Public Perceptions of Causes

of Childhood Obesity
Parental responsibility
Modern technology and media
Over-consumption of unhealthy foods
Children’s lack of knowledge and
motivation
Physical activity environment
Lack of healthy food
Lack of physical activity
Genes
Individual Responsibility … Environment
International Journal of Obesity, Hardus, 2003
 Individual Choice/Environment
Time 7:00 am 10:00 Noon 2:00 pm 4:00 pm 5:00 pm 6:30 pm
am

Meal Break- Reward Lunch B-day MD Dinner Fund-

fast Party Check raiser
up
Food/ waffles candy threw out Cup- lollipop McDs ¼ Cookies
Drink syrup sandwich; cake; pounder
juice drink cheese, Re
Juice juice com
S ug
& twix bar drink md fries ar m en d
lg coke Max ed
Re =4
Sugar 60 24 28 48 12 co86 20 5g
Fat m
Ma mend
grams x = ed
6 0g
278 g
Fat 7 8 8 8 0 52 2
grams
85 g
SocioEcological Web and
Childhood Obesity
Public Policy Factors e ls
a b
FD A-l
Community Factors f o o ds
Sch ool
Institutional Factors
r tis ing
il i es adve
Interpersonal Fam
Factors o l
S ch o
u r a nts
a
Individual Rest
s ets
l i nk r m a r k
m i c Sup
e
na
Dy it ies
un
p port
PA o
 SocioEcological Web
Influencing Childhood Obesity
Individual (individual choice & responsibility)
 Dietary intake, physical activity, sedentary
behavior
 Influenced by knowledge,attitudes, beliefs, skills
Interpersonal
 Families, friends, peers
 Provide social identity, support and role definition
Institutional
 Schools, local sporting institutions
 Rules, regulations, policies that constrain or
encourage particular behaviors
 SocioEcological Web
Influencing Childhood Obesity
Families
Community
 Formal or informal local networks and
norms
 Resources that encourage or discourage
healthy eating and physical activity
Public Policy
 Local, state and federal policies or laws
that regulate or effect eating practices and
exercise habits
 Families
Powerful and complex fields of influence
embedded in a multi-layered
environment
Characteristics
 Foods available at home
 Food/meal routines – feeding styles
 Family members’ weight status and diet
 Attitudes towards weight individuals’ weight status
 Encouragement of physical activity
 Rules regarding TV use
 Families, continued
Changes in home environment
 Increased use of fast foods and home
replacement meals (1987-2.6 billion sales;
1992 –5.7 billion sales)
 1965 – 30% of food $ spent away from
home; 1998 increased to 47%
(Bowers, D.E., Food Review January-April 2000:23-29, Jekanowski, M.D. Food
Review January-April 1999:32-34, Jekanowksi, M.D., Food Review January-April
1999:11-16)
Parent-Child Eating Styles
Parents shape children’s eating style
 Foods available
 Parent feeding styles
 restriction of intake (restrict child’s access to unhealthy
foods)
 pressure to eat (pressure child to eat more food, typically
healthy foods)
 Mothers report > use of restrictive practices
 With increased mothers’ own weight/eating concerns
 With increased perception of daughters’ risk for weight
problem
 Mothers report > use of pressure to eat
 With increased perception of daughter as underweight

Francis, Appetite, 2001

Potential Adverse Effects
Result is to focus child away from internal
cues regarding hunger and satiety
Parent assumes responsibility of initiating or
terminating eating
Potential to compromise child internal
awareness of hunger/fullness and appropriate
responses
Limitations – white well educated sample of
mothers and 5 yo daughters (n=196

Francis, Appetite, 2001

Long Term Effects of Parental
Restrictive Feeding Styles
Assessment of 5-7 yo girls intake of palatable foods
after a standardized lunch
Girls with large intakes of snack foods in the absence
of hunger were 4.6 times more likely to be overweight
at 5 and 7 years of age
For each unit of increase in parents’ reported
restrictive feeding styles at 5 y, girls were 2.1 times as
likely to eat in absence of hunger at age 7 (even after
controlling for BMI and hunger related eating at age 5)
About 50% girls reported negative self evaluation after
eating; such report linked to perceptions of being
restricted from such foods

Fisher, American Journal of Clinical Nutrition, 2002

Attitudes, Practices & Concerns
Re: Child Feeding and Weight
Need to tailor interventions based on attitudes,
practices and concerns
Build on mothers goals to provide good nutrition
while balancing convenience, variety and cost
Provide strategies to overcome stress associated
with providing meals
Focus parents on encouraging child-based
hunger/fullness cues and appropriate responses
Recognize differences in cultural perceptions of
overweight and facilitate recognition of unhealthy
weights
Sherry, JADA, 2004
Parent’s Perceptions Re:
Children’s Weight
3 focus groups (n=18; 13 black, 5 white); WIC
participants
 Mothers don’t use reported anthropometrics to
assess weight, instead use reported teasing and
limitations on exercise; if active with good appetite
not considered overweight; overweight children
described as “thick or solid”; genes considered
cause independent of environment; emotionally
difficult to deny or limit foods
Parent’s Perceptions Re:
Children’s Weight
Cross sectional survey of 622 WIC
participants with children 2-5 years
 45% low education (30% moms obese; 19%
children overweight)
 55% high education (17% moms obese; 14%
children overweight)
 79% of mothers failed to perceive overweight
children as overweight; almost all accurately
perceive their own weight
 Among 99 moms with overweight children, low
maternal education associated with misperception
after controlling for income, maternal obesity, age,
smoking and child’s age, race and gender
Baughcum, Pediatrics, 2000
Media – Influences Families
Conflicting messages
 Healthy-weight children shown in advertisements
 negative stereotypes of overweight children
among many segments of the population –
including health care professionals
 Unhealthy, academically unsuccessful, socially inept,
unhygienic and lazy (Hill, Int J Obesity 1995, Teachman,
Int J Obesity 2001)
 Promotion/Advertisement of energy dense foods in
all venues (TV, schools, community sites, Internet
Calories 110 Calories 110 Calories 120
Fat 2 g Fat 1 g Fat 1 g
Sugar 1 g Sugar 6 g Sugar 14 g
Fiber 3 g Fiber 3 g Fiber 0 g

