Adolescents' with type 2 diabetes perceptions of their weight status

Nutrition Research Newsletter, March, 2008

Over 80% of children with type 2 diabetes are overweight or at risk for becoming overweight. Critical to modifying diet and physical activity is the recognition by overweight children and their parents that the child is overweight and therefore at risk for serious negative health consequences. Adolescents under physicians' care for type 2 diabetes should be aware they are overweight and understand the importance of self-care behaviors to reduce weight and prevent complications, as should their parents. To determine whether weight perceptions are related to self-care behaviors, researchers examined the associations between weight perceptions of adolescents with type 2 diabetes and their parents, and self-report of diet and exercise behaviors and perceived barriers to performing these behaviors.

The sample consisted of adolescents aged 12-20 years with type 2 diabetes and their parents/primary caregivers. Via telephone interview, parents provided information on demographics, the adolescent's diabetes regimen, perceptions of the adolescent's weight, the adolescent's self-care behaviors, and perceptions of barriers to self-care. Adolescents telephone interviews included the same questions, with additional questions about perceived barriers to healthy diet and exercise behaviors.

Investigators calculated adolescents' BMI using actual weight from medical records and categorized it using current Centers for Disease Control (CDC) recommendations. They assessed both parents' and adolescents' reports of the adolescents' diet and exercise behaviors.

The study included 104 participants. Parents were 85% mothers, 8.5% fathers, and 6.5% other guardians. The adolescents' mean weight was 100.3 kg (220.7 lbs). Most (69%) were female, and 47% were African American. Based on CDC guidelines, 87 of adolescents were classified as overweight, and an additional 5.9% were at-risk for overweight. Mean A1C levels were 7.7[ or -]2.6%. Only 41% of parents and 35% of adolescents considered the adolescent "very overweight." Among parents who reported their child's weight as "about right," 40% had children whose BMI was 95th percentile; 55% of adolescents who reported their weight as "about right" had BMI 95th percentile. Adolescents were more likely to underestimate their weight when their parents also underestimated weight than when parents accurately perceived weight (66.2 vs 34.2, P.001).

Girls were more likely than boys to underestimate the severity of their weight. Compared with parents who either correctly estimated or overestimated the adolescents' weight, those who underestimated their adolescents' weight were less likely to report good dietary behaviors. Similarly, adolescents who underestimated their weight were significantly less likely to report good diet behaviors. The pattern was similar, but weaker for physical activity behaviors.

This study found that the poor recognition of overweight seen among overweight adolescents is also seen in adolescents with type 2 diabetes. Addressing misperceptions of weight by adolescents and their parents may be an important first step to improving weight in these patients.

A. Skinner, M. Weinberger, S. Mulvaney, et al. Accuracy of perceptions of overweight and relation to self-care behaviors among adolescents with type 2 diabetes and their parents. Diabetes Care. 31;227-229 (February, 2008). [Correspondence. Dr. Skinner, University of North Carolina at Chapel Hill, CB 7411, Chapel Hill, NC 27599-7411. E-mail: asheley@unc.edu]