Abstract
Background
Parental awareness and involvement are crucial in managing obesity in children and adolescents. Although awareness of obesity-related health risks is increasing, public understanding of specific aspects remains limited. This study examines parental perceptions and practices regarding pediatric obesity in Korea.
Methods
An online survey was conducted from June 3 to 14, 2024, targeting 102 parents/guardians of children and adolescents who were overweight or obese according to the 2023 Student Health Examination results. The survey assessed experiences with medical consultations, awareness and management practices regarding obesity, awareness of related policies, and barriers and facilitators for obesity management.
Results
A significant gap exists between awareness and actual practice in managing pediatric obesity. Although 90.2% of the respondents recognized the importance of dietary and exercise management, the actual implementation rates were low (68.6% and 66.7%, respectively). Notably, 62.1% of respondents were unaware of any existing national policies or programs: 39.7% were aware of relevant policies, and only 35.3% were aware of related programs. Barriers to obesity management included a lack of awareness and motivation among children and adolescents, insufficient information for parents/guardians, and financial and time constraints. Facilitators of effective management include accurate diagnosis, coordination between schools and healthcare providers, and increased community support.
Conclusion
Combating pediatric obesity will require improved awareness and education, reduced financial burden, and the promotion of national policies. Strengthening coordination among schools, healthcare providers, and community resources will facilitate the successful management of obesity.
Keywords: Pediatric obesity, Surveys and questionnaires, Parents, Korea
INTRODUCTION
Medical awareness about the health risks associated with body weight is increasing due to research findings and education within the healthcare community. However, the extent to which the general public comprehends this information and how that comprehension affects childhood obesity or overweight conditions remain unclear.1 Childhood obesity is a complex issue that requires a multifaceted approach, and parental awareness of the impact of excess weight on children’s health is a critical aspect that must be considered.2
Rapid identification and intervention are crucial for children and adolescents who are overweight or at risk of becoming overweight to prevent obesity from persisting into adulthood. Parents play a critical role in this process; if they fail to recognize that their child’s weight is an issue, the likelihood of delayed intervention increases. To effectively reduce childhood obesity, it is essential for parents to understand how healthy eating habits and physical activities can support their children in leading healthy lives.3,4
Despite the critical role that they play in managing pediatric obesity, the parents of overweight or obese children and adolescents often face significant challenges in addressing weight issues.5 Moreover, although parental involvement is essential for preventing pediatric obesity, research on effective strategies for encouraging parents to foster long-term behavioral and environmental changes for their children is notably lacking.6
One study from the United States7 explored parents’ understanding of the health risks associated with being overweight, knowledge of healthy eating habits, and perceptions of their children’s obesity. Insights into cultural influences on obesity perceptions were offered by research examining how Hispanic parents viewed weight among preschool-aged children.8 Additionally, a study involving Iranian mothers9 investigated their knowledge, attitudes, and practices toward pediatric obesity. In South Korea, a study was conducted among obese individuals at health promotion centers in general hospitals to explore perceptions of obesity, lifestyle modifications, and associated factors.10 A survey of Korean high school students assessed their awareness of obesity and examined its relationship with their lifestyle habits.11 Also, a secondary data analysis in South Korea examined the influence of parental weight, parental perceptions of their child’s weight, and parental dietary habits on the prevalence of pediatric obesity.12 However, limited recent research has been conducted in South Korea. In particular, a comprehensive survey of parental awareness of various national-level obesity-related policies and programs for children and adolescents in South Korea has not yet been conducted.
In this research, we investigated the awareness and management practices of parents/guardians with overweight or obese children and adolescents in South Korea, while also gathering their opinions on areas requiring improvement. To our knowledge, this was the first nationwide survey in South Korea to explore parental perceptions of pediatric obesity, and thus we address an area previously unexplored in the literature.
METHODS
Ethical considerations
This study was approved by the Institutional Review Board of the National Evidence-based Healthcare Collaborating Agency, Seoul, Korea (Approval Number: NECAIRB23-015, NECAIRB24-006). All participants provided informed consent prior to participation.
Participants and recruitment
The survey was conducted by Hankook Research, a professional firm, using a web-based method. This study targeted parents/guardians who share daily life and residence with children classified as overweight or obese in the 2023 Student Health Examination for 1st and 4th grade elementary school students (7 and 10 years old, respectively) and 1st grade middle school students (13 years old).
