A Literature Review: Parent Involvement for Healthy Children

Britney Jayne

Liberty University
HLTH 634-BO1
Health Communication and Advocacy

June 4th, 2017

Word Count: 1,729

Introduction:
 The health of our children could be one of the most important

pieces of public health today. They are future world changers,

presidents, teachers, community healthy workers, parents, and adults.

Raising children to cherish and protect their bodies will not only affect

they way they view themselves, but it will ultimately affect the health

status of our nation. Currently, the prevalence of children with obesity

in the United States is alarming. According to the CDC, it has more

than tripled since the 1970s. 1 In order to change that 1 in 5 school-

aged child from ages 6-19 is obese, we must address the deep rooted

connections to childhood obesity such as eating behaviors and

psychology.

The intervention Healthy Wolly Kids will hopefully test the

thought that parents are the first line of defense against these

behavioral and psychological needs the child faces. For ultimate

change, it must be understood that the child cannot do it alone.

Parents are the caregivers, the grocery shoppers, the meal preparers,

and the first emotional supporters the child has. With a group of willing

and ready parents at Wollaston Church of the Nazarene, the program

hopes to address the behavioral and psychological basis for childhood

obesity by guiding a healthy discussion. By actively helping plan meals

and make grocery lists, Healthy Wolly Kids can assist parents in making

sure their children are getting the proper amount of well rounded fruits

and vegetables every day by offering variety ideas and healthy snack

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options, and help to decrease the amount of added sugar in their

childrens diet. With biblical references the program will also aim to

encourage parents to vocalize the importance of not only loving the

body God has given them, but treat it well, treat it as the temple of the

Holy Spirit.

This literature review will address the thought and framework

around parent and family intervention as a tool in directing childhood

obesity. The references found will focus on healthy eating as a family,

increasing fruits and vegetables, decreasing added sugar content,

importance of nutritious snacking, and the influence of a healthy body

image. By using a comparing and contrasting approach to summarize

findings within references, this literature review will explain in the body

of evidence what the references say about each topic listed above and

report the research conducted. The summary and conclusion portion

will aim to address how the references contribute to the overall goal of

the intervention; helping kids eat healthier and have a positive body

image to ultimately decrease the prevalence of childhood obesity.

Body of Evidence:

The first contribution to research was found from the

International Journal of Behavioral Nutrition and Physical Activity.

Davison and colleagues assessed families with children from ages 2-5

in Head Start centers to see if a parent-centered community-based

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participatory research approach could influence childs weight status.2

They found that shifting a best practices to a best processes

approach builds the most promise for change.2 They found that using

intervention principles such as increasing parents awareness of childs

weight status, reducing myths about obesity in children, and promoting

parents empowerment, is a guiding force in overall children well-

being.2

With a similar goal in mind, Nyberg and colleagues researched

parents and children aged 6 in a Healthy School Start program to see if

parent involvement of influencing childrens dietary and physical

activity habits would lower BMI.3 They found mounting evidence that

parental involvement over school involvement leads to higher

intervention effect.3 In dietary behavior particularly, results showed at

the end of their intervention that there was an increase of .26 portions

per day of vegetables compared to the control group with a family

style intervention plan.3 In an article about family planning and

intervention, Manios and colleagues assessed what is called the

ToyBox-intervention on kindergarten children in European countries.4

This method is more teacher and school centered, aiming to change

environmental factors in the classroom, movement breaks, healthy

snack breaks, and proper role modeling. 4 The final stage in ToyBox is

parental involvement, which includes changing their personal

behaviors at home to reflect a positive role model in implementing

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lifestyle behaviors together with their children. 4 This study expressed

the thought that all daily influences need to be on the same page for

ultimate and effective change.4 In this same premise, Lawlor, a

researcher at the University of Bristol, conducted a study at 60 primary

schools in the south west of England for children aged 8-9 years.5 He

used the Active for Life Year 5 intervention, which is based on teacher

training, child-parent interactive homework assignments, and school

newsletters.5 Lawlor found that this intervention plan was not effective

at increasing fruit and vegetable consumption among other things such

as increasing physical activity and decreasing sedentary behavior. 5 He

believes these findings point to a need for a more intensive behavior

intervention far past that of school and family intervention, such as the

individual child and at the societal level.5

In a systematic review and meta-analysis of children and adults

based on PubMed, EMBASE, and the Cochrane Library databases, Malik

and colleagues found that there is a direct relationship between sugar-

sweetened beverages (SSB) and weight gain in children.6 SSBs can

lead to weight gain through their high added-sugar content, low

satiety, and in incompletely compensatory reduction in energy intake

at subsequent meals after intake of liquid calories.6 Their meta-

analysis further supports the claims made by the American Heart

Association, American Academy of Pediatrics, and the US 2010 Dietary

Guidelines technical review committee that reduction of SSBs can help

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prevent obesity and improve overall health. They also intriguingly

point out the lack of targeted strategies to reduce SSB consumption in

high risk populations, particularly children who are already

overweight.6 Once a child is obese, it is increasingly difficult to achieve

and maintain weight loss, so primary prevention strategies need to be

in place.6

Portion size and healthy snacking are factors that can be

somewhat regulated by parents, particularly parents of young children.

