Epidemiologic and qualitative studies have found that most mothers with overweight preschool children do not think their children are overweight. This might present a challenge for clinicians who wish to address obesity in young children. To understand mothers’ perceptions of their overweight children’s weight, we conducted semistructured interviews with 21 mothers of overweight preschool children enrolled in Kentucky’s Special Supplemental Nutrition Program for Women, Infants, and Children. Although these mothers did not label their children as overweight, they were worried about children’s weight, particularly as it related to their emotional well-being. These worries about obesity were reflected in three central tensions that shaped the way mothers perceived their children’s weight and informed maternal feeding strategies: (a) nature vs. nurture, (b) medical authority vs. lived experience, and (c) relieving immediate stress vs. preventing long-term consequences. Acknowledging mothers’ concerns and tensions might help clinicians communicate more effectively with them about obesity.
Adler, N.E., & Stewart, J. ( 2009). Reducing obesity: Motivating action while not blaming the victim. Milbank Quarterly, 87(1), 49-70.
2.
Amin, M.S., & Harrison, R.L. (2009). Understanding parents’ oral health behavior for their young children. Qualitative Health Research, 19, 116-126.
3.
Anderson, S.E., & Whitaker, R.C. (2009). Prevalence of obesity among U.S. preschool children in different racial and ethnic groups. Archives of Pediatric and Adolescent Medicine, 163(4), 344-348.
4.
Appalachian Regional Commission. (2008). Area development program distressed counties grants. Retrieved March 23, 2009, from http://www.arc.gov/index.do?nodeId=18
5.
Barlow, S.E. ( 2007). Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics, 120(Suppl. 4), S164-S192.
6.
Baughcum, A.E., Burklow, K.A., Deeks, C.M., Powers, S.W., & Whitaker, R.C. (1998). Maternal feeding practices and childhood obesity: A focus group study of low-income mothers. Archives of Pediatric and Adolescent Medicine, 152(10), 1010-1014.
Baumrind, D. ( 1971). Current patterns of parental authority. Developmental Psychology, 4(1), 1-103.
9.
Bentley, M., Gavin, L., Black, M.M., & Teti, L. ( 1999). Infant feeding practices of low-income, African-American, adolescent mothers: An ecological, multigenerational perspective. Social Science & Medicine, 49(8), 1085-1100.
10.
Berman, R.C., & Wilson, L. ( 2009). Pathologizing or validating: Intake workers’ discursive constructions of mothers. Qualitative Health Research, 19, 444-453.
11.
Besharov, D.J., & Germanis, P. ( 2001). Rethinking WIC. Washington, DC: American Enterprise Institute.
12.
Campbell, M.W., Williams, J., Hampton, A., & Wake, M. ( 2006). Maternal concern and perceptions of overweight in Australian preschool-aged children. Medical Journal of Australia, 184(6), 274-277.
13.
Carnell, S., Edwards, C., Croker, H., Boniface, D., & Wardle, J. ( 2005). Parental perceptions of overweight in 3-5 y olds. International Journal of Obesity, 29(4), 353-355.
14.
Chamberlin, L.A., Sherman, S.N., Jain, A., Powers, S.W., & Whitaker, R.C. (2002). The challenge of preventing and treating obesity in low-income, preschool children: Perceptions of WIC health care professionals. Archives of Pediatric and Adolescent Medicine, 156(7), 662-668.
15.
Crawford, P.B., Gosliner, W., Anderson, C., Strode, P., Becerra-Jones, Y., Samuels, S., et al. (2004). Counseling Latina mothers of preschool children about weight issues: Suggestions for a new framework. Journal of the American Dietetic Association, 104(3), 387-394.
16.
Davison, K.K., & Birch, L.L. ( 2001). Childhood overweight: A contextual model and recommendations for future research. Obesity Reviews, 2(3), 159-171.
17.