The sample was selected from a general panel maintained by the research firm, with stratification based on school grade (2nd and 5th grades of elementary school, and 2nd grade of middle school in 2024) and residential area (metropolitan and non-metropolitan regions), resulting in six strata for sampling. This study defined metropolitan areas as Seoul, Gyeonggi, and Incheon and non-metropolitan areas as all other regions.
Online survey
A comprehensive review of both domestic and international literature was conducted to investigate the current status of research, policies, and interventions related to childhood and adolescent obesity. Following that review, a draft of the survey questions was prepared, and a validity assessment was performed through consultations with experts, which informed the design of the survey questions. Subsequently, a pilot study with a group of experts was conducted to refine the survey, leading to the final selection of items for the main survey.
The survey collected the following information: characteristics of the participants and their children; experiences with medical consultations related to obesity; channels for obtaining information about obesity; parental awareness and management practices regarding obesity; awareness of national policies related to pediatric obesity; and barriers and facilitators to the prevention, management, and treatment of pediatric obesity. The survey period ran from June 3 to June 14, 2024, and the target was 102 respondents. Given that 30,516 students underwent the Student Health Examination in 2023, the sample size was calculated with a 95% confidence level and a 10% margin of error, resulting in a required sample size of 96. In total, 102 participants were recruited to account for the anticipated dropout rate. To promote participation, we offered a mobile gift voucher worth 10,000 Korean won to those who completed the survey.
Data analysis
Quantitative data collected from the survey were analyzed using descriptive statistical methods (e.g., mean±standard deviation). The body mass index (BMI) z-scores for children and adolescents were calculated based on the height and weight values provided by the survey respondents. Reference values for the scores were determined according to the children’s age and sex, using the 2017 Korean National Growth Charts as the standard.
The results obtained from the multiple-response options were weighted according to the order of importance and are presented as weighted rankings. For example, when there were five items, higher scores were assigned based on their importance: first priority (five points), second priority (four points), third priority (three points), fourth priority (two points), and fifth priority (one point).
RESULTS
Characteristics of the participants and their children
We gathered survey responses from 102 parents; 54.9% were fathers and 45.1% were mothers. The participants were stratified by their children’s age group as follows: 34 second-grade respondents (8 years old, born in 2016), 34 fifth-grade respondents (11 years old, born in 2013), and 34 second-year middle school respondents (14 years old, born in 2010). The respondents were evenly distributed between metropolitan and non-metropolitan areas, with each area constituting 50.0% of the sample. In the metropolitan areas, participants were from: Seoul (30.4%) and Gyeonggi Province (19.6%). The participation rates in non-metropolitan regions were as follows: Busan (6.9%), Daegu (7.8%), Gwangju (2.9%), Daejeon (4.9%), Ulsan (2.0%), Sejong (2.9%), Gangwon-do (3.9%), Chungcheongnam-do (1.0%), Jeollabuk-do (1.0%), Jeollanam-do (2.0%), Gyeongsangbuk-do (3.9%), and Gyeongsangnam-do (10.8%). The characteristics of the respondents and their children are presented in Table 1. Using height and weight information reported by the parents, the children and adolescents were classified as overweight or obese (Table 2).
Table 1.
Characteristics of the respondents and their overweight/obese children
| Characteristic | Sample size (n=102) |
|---|---|
| Children and adolescents | |
| Grade | |
| Elementary school 2nd | 34 (33.3) |
| Elementary school 5th | 34 (33.3) |
| Middle school 2nd | 34 (33.3) |
| Sex | |
| Male | 65 (63.7) |
| Female | 37 (36.3) |
| Parents | |
| Age (yr) | 44.5 ± 5.7 |
| Parental role | |
| Father | 56 (54.9) |
| Mother | 46 (45.1) |
| Residence | |
| Metropolitan area* | 51 (50.0) |
| Non-metropolitan area | 51 (50.0) |
| Education level† | |
| High school degree | 14 (13.7) |
| Bachelor’s degree | 72 (70.6) |
| Graduate degree or higher | 15 (14.7) |
| Medical Aid recipients and near-poverty individuals† | |
| Yes | 5 (4.9) |
| No | 90 (88.2) |
| Not sure | 4 (3.9) |
| Single-parent household† | |
| Yes | 7 (6.9) |
| No | 94 (92.2) |
| Dual-income household‡ | |
| Yes | 70 (74.5) |
| No | 24 (25.5) |
Values are presented as number (%) or mean±standard deviation.
