5-2-1–Almost None: Parents’ Perceptions of Changing Health-Related Behaviors in Their Obese Child


Michael Campbell, PhD, LCSW; Jane M Benton, MD; Lloyd N Werk, MD, MPH

Summer 2009 - Volume 13 Number 3



Objective: Recent clinical pediatric practice guidelines reiterate the importance of key messages to prevent childhood overweight and obesity, including the consumption of at least five servings of fruits or vegetables each day, a limit to screen time (time spent watching TV, using a computer, and playing video games) of two hours or less per day, engagement in at least one hour of physical activity per day, and the consumption of no sugary beverages each day. The perceptions of primary caregivers of obese children of these key messages are less clear. We explored parents' (or caregivers') awareness of and confidence in adopting a variation of the expert committee's recommended (5-2-1–Almost None [AN]) behaviors.

Materials and Methods: Before the initiation of treatment, parents of obese children completed a survey designed to explore their awareness of and confidence in adopting 5-2-1–AN behaviors. Qualitative and quantitative analyses were conducted to assess how aware these families are of 5-2-1–AN behaviors and how confident they would be of their ability to guide adoption of these specific behaviors.

Results: Parents from 193 families indicated that weight management depends substantially on physical activity (63%). However, parents rated as less important consuming fruits and vegetables (17%), controlling portions (13%), eliminating sugary drinks (4%), reducing screen time (3%), eating breakfast each morning (1%), and having family dinners (1%). Almost universally, respondents reported significantly reduced confidence in helping their child adopt nonspecific lifestyle changes in eating and physical activity versus the targeted behaviors identified in 5-2-1–AN.

Conclusion: Parents surveyed for this clinical study readily accept certain aspects of the 5-2-1–AN message as factors in healthy living. Despite low levels of reported awareness of the message, the consumption of almost no sugary drinks was the only actionable behavior in the 5-2-1–AN message that parents felt significantly more confident they could achieve than the nonspecific goal of improved eating. These perceptions can be used to help guide the adoption of 5-2-1–AN strategies as well as help clinicians target messages for specific healthy behavior adoption.


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