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The Challenge of Preventing and Treating Obesity in Low-Income, Preschool Children
Perceptions of WIC Health Care Professionals
Leigh A. Chamberlin, MEd, RD;
Susan N. Sherman, DPA;
Anjali Jain, MD;
Scott W. Powers, PhD;
Robert C. Whitaker, MD, MPH
Arch Pediatr Adolesc Med. 2002;156:662-668.
Background Obesity has become a common nutritional concern among low-income, preschool
children, a primary target population of the Special Supplemental Nutrition
Program for Women, Infants, and Children (WIC). Nutrition counseling efforts
in WIC target childhood obesity, but new approaches are needed that address
the different perceptions about obesity that are held by clients and health
care professionals.
Objective To develop these new approaches, we examined WIC health care professionals'
perceptions about the challenges that exist in preventing and managing childhood
obesity.
Design A qualitative study using data transcribed from audiotapes of focus
groups and individual interviews. We independently read each transcript and
coded themes; then, the common themes were selected through group meetings
of the authors.
Setting Kentucky WIC.
Participants Of the 19 health care professionals participating, all had provided
nutrition counseling in WIC and all but one were white women.
Results Twelve major themes clustered into 3 domains. The first domain centered
on how WIC health care professionals perceived the life experiences, attitudes,
and behaviors of the mothers they counseled. They perceived that mothers (1)
were focused on surviving their daily, life stresses; (2) used food to cope
with these stresses and as a tool in parenting; (3) had difficulty setting
limits with their children around food; (4) lacked knowledge about normal
child development and eating behavior; (5) were not committed to sustained
behavioral change; and (6) did not believe their overweight children were
overweight. The second domain described WIC health care professionals' perceptions
of counseling interactions. They felt that (7) they might offend mothers when
talking about weight, (8) counseling was driven by protocols, and (9) their
nutritional advice often conflicted with the advice from the mothers' relatives,
friends, or primary care physicians. The last domain described programmatic
suggestions WIC health care professionals offered to address childhood obesity:
These included (10) promoting a more client-centered approach to counseling,
(11) establishing behavioral change goals that were small and endorsed by
the mother, and (12) working with primary care physicians to create a more
uniform approach to counseling on obesity.
Conclusions To become more responsive to the problem of childhood obesity, WIC should
consider the following: (1) providing staff training in counseling skills
that educate parents on child development and child-rearing and that elicit
the client's social context and personal goals, (2) shifting time allocation
and programmatic emphasis in the WIC visits away from nutritional risk assessment
and toward counseling, and (3) developing collaborations with primary health
care providers and community agencies that impact childhood obesity.
From the Divisions of General and Community Pediatrics (Ms Chamberlin
and Dr Whitaker) and Psychology (Dr Powers), Children's Hospital Medical Center,
Cincinnati, Ohio; SNS Research, Cincinnati (Dr Sherman); Department of Pediatrics,
University of Chicago, Chicago, Ill (Dr Jain); and the University of Cincinnati
College of Medicine (Drs Powers and Whitaker).
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