*The metropolitan areas were Seoul, Incheon, and Gyeonggi Province; †Participants were permitted to leave responses unanswered; ‡This investigation included the 94 respondents who indicated they were not single parents.
Table 2.
Baseline demographic and anthropometric data of overweight/obese children
| Variable | Height (cm) | Weight (kg) | BMI (z-score) |
|---|---|---|---|
| Elementary school 2nd | |||
| Male (n = 23) | 132.7 ± 8.4 (120.0 to 156.0) | 41.6 ± 7.4 (30.9 to 60.0) | 2.51 ± 0.8 (0.78 to 4.03) |
| Female (n = 11) | 133.2 ± 11.0 (122.0 to 152.0) | 44.2 ± 10.8 (35.0 to 70.0) | 2.81 ± 0.9 (2.81 to 4.35) |
| Elementary school 5th | |||
| Male (n = 21) | 140.0 ± 7.1 (140.0 to 162.0) | 57.6 ± 9.1 (45.0 to 75.0) | 2.05 ± 0.8 (0.79 to 3.86) |
| Female (n = 13) | 150.3 ± 7.3 (140.0 to 162.0) | 56.0 ± 7.7 (45.0 to 70.0) | 2.06 ± 0.9 (0.47 to 3.52) |
| Middle school 2nd | |||
| Male (n = 21) | 165.2 ± 6.4 (155.0 to 177.0) | 72.3 ± 8.3 (54.0 to 80.0) | 1.74 ± 0.8 (–0.08 to 3.01)* |
| Female (n = 13) | 160.0 ± 2.9 (153.0 to 164.0) | 63.0 ± 7.9 (52.0 to 78.0) | 1.42 ± 1.0 (0 to 3.72) |
Values are presented as mean±standard deviation (maximum to minimum).
*One boy was found not to be classified as overweight/obese based on the BMI z-score.
BMI, body mass index.
Experience with medical consultations related to obesity
After their children were diagnosed as overweight or obese during the Student Health Examination in 2023, 69 parents (67.6%) reported that their children underwent additional blood tests. Among them, 39 (56.5%) had abnormal results, and among those children, 28 (71.8%) sought medical treatment for obesity. An examination of the types of healthcare institutions visited by the 28 students revealed that 46.4% attended hospitals or general hospitals, and 42.9% visited primary clinics. Pediatrics was the most prevalent medical specialist (67.9%), followed by internal medicine (21.4%) and family medicine (10.7%).
Channels for obtaining information on obesity
The respondents were asked about the primary channels through which they acquired information about obesity management. Using a multiple-response format, the data were analyzed by applying the weighted importance to each ranked option. The top-ranked channel was internet (e.g., portals and websites), followed by social media (e.g., social network service: KakaoTalk, YouTube, Facebook, Instagram, and TikTok) and acquaintances, family members, or friends, in that order.
Parental awareness and management practices regarding obesity
Approximately 58.8% of the parents reported knowing their child’s appropriate weight. When asked about the frequency with which they monitored their child’s weight, 37.3% indicated that they checked weekly, and 23.5% checked monthly, but 12.7% stated that they did not monitor their child’s weight at all.
Regarding obesity prevention and management, 90.2% recognized the need for dietary control; however, only 68.6% implemented dietary changes after their child was diagnosed as overweight or obese, indicating a gap between awareness and action (Fig. 1). The most commonly cited reasons for not implementing dietary control were: concerns about the child’s growth phase (40.6%), the child finds it difficult (31.3%), and parents too busy to manage it properly (25.0%). Among those who initiated dietary control, 64.3% discontinued treatment within 6 months.
Figure 1.
