Cross-sectional associations between maternal self-efficacy and dietary intake and physical activity in four-year-old children of first-time Swedish mothers.

BACKGROUND: Healthy dietary and physical activity behaviours are established early in life where children learn by observing their parents. Therefore, parents can act as role models and influence their children toward a healthier lifestyle. Besides a strong association between parental and child health behaviours, parents also influence their children's health behaviours through socio-cognitive processes, where perceived self-efficacy is the central component. The objective was to examine if parental self-efficacy among Swedish mothers was associated with their four-year-old children's dietary and physical activity behaviours. METHODS: This cross-sectional study was based on information from control participants that took part in the Swedish primary prevention trial of childhood obesity (PRIMROSE) (n = 420 mother-child pairs). Linear regression models were used to examine the associations between parental self-efficacy (Parental Self-Efficacy for Promoting Healthy Physical Activity and Dietary Behaviours in Children Scale) and children's dietary intake (parent reported) and levels of physical activity (accelerometer) with adjustments for potential confounders. RESULTS: Mothers' efficacy beliefs in promoting healthy dietary or physical activity behaviours in their children were associated with a slightly higher consumption of fruit and vegetables among their children (ß: 0.03 [95%CI: 0.01; 0.04] P < 0.001) and slightly higher levels of moderate-to-vigorous activity (ß: 0.43 [95%CI: 0.05; 0.81] P = 0.03). Mothers' belief in their ability to limit unhealthy dietary and physical activity behaviours was inversely associated with children's intake of unhealthy snacks (ß: -0.06 [95%CI: -0.10; -0.02] P < 0.01). CONCLUSION: Our cross-sectional study suggests weak positive correlations between maternal self-efficacy and healthy dietary and physical activity behaviours, and weak inverse associations between maternal self-efficacy and unhealthy dietary and physical activity behaviours among their children.

Associations Between Swedish Mothers' and 3- and 5-Year-Old Children's Food Intake.

OBJECTIVE: To investigate associations between mothers' and children's food intake. DESIGN: Cross-sectional study. Background variables collected through self-reports and from the register of the total population. Mothers recorded their own and their children's food intake in a diary during 2 4-day periods. SETTING: Eight counties in mid Sweden. PARTICIPANTS: Three- and 5-year-old children and their mothers were randomly selected from the register of the total population. A total of 2,045 families were invited, 355 of whom accepted. Mothers who accepted were older and to a larger extent born in Sweden. The final sample of mother-child pairs with complete food records was 189. MAIN OUTCOME MEASURES: Mothers' and children's food intake (16 food items). ANALYSIS: Spearman rank-order correlation with 95% confidence intervals (2-sided). Moderation was investigated using generalized estimation equations with robust variance. RESULTS: The strongest correlations between mothers' and children's food intake were found for pizza and oily fish (r = .70-.80). The weakest correlations were found for sugared drinks and fruit and berries (r = .24-.26). Children's age moderated the relationship between mothers' and children's intake of savoury snacks, as did place of residence for pizza intake. CONCLUSIONS AND IMPLICATIONS: There were substantial correlations between children's and mothers' intake of various foods. Modeling of mothers' intake might be more effective in influencing young children's intake of certain foods, whereas other strategies, such as encouraging parents to influence food availability (eg, gatekeeping), might be more useful for some foods.

Association between perceived health care stigmatization and BMI change.

BACKGROUND/AIMS: This study examined the association between experiences of health care stigmatization and BMI changes in men and women with normal weight and obesity in Sweden. METHODS: The participants were drawn from a population-based survey in Sweden (1996-2006), and data on their perceived health care stigmatization were measured in 2008. They were categorized in individuals with normal weight (n = 1,064), moderate obesity (n = 1,273), and severe obesity (n = 291). The main outcome measure was change in BMI. RESULTS: Individuals with severe obesity experiencing any health care stigmatization showed a BMI increase by 1.5 kg/m2 more than individuals with severe obesity with no such experience. For individuals with moderate obesity, insulting treatment by a physician and avoidance of health care were associated with a relative BMI increase of 0.40 and 0.75 kg/m2, respectively, compared with their counterparts who did not experience stigmatization in these areas. No difference in experience of any form of health care stigmatizing associated BMI change was observed for men and women with normal weight. CONCLUSION: In this large, population-based study, perceived health care stigmatization was associated with an increased relative BMI in individuals with severe obesity. For moderate obesity, the evidence of an association was inconclusive.