Snack foods include things such as chips, baked goods, and candy.7

There are few studies that have been able to connect a direct

connection with these foods and obesity, but they have been studied

and shown to increase total overall caloric intake.7 In addition to this,

portion sizes have increased dramatically in the past decade.7 When

you combine the added calories from unhealthy snacking and these

now large portions, energy imbalance occurs, which can cause weight

gain and consequently obesity.7

Besides the overall dietary influences parents can have on

childrens eating habits, it is no secret that parental factors

significantly shape the body image of children as well. In an article

written by Michael and colleagues, they express that parents both

directly and indirectly influence and have a lasting effect on their

childrens body image. Directly, parents who are emotionally warm,

affectionate, available, and have a firm but fair disciplinary style,

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create an emotional context in which children and adolescents tend to

be more secure, healthier, and safer than peers raised in other

settings.8 Parents can also indirectly affect how children view their

bodies by expressing dissatisfaction with their own or tease their

children about their weight.8 Children who do not have this supportive

atmosphere are put at greater risk for developing eating disorders,

depression, and obesity.8 From their findings, they suggest that

prevention efforts to consider are educating parents on how to

influence their childrens self-worth and perception of their body size.8

Similarly to this article on the influence of parents, the book

titled Body Image, Eating Disorders, and Obesity in Youth, speaks to

this issue as well. A section of the book mentions that the essential

role of the parent, whether via modeling, parental control, or because

parents largely control the home environment and promote or impede

the childs healthy lifestyle change has led to family-based

interventions.9 The authors mention a lack of studies done on the

subject simply because of families that drop out of studies.9 The book

states four ways for parents to help prevent a broad range of weight-

related problems. They are to role model healthful behaviors, provide

an environment that makes it easier for children to make healthful

choices, focuses less on weight and more on healthy lifestyle

behaviors, and provides a supportive environment for children.9

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 A final resource found that proves to be a great source of

information is through the American Academy of Pediatrics. They have

a guide called Healthy Active Living for Families (HALF), which has

been proven to help guide families in obesity prevention and care

during the infancy, toddlerhood, and early childhood development.10

Summary and Conclusions

The one finding that seems to be consistent with all the studies

found is that family planning, whether alone or in combination with

other strategies, is an effective tool to influence childhood obesity and

body image concerns. The research shows the importance of family

involvement based on dietary practices as well as emotional influence.

The articles that spoke on vegetable intake and calorie balance show

the importance of proper nutrition information in efforts to control

childhood obesity. The article written by Michael and colleagues may

be the most influential, as this shows that both direct and indirect

parental influences greatly affect childrens eating behavior and body

image. This finding is something that will greatly be considered when

implementing the strategies for parents.

There are many areas for future research on this topic, pointed

out by two different references. One article pointed out the importance

of an individualized plan, which would be much more difficult to

implement. In the textbook, the authors noted the issue of families

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dropping out of studies. A final gap in research found in selecting

references is the affect of a spiritual influence on childhood obesity,

which would be extremely difficult to ethically study and assess.

Hopefully this will be something parents find helpful, but the lack of

information on this subject proves that it is an area that has not been

considered by many credible researchers in the field of public health.

These references all support the belief that no matter what

strategy is in place for childhood obesity prevention, families must be

involved and present throughout the journey. The intervention

program is aiming for exactly that. Giving the parents the confidence,

tools, discussion, and support will allow for them to feel mentally and

emotionally prepared to direct their children to a healthy lifestyle.

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References:
1. Childhood Obesity Facts. Centers for Disease Control and Prevention.
https://www.cdc.gov/healthyschools/obesity/facts.htm. Accessed May
25, 2017.

2. Davison K. Jurkowski J. Li K. Kranz S. Lawson H. A childhood obesity

intervention developed by families for families: results from a pilot
study. International Journal of Behavioral Nutrition and Physical Activity.
DOI: 10.1186/1479-5868-10-3. Published January 5, 2013. Accessed
May 25, 2017.

3. Nyberg G. Sundblom E. Norman A. Bohman B. Hagberg J. Elinder L.

Effectiveness of a Universal Parental Support Program to Promote
Healthy Dietary Habits and Physical Activity and to Prevent Overweight
and Obesity in 6-Year-Old Children: The Healthy School Start Study, a
Cluster-Randomized Controlled Trial. PLOS Journals. DOI:
https://doi.org/10.1371/journal.pone.0116876. Published February 13,
2015. Accessed June 1, 2017.

4. Manios Y. et al. Designing and implementing a kindergarten-based,

family-involved intervention to prevent obesity in early
childhood: the ToyBox-study. Department of Nutrtion and Dietetics. doi:
10.1111/obr.12175. Published April 8, 2014. Accessed June 1, 2017.

5. Lawlor D. et al. Effect of intervention aimed at increasing physical

activity, reducing sedentary behaviour, and increasing fruit and
vegetable consumption in children: Active for Life Year 5 (AFLY5) school
based cluster randomised controlled trial. BMJ. doi:
https://doi.org/10.1136/bmj.g3256. Published May 27, 2014. Accessed
June 2, 2017.

6. Malik V. Pan A. Willett W. Hu F. Sugar-sweetened beverages and

weight gain in children and adults: a systematic review and meta-
analysis. The American Journal of Clinical Nutriton. doi: 10.3945/
ajcn.113.058362. Published August 21, 2013. Accessed June 2, 2017.

7. Sahoo K. Sahoo B. Chourdhury A. Sofi N. Kumar R. Bhadoria A.

Childhood obesity: causes and consequences. Journal of Family
Medicine and Primary Care. DOI: 10.4103/2249-4863.154628.
Published 2015. Accessed June 2, 2017.

8. Michael S. et al. Parental and Peer Factors Associated with Body

Image Discrepancy among Fifth-Grade Boys and Girls. PMC. doi:

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10.1007/s10964-012-9899-8. Published January 19, 2013. Accessed
June 3, 2017.

9. Smolak & Thompson, Body Image, Eating Disorders, and Obesity in

Youth. (2009)

10. HALF Implementation Guide. American Academy of Pediatrics.

https://www.aap.org/en-us/advocacy-and-policy/aap-health-
initiatives/HALF-Implementation-Guide/Pages/HALF-Implementation-
Guide.aspx. Updated 2017. Accessed June 4, 2017.

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