Associations Between Health Literacy and Child Weight Control Strategies Among Parents of Preschoolers

Purpose: Low health literacy among parents has been associated with poor child health outcomes, but little is known about the relationship between parental health literacy and parent strategies to control children’s weight. Parents are concerned about children’s risk for overweight and frequently alter their interactions with children around food to try to influence child weight. However, safe and effective child weight monitoring can be a demanding task which parents may be unprepared to handle. Moreover, parental obesity is strongly associated with child obesity, and so many parents trying to improve their child’s weight status may also be struggling with their own weight. Little is known about parental health beliefs regarding appropriate weight loss strategies or how these are shaped by overall health literacy. In this context, health literacy can be defined as a parent’s ability to obtain, understand, communicate, and apply weight-related health information to improve their child’s healthy weight status. The purpose of this study was to identify potential gaps or misinformation among parents that could impact child health and be targeted for intervention. We sought to describe parents’ beliefs about appropriate weight loss strategies for young children and examine relationships between health literacy and these beliefs, after controlling for background factors.   

Method: Data were drawn from the first wave of a state funded 5-year panel study on childhood obesity prevention among preschoolers and their parents. Parents (n=497; 90% female) were 6% Hispanic, 71% White, 19% African American, and 8% Asian. About one-third (36%) reported receiving WIC. Health Literacy was measured using two standardized scales including the nutrition-oriented Newest Vital Signs. Parent endorsement of weight loss strategies for children and for adults was assessed by checklist. Parent concern about their child’s weight was measured by a subscale of the Child Feeding Questionnaire. Descriptive, correlational, and multivariate regression analyses were performed to assess relationships between constructs.   

Results: Nearly a third (29%) of parents had limited health literacy. Very few parents (2%) endorsed any of the 10 unsafe weight loss methods for preschool children; however, those who did selected an average of 3.5 unsafe strategies such as the use of laxatives, diuretics, and skipping meals; and 28% endorsed these and other unsafe strategies for adults. The most common type of child weight control strategy endorsed involved calorie restriction. Most parents (83%) endorsed one or more of the 10 dietary restraint strategies for young children; and two-thirds endorsed 3 or more. Linear regressions showed that higher health literacy was associated with fewer unsafe child weight loss strategies (β = -.162, R² = .053, p = .002), but more child dietary restraint strategies (β = .210, R² = .028, p= .000) after controlling for parent age, education, and race/ethnicity.

Implications: Parents concerned about child obesity hold misconceptions about safe and effective weight management strategies, suggesting targets for intervention to improve weight-related health literacy. Health Social Workers are needed to educate and empower parents to develop the knowledge, skills, and strategies to successfully promote healthy weight and eating among their children.