(A) Awareness and management status of pediatric obesity. (B) Awareness of obesity-related complications and consensus on the need for active treatment. *The level of awareness was assessed using a 5-point scale: +++ (well aware), ++ (aware), + (moderately aware), – (unaware), –– (completely unaware); †The level of agreement was assessed using a 5-point scale: +++ (strongly agree), ++ (agree), + (neutral), – (disagree), –– (strongly disagree).
A similar trend was observed for exercise management: 90.2% recognized its necessity, but only 66.7% implemented it after their child was diagnosed (Fig. 1). The primary reasons for not engaging in exercise management were: the child dislikes exercise (34.4%), perceived lack of need for additional exercise (34.4%), and lack of time due to being busy (28.1%). Among parents who initiated exercise management, 55.9% discontinued exercise within 6 months.
The assessment of awareness about the potential complications of obesity (e.g., type 2 diabetes mellitus, hypertension, dyslipidemia, and non-alcoholic fatty liver disease) revealed variations in knowledge levels: 93.1% were aware of the risks, and 92.2% recognized the potential danger of developing such complications. Consequently, 99.9% agreed on the need for active treatment for pediatric obesity, including medical services and professional assistance (Fig. 1).
Public awareness of national policies related to pediatric obesity
In South Korea, various national policies and programs have been established and implemented to address pediatric obesity. Our investigation focused on parental awareness of six key policies and four representative programs. Three of the policies have been implemented by the Ministry of Health and Welfare (MOHW): the National Comprehensive Plan for Obesity Management, National Health Promotion Plan, and Basic Plan for National Nutrition Management. The Basic Plan for Student Health Promotion is jointly administered by relevant ministries. The School Physical Education Promotion Plan is led by the Ministry of Education (MOE), and the Comprehensive Plan for Children’s Dietary Safety Management is overseen by the Ministry of Food and Drug Safety (MFDS). The four programs are the Healthy Care Playground led by the MOHW, the Healthy Fitness Class supervised by the MOE, the Sports Class Voucher Program managed by the Ministry of Culture, Sports, and Tourism, and the Food Safety and Nutrition Education Support Program administered by the MFDS.
In our results, 62.1% of the respondents reported being unaware of any policies or programs related to pediatric obesity. When analyzed by category, 39.7% of the respondents indicated awareness of the relevant policies, and only 35.3% recognized the names of the associated programs. The survey results indicating the awareness levels for each policy and program are presented in Fig. 2.
Figure 2.
Levels of awareness of national policies and programs.
Barriers to the prevention, management, and treatment of pediatric obesity
Barriers to preventing, managing, and treating pediatric obesity were assessed using a ranked multiple-response format. The foremost barrier identified was a lack of awareness and motivation among children and adolescents, followed by a deficiency in parental/guardian knowledge about the severity of obesity. Financial constraints associated with dietary and exercise interventions for obesity management ranked third (Table 3).
Table 3.
Barriers to the prevention, management, and treatment of pediatric obesity
| Weighted ranking | Potential barriers | 1st | 2nd | 3rd | 4th | 5th |
|---|---|---|---|---|---|---|
| 1st | Lack of awareness and motivation among children and adolescents | 36 (35.3) | 16 (15.7) | 8 (7.8) | 12 (11.8) | 8 (7.8) |
| 2nd | Lack of knowledge, information, or awareness among guardians regarding the severity of obesity | 27 (26.5) | 24 (23.5) | 9 (8.8) | 1 (1.0) | 7 (6.9) |
| 3rd | Financial burden associated with diet and exercise for obesity management | 11 (10.8) | 23 (22.5) | 13 (12.7) | 16 (15.7) | 4 (3.9) |
| 4th | Lack of time among children, adolescents, and their guardians | 8 (7.8) | 8 (7.8) | 23 (22.5) | 10 (9.8) | 14 (13.7) |
| 5th | Financial burden associated with medical expenses for related treatments | 10 (9.8) | 9 (8.8) | 13 (12.7) | 11 (10.8) | 9 (8.8) |
| 6th | Insufficient guidance on participation in community programs (e.g., public health center programs and sports facilities) | 2 (2.0) | 12 (11.8) | 14 (13.7) | 8 (7.8) | 17 (16.7) |
| 7th | Insufficient prevention programs for pediatric obesity | 1 (1.0) | 2 (2.0) | 10 (9.8) | 11 (10.8) | 15 (14.7) |
| 8th | Lack of promotion and effectiveness of government policies or programs | 2 (2.0) | 5 (4.9) | 4 (3.9) | 9 (8.8) | 11 (10.8) |
| 9th | Exposure to media promoting binge-eating or cooking shows | 5 (4.9) | 2 (2.0) | 4 (3.9) | 8 (7.8) | 5 (4.9) |
| 10th | Deficiencies in the national screening system for pediatric obesity | - | 1 (1.0) | 4 (3.9) | 16 (15.7) | 12 (11.8) |
| Total | 102 (100.0) | 102 (100.0) | 102 (100.0) | 102 (100.0) | 102 (100.0) |
Values are presented as number (%). The results from the multiple-response options were weighted according to their level of importance and are presented as weighted rankings. Higher scores were assigned based on the relative significance of each item.
