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Citation:

Study Design:

Class:

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Quality Rating:

Research Purpose:

To examine the relationships among 5-year-old girls' weight status, parents' reaction to their daughter's weight status and the girls' self-concept.

Inclusion Criteria:

Inclusion critieria included girls of preschool age living with both biological parents.

Exclusion Criteria:

Girls with severe food allergies or chronic medical problems affecting food intake and dietary restrictions involving animal products.

Description of Study Protocol:

Each girl was individually interviewed by a trained interviewer on two separate occasions about one week apart.
The girls' self-concept was assessed using the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (PSCA).
In addition to the PSCA the Body Esteem Scale was also obtained from each girl.
Weight status (weight for height percentile) was calculated based on height and weight measurements.
Parents were asked to complete a series of questionnaires including the Child Feeding Questionnaire and the General Parental Control Scale (GPCS) and had their weight & height measured and recorded within one month of the daughter's visit.

Statistical Analysis

Statistical analyses were conducted using SAS Software, 6.12.

Hierarchical Multiple Regression Analysis was used to assess the relationship between:

girls' weight status and self-concept,
parental concern with weight/food restriction and girls' self-concept
parental concern with weight/food restriction and girls' self-concept and girls' weight status
cognitive ability, physical ability, physical apearance or body esteem, maternal acceptance and peer acceptance and girls' weight status, parent concern or restriction and weight status and parent concern/restriction

Correlations between parental control (Scores form GPCS) and parental restriction and concern were calculated to determine whether restriction and concern reflected broader parenting practices and beliefs.

Data Collection Summary:

Dependent

Girls’ self-concept – perceived competence score (Pictorial Scale of Perceived Competence & Social Acceptance for Young Children & Body Esteem Scale)

Independent

Parent Child-Feeding Practices – Concern about child overweight & restriction of Child access to and intake of food (Child Feeding Questionnaire),
Parental Control – not specific to the feeding domain (General Parental Control Scale)

Control Variables

General parent control

Description of Actual Data Sample:

Sample: 197 girls

Age: 5.4±0.3 years (range 4.6-6.4 years)

Ethnicity: non-Hispanic white girls and their parents

SES: Two thirds of parents reported > high school education with equal proportion reporting incomes of < $35,000, between $35,000 and $50,000, and > $50,000.

Location: rural and nonrural areas in central Pennsylvania

Summary of Results:

Mean Self-Concept, Parent Concern and Parent Restriction for the Entire Sample and for Overweight and Nonoverweight Girls
	Nonoverweight Girls (n=149) WHP<85	Overweight Girls (n=48) WHP>85	Entire Sample
Weight for height percentile	51.81(21.45)**	93.33(4.85)**	61.92(25.93)
Body Esteem	57.03(7.05)*	54.68(6.51)*	56.45(6.98)
Physical ability	3.47(0.43)	3.36(0.57)	3.45(0.47)
Cognitive ability	3.61(0.38)**	3.330.63)**	3.540.47)
Peer acceptance	3.04(0.62)	2.98(0.66)	3.03(0.63)
Maternal acceptance	3.08(0.60)	3.11(0.61)	3.09(0.60)
Maternal concern	2.06(1.10)	2.97(1.08)**	2.28(1.15)
Paternal concnern	2.09(1.11)**	2.84(1.11)**	2.28(1.15)
Maternal restriction	2.89(0.85)	3.07(0.95)	2.93(0.85)
Paternal restriction	3.08(0.69)	3.22(0.72)	3.11(0.69)

*p<0.05, **p<0.01

Body Esteem

There was a negative relationship between girls' weight status and girls' body esteem-girls with higher weight status reported lower body esteem than girls with lower weight status (p<0.05)
A negative relationship was found between fathers' concern about their daughter's weight status and girls' esteem (p<0.05). Higher concern among fathers was associated with lower body esteem among their daughters independent of girls' weight status.

Perceived Physical Activity

There was no relationship between girls' weight status and perceived physical activity.
There was a negative relationship between mothers' concern about their daughter's weight status and girls' perceived physical ability (p<0.01). Higher concern among mothers was associated with a lower perceived physical ability among their daughters independent of weight status.
A negative interaction was found between maternal restriction and girls' weight status in predicting girls' perceived physical ability (p<0.01). When maternal restriction was high, girls with higher weight status reported lower perceived physical ability in comparison to girls with lower weight status.

Perceived Cognitive Ability

Girls with higher weight status reported lower perceived cognitive abilty than girls with lower weight status (p<0.01).
Higher concern among mothers was associated with lower perceived cognitive ability among their daughters independent of weight status (p<0.01).
When maternal restriction was high, girls with higher weight status reported lower perceived physical ability in comparison to girls with lower degrees of weight status (p<0.01).

A significant correlation was found between mothers' scores on the GPCS and mothers' concern about their daughter's weight status (r=0.15,p=0.03). A significant correlation was found between fathers' scores on the GPCS and paternal concern about their daughter's weight status (r=0.18, p=0.01) and paternal restriction (r=0.15, p=0.03).

All signficant relationships were reassessed controlling for parents' GPCS scores to determine whether the effects identified were independent of general parental control. Neither the significance level nor the strength of the associations changed after controlling for general parental control.

Author Conclusion:

Negative associations between weight status and self-concept are present in girls as young as 5 years of age. Maternal and parenteral concern about child's weight status and restriction of food intake may have a negative impact on girls' self-preceptions.

Funding Source:

Government:

National Institute of Health Grant RO1 HD 32973

Reviewer Comments:

This study was limited to non-Hispanic white families that were reasonably well educated. Additional research with longitudinal data and with more ethnic diversity and socioeconomic status groups is needed to determine directionality and generalizability of the results.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	N/A
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	N/A

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		Yes
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	Yes
	2.2.	Were criteria applied equally to all study groups?	Yes
	2.3.	Were health, demographics, and other characteristics of subjects described?	Yes
	2.4.	Were the subjects/patients a representative sample of the relevant population?	Yes
3.	Were study groups comparable?		Yes
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	Yes
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	Yes
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	No
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	Yes
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	Yes
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		Yes
	4.1.	Were follow-up methods described and the same for all groups?	N/A
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	Yes
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	N/A
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		No
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	N/A
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	No
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	No
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		Yes
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	N/A
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	Yes
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	N/A
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	N/A
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	N/A
	6.6.	Were extra or unplanned treatments described?	N/A
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	N/A
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	N/A
7.	Were outcomes clearly defined and the measurements valid and reliable?		Yes
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	N/A
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	Yes
	7.5.	Was the measurement of effect at an appropriate level of precision?	Yes
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	Yes
	7.7.	Were the measurements conducted consistently across groups?	Yes
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		Yes
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	Yes
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	Yes
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	Yes
	8.6.	Was clinical significance as well as statistical significance reported?	Yes
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	N/A
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	Yes
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	Yes
	10.2.	Was the study free from apparent conflict of interest?	Yes