Parents’ health literacy affects child weight-loss tactics


Parents who have low health literacy are less likely to choose government-recommended weight-loss strategies, such as increasing physical activity or serving more fruits and vegetables, to help their children control their weight than parents who are better able to understand basic health-related information, a new study suggests.

About one in six – or 16 percent – of the nearly 500 parents in the study had low health literacy, which the U.S. Dept. of Health and Human Services defines as a limited ability to understand, communicate and apply basic health information in improving one’s health.

Janet Liechty
Janet Liechty is a professor of social work and of medicine at the University of Illinois. Credit: Photo by L. Brian Stauffer

Parents’ level of health literacy was determined by their ability to correctly interpret the nutrition information on an ice cream container label. They also were asked about their preferred sources of weight-control information and the methods they would consider using to help an overweight child lose weight. A paper on the study was published in the August issue of the journal Appetite.

The data used in the project were drawn from the STRONG Kids Study, a Midwest panel survey of parents of preschool-aged children conducted by a multi-disciplinary team of researchers from the University of Illinois and the University of Michigan.

When presented with a 15-item list of recommended, neutral and unsafe weight control strategies, nearly a third of the parents with low health literacy did not select any of the practices recommended on governmental websites, such as the U.S. Centers for Disease Control and Prevention, the researchers found.

“Parents with higher health literacy were more likely to check the recommended weight-control strategies, and it’s concerning that parents with lower health literacy were significantly less likely to do so,” said lead investigator Janet Liechty, a professor of social work and of medicine at Illinois. “About 3 percent of the parents with lower health literacy also indicated that they would consider using unsafe tactics, such as having their child take laxatives or diet pills.”

Parents who had higher levels of health literacy selected a greater number of weight-control strategies overall, including more neutral strategies, such as counting calories or reducing consumption of carbohydrates which, while not considered unsafe, are not necessarily recommended for children, Liechty said.

The majority of parents indicated that health care professionals, such as doctors, nurses and nutritionists, were their primary sources for weight-control information. However, parents with higher health literacy were more likely to consult books and websites, while other parents were significantly more likely to consult members of the clergy, the researchers found.

The associations between health literacy and the number and types of resources and strategies chosen remained significant even when the researchers controlled for factors such as parents’ age, race and level of education, Liechty said.

“Just like the rest of us, these parents already have ideas about dieting and what they would do to help a child control their weight, and unless we take the time to understand their thinking and offer education, they may be operating on common dieting myths,” Liechty said. “If health care practitioners are parents’ preferred resource, then we can find ways to help practitioners more effectively communicate with patients and clients about ways to help kids build healthy habits.”

“If a health care provider counsels parents that their child is overweight or obese and some behavior changes are needed, we need to do a more careful job of monitoring what the parent actually hears and does with that recommendation,” Liechty said. “If parents tend toward unhealthy or ineffective methods, we need to make it easier for them to learn about recommended strategies that are safe and effective, and provide access to user-friendly resources.”

While governmental health agencies’ websites provide an abundance of weight-control information, the study’s findings suggest that they may not be reaching the parents who need it most, either because they lack Internet access or they prefer to consult other sources that may not be as credible, Liechty said.

“How accessible is this information to parents in general, and especially to those struggling with lower health literacy?” Liechty said. “How do we, as health care social workers and interdisciplinary health care teams, create some bridges between the great information that’s available and the ways parents want to obtain it?”

While the ideal approach for helping families of children with weight problems would be to refer them to comprehensive, multidisciplinary treatment programs that include medical oversight and counseling, many families don’t have access to these programs because they’re unavailable or unaffordable, Liechty said.


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