How can we help parents recognise unhealthy body weight in their children?

Childhood obesity is an important public health problem worldwide and identifying effective preventive strategies remains a priority. Parents are central to the development of their child's health-related behaviours and play a key role in both the development and implementation of prevention strategies.

However, many studies show that parents do not recognise when their child is overweight compared with guidance on healthy body weights for children. For example, our previous NPRI funded work showed that over 2/3rdsof parents of overweight children described their child as being of 'normal weight' at 7 years. Evidence indicates that parents tend to use how their children look compared with others who may be more overweight to identify their weight status. Thus in the context of a high prevalence of childhood overweight, this means that parents rely on extreme cases as a reference point and a shift in their understanding of what 'overweight' means is likely to have occurred.

Addressing the difference between parents' perceptions and actual child weight status is important. If parents do not perceive their child as overweight they are unlikely to make appropriate changes to their child's lifestyle. However there is evidence that parents are more likely to make such changes if they perceive their child's weight as being a health problem. So increasing parents' knowledge of what an OW child does look like, plus increasing their knowledge about the health consequences of childhood overweight is a strategy worth exploring.

The National Child Measurement Programme (NCMP) currently measures weight status in all Reception and Year 6 children. Parents are informed of the results by letter but anecdotal evidence suggests that the letters are often not well received and do not to promote appropriate action. Another common method of monitoring children's growth is the use of growth charts, but their usefulness is questionable because it is unclear whether the general population understands them.

This multistage study aims to address the need for improving strategies for informing parents about their child's weight status. It will develop and test tools to improve parents' ability to correctly assess their child's weight status (in line with NCMP criteria) as well to increase their knowledge of the health consequences of childhood overweight.

Body image scales are visual images of body shapes ranging from underweight to obese. Existing body image scales do not correspond to any cut-offs for overweight commonly used in the UK such as those employed by the NCMP. In stage 1 we will use portable 3D body scanning technology to obtain body scans from 800 children. The body scans will be used to produce age and gender specific body image scales for Reception and Year 6 aged children. In stage 2 parents will be consulted extensively to further develop the body image scales as a method to improve parents' ability to recognise overweight in children and to develop supporting information to increase parental knowledge of the consequences of childhood overweight. Two methods of delivering the tool will be developed (paper based and web based). In stage 3 a feasibility study of the tool, supporting information, and the two methods of delivery will be conducted. Parents' views and experiences of the developed methods will be sought by conducting focus groups and the findings will be used to improve all aspects. Finally, in stage 4, a cluster randomised control trial will be conducted with 2040 families to test whether the tool is effective and which method of delivery is most effective in improving parental recognition of childhood overweight and understanding of its consequences.

Policy and practitioner partners in the study team will ensure that the study outputs are directly transferable to practice and will support the work of the National Obesity Observatory and NHS Choices.

Identifying effective preventive strategies for childhood obesity is a public health priority. Parents have a central role in their child's health-related behaviours but evidence shows that parents tend not recognise overweight (OW) in their own child. Parents do not use objective methods when identifying child weight status. Rather they use visual assessments such as comparing their child with others. The National Child Measurement Programme (NCMP) measures weight status in Reception and Year 6 children. Parents are informed of the results but anecdotal evidence suggests this fails to promote action. Parents who perceive their child's weight as a health issue are more likely to modify their child's lifestyle.
This research will address the fundamental issue of recognition and awareness of a healthy body weight in children and therefore of childhood overweight. These are prerequisites to behaviour change.
This multistage study will develop and test measures to improve parents' ability to assess their child's weight status (in line with NCMP criteria), increase their knowledge of the health consequences of childhood OW and intention to take action.
Body image scales (BIS) are visual images of body shape but as yet none map onto commonly used body mass index cut-offs. In stage 1 3D body scans of 800 children will be used to create age and gender specific BIS for Reception and Year 6 children. The BIS, supporting information to increase parental knowledge of the consequences of childhood OW, and the approach to delivery will be further developed using extensive consultation with parents in stage 2. A feasibility study using the tool will follow (stage 3) with further user feedback. The final tool and methods of delivery will be tested in a cluster randomised trial in stage 4.
Policy and practitioner partners in our team will ensure that the study outputs are directly transferable to practice and support the work of the National Obesity Observatory and NHS Choices.

In 2007 Foresight in its 'Tackling obesities: future choices' project report (T.S. Office, London 2007) identified that obesity and associated co-morbidities costs the UK economy in the region £16 billion/year. Effective strategies to achieve long-term weight loss have proved elusive and therefore prevention of obesity is paramount. Evidence shows that childhood obesity is strongly predictive of obesity in adulthood and yet in 2009/10 National Child Measurement Programme (NCMP) 5.9% of 4-5 yr olds were obese with a further 9.5% overweight and 11.9% of 10-11 yr olds were obese with a further 13.9% overweight (91st and 98th clinical cut-offs). Identifying effective strategies for the prevention of obesity is a public health priority.

This research will address the fundamental issue of recognition and awareness of a healthy body weight in children and therefore the early recognition of childhood overweight (and obesity). This awareness and recognition is a prerequisite to behaviour change. Current methods for relaying information on their child's body weight to parents relies on BMI charts which many parents find difficult to interpret and understand. We propose the development of a practical and visual tool to help parents recognise a healthy and unhealthy body weight in their children.

If the tool and supporting resources to be developed are found to be effective in increasing parental recognition of childhood overweight and obesity, in improving parental knowledge of the consequences of childhood overweight and obesity and increasing intention to take action to prevent childhood overweight and obesity, then this has high potential impact. This impact will be on the public in general in a reduction of health burden and high cost associated with the management of obesity. This impact will be achieved through impact on practitioners in facilitating their work in childhood obesity such as in the NCMP feedback to parents. The direct impact will be with parents and their children both through practitioners working with families, but also directly with parents through NHS Choices in better understanding of healthy body weight in their children and the importance of a healthy lifestyle and maintaining a healthy body weight. Ultimately the impact of this work will be on children in the reduction of childhood obesity and so better health. The key stakeholders to ensure this happens are directly engaged in this proposal, that is, the National Obesity Observatory (NOO), NMCP and NHS Choices.

The results of this research will be available at the end of the 20 month study period and will be available to be translated to practice for direct public and patient benefit. The partners in and supporters of this proposal are ideally placed to ensure rapid translation to practice. For example through The National Obesity Observatory (NOO) is a national portal for obesity evidence and data, and works closely with the NHS Information Centre and Department of Health to support the implementation and use of the NCMP and NHS choices who have confirmed there support of this work and intention to host the web tool to be produced.