Facilitators for improving pediatric obesity management
Additionally, our survey asked about the essential support and services required to effectively address pediatric obesity. The findings indicate that the respondents’ highest priority was comprehensive obesity management, including precise diagnosis, comorbid condition assessment, and lifestyle modifications. The second highest priority was enhancing collaborative efforts between educational institutions and healthcare providers. The third highest priority involved expanding and sustaining community resources such as public health centers and recreational facilities (Table 4).
Table 4.
Essentials for the prevention, management, and treatment of pediatric obesity
| Weighted ranking | Support needed for obesity management | 1st | 2nd | 3rd | 4th | 5th |
|---|---|---|---|---|---|---|
| 1st | Accurate diagnosis, evaluation of comorbidities, and lifestyle modification for obesity management | 22 (21.6) | 17 (16.7) | 20 (19.6) | 9 (8.8) | 4 (3.9) |
| 2nd | Collaboration and communication between schools and medical institutions | 21 (20.6) | 21 (20.6) | 3 (2.9) | 7 (6.9) | 11 (10.8) |
| 3rd | Program expansion and continuous activation of existing community resources (e.g., public health centers and sports facilities) | 21 (20.6) | 12 (11.8) | 12 (11.8) | 6 (5.9) | 5 (4.9) |
| 4th | Reducing financial burden through insurance coverage for educational consultations with physicians | 10 (9.8) | 10 (9.8) | 14 (13.7) | 15 (14.7) | 5 (4.9) |
| 5th | Reducing financial burden through insurance coverage for obesity exercise prescriptions | 5 (4.9) | 11 (10.8) | 13 (12.7) | 14 (13.7) | 12 (11.8) |
| 6th | Reducing financial burden through insurance coverage for obesity nutrition counseling | 6 (5.9) | 9 (8.8) | 8 (7.8) | 18 (17.6) | 15 (14.7) |
| 7th | Coordination of participation in related activities/educational programs (e.g., youth centers, public health centers, and afterschool programs) | 5 (4.9) | 6 (5.9) | 5 (4.9) | 6 (5.9) | 14 (13.7) |
| 8th | Provision of educational materials, informational brochures, and promotional videos about obesity management | 5 (4.9) | 5 (4.9) | 5 (4.9) | 7 (6.9) | 10 (9.8) |
| 9th | Reducing financial burden through insurance coverage for obesity treatment medications (e.g., oral medications and injections) | 3 (2.9) | 4 (3.9) | 8 (7.8) | 4 (3.9) | 8 (7.8) |
| 10th | Strengthening of national screening systems | 2 (2.0) | 5 (4.9) | 4 (3.9) | 2 (2.0) | 7 (6.9) |
| 11st | Establishment of preventive programs | 1 (1.0) | 1 (1.0) | 8 (7.8) | 8 (7.8) | 4 (3.9) |
| 12nd | Strengthened promotion of government policies or programs | 1 (1.0) | 1 (1.0) | 2 (2.0) | 6 (5.9) | 7 (6.9) |
| Total | 102 (100.0) | 102 (100.0) | 102 (100.0) | 102 (100.0) | 102 (100.0) |
Values are presented as number (%). The results from the multiple-response options were weighted according to their level of importance and are presented as weighted rankings. Higher scores were assigned based on the relative significance of each item.