Dibley, M.J., Goldsby, J.B., Staehling, N.W., & Trowbridge, F.L. (1987). Development of normalized curves for the international growth reference: Historical and technical considerations . American Journal of Clinical Nutrition, 46(5), 736-748.
18.
Drewnowski, A., & Specter, S.E. ( 2004). Poverty and obesity: The role of energy density and energy costs. American Journal of Clinical Nutrition, 79(1), 6-16.
19.
Golan, M., & Crow, S. ( 2004). Parents are key players in the prevention and treatment of weight-related problems. Nutrition Reviews, 62(1), 39-50.
20.
Goodell, S.L., Pierce, M.B., Bravo, C.M., & Ferris, A.M. ( 2008). Parental perceptions of overweight during early childhood . Qualitative Health Research, 18, 1548-1555.
21.
Hamill, P.V., Drizd, T.A., Johnson, C.L., Reed, R.B., Roche, A.F., & Moore, W.M. ( 1979). Physical growth: National Center for Health Statistics percentiles. American Journal of Clinical Nutrition, 32(3), 607-629.
22.
Institute of Medicine. (1996). WIC nutrition risk criteria: A scientific assessment. Washington, DC: National Academies Press.
23.
Institute of Medicine. (2005). Preventing childhood obesity: Health in the balance. Washington, DC: National Academies Press.
24.
Jain, A., Sherman, S.N., Chamberlin, L.A., Carter, Y., Powers, S.W., & Whitaker, R.C. (2001). Why don’t low-income mothers worry about their preschoolers being overweight? Pediatrics, 107(5), 1138-1146.
25.
Kaufman, L., & Karpati, A. ( 2007). Understanding the socio-cultural roots of childhood obesity: Food practices among Latino families of Bushwick, Brooklyn. Social Science & Medicine, 64(11), 2177-2188.
26.
Kuczmarski, R.J., Ogden, C.L., Guo, S.S., Grummer-Strawn, L.M., Flegal, K.M., Mei, Z., et al. (2002). 2000 CDC growth charts for the United States: Methods and development. Vital Health Statistics, 11(246), 1-190.
27.
Maynard, L.M., Galuska, D.A., Blanck, H.M., & Serdula, M.K. ( 2003). Maternal perceptions of weight status of children. Pediatrics, 111(5 Part 2), 1226-1231.
28.
Morland, K., Diez Roux, A.V., & Wing, S. ( 2006). Supermarkets, other food stores, and obesity: The Atherosclerosis Risk in Communities Study. American Journal of Preventive Medicine, 30(4), 333-339.
29.
Morse, J. ( 1999). Qualitative generalizability. Qualitative Health Research, 9, 5-6.
30.
Ness, D.E., & Ende, J. ( 1994). Denial in the medical interview: Recognition and management . Journal of the American Medical Association, 272(22), 1777-1781.
31.
Nord, M., Andrews, M., & Carlson, S. ( 2008). Household food security in the United States, 2007. Alexandria, VA: Economic Research Service.
32.
Ogden, C.L., Carroll, M.D., Curtin, L.R., McDowell, M.A., Tabak, C.J., & Flegal, K.M. ( 2006). Prevalence of overweight and obesity in the United States, 1999-2004. Journal of the American Medical Association, 295(13), 1549-1555.
33.
Ogden, C.L., Carroll, M.D., & Flegal, K.M. ( 2008). High body mass index for age among U.S. children and adolescents, 2003-2006. Journal of the American Medical Association , 299(20), 2401-2405.
34.
Ogden, C.L., Flegal, K.M., Carroll, M.D., & Johnson, C.L. ( 2002). Prevalence and trends in overweight among U.S. children and adolescents, 1999-2000. Journal of the American Medical Association, 288(14), 1728-1732.
35.
Olson, C.M. ( 1999). Nutrition and health outcomes associated with food insecurity and hunger. Journal of Nutrition, 129(Suppl. 2), 521S-524S.
36.
