Persistent obesity among adolescents is a problem well known to health care providers. An obvious clinical intervention is to attempt to increase a caregiver’s concern for their adolescent’s well-being by pointing out the obesity and its persistence to ensure that a caregiver has an accurate understanding of the adolescent’s weight status and physical health risks. However, the results of the current study indicate that information about the adolescent’s weight has no bearing on increasing caregiver concern for adolescents with persistent obesity. Instead, in this context, caregivers determine their level of concern based on the effect that an obese adolescent’s weight has on their QOL. This is in contrast to Kaur et al26
who reported a significant correlation (r
= 0.59) between parent’s perception of adolescent weight and concern, and may be due to the fact that the Kaur study did not include QOL in their model. As we hypothesized, the current data suggest that caregiver-reported QOL accounts for parental concern while perceived weight does not contribute when examining only unique sources of variance.
As hypothesized, caregiver underestimation of their adolescent’s body size, adolescent zBMI, and caregiver BMI do not appear to play a meaningful role in determining concern among caregivers of adolescents with persistent obesity. Thus, health care providers treating these patients should consider discussing caregiver-perception of QOL as a means of changing caregiver concern rather than discussing clinical categories of weight, which are understandably concerning to the physician but appear to be discounted by the caregiver.
Within this sample of adolescent’s with persistent obesity, caregiver concern for their adolescent’s weight significantly predicted the desire for a physician to address the condition. These findings are consistent with previous studies demonstrating that caregiver concern for their adolescent’s health plays an important role in determining whether caregivers desire an intervention.33
Moreover, these findings provide initial evidence that caregiver-reported QOL serves as a more salient factor than the caregiver’s perception of their adolescent’s clinical weight category or the adolescent’s actual zBMI.
The importance of caregiver buy-in and participation in weight-loss interventions for their children is well established.34–36
The current American Academy of Pediatrics recommendations on the prevention, assessment, and treatment of pediatric overweight and obesity acknowledge the importance of the family and the need for caregivers to make changes in the adolescent’s home environment, dietary intake, and exercise schedule when treating pediatric overweight and obesity; however, little guidance is given on how providers should motivate caregivers of patients to make changes when they do not perceive a problem or when the changes required are difficult.37
Assessments of obesity-specific QOL in pediatric populations provide brief and targeted information regarding an adolescent’s subjective functioning in physical, social, and emotional domains.16
Items are typically face-valid questions about a given adolescent’s functioning. Generally speaking, an obesity-specific QOL assessment administered to a caregiver is a detailed and valid method of asking, “How is your adolescent doing day-to-day with regard to weight?” It is likely that indicators of QOL are more consistent with the methods caregivers are already using to assess their adolescent’s functioning, and may tap more into a caregiver’s desire to promote general well-being in their adolescent than anthropometric methods.8
In a way, QOL provides a method for physicians and caregivers to “speak the same language” regarding concerns for these difficult to treat patients.
It is also noteworthy that the effect of caregiver-reported QOL on caregiver concern, while present only as a trend in Caucasians, is pronounced in African American caregivers. This indicates that QOL discussions are particularly important to ensure appropriate care is available to African American adolescents who are persistently obese. The markedly greater magnitude of the finding in African Americans combined with the previous literature indicating that African American caregivers are more likely to identify problems with physical functioning and bodily pain in their adolescent result in a particularly compelling case for caregiver report of obesity-specific QOL assessment among African American adolescents who are persistently obese.18
Departing from study hypotheses, adolescent sex did not emerge as a significant predictor of caregiver concern most likely due to low statistical power. Future studies, and with larger and more diverse samples (e.g., race/ethnicity, socioeconomic status), are needed to fully examine these associations and to understand whether they vary across demographic sub-groups (i.e, moderator or group-wise analysis). In particular a larger study examining boys and girls as independent groups may be useful. Finally, the present sample is arguably unique given they represent adolescents who, despite their previous presentation to a hospital clinic setting for weight management intervention, remained obese over time. Admittedly, this was an unexpected finding that emerged only when we executed the present follow-up of the originally “clinical” sample. It is possible that caregiver concern is different for adolescents with persistent obesity who have never sought clinic-based treatment, or adolescents with new onset of obesity, or adolescents with prior obesity (e.g., successful weight loss) who remain overweight.