Pacific Island Families Study: parental perceptions of overweight obesity and future concern for child’s weight status
Across the life course, social and cultural determinants of overweight and obesity need better understanding. Two out of three New Zealand (NZ) born Pacific children are either overweight or obese but little is known about the perception of overweight, expressed as a level of concern, of Pacific parents. The aim of this study was to analyse data collected at birth, four and six years in the Pacific Island Families (PIF) study to provide longitudinal information about the relationship of parental perceptions of child weight status and actual weight status. The influence of the context of the socio economic and cultural environment at the birth of the child could also be explored. A total of 569 parent child dyads (299 boys (52.5%), 270 girls (47.5%); 47.1% Samoan, 20.9% Tongan, 18.6 % Cook Island, 4.9% Niue, 8.4% other Pacific) were examined in this Parental Perception of Overweight Obesity Study (PPOS). At four and six years the question was asked of the parent “How concerned are you about your child becoming overweight?” Possible answers ranged from “unconcerned” through increasing levels of concern to “very concerned”. At four and six years weight, height and percentage body fat were measured and body mass index (BMI) derived. Weight status and levels of adiposity were referenced to international standards. Mothers’ BMI (n=140) was calculated using height and weight measured when their child was six years old. The majority of parents were unconcerned at four and six years (62% and 69.1%) about the future overweight status of their child. Between four and six years 15.6% of parents maintained a level of concern and 47.1% remained unconcerned, 15.3% became more concerned and 22.0% went from any level of concern to unconcerned. Using the international Cole cut-offs, at four years 40.1 % of the children were classified as normal, 34.1%, as overweight and 25.8% obese. At six years the proportions were similar; normal 41.3%, overweight 31.1% and obese 27.6%. Compared with the Centre for Disease Control (CDC) children centiles 2000, at four years the mean BMI standard deviation score (SD) was 1.62 ±1.08 (±SD) and six years 1.38 ±0.88. At four and six years the proportion of parents who were concerned was related to the child weight status e.g. at 6 years 20% of parents of normal children, 28% percent of parents of overweight and 51% of parents of obese children were concerned (p trend <0.0001). The factors associated with parental perception were examined in a multivariate model using logistic regression. Factors examined included the sex of the child, acculturation, ethnicity, education, smoking, marital status, mothers age, household income, parity and household size. Ethnicity and parity were found to have statistical significance (p<0.0001) in relation to parental perception. Identification with Tongan ethnicity was related to a higher proportion of concerned parents and an increased number of children in the family were related to a smaller proportion of concerned parents. Using an obesity cut-off of 30kg/m2 for maternal BMI, 92.1% of mothers were obese. There was no association of maternal BMI with child body size. This study is unique because it was able to examine, in a contemporary Pacific cohort, the association of actual child overweight and obesity with parental concern for future overweight status of their child. While the level of concern was low and the prevalence of overweight and obesity high, the context of the socio economic and demographic environment must be taken into account in the formulation of interventions. Overweight and obese Pacific children may benefit from interventions that target the awareness of parents, making them more conscious of the relationship of obesity with food and activity patterns and give practical support to change the environment. Interventions firstly should address the socio economic demographic environment of a Pacific family. Then emphasis should be placed on the life course concept, highlighting firstly the socio cultural exposures from conception that are associated with childhood overweight and obesity and secondly the increasing inability/difficulty in reversing health projections established during childhood, which may motivate parents to provide and adapt the child’s environment. Careful consideration should be made when disseminating information about perception to the parents of overweight and obese children, as not to unnecessarily raise concern if appropriate and timely interventions are not intended. Support (socio, economic and cultural) should be made available to parents in conjunction with information. Whole family focussed interventions may be effective, targeting aspects both in the child’s immediate and intermediate environment. This study adds much needed ethnic-specific information, offering Pacific cultural insight of parental perception of childhood weight status. The study can be used to identify the opportunities for intervention within both the micro and macro scale of the environment of Pacific families. There are a number of stressors identified in socio economic environment that these Pacific families exist in and take precedence over concern for child weight status. Pacific parents have more pressing matters to worry about. Policies need to address the issue of easing these identified environmental stressors. (i.e. GST on fruit and vegetables to increase the recommended intake). Communal interventions with multi level benefits and socially culturally significance may also be warranted.