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Parenting an Overweight Or Obese Teen: Issues and Advice from Parents Kerri N

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Parenting an Overweight Or Obese Teen: Issues and Advice from Parents Kerri N Podcast available online at www.jneb.org Research Article Parenting an Overweight or Obese Teen: Issues and Advice from Parents Kerri N. Boutelle, PhD1,2,3,4; Shira Feldman, MPH, RD1,2,5; Dianne Neumark-Sztainer, PhD, RD1,2 ABSTRACT Objective: This qualitative study addresses: (1) what challenges parents of overweight adolescents face and (2) what advice parents of overweight adolescents have for other parents. Design: One-on-one interviews were conducted with parents of overweight or previously overweight adolescents. Setting: Medical clinic at the University of Minnesota. Participants: Twenty-seven parents of adolescents (12-19 years) who were either currently or previously overweight recruited from the community. Main Outcome Measures: Qualitative interviews related to parenting overweight adolescents. Analysis: Content analysis was used to identify themes regarding parental experiences. Results: Issues most frequently mentioned were (1) uncertainty regarding effective communication with adolescent about weight-related topics; (2) inability to control adolescents’ decisions related to healthful eating and activity behaviors; (3) concern for adolescents’ well-being; and (4) parental feeling of responsibil- ity/guilt. Parental advice most often provided included: (1) setting up a healthful home environment; (2) pa- rental role modeling of healthful behaviors; and (3) providing support/encouragement for positive efforts. Conclusions and Implications: Topics for potential intervention development include communication and motivation of adolescents regarding weight-related topics, appropriate autonomy, and addressing neg- ative emotions concerning the adolescent’s weight status. Targeting these topics could potentially improve acceptability and outcomes for treatments. Key Words: adolescence, parenting, obesity, overweight (J Nutr Educ Behav. 2012;44:500-506.) INTRODUCTION Most treatment studies of over- obese. On the other hand, parents weight and obese youth have focused also recognize their adolescent's need The high prevalence and steady in- on the preadolescent age range,6,7 and for autonomy. Thus, parents may creases in overweight and obesity fewer have focused on adolescents.8,9 struggle with what to say or do to among adolescents over the past 30 It can be challenging to know how best help their adolescent manage years are of significant public health to involve parents in interventions his or her weight. concern.1 Overweight and obese ado- for adolescents because of issues Parents have an important role in lescents have an increased risk for related to developing autonomy and helping their children and adolescents physical comorbidities, including increasing independence. Parents of to adopt healthful behaviors.10,11 type 2 diabetes, and negative psycho- overweight and obese adolescents Mechanisms by which parents may social consequences stemming from often find themselves in a dilemma. influence eating habits and behaviors the stigma associated with being over- On one hand, parents may be include family meals,12-15 food avail- weight.2 Additionally, overweight concerned about their adolescent's ability at home,16-19 and discussing or and obese adolescents are at a signifi- health, the psychosocial stigmas, and encouraging dieting.20-24 Mechanisms cantly increased risk for obesity in the negative physical consequences bywhichparentscaninfluence adulthood.3-5 associated with being overweight or physical activity levels are parent modeling of physical activity behavior25,26 and support for their 1Division of Epidemiology, University of Minnesota, St. Paul, MN children's physical activity.27,28 2Department of Pediatrics, University of Minnesota, St. Paul, MN Unfortunately, providing this type of 3Department of Pediatrics, University of California, San Diego, CA support can be challenging for families 4Department of Psychiatry, University of California, San Diego, CA and can become especially difficult 5Emily Program, St. Paul, MN when coupled with an adolescent's Address for correspondence: Kerri N. Boutelle, PhD, Pediatrics and Psychiatry, University development of autonomy. To ulti- of California, San Diego, 9500 Gilman Dr, MC 0985, La Jolla, CA 92037; Phone: (858) 534- mately inform interventions, it is 8037; Fax: (858) 534-6727; E-mail: [email protected] important to develop a greater body of Ó2012 SOCIETY FOR NUTRITION EDUCATION AND BEHAVIOR knowledge related to parenting http://dx.doi.org/10.1016/j.jneb.2011.12.005 overweight and obese adolescents. 