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 involves hyperphagia, characterized by insatiable hunger and shortened satiety duration. Treatment generally requires caregivers to adjust their child's diet and exercise, but research on caregiver confidence in managing these changes is limited. This study aims to assess: 1) caregivers' confidence in addressing obesity-related behaviors in children with severe early-onset obesity and 2) differences in lifestyle behaviors between children with and without impaired satiety at a specialized clinic. Methods Caregivers from a specialized pediatric obesity clinic completed the Lifestyle Behavior Checklist (LBC), a 25-question tool evaluating their perceptions and confidence in managing obesity-related behaviors. Diagnoses of hyperphagia or impaired satiety were based on clinical ascertainment of at least three abnormal eating behaviors across multiple settings. Data were analyzed using averages, standard deviations, and non-parametric Mann-Whitney tests to compare responses between caregivers of children with and without impaired satiety. Results Caregivers felt least confident managing four of the five most problematic behaviors. They identified excessive eating, requesting extra portions, and unhealthy snacking as the top 3 problematic behaviors. 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. Parents rated 16 behaviors as more problematic in children with impaired satiety compared to those without, and their caregivers reported significantly lower overall confidence. Conclusion Participants showed reduced confidence in managing the most challenging behaviors related to severe early-onset obesity. These challenging behaviors often involve controlling food intake. Therefore, alongside providing information on lifestyle changes, there is a need to enhance caregivers' ability to manage food-related behaviors, especially for children with impaired satiety.