Addressing pediatric obesity: The crucial role of parenting

Pediatric obesity has become a significant health concern in recent years, with the prevalence reaching higher levels. It is a complex condition influenced by various factors, including genetics, lifestyle choices and environmental factors.

However, the role of parenting cannot be overlooked when it comes to developing and managing childhood obesity. Parents play a pivotal role in shaping their child’s eating habits, physical activity levels and overall lifestyle choices.

There are four parental feeding styles: authoritative, authoritarian, permissive/indulgent and negligent.

1. Authoritative: Parents with authoritative styles are described as responsive and warm with high expectations. These parents respond to the child’s hunger and satiety cues and direct healthy eating limits. Children raised with this pattern are healthier and more physically active. This style of parenting is thought to be protective against excess weight gain.
2. Authoritarian: The authoritarian feeding parental style is linked to the highest risk for obesity. This style is described as nonresponsive to the child's hunger cues but with high expectations and rules. Children may not learn valuable skills to self-regulate food intake with this style. When the restriction is removed, the child will overindulge in the calories.
3. Permissive/indulgent: In this feeding style, the parent is responsive and warm but lenient with few rules. The parent does not regulate the energy intake and offers food when the child is not hungry. Children do not learn self-regulation and may be at risk of overeating. This feeding style is also associated with the risk for developing obesity.
4. Negligent: The parent who has this feeding style often is not responsive to their children’s cues. This can put children at risk for unhealthy eating patterns. Children raised with this style also do not learn self-regulation and may overindulge in food when given the opportunity. This feeding style is also associated with obesity.

Clinicians can ask questions about family meal structure to understand which of the feeding environments the children are growing up in. If a concerning feeding style is found, medical professionals can educate families on the structure that is most beneficial to prevent childhood obesity. When communicating with parents about treating and managing pediatric obesity, clinicians play a vital role in providing guidance, support and education. At clinic visits, health care providers can initiate safe, nonjudgmental communication that uses patient-first language. Before beginning, clinicians can ask permission to bring up weight with parents and children. Once permission is granted, clinicians can gather information and work with families to develop mutual plans to address the issues. By employing these strategies, clinicians can effectively communicate with parents, empower them to support their child with obesity and promote positive changes that contribute to long-term health and well-being.

Pediatric obesity is a multifaceted issue that requires a comprehensive approach. Likewise, obesity care has many different components, including the evaluation of nutrition, sleep, physical activity, mental health and the use of medications. Each component is essential and should be addressed. The Obesity Medicine Association (OMA) has developed the four pillars of clinical obesity treatment to help guide health care providers in managing and treating obesity: nutrition therapy, physical activity, behavioral modification and pharmacotherapy.

Although genetics and external factors undoubtedly play a role, the influence of parenting cannot be underestimated. By encouraging parents to take an active part in shaping their child's eating habits, physical activity levels and overall lifestyle choices, we can significantly impact preventing and managing pediatric obesity.

There are several resources to learn more about environmental factors that contribute to pediatric obesity:

• North American Society for Pediatric Gastroenterology, Hepatology and Nutrition webinar on factors for pediatric obesity;
• AAP’s clinical guideline on obesity; and
• OMA’s Pediatric Obesity Algorithm.

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