Evaluating parental perception and confidence managing obesity-related behaviors among children with severe early-onset obesity in a tertiary care clinic

Authors: MORALES, JULIA - Baylor College Of Medicine; GONZALEZ, MAYVER - Baylor College Of Medicine; ELATRASH, CITRINE - Baylor College Of Medicine; MEDINA, DAPHNE - Baylor College Of Medicine; LADHA, FARAH - Baylor College Of Medicine; ALFONSO, CLAUDIA - Baylor College Of Medicine; SISLEY, STEPHANIE - Baylor College Of Medicine

Submitted to: Childhood Obesity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/15/2025
Publication Date: 5/7/2025
Citation: Morales, J.M., Gonzalez, M., Elatrash, C., Medina, D., Ladha, F., Alfonso, C.S., Sisley, S. 2025. Evaluating parental perception and confidence managing obesity-related behaviors among children with severe early-onset obesity in a tertiary care clinic. Childhood Obesity. https://doi.org/10.1089/chi.2025.0016.
DOI: https://doi.org/10.1089/chi.2025.0016

Interpretive Summary: Some young children have very serious obesity that starts before age 5. Treatment of obesity requires parents to limit portions and replace unhealthy foods with healthy ones. However, sometimes children become angry and emotional when faced with new limits on foods. Researchers in Houston, TX examined how confident parents feel when trying to manage their child’s eating habits and behaviors. Almost 90 parents filled out a survey about their child’s eating behaviors and how hard it is to manage them. The most difficult behaviors were: eating too much, asking for more food, snacking on unhealthy foods, and eating too fast. Parents of kids who didn’t feel full easily (impaired satiety) said these behaviors were even more of a problem and felt less confident handling them. Even though all parents struggled with these issues, those whose children had trouble feeling full had a harder time overall. This shows that parents may need special help or advice to manage these behaviors in children who develop severe obesity at a young age.

Technical Abstract: Children with severe early-onset obesity (defined as a body mass index >120% of the 95th percentile before age 5) are a high-risk population often displaying disruptive food-related behaviors. This study assessed: (i) caregivers' confidence addressing obesity-related behaviors in children with severe early-onset obesity and (ii) differences in behavior perceptions between children with and without impaired satiety. Caregivers from a specialized pediatric obesity clinic completed the Lifestyle Behavior Checklist (LBC), a 25-question tool, evaluating their perceptions and confidence managing obesity-related behaviors. Impaired satiety diagnoses were based on clinical ascertainment of at least three abnormal eating behaviors across multiple settings. Data were analyzed using appropriate statistical tests. Results: A total of 89 caregivers completed the LBC. Parents felt least confident managing four of the top five perceived most problematic behaviors: excessive eating, requesting extra portions, unhealthy snacking, and eating too quickly. Parents of children with impaired satiety rated 16 behaviors as significantly more problematic (Q-value <0.05) and reported lower overall confidence in managing these behaviors compared with parents of children without impaired satiety (Q-value = 0.04). Despite these differences, both groups identified excessive eating as the most problematic behavior and the one they were least confident in managing. Parents of children with severe, early-onset obesity, reported difficulty managing food-related behaviors. Children with severe, early-onset obesity and impaired satiety displayed similar, but more pronounced, problematic lifestyle-related behaviors compared with those without satiety impairments. Future research should determine if behavior-specific counseling would be helpful to parents of children with severe, early-onset obesity.