Obesity: Assessment Tools and the Family Approach

D. Sinha, M. Mason, K. Kaufer Christoffel, Children’s Memorial Hospital

Background
To effectively address childhood obesity prevention and management, we must understand families’ knowledge, attitudes and behaviors (KAB) towards nutrition and physical activity (PA). This requires appropriate assessment tools.

Objective
This study aimed to a) Use the NIH-promoted “Hearts n’ Parks (HNP)” surveys to identify the KAB of children and parents, b) Compare child and parent responses, c) Determine any correlation between KAB and body mass index (BMI), and d) Assess the reliability of the HNP Adult Survey.

Methods/Design
Children from kindergarten and grade 1 were recruited from Namaste Charter School. Parents completed 5 surveys, including the HNP Adult Survey (Spanish and English), with help provided to low literacy parents. Every third parent repeated the surveys 2 weeks later. The children did the HNP Child Survey in class and had their height, weight, blood pressure (BP) and abdominal circumference (AC) measured by research nurses. KAB scores were the sum of each question and were divided into tertiles of full range of scores. Pearson correlation was used for comparisons, with significance set at p <0.01.

Results
69 children (79% of eligibles) participated, with 44 (64%) boys. The mean age was 6.0 years (SD + 0.6, range 5.1-8.0 years). 68% were Hispanic, 15% white and 15% African-American. On exam, 29 (42%) children were either at risk or overweight. BP was >95th percentile in 39 (57%) children. There was significant correlation between BMI and AC (R= 0.91), BMI and BP (R= 0.49), and AC and BP (R= 0.52). Based on parent HNP scores, nutrition KAB was low for 1 parent (2%), moderate for 55 (81%), and high for 12 (18%). For child HNP scores, 12 (18%) were low, 42 (64%) moderate, and 12 (18%) high (no overlap with ‘high’ scoring adults). There was no correlation between BMI and child or parent KAB nutrition score. 24 parents repeated the survey at an average interval of 14 days. Overall the HNP Adult Survey was found to be reliable (R= 0.85). There was a 2% mean change in KAB scores; for 5 parents (21%) this resulted in a KAB category change. Parent activity recall responses showed poor stability (R=0.49).

Conclusions
This predominantly Hispanic school had almost half of its children either at risk or overweight. BMI correlated with AC and BP, but not KAB. The HNP Adult Survey showed reliability in this sample in all sections except activity recall.

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