Careful conversations: an educational video to support parents in communicating about weight with their children

The prevalence of obesity amongst children in North America remains high, and has risen to over 17% [1, 2]. Further, in a population-based survey of over 10,000 adolescents between 13 and 18 years of age, lifetime prevalence of anorexia nervosa, bulimia nervosa, and binge eating, were notably prevalent with rates of 0.3, 0.9, and 1.6%, respectively [3]. While parents generally believe discussing the weight of their children is important, some parents can experience difficulties doing so, fearing that it may lower their child’s self-esteem, as stigmatization of obesity in youth may lead to harm and the development of unhealthy behaviours, such as binge eating and avoidance of health care services [4, 5]. This is reinforced by evidence suggesting that focusing on conversations involving weight or size may increase the risk of disordered eating behaviours, whereas an emphasis on growth and healthy behaviours is a more effective strategy for parents wishing to engage with their children [6, 7]. Few resources exist to guide these sensitive discussions.

Educational videos can be an effective tool to improve knowledge and self-efficacy on a given topic [8, 9]. However, the development and implementation of a video guiding parents who wish to engage in weight-related conversations with their child has not yet been studied. Accordingly, the objective of the present study is to create an educational video, and to assess the effect on parents’ self-efficacy for communicating about weight-related issues with their children. We hypothesized that the video would have a positive effect on parent’s self-efficacy with regards to raising the issue of weight with their children, and addressing questions their child may have about this topic.

This non-randomized, prospective, single arm pilot trial was conducted at the Hospital for Sick Children (SickKids), an urban pediatric academic hospital in Toronto, Canada. Approval for the study was granted by the SickKids Institutional Research Ethics Board.

In this study, we developed an educational video based on evidence, parental, and HCP feedback, and assessed its impact on parent’s self-efficacy in communicating about weight-related issues with their children. Parents’ perceived self-efficacy scores for “raising the issue of weight” with their children and “answering questions or concerns” increased significantly immediately after watching the video, however this returned to baseline at follow-up 4–6 months later. Although this effect was not maintained at follow-up 4–6 months later, no significant decline was observed, suggesting skill retention. Interestingly, compared with parents who showed no concern with their child’s weight, parents who had concerns about their child being overweight had significantly lower perceived self-efficacy scores for answering questions or concerns their child may have about their weight. Evaluation of the video indicated that parents were satisfied with its length and content, and a majority of parents felt that the information would change their behaviour.

The need for evidence-based educational resources on how to communicate about weight with their child was identified by parents in focus groups and through a scoping review [4, 7]. Research has also shown that when parents encourage their child to adopt healthy lifestyle behaviours, children are less likely to engage in unhealthy weight loss practices and are less likely to experience depressive symptoms [19]. In a study of 165 mother-daughter dyads where the mothers were actively encouraging their daughters to diet, the child was eight times more likely to diet, but many had unexpected body mass index percentile increases [20]. Emerging evidence also suggests that avoidance of weight-based teasing and negative commentary directed towards the child leads to more favourable psychological outcomes and fewer weight-control behaviours [21‐23]. These factors led to the video’s focus on developing healthy habits, rather than a focus on weight. Of note, perceived self-efficacy scores were lower for parents with overweight concerns for their child. Existing literature suggests that parents who view their children as being overweight are associated with their children viewing their body size negatively, leading to unexpected weight gain as a result of failed weight loss attempts [24]. The self-perception of being overweight has also been reported to increase the odds of medium and high psychological distress [25]. Moreover, a systematic review revealed that individual overweight perception was linked to disordered eating and increased weight gain over time, in some study groups [26]. Whether this diminished self-efficacy in parents with overweight concerns for their child translates to changes in behaviour remains to be determined.

To our knowledge, this is the first study to use a video to assess parents’ self-efficacy in initiating weight-related conversation with their children. In a previous study that made usage of a video-intervention program for parents with Prelingual Deaf and Hard-of-Hearing children, video intervention led to increases in parental sensitivity, child responsiveness, and reported self-esteem compared to the non-treatment baseline. It also encouraged more connected parent-child interactions [27]. The majority of our respondents were satisfied with our video’s duration and content (comprehensibility and presentation). These findings are in line with a previous report which found that the most effective educational videos are those that are brief and specific, provide complementary audio and visual elements, have embedded active learning, and have an enthusiastic conversational style [28]. The use of a video for education has additional potential benefits including translatability and inclusivity (narration can be done in different languages and closed captions can be included for the hearing impaired), accessibility, ability to self-pace and view on multiple occasions, as well as cost-effectiveness when compared to in-person teaching [29].

This study is not without limitations. Inclusion of a control cohort could have strengthened our findings. Due to the self-selected nature of the parent recruitment, extrapolation of results to other parent populations may be limited. It is possible that the self-selected recruitment biased participants to those who already had higher self-efficacy due to an interest in the topic, and to those less concerned about their child’s weight. Although we observed an improvement in self-efficacy post-video, we may have underestimated the potential effect of the video to increase self-efficacy. Respondents were relatively homogenous with respect to multiple demographic characteristics. This lack of diversity in the sample may reduce generalizability of the results. This study design makes use of participant self-assessment using a questionnaire, and some individuals may overrate their ability to perform a skill or task, and may have difficulty assessing how well or poorly they comprehend new material [30]. The video was designed to provide a general approach to communicating about weight with children of varying ages; more directed approaches toward younger versus older children and adolescents could be the subject of future work.

The strengths of this study include a 4–6 month follow-up to evaluate the longitudinal effects of the video on perceived self-efficacy. Additionally, the video seemed most effective for parents who identified concerns with their child’s weight, which is important, as these families may be most at risk of negative unanticipated consequences after discussing weight.

In summary, this pilot study demonstrated improvements in parents’ perceived self-efficacy for initiating weight-related conversations with their children and answering their questions after watching an evidence-based educational video. Future research in other parent populations (e.g. parents of children attending weight management programs, parents of diverse ethnicity etc.) as well as the clinical and behavioural outcomes of children whose parents have watched and successfully implemented the video’s teachings would provide further insight into the potential utility of this educational tool.