Ofelia Zamudio-Solorio,1 Rosa María Muñoz-Arenillas2
1Hematología 5-B, Unidad Médica de Alta Especialidad Hospital de Oncología Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social. Distrito Federal; 2Coordinación Clínica de Educación e Investigación en Salud, Hospital General de Zona/Unidad de Medicina Familiar 7, Instituto Mexicano del Seguro Social. Cuautla, Morelos. México
Correspondence: Ofelia Zamudio Solorio
Date received: July 24th, 2014
Date judged: October 24th, 2014
Date accepted: February 7th, 2015
Introduction: According to World Health Organization (WHO) data, in 2013 more than 42 million children under age five were overweight. In low and middle-income countries overweight and obesity has increased 30% more than in developed ones. Childhood obesity is associated with a higher risk of obesity, premature death and disability in adulthood.
Objective: To evaluate the perception of parents regarding overweight and obese children in the Family Medicine Unit 24, in Yecapixtla, Morelos, México.
Methodology: Cross-sectional study, 107 children whose weight and height percentile measured and selected; and in the parents’ perception was assessed with the scale Body Shaper. Univariate analysis was performed descriptive and bivariate using Chi squared, Stata 10 was used.
Results: 107 children are obese (18.6 %), 11.2 % of parents felt their children and obesity in 7.4 % overweight. 18.6 % of obese children only 1.8% performed physical activity. Children of parents with secondary education (44.8 %), 95.6 % are not physically active.
Conclusions: The perception of parents regarding overweight or obese children from infancy is important to prevent obesity.
Keywords: Pediatric obesity; Overweight; Child nutrition.
According to figures from the World Health Organization (WHO), in 2014 more than 1900 million adults 18 years or older were overweight, of which 600 million were obese. Most of the world's population lives in countries where overweight and obesity claim more lives than underweight, comparable to the number of humans suffering from malnutrition.
In 2013, more than 42 million children under five were overweight, of which almost 35 million live in developing countries with emerging economies (classified by the World Bank as low- and middle-income countries). The prevalence of childhood overweight and obesity among preschool children exceeds 30%. If current trends continue, the number of infants and young children who are overweight will increase to 70 million by 2025; without intervention, infants and young children with obesity will remain obese during childhood, adolescence, and adulthood.1
The United Nations Fund for Children (UNICEF) says obesity is a severe problem in Mexico because it ranks second worldwide, specifying that one of every three Mexicans suffers from it.2
As such, childhood overweight and obesity are associated with a wide range of serious health complications, as well as an increased risk of premature disease, such as diabetes and heart disease; it is therefore necessary to give a high priority to the prevention of childhood obesity.3 Exclusive breastfeeding from birth to six months of age is an important way to help prevent overweight in infants.
Obesity has its origin in several factors, but the most important are related to changes due to technological development, social and working conditions, and the current lifestyle that prevails in developed societies.4 Unfortunately, people seek health services when there are already psychological, orthopedic, and cardiovascular effects, hypertension, diabetes, or several conditions combined.
The first step to avoid obesity is to identify overweight; in this aspect the perception of parents plays an important role, since early identification of an overweight condition can start early measures to prevent obesity. The leading role of parents in preventing obesity is related to the influence of psychological, social, environmental, and physical factors, as they are models of eating behavior.
Perception is the construction of mental symbols or representations of reality acquired through the senses. Thus, the reality perceived by parents about their children's weight may differ from the objective reality (anthropometric evaluation of the child).
Some research has shown that most mothers do not perceive overweight or obesity in their children. Regarding the ideal weight, mothers perceive their children to have 7 and 10% lower weight, in boys and girls respectively; few parents worry about overweight and obesity in their children as they do not consider it a health problem, or they say that the doctor has not made any indications regarding the diet and physical activity of their children.5,6 Other reviews have shown that more than 50% of parents do not accurately perceive the weight of their children, which is explained in part by the lack of knowledge of obesity, mothers’ refusal to accept that their child is obese, and the lack of recognition of overweight or obesity as a health problem. It has also been found that the underestimation or overestimation of children’s weight by their parents varies according to the age and sex of the children, their socioeconomic status, and the parents’ ethnicity, among other factors.7
The objective of this study was to evaluate parents’ perception regarding obesity of their children from 6 to 12 years attending the UMF 24 Yecapixtla, Morelos, through locating the percentile of each child and the parents’ perception regarding overweight or obesity of their own children.
A cross-sectional descriptive study was performed in Unidad de Medicina Familiar 24 of IMSS in Yecapixtla, Morelos. There was participation from the enrolled population of 107 schoolchildren aged 6 to 12 and their parents, who came to appointments during both shifts in 8 different offices; it did not include children outside the age range, with any physical limitations that prevent weighing and measuring the child, and who were not members of the medical unit. After explanation of the study, signing the informed consent for parents, and assent from the children, weight and height were measured.