Primary prevention of childhood obesity through counselling sessions at Swedish child health centres: design, methods and baseline sample characteristics of the PRIMROSE cluster-randomised trial.

BACKGROUND: Childhood obesity is a growing concern in Sweden. Children with overweight and obesity run a high risk of becoming obese as adults, and are likely to develop comorbidities. Despite the immense demand, there is still a lack of evidence-based comprehensive prevention programmes targeting pre-school children and their families in primary health care settings. The aims are to describe the design and methodology of the PRIMROSE cluster-randomised controlled trial, assess the relative validity of a food frequency questionnaire, and describe the baseline characteristics of the eligible young children and their mothers. METHODS/DESIGN: The PRIMROSE trial targets first-time parents and their children at Swedish child health centres (CHC) in eight counties in Sweden. Randomisation is conducted at the CHC unit level. CHC nurses employed at the participating CHC received training in carrying out the intervention alongside their provision of regular services. The intervention programme, starting when the child is 8-9 months of age and ending at age 4, is based on social cognitive theory and employs motivational interviewing. Primary outcomes are children's body mass index and waist circumference at four years. Secondary outcomes are children's and mothers' eating habits (assessed by a food frequency questionnaire), and children's and mothers' physical activity (measured by accelerometer and a validated questionnaire), and mothers' body mass index and waist circumference. DISCUSSION: The on-going population-based PRIMROSE trial, which targets childhood obesity, is embedded in the regular national (routine) preventive child health services that are available free-of-charge to all young families in Sweden. Of the participants (n = 1369), 489 intervention and 550 control mothers (75.9%) responded to the validated physical activity and food frequency questionnaire at baseline (i.e., before the first intervention session, or, for children in the control group, before they reached 10 months of age). The food frequency questionnaire showed acceptable relative validity when compared with an 8-day food diary. We are not aware of any previous RCT, concerned with the primary prevention of childhood obesity through sessions at CHC that addresses healthy eating habits and physical activity in the context of a routine child health services programme. TRIAL REGISTRATION: ISRCTN16991919.

Attitudes towards obesity in the Swedish general population: the role of one's own body size, weight satisfaction, and controllability beliefs about obesity.

This study examined the associations of different socio-demographic and psychological factors with attitudes towards obesity. Individuals with different weight status (N=2436) were drawn from an annual population-based survey in Sweden, and data on attitudes towards obesity (ATOP) and predictor variables were assessed in 2008. The strongest predictor of ATOP was controllability beliefs about obesity (ß=0.83). Thus, greater controllability beliefs about obesity predicted more negative attitudes. Sex and weight satisfaction were also independently associated with ATOP. However, there was no, or only a weak, association between weight satisfaction and ATOP among individuals with normal weight or overweight. And the higher the weight satisfactions of individuals with obesity, the more positive were their attitudes. It seems that stigma-reduction strategies in the general public should address the uncontrollable factors in the aetiology of obesity. However, more research is needed to understand the underlying causes of people's attitudes towards obesity.

General practitioners' and district nurses' conceptions of the encounter with obese patients in primary health care.

BACKGROUND: Primary health care specialists have a key role in the management of obesity. Through understanding how they conceive the encounter with patients with obesity, treatment may be improved. The aim of this study was thus to explore general practitioners' and district nurses' conceptions of encountering patients with obesity in primary health care. METHOD: Data were collected through semi-structured interviews, and analysed using a phenomenographic approach. The participants were 10 general practitioners (6 women, 4 men) and 10 district nurses (7 women, 3 men) from 19 primary health care centres within a well-defined area of Sweden. RESULTS: Five descriptive categories were identified: Adequate primary health care, Promoting lifestyle change, Need for competency, Adherence to new habits and Understanding patient attitudes. All participants, independent of gender and profession, were represented in the descriptive categories. Some profession and gender differences were, however, found in the underlying conceptions. The general staff view was that obesity had to be prioritised. However, there was also the contradictory view that obesity is not a disease and therefore not the responsibility of primary health care. Despite this, staff conceived it as important that patients were met with respect and that individual solutions were provided which could be adhered to step-by-step by the patient. Patient attitudes, such as motivation to change, evasive behaviour, too much trust in care and lack of self-confidence, were, however, conceived as major barriers to a fruitful encounter. CONCLUSIONS: Findings from this study indicate that there is a need for development and organisation of weight management in primary health care. Raising awareness of staff's negative views of patient attitudes is important since it is likely that it affects the patient-staff relationship and staff's treatment efforts. More research is also needed on gender and profession differences in this area.