To assess the service needs of the parents of overweight and obese children and adolescents, we asked which healthcare services they would deem beneficial for obesity management if they were covered by health insurance. This assessment also used a ranked multiple-response format. The highest-ranked service was structured exercise programs with certified exercise specialists, followed by routine consultations with healthcare providers as the second priority. The third priority was ongoing nutritional counseling with registered dietitians, and the fourth priority was insurance-covered medications for obesity. If those needs were properly met, they could serve as key facilitators for pediatric obesity management.
DISCUSSION
Pediatric obesity arises from a complex interplay of multiple factors, making it difficult to resolve through individual efforts alone. Healthcare professionals emphasize the need for a comprehensive and integrated approach to treatment.13 Family-based behavioral strategies that include both dietary regulation and physical activity have been identified as effective interventions.14 Furthermore, family-based therapy improved weight loss outcomes not only for the affected children but also for their parents and siblings.15 This study offers valuable insights into parental awareness, perceptions, and challenges in managing pediatric obesity in South Korea. The significance of this study lies in its holistic examination of parental perceptions of various ongoing national policies related to pediatric obesity, filling a gap in the literature by providing a comprehensive assessment of parental awareness of multiple national initiatives.
Considering the crucial role of parental involvement in the prevention and management of childhood obesity and its impact on children’s health-related behaviors and outcomes,16 we surveyed parents of overweight or obese children and adolescents. Given regional disparities in pediatric obesity rates,17 participants were recruited from both metropolitan and non-metropolitan areas. To account for research findings that highlight a significant correlation between parental education levels and pediatric obesity, with household income serving as a crucial mediating factor,18,19 data were collected on parental education levels and whether the family was receiving medical aid or classified as a low-income household. Furthermore, in light of studies reporting a higher risk of pediatric obesity in single-parent households than in two-parent households,20,21 the survey included questions about single-parent status and whether both parents were employed (Table 1).
The survey results reveal that the primary sources of obesity-related knowledge for respondents were the internet, social media, and people around them. However, some obesity-related information on social media has been found to be incomplete or inaccurate. Low-reliability sources can negatively influence users’ obesity-related behaviors.22
The survey results about the awareness and management of pediatric obesity indicate that most respondents were aware of the importance of dietary regulation and exercise in preventing and controlling obesity. However, a significant gap remained between the awareness and actual practice. Various barriers, such as concerns about the child’s growth, reluctance on the child’s part, and time constraints, hinder the consistent implementation of treatment practices. To bridge this gap, it is essential to translate awareness into active steps. This highlights the need for comprehensive support systems that not only meet the needs of children but also equip parents with the resources, education, and time-management strategies required for effective obesity prevention and intervention. Such an approach is crucial for fostering sustainable behavioral changes that can significantly affect pediatric obesity outcomes.
This study also identified a substantial gap in public awareness of national policies and programs to combat pediatric obesity. Preventing and managing obesity requires an integrated and systematic approach, in addition to coordinated policy efforts across various government sectors.23 As part of a global initiative, an international analysis based on Global Matrix data recognized South Korea’s pediatric obesity prevention policies as effective. The evaluation criteria included government investment and support, policy implementation, impact on physical activity levels, alignment with global standards, and the long-term sustainability of the policies. South Korea, in particular, has been highly commended for its remarkable achievements in promoting active transportation (such as walking and cycling) and organized sports participation. Additionally, the country’s ability to translate diverse policies into concrete and actionable programs has been acknowledged.24,25 However, our survey results revealed a low level of public awareness of those policies and programs. Clearly, despite various implementation initiatives, more active promotion is necessary. Therefore, it is essential to identify and address the shortcomings and limitations of the current promotional strategies and develop targeted approaches to enhance public engagement and awareness.
