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Case study: Moms and childhood obesity

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  • Case study: Moms and childhood obesity

The following Paper 3 looks at the role of mothers in a child's eating and exercise behaviour.  It is a study that focuses on childhood obesity.  It is also a case study.  You will find sample responses at the end of the text.

I have used this Paper 3 as part of our study of obesity - a good way to discuss the role of environmental factors in childhood obesity.

Student copy

The stimulus piece

Health psychologists are interested in what is called the obesogenic environment - that is, the combination of environmental and biological factors that promote obesity in individuals or populations.  The environmental factors include the physical neighbourhood environment, media and advertising, food tax policies, access to health care and the home environment. The home environment and parenting can influence a child's health by shaping dietary and physical behaviours, such as providing access to fruits and vegetables or encouraging kids to play outside.

In this case study, Østbye and his team examined the relationship between the home environment and behaviours related to obesity -- dietary and exercise habits -- among preschoolers. The study was carried out in North Carolina from 2007 to 2011. Women were recruited from a previous study of overweight and obese women, also carried out by Østbye. In order to be in the study, the women had to have someone living in their home who shared parenting responsibilities (i.e., a “partner”).

The researchers studied data from 190 children, ages two to five, whose mothers were overweight or obese. They collected information from the mothers on the children's food intake, with foods rated as healthy or “junk food.”  To gauge their levels of physical activity, the children wore accelerometers for a week, which measured moderate to vigorous physical activity as well as sedentary time.

The mothers were asked to fill in a questionnaire which asked about family policies around food and physical activity, accessibility of healthy versus junk foods, availability of physical activity equipment, and whether they model healthy eating or exercise for their kids.

The researchers looked at socioeconomic factors of the mothers, including their education levels and whether they worked, to see if this had an effect on the children's behaviours. The mother's socioeconomic factors did not affect their kids' physical activity but had mixed results when it came to their dietary habits. Among children of mothers with no college education and not working, limiting access to unhealthy foods and role modelling reduced 'junk' food intake scores whereas parental policies supporting family meals increased 'junk' food intake scores.  Overall, the home environment had more influence on the children's dietary habits than on their physical activity levels.

Østbye, T, R Malhotra, M Stroo, C Lovelady, R Brouwer, N Zucker, B Fuemmeler. The effect of the home environment on physical activity and dietary intake in preschool children. International Journal of Obesity, 2013; DOI: 10.1038/ijo.2013.76

Questions

1a. Identify the method used and outline two characteristics of the method.

The study was a case study.  A case study uses method triangulation - in this case, data was gathered by using the accelerometers as well as from questionnaires given to the mothers.  Case studies are also longitudinal in nature.  The study was carried out over a four-year period, from 2007 to 2011.  This is important because it allows researchers to see change over time.

1b. Describe the sampling method used in the study.

The sampling method was a volunteer sample taken from a sample of opportunity.  The women had already taken part in a different study and volunteered to take part in this study.  BTW - the original study was a study of post-partum intervention methods.  It would be interesting for your students to think about how this might have influenced the outcome of this study!

1c. Suggest an alternative or additional research method giving one reason for your choice.

One alternative might be an experiment.  Mothers could be randomly allocated to either a daily exercise routine or no routine.  They could then see if this had an effect over time on the exercise habits of the child. The reason for this is that the self-reporting in the questionnaires could be open to optimism bias where the mother overestimates the amount of physical activity that she does.  This could be a reason why this did not have a significant effect on the child's behaviour.

2. Describe the ethical considerations that were applied in the study and explain if further ethical considerations could be applied.

Consent would need to be obtained from the parents.  The children's consent would be obtained from the parents.  The consent would need to include an overview of their rights, as well as an explanation of the goals of the study and how this data would be used.  All information would have to be anonymous - meaning the names of the individuals, as well as any information that may lead to their identification, would have to be protected.  The questionnaires should be anonymized by using coding.  The mothers and their children would have the right to withdraw at any time. There is no deception being used in the study, although this may mean that demand characteristics may influence the results of the self-reported survey data. There is no undue stress or harm in the study as the sample is voluntary and is aware of the goals of the study.  Finally, the researchers would have to debrief their participants.  Part of the debriefing would be to share their findings with the participants with the goal of informing them about ways to improve the health of their children.

3. Discuss the possibility of generalizing/transferring the findings of the study.

There are three ways in which the study could be generalized - to the population from which the sample is drawn, to another population and to theory.

It is questionable to what extent the study's findings can be generalized to the sample from which it was drawn.  Since the study was a volunteer sample, there may be characteristics of the women that may influence the findings of the study. It may be a higher level of confidence or extraversion, for example. It is also not clear from the stimulus piece how many women were in the original study or the characteristics of those women.  It is not clear if this sample is a fair representation of the women in the original study, or if the sample is large enough to make a generalization.

As for transferring the findings to other populations, there are several variables to consider.  The study is of the obesogenic environment, but only considers the role of the mothers in eating and exercise behaviour.  In transferring the findings one would have to consider the neighbourhoods in which the children are being raised - are they more urban or more rural?  What does "outdoor time" look like?  Are there playgrounds available? In addition, it is not clear from this study how many of the children were in preschool.  Different communities may or may not have the same access to early education and this may influence the transferability of the results.  Finally, one would have to consider cultural factors.  The US is a highly individualistic society which also tends to have a small family size.  A more collectivistic society where there are typically larger families and more support from extended family may have different results.

The study encourages further study of the role of parents in eating and exercise behaviour. More research should be done on the role of social cognitive theory in exercise behaviour - and the potential that mothers may not play as strong a role in exercise behaviour as expected. In addition, theory could be generated about the importance of early interaction with a primary caregiver on the development of obesity and subsequent health in adulthood.