The percentile was determined based on the Body Mass Index (BMI) of each child, <5 percentile was considered underweight, > 5 to < 85 ideal weight, > 85 to < 95 percentile overweight, and > 95 obesity.
A general data identification sheet was provided to parents and children; the perception of body image was assessed through the selection of the figure that according to the parents’ perception corresponded with the current image of their children. The figures were chosen from among nine different silhouettes of women and men in different ranges (Figure 1).
Figure 1. Silhouettes of body images shown to parents to select one. Source: Pérez-Izquierdo O, Estrella D. Percepción de la imagen corporal y prácticas alimentarias entre indígenas Mayas de Yucatán, México. Rev. chil. nutr. vol. 41 no. 4 Santiago dic. 2014.
The data obtained were assimilated in a Microsoft Excel sheet along with univariate descriptive analysis with frequency distribution and proportions for qualitative variables, mode, and standard deviation for quantitative variables. Bivariate analysis was also performed using Chi-squared using the Stata 10 program.
All information obtained from participants in this study was protected with privacy, confidentiality, and anonymity, in accordance with the Helsinki Declaration of 1975. This research is self-sustainable and feasible.
Overweight was determined in 13.3% and obesity in 18.6% of the children, of which 7.4% of parents perceived overweight and 11.2% perceived obesity in their children. In their current state, only 0.93% of parents think that their children will gain weight over the next 5 years. Of the total of obese children, only 1.8% do physical activity outside school hours on a specific schedule, and 8 children watch more than three hours of television a day; there is a difference with children who are normal weight, 59 of whom watch more than three hours of television a day; the children who engaged in less physical activity were those who watched more hours of television per day, representing 46.8%. As for parents’ educational level relative to the physical activity of children outside of school, in the case of parents with only secondary education (44.8%), 95.6% of their children do not exercise; in contrast, for parents with undergraduate education (9.3%), 50% of their children are physically active. The average age of parents is 45.5 years (Tables I and II).
|Table I. General data of parents|
|Parents (n = 107)|
|Age in years|
|Between 19 and 70|
|Parents’ perception||Current||In five years|
|Table II. General data of children|
|Children (n = 107)|
|Age in years||Frequency||%||Frequency||%|
|Number of hours spent in front of TV|
|Engages in physical activity|
As for the percentile of each child, 8 children with low weight were identified, ages 6, 10, and 11, 65 normal weight children between 6 and 12 years old, 14 overweight children, and a total of 20 obese children (4 children age 6, 4 age 7, 3 age 8, two age 10, 3 age 11, and 4 age 12). In total, 35 parents (32.7%) perceived their children to be underweight, 52 parents (48.6%) perceived them to have normal weight, 8 parents (7.4%) saw them as overweight, and 12 (11.2%) as obese. In contrast, 4 children (3.7%) are underweight and their parents do not see them as obese, of normal weight children 8 parents (4.4%) see them as obese, 60 (56%) do not see them as obese, and one does not know. Of the total number of overweight children, five parents (4.6%) see them as obese, and 9 parents (10.8%) do not see them as obese; of all obese children 14 parents (13%) see them obese, and 6 other parents (7.2%) do not see them as obese.
Out of 107 children between 6 and 12 years, 13.3% are overweight and 18.6% are obese, with a difference 1.9 times greater than expectations based on other national studies from the north of the country; according to the 2006 ENSANUT, this is concentrated in ages 8 and 9 nationally, in this study, it is concentrated at age 9. Children with normal weight were 60.7%, 4.8% lower than expected compared to other national studies of ages 7 and 8, where the percentage is higher, as well as 7.4% underweight children, 3.4 times higher than expected, predominantly in children age 6.8,9
As for parents’ perception regarding overweight and obesity of their children, 13% felt that their children were overweight and 18.6% perceived them to be obese, the difference is 2.69 times higher than expected relative to other national studies; but although it is higher, parents have an expectation that in 5 years children will cease to be overweight or obese, so, as in Tamaulipas and Sonora, this disease is underestimated, which may explain why they have reached first place in childhood obesity in less than one decade.10,11
It is important to create strategies that allow us to inform parents about the importance of recognizing childhood obesity and its consequences, and to implement diet and physical activity strategies tailored to each community in the country. During this study we realized how little information exists regarding parental knowledge about child doctors’ appointments between 6 and 12 years; however, when told that their child is overweight or obese, they cooperate with the measures to take to correct this childhood disease, which can be modified in some factors, so we recommend wider dissemination of monitoring during this key age, and correcting the number of hours per day spent watching television.