A Better Start National Science Challenge’s Model Acceptance study is the first large-scale survey on the subject of caregiver acceptability of early childhood obesity prediction models in a multi-ethnic cohort of parents, caregivers, and grandparents anywhere in the world.
Worldwide, an estimated 40.6 million children aged 5 years and under have overweight or obesity. New Zealand is no exception, as 1 in 3 children are already above a healthy weight by the time they start school. High body mass index (BMI) in infancy usually continues into childhood and adolescence, and from there into adulthood. Childhood obesity is also associated with a number of ongoing physical and psychological conditions.
Obesity prediction models are statistical methods used to calculate the risk of obesity by a later date. These models are based on a combination of clinical and demographic factors, such as the mother’s BMI or level of education. In this study, caregivers were asked about their acceptance of early childhood obesity prediction models, which can predict an infant’s risk of obesity by the time they start school.
Until very recently, little was known about the acceptability of communication regarding the prediction of early childhood obesity to parents and caregivers, or how families would respond to information about their infant’s obesity risk. Two small studies in the UK have found that such communication may be acceptable, but these findings may not be applicable to the New Zealand population. Therefore A Better Start’s research team conducted a large-scale anonymous online survey of almost 2,000 New Zealand parents, grandparents, and other caregivers of children aged 5 years and under, of various ethnicities and levels of education to determine their acceptance of this information. Over 30 per cent of the respondents were of Māori or Pacific ethnicity.
Over 60% of respondents were accepting of such communication, with no major differences in terms of respondents’ ethnicity, socioeconomic status, or levels of education. In general, caregivers wanted to know whether their infant was at risk of early obesity.
“As long-term weight loss is difficult to achieve in children and adults, initial obesity prevention is preferable to treatment from a public health perspective,” says A Better Start Director, Professor Wayne Cutfield. “Early prediction information of their child’s risk of obesity means that caregivers can better manage their health and lifestyle from a young age,” he says.
Almost two-thirds of respondents were receptive to communication about early childhood obesity prediction, and 62.1 per cent would “definitely” or “probably” want to hear if their child was at risk of early child obesity. Although 77.0 per cent said that they would be “worried” and 53.0 per cent said that they would be “upset” to receive such information.
“The study’s findings suggest that if delivered in a sensitive manner to minimise caregiver distress, early childhood obesity risk prediction could be a useful tool to inform interventions to reduce childhood obesity in New Zealand,” says Professor Cutfield.
Lead researcher PhD student Éadaoin Butler said that the findings were fascinating. “Our study has shown that the prediction of early childhood obesity may be an acceptable means of reducing the high prevalence of obesity experienced by children in New Zealand. However, childhood obesity is a highly stigmatising issue, and any such risk communication would need to be delivered in a sensitive and supportive manner, ” says Ms Butler
The study did not find any differences in acceptability of the information according to socioeconomic status, education or ethnicity (with the exception of Asian respondents who were more accepting of the prediction information than other ethnicities).
While many respondents were accepting of the prediction information, there remained a significant minority (almost 40 per cent) who were not. While the study’s results are hypothetical (i.e. no actual risk communication was discussed with caregivers), they suggest that if delivered in a sensitive manner, communication regarding early childhood obesity risk may be useful to assist interventions to prevent this condition.
“Importantly, we did not see reduced acceptance among communities more likely to be affected by childhood obesity (those of Māori or Pacific ethnicity, less affluence, or less education),” says Ms Butler. “Given the generally high rates of acceptance and if delivered in a sensitive manner, interventions based on early childhood obesity prediction models could be useful to help prevent the condition in New Zealand children,” she says.
The study indicated that early childhood obesity prediction was also deemed acceptable by Māori and Pacific families. This is significant as it may be able to be used as a resource to assist with the reduction of early childhood obesity in these communities.
“In addition, we also observed greater acceptance of the prediction information by grandparents (compared to other caregivers) and males (compared to females). However, the study had small numbers of responses from these groups, so it is possible that these findings are just reflective of highly motivated respondents. The increasing numbers of pre-school children now being cared for by grandparents means that they may play an important role in the prevention of early childhood obesity,” Ms Butler says.
The general preference for receiving the prediction information was when the child started eating solid foods, rather than at earlier stages of the child’s life. Respondents also wanted more nutritional support to provida healthier diet to their baby.
The majority of respondents wanted a medical professional to discuss the prediction information with them, with just over half selecting “family doctor or nurse”, with another 33 per cent choosing “Plunket or Tamariki Ora nurse” (which are those delivering the nationally-funded Well Child programme from birth to age 5 years). “Knowledgeable” was frequently selected as the quality that caregivers wanted their healthcare professional to have, which indicates that the credibility of the person communicating the obesity prediction is very important.
