When Jacksonville, Fla., psychologist Amanda Lochrie, PhD, decided to study children at risk of developing type 2 diabetes, she was immediately intrigued by the question of perception. To develop a program to help kids lose weight and be healthier, she first had to know how obese children felt about themselves.
What she found was surprising. Talking with nearly 150 children and their parents, the Nemours Children's Clinic researcher discovered that kids and parents both underestimated how serious the children's weight problems were. That reflected a larger trend: As waistlines in America grow, perception of what's normal also expands. "These are significantly overweight kids," Lochrie says. But "they often don't perceive themselves as overweight, and their parents don’t either."
Amanda Lochrie, PhD
Nemours Children’s Clinic
ADA Junior Faculty Award
The perception gap first showed up in the study's recruiting process. Lochrie was looking for high-risk cases, not kids who needed to lose a few pounds. To make sure she got enough volunteers, she decided to include children in the top 15 percent of their age group in terms of body mass index, or BMI, a way of evaluating the body's weight relative to its height. But when she signed up the participants, it turned out that almost all of the kids referred by schools and family doctors were at the extreme end of the spectrum: The BMIs of most of the study participants were in the 97th percentile. In other words, it took a lot before children's weight made the alarm bells start to ring in school health centers and doctor's offices.
The skewed perception reached all the way into Lochrie's lab. The seasoned nurse practitioner on the research team who was charged with calculating the children's BMI was flummoxed when the numbers put them at the highest end of the scale. "She checked and rechecked the BMI percentile, because [the kids] didn't look that big to her," Lochrie says.
The gap between perception and reality contains a difficult truth: According to the Centers for Disease Control and Prevention, the number of obese children between 6 and 11 years old has doubled in the past 20 years. For older kids, the numbers are even worse: The share of U.S. teens who are obese has nearly tripled, from 6.5 percent in 1980 to more than 17 percent today. The changes reflect trends seen throughout American society. "Particularly in the U.S., I think the idea of what constitutes overweight and obese is probably changing, because [obesity is] everywhere," Lochrie says.
Yet in terms of diabetes risk, perception isn't the key. Whether or not they see themselves as overweight, children with serious weight problems are more likely to develop type 2 diabetes. Those are the children Lochrie is most hoping to reach with the lifestyle intervention program she is testing with funding from the American Diabetes Association. "We're trying to target kids at risk for type 2, who have elements of metabolic syndrome [such as high blood pressure and high cholesterol] and are overweight and obese," she says. "We're testing the lifestyle intervention to see if we can prevent the deterioration of health."
She was particularly interested in how psychology—and perception—might play a role in developing lasting healthy habits. According to her research, for example, kids who see themselves as obese are more likely to report symptoms of depression, which in turn makes it harder for them to lose weight and more likely to develop psychological problems. "It's a lot easier to be in denial," says Lochrie. "Because we're addressing emotional quality of life, we're hoping we can make kids more aware and parents more aware" without making them feel bad about themselves.
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The program she came up with involved 14 group sessions that brought in kids and parents for counseling on a wide range of skills. "We're not just educating them on the proper nutrition and exercise, but also on parenting, setting limits and goals," she says. "If parents don't buy into this, there's no chance with the kids." Along with the counseling came follow-up calls and regular sessions to measure weight change.
Ultimately, Lochrie wants to see if such intensive counseling can stave off diabetes in high-risk children. "We're trying to influence outcomes—decrease their BMI, help them lose weight," she says. "We really want a reduction of risk factors. If they don't lose weight, but reduce their body fat or waist circumference or increase the amount they exercise, that's good, too."
Though she's only partway through the study, the initial reports are encouraging. "There were a lot of families that really liked it," Lochrie says. "And there were some children who lost a lot of weight"—which could ultimately bring reality more in line with perception, to boot.