Abstract
Objective
New approaches for obesity prevention and management can be gleaned from positive
outliers—that is, individuals who have succeeded in changing health behaviors and
reducing their body mass index (BMI) in the context of adverse built and social environments.
We explored perspectives and strategies of parents of positive outlier children living
in high-risk neighborhoods.
Methods
We collected up to 5 years of height/weight data from the electronic health records
of 22,443 Massachusetts children, ages 6 to 12 years, seen for well-child care. We
identified children with any history of BMI in the 95th percentile or higher (n = 4007)
and generated a BMI z-score slope for each child using a linear mixed effects model. We recruited parents
for focus groups from the subsample of children with negative slopes who also lived
in zip codes where >15% of children were obese. We analyzed focus group transcripts
using an immersion/crystallization approach.
Results
We reached thematic saturation after 5 focus groups with 41 parents. Commonly cited
outcomes that mattered most to parents and motivated change were child inactivity,
above-average clothing sizes, exercise intolerance, and negative peer interactions;
few reported BMI as a motivator. Convergent strategies among positive outlier families
were family-level changes, parent modeling, consistency, household rules/limits, and
creativity in overcoming resistance. Parents voiced preferences for obesity interventions
that include tailored education and support that extend outside clinical settings
and are delivered by both health care professionals and successful peers.
Conclusions
Successful strategies learned from positive outlier families can be generalized and
tested to accelerate progress in reducing childhood obesity.
Keywords
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References
- Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010.JAMA. 2012; 307: 483-490
- Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity.Prev Med. 1999; 29: 563-570
- A systems-oriented multilevel framework for addressing obesity in the 21st century.Prev Chronic Dis. 2009; 6: A82
- The Power of Positive Deviance: How Unlikely Innovators Solve the World’s Toughest Problems.Harvard Business Press, Boston, Mass2010
- The power of positive deviance.BMJ. 2004; 329: 1177-1179
- A positive deviance–based antenatal nutrition project improves birth-weight in Upper Egypt.J Health Popul Nutr. 2006; 24: 498-507
- Using positive deviance techniques to improve smoking cessation outcomes in New South Wales prison settings.Health Promot Austr. 2008; 19: 72-73
- Research in action: using positive deviance to improve quality of health care.Implement Sci. 2009; 4: 25
- Amount of food group variety consumed in the diet and long-term weight loss maintenance.Obes Res. 2005; 13: 883-890
- Long-term weight loss and breakfast in subjects in the National Weight Control Registry.Obes Res. 2002; 10: 78-82
- Consistent self-monitoring of weight: a key component of successful weight loss maintenance.Obesity. 2007; 15: 3091-3096
- Television viewing and long-term weight maintenance: results from the National Weight Control Registry.Obesity. 2006; 14: 1816-1824
- Using positive deviance for determining successful weight-control practices.Qual Health Res. 2011; 21: 563-579
- Study design in qualitative research—2: sampling and data collection strategies.Educ Health. 2000; 13: 263-271
- 2000 CDC growth charts for the United States: methods and development.Vital Health Stat. 2002; : 1-190
Massachsetts Department of Public Health. The status of childhood weight in Massachusetts, 2011. Available at: http://www.mass.gov/eohhs/docs/dph/com-health/school/status-childhood-obesity-2011.pdf. Accessed February 18, 2014.
- Reducing social disparities in tobacco use: a social-contextual model for reducing tobacco use among blue-collar workers.Am J Public Health. 2004; 94: 230-239
- Immersion/crystallization.in: Crabtree B. Miller W. Doing Qualitative Research. Sage Publications, Thousand Oaks, Calif1999: 179-194
- Crystallization processes at the surface of polylactic acid–bioactive glass composites during immersion in simulated body fluid.J Biomed Mater Res B Appl Biomater. 2011; 99: 412-419
- Maternal perceptions of weight status of children.Pediatrics. 2003; 111: 1226-1231
- Childhood obesity: do parents recognize this health risk?.Obes Res. 2003; 11: 1362-1368
- Use of a pediatrician toolkit to address parental perception of children's weight status, nutrition, and activity behaviors.Acad Pediatr. 2010; 10: 274-281
- Parents' perceptions of their child's weight and health.Pediatrics. 2006; 117: 681-690
- Factors associated with parental recognition of a child's overweight status—a cross sectional study.BMC Public Health. 2011; 11: 665
- Parenting an overweight or obese child: a process of ambivalence.J Child Health Care. 2011; 15: 71-80
- Parental perceptions regarding healthy behaviours for preventing overweight and obesity in young children: a systematic review of qualitative studies.Obes Rev. 2010; 11: 338-353
- A qualitative assessment of barriers and facilitators to achieving behavior goals among obese inner-city adolescents in a weight management program.Diabetes Educ. 2008; 34: 277-284
- Adolescent–parent interactions and communication preferences regarding body weight and weight management: a qualitative study.Int J Behav Nutr Phys Activity. 2010; 7: 16
- Parents' journey through treatment for their child's obesity: a qualitative study.Arch Dis Child. 2008; 93: 35-39
- Why don't low-income mothers worry about their preschoolers being overweight?.Pediatrics. 2001; 107: 1138-1146
- Evaluating parents and adult caregivers as “agents of change” for treating obese children: evidence for parent behavior change strategies and research gaps: a scientific statement from the American Heart Association.Circulation. 2012; 125: 1186-1207
- Association between parenting practices and children’s dietary intake, activity behavior and development of body mass index: the KOALA Birth Cohort Study.Int J Behav Nutr Phys Activity. 2011; 8: 18
United States Census Bureau. State and county quick facts, Massachusetts. Available at: http://quickfacts.census.gov/qfd/states/25000.html. Accessed July 9, 2014.
- Rising social inequalities in US childhood obesity, 2003–2007.Ann Epidemiol. 2010; 20: 40-52
- Randomized controlled trial to improve primary care to prevent and manage childhood obesity: the High Five for Kids study.Arch Pediatr Adolesc Med. 2011; 165: 714-722
Article Info
Publication History
Accepted:
August 4,
2014
Received:
March 8,
2014
Footnotes
The authors declare that they have no conflict of interest.
Identification
Copyright
© 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
