention; weight management interventions targeted at the parents of overweight children are unlikely to register with the intended audience if few parents consider their child to be overweight. Prev med 31(6):702– onis m, blössner m, borghi e (2010) global prevalence and trends of overweight and obesity among preschool children. Reilly jj, kelly j (2011) long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Parry ll, netuveli g, parry j, saxena s (2008) a systematic review of parental perception of overweight status in children. 2012) scoping the impact of the national child measurement programme feedback on the child obesity pathway: study protocol. Doolen j, alpert pt, miller sk (2009) parental disconnect between perceived and actual weight status of children: a metasynthesis of the current research.
2013) perceptions of health risk among parents of overweight children: a cross-sectional study within a cohort. Saxena s, ambler g, cole tj, majeed a (2004) ethnic group differences in overweight and obese children and young people in england: cross sectional survey. We do not capture any email multiple addresses on separate lines or separate them with are going to email the obesity cut-offs as derived from parental perceptions: cross-sectional questionnaire. Your name) thought you would like to see this page from british journal of general personal obesity cut-offs as derived from parental perceptions: cross-sectional a black, minhae park, john gregson, catherine l falconer, billy white, anthony s kessel, sonia saxena, russell m viner, sanjay j gen pract 2015; 65 (633): e234-e239. On manager bookendseasybibendnote (tagged)endnote 8 (xml)medlarsmendeleypapersrefworks taggedref obesity cut-offs as derived from parental perceptions: cross-sectional a black, minhae park, john gregson, catherine l falconer, billy white, anthony s kessel, sonia saxena, russell m viner, sanjay j gen pract 2015; 65 (633): e234-e239. Widgetfacebook likegoogle plus one icleabstractintroductionmethodresultsdiscussionreferencesfigures & datainfoeletters mass indexchildcross-sectional studiesfemalehumansmaleobesityparentspreschoolprimary in this toc ’ experiences of children with anxiety disorders in primary care: a qualitative of the electronic frailty index to identify vulnerable patients: a pilot study in primary role of the quality and outcomes framework in the care of long-term conditions: a systematic more research related articles cited by... Bjgpjournal's likes on h journal of general sion on ending childhood sion on ending childhood obesity (echo). In infants and children under 5 years of age obesity is assessed according to the who "child growth standards" (weight-for-length, weight-for-height) and the who reference for 5-19 years (body mass index-for-age). In adults bmi greater than or equal to 25 is overweight; and bmi greater than or equal to 30 is are the health consequences of obesity in childhood? Infants and children are likely to continue being obese during adulthood and are more likely to develop a variety of health problems as adults. Policies, environments, schools and communities are fundamental in shaping parents’ and children’s choices, making the healthier choice of foods and regular physical activity the easiest choice (accessible, available and affordable), thereby preventing infants and young children, who recommends:Early initiation of breastfeeding within one hour of birth;. Breastfeeding for the first 6 months of life; introduction of nutritionally-adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to two years of age or -aged children and adolescents should:Limit energy intake from total fats and sugars;. Food industry can play a significant role in reducing childhood obesity by:Reducing the fat, sugar and salt content of complementary foods and other processed foods;. Responsible marketing especially those aimed at children and has who formed a high-level commission on childhood obesity? Present, there is lack of consensus worldwide on which approaches and which combinations of these interventions are likely to be most effective to prevent childhood obesity in different contexts and societies. The high-level commission on ending childhood obesity has been tasked with garnering advice from experts around the world and making recommendations to the who director-general on how to tackle the current single discipline can provide the groundwork for a strategic approach to tackling childhood obesity. One group will examine all available evidence on prevention of childhood obesity and how to reverse it in affected children; and determine the best combination of policies to put in place to achieve these goals.
