A Positive Deviance Approach to Early Childhood Obesity: Cross-Sectional Characterization of Positive Outliers

Abstract

Objective: Positive deviance methodology has been applied in the developing world to address childhood malnutrition and has potential for application to childhood obesity in the United States. We hypothesized that among children at high-risk for obesity, evaluating normal weight children will enable identification of positive outlier behaviors and practices.Methods: In a community at high-risk for obesity, a cross-sectional mixed-methods analysis was done of normal weight, overweight, and obese children, classified by BMI percentile. Parents were interviewed using a semistructured format in regard to their children's general health, feeding and activity practices, and perceptions of weight.Results: Interviews were conducted in 40 homes in the lower Rio Grande Valley in Texas with a largely Hispanic (87.5%) population. Demographics, including income, education, and food assistance use, did not vary between groups. Nearly all (93.8%) parents of normal weight children perceived their child to be lower than the median weight. Group differences were observed for reported juice and yogurt consumption. Differences in both emotional feeding behaviors and parents' internalization of reasons for healthy habits were identified as different between groups.Conclusions: We found subtle variations in reported feeding and activity practices by weight status among healthy children in a population at high risk for obesity. The behaviors and attitudes described were consistent with previous literature; however, the local strategies associated with a healthy weight are novel, potentially providing a basis for a specific intervention in this population.

Eat, play, view, sleep: Exploring Mexican American mothers' perceptions of decision making for four behaviors associated with childhood obesity risk

“…Similar to other research with Latino mothers, 22,40 participants in this study seemed to value family dinners, and most mothers reported eating dinner with their children. However, most participants reported that their child ate breakfast with siblings but without a parent.…”

“…Other studies have found children’s food preferences to be a primary determinant of mothers’ child feeding decisions. 17 For instance, in a qualitative study of Latino parents of preschoolers, Foster et al 40 observed that parents of healthy weight children appeared to offer only healthy foods when they provided options to their children and to have a greater sense of control over food decisions, whereas parents of obese children seemed to feel less control over their children’s food choices and a greater tendency to respond to their children’s food preferences. Consistent with other research, 41 participants’ qualitative comments suggest that children’s prior intake may have also influenced the foods that mothers provided.…”

A county-level cross-sectional analysis of positive deviance to assess multiple population health outcomes in Indiana

“…[1][2][3][4] Persons facing social or economic obstacles to good health may nevertheless practise health-promoting behaviours when those behaviours are viewed as acceptable, affordable, effective and consistent with local culture. [5][6][7] In this study, we extend the idea of positive deviance from characteristics of individuals to those of communities 8 and hypothesise that communities may also possess collective attributes that allow them to outperform expectations given traditional risk indicators.…”

“…Another study, conducted in a largely Hispanic community in Texas at high risk for childhood obesity, found unique feeding behaviours and healthy habits among parents with normal weight children. 1 However, it may be the case that features of communities can influence collective personal decisions about health behaviours, leading to positive deviant outcomes at the level of the group. Research on community-level positive deviance is sparse.…”

A randomized clinical trial of the effects of parent mentors on early childhood obesity: Study design and baseline data

“…We recently completed a pilot study to examine the potential for identifying positively deviant behaviors and practices regarding childhood weight status in south Texas [7]. We subsequently designed the randomized clinical trial (RCT) reported herein to test whether these identified behaviors and practices could be implemented in an intervention using peer mentors.…”