Obesity has long been a major health concern among adults but more recently has become a public health priority among children and adolescents due to the increasing prevalence rates and associated health risks over the last three decades. Over 32% of children and adolescents in the United States are classified as overweight or obese, with the highest rates among ethnic minorities [1
]. Obesity places children at greater risk for a number of physical and mental health conditions including type II diabetes mellitus (T2DM) [3
]. However, the factors that determine childhood body weight are still not completely understood. Though it is clear that energy intake and energy expenditure are under genetic influence, it is also clear that genetic factors do not fully explain the current increases in the prevalence of overweight and obesity [4
Recent reviews indicate that parental involvement and parental monitoring of child health behaviors are important factors to consider in preventing and treating childhood obesity [6
]. Some investigators have argued that the home environment is an important setting for shaping children's eating and physical activity (PA) behaviors and that parents are powerful change agents [7
]. As such, primary and secondary prevention efforts are needed to focus on the treatment of obesity by altering the perceptions, attitudes, and behaviors of parents who influence their children's diet and energy expenditure [8
]. The purpose of the present study was to evaluate parent factors that may contribute to adolescent overweight. Parent factors including parental nurturance, parental limit setting of sedentary behavior, and parental perceived risk for development of T2DM were evaluated as predictors of adolescent zBMI. Understanding parenting-related factors of childhood obesity will help in directing future interventions for preventing overweight.
Family systems theory (FST) provides a framework for understanding how families and parents may influence youth health behaviors. According to FST, functional families are more able to manage daily life in the context of warm and supportive family interactions [10
]. Parenting styles that are authoritative having moderate levels of control and high levels of support result in more positive family function including better communication, problem solving, and conflict resolution and have been associated with a range of positive adolescent outcomes [11
]. Locke and Prinz [13
] consider the dimensions and measurement of parental nurturance and discipline as key parent-related factors in youth development. Parental nurturance has been shown to be associated with a variety of health-related behaviors, including higher levels of fruit and vegetable intake [14
], positive body satisfaction, and self-esteem [15
], and with more frequently eating breakfast [14
]. Taken together the above studies suggest that parental nurturance may serve as an important dimension of the familial context and has an important role in family and child health practices.
Screen time is also considered a substantial contributor to overweight in youth. The American Academy of Pediatrics recommends that screen time for youth be limited to 1-2 hours per day [16
]. Nonetheless, youth aged 12–17 years watch over 24 hours of television per week [17
]. In a study by Andersen et al. [18
] youth who watched four or more hours of television per day were found to have greater body fat and higher BMI than those who watched less than two hours per day. In addition, ethnic minorities exhibited significantly higher levels of television viewing and lower rates of vigorous physical activity (PA). Parental limit setting of screen time may be one important intervention avenue. The current study seeks to examine limit setting in the context of other parent-related variables—such as nurturance—thought to be important in the context of pediatric obesity.
A hallmark clinical trial—the Diabetes Prevention Program (DPP)—found that high-risk individuals (such as those who are overweight) can implement lifestyle changes to avoid the development of T2DM [19
]. Unfortunately, research has shown that parents often do not perceive their child as overweight (the most significant risk factor for T2DM) or at risk for health problems such as T2DM, despite the contrary [20
], and thus may fail to implement those critical changes. Recently, however, the concept of risk perceptions has begun to be explored more thoroughly and recognized as influential in both preventing and treating overweight in youth [21
]. The literature supports the idea that parents often underestimate their child as obese; low parental recognition of overweight status has been replicated across studies [8
]. This suggests that those at greatest risk for obesity are also at greatest risk for failing to seek treatment or engaging in active health promotion effort for their youth [24
]. In addition to parental nurturance and limit setting, in order to initiate and maintain family behavior change parents must likely also perceive their child to be at risk for negative health consequences. No known study to date has examined the association of parental risk perceptions with other parent related variables (limit setting, nurturance) thought to be related to pediatric obesity.
The goal of this study was to expand on past research by evaluating whether parental nurturance, limit setting, and perceptions of adolescent risk are associated with adolescent zBMI. Specifically, this study examined the associations of parental risk perceptions for their adolescent's development of T2DM, parental limit setting of sedentary behavior, and parental nurturance with adolescent zBMI in a primarily African American population. It was hypothesized that higher levels of parental risk perceptions, limit setting, and nurturance would be associated with lower adolescent zBMI.