The second group will determine how to monitor achievements in tackling childhood obesity worldwide and track results. Issue ibe totable of contents of contents receive news and publication updates for journal of obesity, enter your email address in the box mation email ons to this to cite this article. The parent and teacher questionnaires are moderately reliable tools for simultaneously assessing child intakes, environments, attitudes, and knowledge associated with healthy eating and physical activity in the home and school and may be useful for evaluation of similar programs. Introductionoverweight and obesity are a global concern in both developed and developing countries and in school age children, the prevalence continues to remain high. There is a clear need for effective prevention efforts to address the high prevalence of childhood and adult obesity [2] without which obesity will become the primary cause of preventative deaths worldwide [3]. Despite a large body of the literature pertaining to the management of childhood obesity, there are a limited but increasing number of community-wide prevention projects. To effectively target childhood obesity, existing and new programs need to be systematically evaluated to determine the efficacy of the implemented strategies and such evaluations should be of high quality in order to contribute to the evidence for addressing childhood obesity [9]. The eat well be active (ewba) community programs were implemented in south australia from 2005 to 2010, focusing on prevention of obesity through environmental change using a community development approach. Briefly, the program aimed to increase the proportion of 0–18 year old children within the healthy weight range by effecting environmental change which in turn would influence healthy eating and physical activity behaviours. To the lack of relevant tools to evaluate the impact of the intervention, a number of program-specific questionnaires were developed to assess behaviours, knowledge, attitudes, and environments relevant to the goals of the program of increasing healthy eating and activity. Four of these tools were completed by children aged 9 to 11 years, their parents, and teachers. Aim of this paper is to report the reliability of the parent and teacher questionnaires, tools that assess the diet and physical activity environments of children in the home and school, respectively. These questionnaires can provide relevant insight into the domains which influence nutrition and physical activity behaviours in children, and may be used to evaluate obesity prevention interventions. Methodsethics approval for this study was obtained from the flinders university social and behavioural research ethics committee, the south australian health ethics committee, and the department of education and children’s services ethics committee. All parents of children in years 5–7 at school 1 were invited to participate in the test-retest reliability study, and all teachers were invited at a staff meeting, in october 2008. Parents who participated in this ewba evaluation follow-up (sept–nov 2009) were invited by letter to complete the questionnaire on a second occasion, and all teachers were asked at a staff meeting to complete the survey a second time. At school 1, the parent questionnaires were sent home by the school to all parents of students in school years five, six, and seven.
An introductory letter, an information sheet, and reply-paid envelope to allow return by post accompanied the questionnaire. At school 2, the parent questionnaires were administered as part of the wider ewba evaluation, as reported in [11]. Two weeks later at both schools, teachers completed the questionnaire again at a staff meeting, and parents who completed the first questionnaire were mailed the second questionnaire with a reply-paid envelope. Reminder letters were sent two weeks later by the school to parents who had not returned the second questionnaire. Development of questionnairesthe parent and teacher questionnaires were part of a suite of questionnaires developed for evaluation of the ewba community programs. The questionnaires were developed by the program evaluation committee which included academics with expertise in childhood obesity, nutrition, physical activity, and community development. The items included in the program-specific questionnaires were specifically selected to evaluate each of the program’s relevant objectives. Thus, these questionnaires were likely to be more sensitive to the programs’ goals and objectives than any existing questionnaires which were more general and did not include the breadth of the programs’ parent questionnaire contains 25 questions requiring 67 responses covering the following domains: demographics; obesogenicity of the home environment; parental knowledge and attitudes towards healthy eating and physical activity; child physical activity and healthy eating behaviours. The teacher questionnaire consists of 15 questions requiring 44 responses covering teaching practices around healthy eating and physical activity inclusion in the school curriculum; training/experience in healthy eating and physical activity; teacher knowledge and attitudes towards healthy eating and physical activity (table 2). Scoring the questionnairesto produce more meaningful and reliable results, some responses are condensed into “scores” by summing items which represent a specific domain. Thus, there are 14 outcomes (seven scores and seven single items) from the parent questionnaire and 12 outcomes (six scores and six single items) from the teacher questionnaire. Internal consistency of the teacher and parent scores (outcomes with multiple items; parent questionnaire seven scores; teacher questionnaire 6 scores) at time 1 was assessed using cronbach’s alpha. Parent questionnaire test-retest reliabilitysixty parents (school 1: 22, school 2: 38) completed the questionnaire on two occasions one to two weeks apart. 55%) were from two children households, 13 (22%) had a university degree, and two (3%) had year 10 schooling or less. It is not possible to calculate response rates for parents at both schools as questionnaires were posted to parents by the school and exact numbers posted are unknown. Table 3 shows the outcomes for each questionnaire and the icc (95% confidence interval) for each score. For the scores from the parent questionnaire, with three of seven scores having alpha values greater than 0.
