P2.J192: Evaluating Parental Perception and Confidence Managing Obesity-Related Behaviors among Children with Severe Early-Onset Obesity

Background: Severe early-onset obesity, defined as a BMI exceeding 120% of the 95th percentile before age 5, often manifests with hyperphagia. Hyperphagia is a clinical diagnosis characterized by insatiable hunger and shortened satiety duration. To treat obesity, caregivers are instructed to change lifestyle behaviors through diet and exercise for their children. Yet, no studies analyze parental confidence in managing problematic lifestyle habits. The project aims to evaluate 1) the confidence of caregivers in addressing obesity-related behaviors in children with severe early-onset obesity and 2) the manifestations of lifestyle behaviors in children with and without clinically-defined impaired satiety in a specialized clinic. We hypothesized that caregivers would be least confident addressing the most problematic behaviors. The study also hypothesized that children with severe-early onset obesity and impaired satiety would exhibit more problematic food-related behaviors than those without clinically-defined impaired satiety.

Methods: Caregivers were recruited from a specialized clinic designed for pediatric patients with severe early-onset obesity to complete the Lifestyle Behavior Checklist (LBC). The LBC includes 25 questions evaluating parental perceptions of obesity-related behaviors and caregivers’ confidence in addressing them. Diagnosis of hyperphagia or satiety impairment was made clinically based on the presence of at least three abnormal eating behaviors across multiple settings and foods reported during the clinical encounter. Averages and standard deviations were reported for each perception and confidence item on the LBC, and t-tests identified statistically significant differences between caregivers of children with and without impaired satiety.

Results: Of the top five behaviors rated as most problematic, caregivers from this specialized clinic felt the least confident in managing four of them. Caregivers identified the top 3 problematic behaviors as excessive eating, requesting extra portions, and unhealthy snacking. Conversely, the least problematic behaviors included complaints about appearance, lack of friends, and food hiding. Parents were most confident addressing food-related yelling, excessive screen time, and food hiding. However, they exhibited the least confidence in managing excessive eating, eating quickly, and unhealthy snacking. Caregivers indicated children with clinically diagnosed impaired satiety had more problems with 12 of the LBC behaviors compared to those without clinically diagnosed impaired satiety. Additionally, the caregivers of children with impaired satiety showed significantly lower confidence scores in the mean confidence of 4 behaviors.

Conclusion: Caregivers from this specialized clinic have less confidence in managing the most problematic behaviors in children with severe early-onset obesity. Interestingly, the most problematic obesity-related behaviors require caregivers to act as gatekeepers limiting food. Thus, in addition to providing information on what lifestyle modifications to implement, there is a significant need to empower caregivers to manage food-related behaviors effectively. This need is amplified in those children with clinically-defined impaired satiety at this specialized clinic.