500 Journal of Nutrition Education and Behavior Volume 44, Number 6, 2012 Journal of Nutrition Education and Behavior Volume 44, Number 6, 2012 Boutelle et al 501 To the best of the authors' knowl- study if they had ever been diagnosed probing questions were used at the in- edge, only 1 published qualitative with an eating disorder or had any terviewers' discretion to obtain more study has explored experiences of par- physical or psychological condition information from participants when enting an overweight child.29 Jackson (ie, cancer, depression) that could necessary or to clarify participant re- and colleagues interviewed mothers have an impact on weight. sponses. of overweight youth (ages 14 months Parental interviews were conducted Interviews were audiotaped and to 15 years) about their experiences in with 26 mothers and 1 father. The av- varied in length, averaging 30-45 min- parenting. The study found that erage age of the parents was 47.5 years, utes. Tape-recorded interviews were mothers often felt judged and blamed and 74% identified themselves as Cau- reviewed immediately to allow the in- for their child's weight status, were casian, 19% as Native American, and terviewer to summarize and record frustrated with how to best help their 7% as African American. Fifteen per- impressions and note themes ex- child, and worried about their child's cent of parents had an income < pressed by parents. Parents were se- future. Additionally, the mothers all $20,000; 7% of parents had an income lected on a rolling basis until themes identified modeling healthful behav- of $20,000-$40,000; 19% of parents began to repeat themselves and theo- iors as a strategy for helping their chil- had an income of $40,000-$60,000; retical saturation was reached. In- dren. Although the Jackson study has 45% of parents had an income > formed consent was obtained from highlighted some of the issues that $60,000; and 14% of parents did not participants prior to the interviews. parents face when they have an over- report their income. Of the mothers Interviews were conducted between weight child, this study recruited par- interviewed, 20 had female adoles- December, 2004 and November, ents of youth from a wide age range. cents and 6 had male adolescents. 2005, and study procedures were ap- Considering the challenges associated The father interviewed had a female proved by the University of Minne- with parenting adolescents in general, adolescent. All parents lived in the sota Human Subjects Committee. and to identify potential targets for in- Minneapolis/St. Paul metropolitan terventions, it is important to identify area. Fourteen interviews were with Data Analysis issues faced specifically by parents of parents whose adolescent did not lose overweight adolescents. The current weight (adolescent mean BMI percen- Interviews were transcribed verbatim study addresses this gap in the litera- tile ¼ 97.5%), and 13 interviews were from audiotape and were then exam- ture by posing 2 research questions: conducted with parents whose adoles- ined using content analysis techniques (1) what issues do parents of over- cent had successfully lost 10 pounds described by Miles and Huberman.31 weight adolescents face? and (2) and kept it off for 3 months (adoles- Transcripts were reviewed using an in- what advice do parents of overweight cent mean BMI percentile ¼ 87.2%). ductive method to identify emerging adolescents have for other parents? Twenty-two percent of the sample (6 themes. Two main themes, issues par- adolescents) reported that he or she had ents face and advice for other parents, worked with a dietitian. Initially, the 2 were identified from the interviews. METHODS parent groups were analyzed separately Based on these themes, a coding tem- Participants to examine similarities and differences plate was developed. Following discus- in responses between the groups. As sion with the research team, a final Parents of adolescents were recruited the interviews were analyzed, no re- coding template was developed and all from a larger study entitled Successful markable differences were noted in re- interviews were analyzed in entirety to 30 Adolescent Weight Losers, which sponses between the parents of ensure all responses were captured, surveyed adolescents (ages 12-17 adolescents who lost weight and those whetherornottheywereindirectre- years) and their parents to determine who did not: therefore, these groups sponse to questions pertaining to pa- factors contributing to successful were combined for final analysis. rental issues or advice. All transcripts weight loss among adolescents. Two were double coded, once by the second groups of overweight and obese adoles- Procedures author and once by an individual with cents were recruited for the Successful expertise in the field of pediatric over- Adolescent Weight Losers study: those One-on-one interviews were conduct- weight and who was not a part of the re- who lost weight and those who did ed with parents at a University of Min- search team. Agreement between
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