Pediatricians Matter in Weighty Matters

May 5, 2010 - Injury Free Coalition for Kids of Baltimore

Pediatricians Matter in Weighty Matters May 05, 2010 Body image, as well as beauty, may be in the eye of the beholder when it comes to parents’ perceptions of their school-age child’s weight. Studies have shown that those perceptions are too often far removed from reality, which can hinder pediatricians’ diet and exercise recommendations to the family. But do similar perceptions apply to the parents of preschoolers?

“Do parents tend to agree on what a healthy or desirable weight is for preschoolers, and, if so, can we use that to help them have clear expectations and manage their overweight or obese child?” asks pediatrician Raquel Hernandez. “Unfortunately, we really haven’t had a good sense about what parents believe is a healthy looking body image for their preschooler.”

Until now. In a recent study, Hernandez, a former fellow in Johns Hopkins General Academic Pediatrics program, and Hopkins Children’s pediatricians Janet Serwint and Tina Cheng, asked parents of 150 preschoolers during well-child visits to select sketches of body images that best resembled their own child’s current weight, a healthy weight preschooler, and what they believe another family member or friend would perceive as a healthy weight preschooler. Simply asking parents if they believe their child is overweight or obese has not proven useful, Hernandez says, while the sketches allow parents to more easily categorize body weights based on appearance.

Not surprisingly the researchers found that the parents’ perceptions were unrealistic across the board. But they also learned that the preschooler parents who most misclassified their preschooler’s weight and ideal body image were the parents of overweight or obese children in the sample. Indeed, some of these parents indicated a desire for a heavier child. Also, the absence of a pediatrician’s comment on the child’s weight strongly predicted misclassification in this group.

“It was very surprising that so few parents in this overweight/obese age group, 7.3 percent, recalled having their pediatrician comment to them about their child’s weight,” says Hernandez, now a pediatrics faculty member at the University of South Florida. “It speaks to the power the pediatrician has in terms of really educating families.”

With national media attention focused on childhood obesity, along with the American Academy of Pediatrics new management guidelines in 2007, Hernandez notes, pediatricians have made a lot of investment in children 6 years of age and up. But not so for preschoolers.

“My message continues to be that despite all the attention we’re giving to adolescents and school-age kids, the preschool age is really the time to make these discussions happen,” Hernandez says. “Pediatricians shouldn’t shy away from the subject. There are tactful ways to approach weight in the office, and families really are listening. Unanimously, families rank us pediatricians as their preferred counselor.”


The Johns Hopkins Children's Center

Drs. Hernandez, Serwint and Cheng's abstract, Parents' Healthy Weight Perceptions and Preferences for Obesity Counseling in Preschoolers: Pediatricians Matter, was presented at the annual meeting of the Pediatric Academic Societies May 1-4 in Vancouver.