Resnicow, K., Dilorio, C., & Soet, J.E. ( 2002). Motivational interviewing in medical and public health settings. In W. R. Miller & S. Rollnick (Eds.), Motivational interviewing: Preparing people for change (pp. 251-269). New York: Guilford Press.
37.
Reutter, L.I., Stewart, M.J., Veenstra, G., Love, R., Raphael, E., & Makwarimba, E. (2009). "Who do they think we are, anyway?": Perceptions of and responses to poverty stigma. Qualitative Health Research, 19, 297-311.
38.
Rhee, K.E., Lumeng, J.C., Appugliese, D.P., Kaciroti, N., & Bradley, R.H. ( 2006). Parenting styles and overweight status in first grade . Pediatrics, 117(6), 2047-2054.
39.
Rich, S.S., DiMarco, N.M., Huettig, C., Essery, E.V., Andersson, E., & Sanborn, C.F. ( 2005). Perceptions of health status and play activities in parents of overweight Hispanic toddlers and preschoolers. Family and Community Health, 28(2), 130-141.
40.
Satter, E. ( 1987). How to get your kid to eat . . . but not too much. Boulder, CO: Bull.
41.
Sherry, B., McDivitt, J., Birch, L.L., Cook, F.H., Sanders, S., Prish, J.L., et al. (2004). Attitudes, practices, and concerns about child feeding and child weight status among socioeconomically diverse White, Hispanic, and African-American mothers. Journal of the American Dietetic Association, 104(2), 215-221.
42.
Thompson, L.S., & Story, M. ( 2003). Perceptions of overweight and obesity in their community: Findings from focus groups with urban, African-American caretakers of preschool children. Journal of the National Black Nurses Association , 14(1), 28-37.
43.
U.S. Department of Agriculture. (1998). WIC policy memorandum 98-9, nutrition risk criteria. Alexandria, VA: Author.
44.
U.S. Department of Agriculture. (2006). Nutrition program facts, WIC: The special supplemental nutrition program for women, infants and children. Retrieved March 21, 2009, from http://www.fns.usda.gov/wic/WIC-Fact-Sheet.pdf
45.
U.S. Department of Agriculture. (2008). How to apply: WIC eligibility requirements. Retrieved July 18, 2009, from http://www.fns.usda.gov/wic/howtoapply/eligibilityrequirements.htm
46.
U.S. Department of Agriculture. (2009). WIC program regulations (C.F.R. Title 7, Part 246.11). Retrieved July 20, 2009, from http://www.access.gpo.gov/nara/cfr/waisidx_09/7cfr246_09.html
47.
U.S. Department of Health and Human Services, U.S. Department of Agriculture. (2005). Dietary guidelines for Americans. Retrieved April 2, 2009, from http://www.healthierus.gov/dietaryguidelines
48.
Waterland, R.A. ( 2008). Epigenetic epidemiology of obesity: Application of epigenomic technology. Nutrition Reviews, 66(Suppl. 1), S21-S23.
49.
Welch, H.G. ( 2004). Should I be tested for cancer?Berkeley : University of California Press.
50.
Whitaker, R.C. ( 2004a). Mental health and obesity in pediatric primary care: A gap between importance and action. Archives of Pediatric and Adolescent Medicine, 158(8), 826-828.
51.
Whitaker, R.C. ( 2004b). Predicting preschooler obesity at birth: The role of maternal obesity in early pregnancy. Pediatrics, 114(1), e29-e36.
52.
Whitaker, R.C., & Orzol, S.M. ( 2006). Obesity among U.S. urban preschool children: Relationships to race, ethnicity, and socioeconomic status. Archives of Pediatric and Adolescent Medicine, 160(6), 578-584.
53.
World Health Organization Expert Committee. ( 1995). Physical status: The use and interpretation of anthropometry . Geneva: Author.
54.
Zhang, Q., & Wang, Y. ( 2004). Trends in the association between obesity and socioeconomic status in U.S. adults: 1971 to 2000. Obesity Research, 12(10), 1622-1632.