Perceived discrimination among men and women with normal weight and obesity. A population-based study from Sweden.

AIMS: We examined whether men and women with obesity reported different types of discrimination to a greater extent than those with normal weight, and explored whether these associations were modified by socioeconomic position. METHOD: National representative sample of men and women, with normal weight (n = 2,000), moderate obesity (n = 2,461) and severe obesity (n = 557). Participants were identified in a yearly population-based survey (1996-2006) and data on perceived discrimination and potential confounding factors were measured in 2008. Logistic regression models tested whether obesity was associated with perceived lifetime, workplace, healthcare and interpersonal discrimination. RESULTS: The overall response rate was 56%. For men, moderate obesity was associated with workplace discrimination, while severely obese women were more likely to report this sort of discrimination than normal weight women. Severely obese individuals were twice as likely to report healthcare discrimination than normal weight individuals. Women, regardless of weight status group, were in turn twice as likely to report healthcare discrimination as men. Women with severe obesity were significantly more likely to report interpersonal discrimination compared with normal weight women. Socioeconomic position modified the association between weight status and healthcare discrimination. Highly educated individuals with moderate and severe obesity were more likely to report healthcare discrimination than their normal weight counterparts, whereas low educated individuals with normal weight, moderate and severe obesity were equally likely to report discrimination. CONCLUSIONS: In this large, population-based study, discrimination was more likely to be reported by obese individuals compared with those of normal weight. The associations, however, varied according to gender and socioeconomic position.

Predictors of 10-year-olds' obesity stereotypes: A population-based study.

INTRODUCTION: Limited research has been conducted on factors that may increase children's likelihood of developing negative attitudes or stereotypes about obesity. The aim of this study was to investigate predictors of children's obesity stereotypes. METHODS AND PROCEDURES: A nationally representative sample of 10-year-old children (N=3,000), and their parents were requested to respond to a questionnaire in 2005. Obesity stereotypes were assessed by asking children to attribute positive and negative adjectives to boy and girl silhouette figures with average, thin and obese body sizes. Children's body esteem was also assessed, as well as parents' belief in the controllability of body weight. Additional data were collected on parents' and children's current body size and socio-demographic variables. RESULTS: The study included 1 383 parent and child pairs. Children assigned on average 3.9 (standard deviation, SD=3.5) more stereotypes to a boy figure with obesity and 3.7 (SD=3.4) more stereotypes to a girl figure with obesity than to thin and average figures. Predictors of obesity stereotypes were parental body size and parents' beliefs concerning controllability of weight. Children's body esteem was inversely associated with boy obesity stereotypes, while only boy's body esteem showed an inverse association with girl obesity stereotypes. DISCUSSION: Obesity stereotyping was a more salient feature among 10-year-olds having leaner parents and/or parents holding stronger beliefs about personal control over body weight. Children's perception of own body size rather than actual body size seem to be important in forming obesity stereotypes.

Prejudice against obesity among 10-year-olds: a nationwide population-based study.

AIMS: Population-based research on children's possible prejudice against thin, obese and average body sizes is scarce. This study examined children's prejudice against various body sizes of both sexes. The effects of sex, body size, place of residence and socio-economic status (SES) on children's prejudice were also investigated. METHODS: In 2005, a nationally representative sample of 10-year-old children (N = 1409) responded to a questionnaire measuring stereotypes and prejudice against thin, average-weight and obese silhouettes. RESULTS: As estimated by odds ratios (ORs), children were more likely to report prejudice against obesity (OR = 53, 95% confidence interval [CI]: 42-67) and thinness (OR = 20, 95% CI: 16-26) than against average body weight. The risk of being prejudiced varied with child's sex and with sex and body size of the silhouette figure. No association was found between own body weight and prejudice against various body sizes. Children with high SES were more likely to be prejudiced against obesity compared with children with low SES (OR = 1.2, 95% CI: 1.1-1.4). CONCLUSION: This large, population-based study showed that Swedish 10-year-old children hold stereotypical attitudes and are prejudiced against not only peers with obesity but also those with thin body sizes. Interestingly, no association was found between own body weight and prejudice against various body sizes.