Parent Perspectives on the 2023 Clinical Practice Guideline for Pediatric Obesity: A Mixed-Methods Study of Acceptance and Concerns.

BACKGROUND: The 2023 Clinical Practice Guideline for pediatric obesity recommends immediate, intensive treatment, including behavioral therapy, medications, and surgery when indicated. Understanding parental agreement with the guideline is critical for successful implementation. OBJECTIVE: To evaluate parental awareness of and agreement with the guideline. METHODS: Parents (n = 150; 62.9% female; 75.5% White; Mage = 37.6 ± 7.4 years) completed an online survey assessing guideline awareness and agreement. K-means cluster analysis identified parent subgroups based on agreement patterns. Linear regression examined predictors of agreement (e.g., parent age, BMI). Inductive content analysis explored underlying perspectives. RESULTS: Few parents (5.3%) were aware of the guideline before the survey. Cluster analysis identified three subgroups: Guideline Skeptics (34%; broadly disagreed), Selective Supporters (28%; mostly agreed but opposed medications and surgery), and Guideline Supporters (38%; broadly agreed). Higher parental BMI predicted lower agreement (β = -0.20, p = 0.018). Qualitative findings added nuance to parents' preference for lifestyle changes, highlighted concerns about mental health and eating disorders, and emphasized parental responsibility in the development and treatment of obesity. CONCLUSIONS: Parental agreement with the guideline varies widely. While most support behavioral treatment, many express concerns about medications and surgery, and a subset of "Guideline Skeptics" reject core principles such as the use of BMI. Tailored implementation strategies are needed to address these diverse views.

Duke Scholars

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