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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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.