Table 4 shows the outcomes for each completion of the questionnaire and the icc (95% confidence interval) for each score. For the scores from the teacher questionnaire, with four of six scores having alpha values greater than 0. Discussionthe purpose of this study was to determine the reliability of the parent and teacher questionnaires developed to evaluate the ewba community programs, two questionnaires that assess the healthy eating and physical activity environments of children. The parent questionnaire assesses child dietary intakes, parent knowledge of health-related recommendations, and attitudes about healthy behaviours. The teacher questionnaire assesses the degree to which teachers incorporate healthy eating and activity facets in their daily teaching regime and their skills, attitudes, and knowledge around healthy eating and physical activity. These different messages are a potential source of confusion which may mean that respondents are “guessing” the correct option and this in turn would be a source of retest internal consistency of the scores in the parent and teacher questionnaires was poor to moderate. Only one score from the parent questionnaire (non-core food) and three from the teacher questionnaire were in line with this recommendation; however, the value is affected by the number of items in the scale, and it is common to find low cronbach’s alpha values with scales with less than ten items [24]. Four scores from the parent questionnaire had between five and ten items and three scores had less than five items. In the teacher questionnaire, four scores had between five and nine items and two scores had less than five items. For example children with a high intake of crisps would not necessarily have a high intake of lollies (both single items in the noncore food score). This could explain the lower than ideal cronbach’s alpha values for some of the parent questionnaires were identified in the literature that had similar ranges (or slightly better) of internal consistency and test-retest reliability observed in this study. The children’s dietary questionnaire, measuring parent report of child eating patterns, had four subscales with cronbach’s alpha for fruit and vegetable and noncore food subscales ranging from 0. The “meals in our household” questionnaire measured parent report of six domains, including family meal structure and mealtime behaviours. Similarly, a questionnaire measuring constructs believed to predict fruit and vegetable consumption (in children, completed by parents) had pearson correlation ranging from 0. Strength of this study is the report on two questionnaires with multiple scores/indexes that simultaneously measure diet and physical activity environments of children. Additionally, these tools are unique because they focus on behaviours, environments and attitudes, all of which have been demonstrated as factors contributing to the obesity epidemic [5]. Hence these two tools have the potential to be used in the evaluation of obesity prevention programs and consequently contribute to the evidence about obesity prevention.
Tools which simultaneously evaluate environments that children are exposed to at home and school, as well as the attitudes of parents and teachers and diet and activity behaviours of children, are lacking in the literature. The low sample size has implications for interpreting the results of the study, in particular those for the teacher questionnaire, because a larger sample size results in a smaller confidence interval which means we can be more certain that the true reliability coefficient is close to that which has been calculated [29]. Despite the recommendation of 100 as the sample size for a test-retest reliability study [29], the sample size for similar studies varies considerably in the literature and the sample size for the parent questionnaire falls within this range. Forty-four parents were used to assess reliability of the “meals in our household” questionnaire [27] and 38 childcare directors completed the “nutrition and physical activity self-assessment for child care” in a test-retest reliability study [30]. A possibility for future research is to test the internal validity of the parent and teacher questionnaires and to retest the reliability of the teacher questionnaire with a larger sample size. Conclusionsthe parent and teacher questionnaires for the ewba community programs are a moderately reliable method for assessing child intakes, environments, attitudes, and knowledge associated with healthy eating and physical activity. These questionnaires assess relevant information and the scores present this information in a meaningful manner, suggesting that they may be useful in similar settings to evaluate similar obesity prevention ct of intereststhe authors declare that they have no conflict of ledgmentsthe eat well be active community programs were funded by the government of south australia, sa health, and implemented by southern primary health, of southern adelaide health service, and murray mallee community health, of country health sa. Jim dollman, fiona verity, and jeremy moller contributed to the development of the questionnaires, and mel haynes undertook preliminary analysis and wrote a first draft. Magarey contributed to the development of the questionnaires, created the parent and teacher scores, undertook further data analysis, and contributed to the first draft and revisions of the paper. Blanck, “population-level intervention strategies and examples for obesity prevention in children,” annual review nutrition, vol. Raza, “dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity,” preventive medicine, vol. Evidence-based recommendations for the development of obesity prevention programs targeted at preschool children,” obesity reviews, vol. Waters, “obesity prevention programs demand high-quality evaluations,” australian and new zealand journal of public health, vol. Mastersson, “reliability and relative validity of a child nutrition questionnaire to simultaneously assess dietary patterns associated with positive energy balance and food behaviours, attitudes, knowledge and environments associated with healthy eating,” international journal of behavioral nutrition and physical activity, vol. Mastersson, “the challenges of quantitative evaluation of a multi-setting, multi-strategy community-based childhood obesity prevention programme: lessons learnt from the eat well be active community programs in south australia,” public health nutrition, vol. Mastersson, “changes in primary school children's behaviour, knowledge, attitudes, and environments related to nutrition and physical activity,” isrn obesity, vol. Colditz, “modifying the healthy eating index to assess diet quality in children and adolescents,” journal of the american dietetic association, vol.
Estabrooks, “validation of a survey instrument to assess home environments for physical activity and healthy eating in overweight children,” international journal of behavioral nutrition and physical activity, vol. Ong, “reliability and validity of the children's dietary questionnaire; a new tool to measure children's dietary patterns,” international journal of pediatric obesity, vol. Bandini, “meals in our household: reliability and initial validation of a questionnaire to assess child mealtime behaviors and family mealtime environments,” journal of the academy of nutrition and dietetics, vol. Beyers, “nutrition screening tool for every preschooler (nutristep): validation and test-retest reliability of a parent-administered questionnaire assessing nutrition risk of preschoolers,” european journal of clinical nutrition, vol.