Are Cocoa Puffs

really part of a
healthy breakfast?
Media Literacy Activities
35 parents with children participating in Head
Start programs; 4 week media literacy program
(compared to 4 week food safety educational
placebo to control for “attention”); pre-post
evaluation
4 week curriculum: advertising techniques,
children’s perceptions of ads, comparing food
label information to claims, role playing dealing
with children’s requests
Improved parents’ understanding of TV
advertising (p<.001), attitudes about TV ads
(p,>001), self-efficacy (p<.001), TV mediation
behaviors (p<.001), and ability to read food
labels (p<.001)

Hindin, JADA, 2004

Family-Based Interventions
Goals
 Build parental/family support
 Create supportive home environment
Epstein’s review of randomised controlled family-based
interventions: “most pediatric obesity interventions are
marked by small changes in relative weight or adiposity
and substantial relapse”.
Example: program with dietary counseling,
encouragement to exercise, and family tx for 14-18
months resulted in smaller increase in BMI than no tx
controls (1.1 vs 2.8 kg/m2 @ 1 yr fu); drop out
substantial

Epstein, Pediatrics, 1998; Isreal, J Ped Psy, 1994

Family-Based Interventions
•Continue to research •Quality (research based)
family-based •Quanity based on
interventions internal hunger/fullness
AND
•Implement in the
context of the
socioecological model
•Saturate communities
with multidisciplinary
teams
•Ex: Heart Links
Project
Hunger-Fullness Scaling
Monday
Breakfast Pla Lunch Dinner Snack
n

Reali
Hung ty
e r/Ful
ln ess

Com
men
ts

0 5 10
Starving Comfortable Stuffed
SocioEcological Framework for
Interventions egs &
e n t r ns
Public Policy Factors v e rnm datio
Go mmen
reco oo d s&
Community Factors o lf
Sc h o
a is ing
r
fund
Institutional Factors ly-based r t is ing
am i o n s A d ve ons
F n t i l a ti
Interpersonal interve o o l re gu
Factors Sch ment
n viron
e
Individual
u n ity
m
Com paigns
cam
n it ies
p o rtu
p
PA o
 Resource
http://www.stonybrook.edu/heartlinks/

NYSDOH Healthy Heart Program

Dept. Family Medicine
Stony Brook University
Pounds per Person

e as e
I ncr
0%
A3

Year

www.cspinet.org
 Sugar Content of Popular Foods
FOOD TSP “% Daily Value”
Snickers bar, 2.1 oz. 5¾ 58
TastyKake Honey Bun, 3¼ oz. 6 60
Lowfat fruit-flavored yogurt, 8 oz. 7 70
Pepsi, 12 oz. 10¼ 103
Pancake syrup, ¼ cup 10¼ 103
Hostess Lemon Fruit Pie, 4½ oz. 11½ 115
Strawberry Passion Awareness
Fruitopia, 20 oz. 17¾ 178

Sources: Manufacturers, USDA, CSPI analyses and/or estimates.

Center for Science in the Public Interest, August, 1999
 Obesity and Mortality
Tobacco Use Poor Diet and
Physical Inactivity
1990 2000 1990 2000
% of all 19% 18.1% 14% 16.6%
deaths
# deaths 400,000 435,000 300,000 400,000
If this trend continues, obesity will become the leading cause
of death by 2005, killing 500,000 people per year.
CDC 3/04
Yoplait Go-Gurt Cherry &
Strawberry Assorted Yogurt
Nutrition Facts
Serv. Size 1 tube (64g;about 2 oz)

Servings  8

Amount Per Serving

Calories 70
Calories From Fat 15
% Daily Value *

 
Total Fat 2g
3%
Saturated Fat 1g
5%
Cholesterol 5mg                                                      

2%
Sodium 40mg
2%
Potassium 125mg
3%
Total Carbohydrate 11g
4%
Dietary Fiber 0g
0%
Sugars 10g
 
 Yoplait Go-Gurt Cherry &
Strawberry Assorted Yogurt
Nutrition Facts
Serv. Size 1 container (227g; 6 oz)
Servings  1

Amount Per Serving

Calories 160
Calories From Fat 0
% Daily Value *

 
Total Fat 0g
0%
Saturated Fat 0g
0%
Cholesterol 0mg
0%
                                                     

Sodium 130mg
5%
Potassium 125mg
3%
Total Carbohydrate 30g
10%
Dietary Fiber 1g
3%
Sugars 29g
 
Protein 8g