Obesity is a complex disease arising from intricate interactions and responses involving social, environmental, and biological factors.26 Therefore, obesity management and treatment are influenced by a complex interplay of factors, necessitating a systematic approach to effectively address the various barriers involved. Multilevel interventions that promote healthy lifestyle behaviors within the community, school, and family settings have been demonstrated to effectively prevent pediatric obesity.27 Collaboration among homeroom teachers, school nurses, nutritionists, physical education instructors, and counselors is essential.28 Furthermore, collaboration between specially trained physicians and other healthcare professionals is crucial to effectively manage obesity and related diseases.29 Inter-organizational collaboration is crucial in community networks, and it is essential for all healthcare and public institutions to collaborate systematically.30,31
Effective collaborative relationships among government agencies, intermediaries, and within and across schools play a crucial role in managing pediatric obesity.32 Such partnerships not only support the implementation of health projects but also establish the foundation for a sustainable approach to long-term obesity management. Although some communities benefit from a well-developed physical activity infrastructure, significant regional disparities persist, limiting access in many areas. Addressing pediatric obesity requires that both children and their parents/guardians be engaged in the development of systematic and appealing programs tailored to the characteristics of local communities.33 According to Korean research, the domestic pediatric obesity prevention and management program showed low actual linkage, both between institutions and among professions within institutions, compared with its perceived importance.33
Our survey examining barriers to preventing, managing, and treating of pediatric obesity identified lack of awareness and motivation among individuals and insufficient knowledge among parents/guardians as significant challenges. Additionally, concerns about the cost and time associated with obesity management are prevalent. To effectively address these issues, it is crucial to shift the perception of obesity from solely an aesthetic concern to a medical condition that requires appropriate treatment. In 2013, the American Medical Association recognized obesity as a disease, highlighting its complex causes, including genetic, environmental, and behavioral factors. Despite that classification, acceptance remains limited among healthcare providers, patients, and the general public, largely because of the misconception that obesity is purely a behavioral issue related to willpower. Obesity is a chronic disease that requires long-term medical management and comprehensive treatment strategies.34
Providing reliable and accurate information about obesity management is essential for fostering this understanding. Treatments that help patients achieve therapeutic weight loss can reduce healthcare costs.35 In addition, implementing support measures to alleviate the financial and time burdens associated with obesity interventions is necessary to promote more effective management strategies.
In response to inquiries about the support and services necessary for effective obesity management, our respondents highlighted the need for an accurate diagnosis of obesity, evaluation of complications, and lifestyle modifications. This finding underscores the importance of access to appropriate medical services and professional support in managing obesity effectively. Many countries have implemented school-based policies and programs to promote a healthy weight.36 Integrating essential services such as regular consultations with healthcare providers, exercise therapy, and nutritional counseling into the national health insurance system could significantly alleviate the financial burden on families and enhance access to these vital services. Additionally, respondents stressed the importance of collaboration between schools and healthcare institutions and the expansion of community-level programs. A strong desire exists to address the financial challenges associated with preventing, managing, and treating obesity, emphasizing the need for suitable insurance reimbursement policies that support comprehensive obesity management strategies.
Future research should focus on practical solutions to the identified challenges by promoting a supportive environment through policy advocacy, public education, and professional support. By implementing these strategies, significant improvements can be achieved in reducing the prevalence of pediatric obesity and enhancing the long-term health outcomes of future generations.
This study has several limitations. First, all data were collected through self-reported responses from parents, which might have limited the accuracy of the information. One of the respondents’ children had a BMI z-score at the time of the survey indicating that he was not overweight or obese, which could reflect improvements following the diagnosis of overweight or obesity in 2023. Second, the survey was constrained by a limited sample size. Although we aimed to gather direct patient feedback and promote patient-centered care, our small sample size might have contributed to potential interpretative bias. Third, although socio-environmental factors of families were considered in the survey, the small sample size limited our ability to analyze differences based on those variables.
To effectively combat pediatric obesity, it is essential to enhance awareness and education while addressing the financial burden and structural barriers that impede effective management. Strengthening collaboration between schools and healthcare institutions and increasing community-level support requires concerted efforts from various stakeholders. This study highlights the importance of bridging the knowledge–practice gap and developing targeted interventions to enhance parental knowledge and motivation.
ACKNOWLEDGMENTS
This study was supported by the National Evidence-based Healthcare Collaborating Agency of the Republic of Korea (grant no. NECA-A-24-001).
We extend our sincere gratitude to the parents who participated in this survey. We also express our sincere gratitude to Professor Sochung Chung (Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine) for her invaluable feedback on the survey questionnaire and her insightful guidance throughout the research process. We thank Sujin Park (Department of Health Sciences, Graduate School, Korea University) for her essential contributions in conducting the pilot study and providing support for the validation of the survey.
Footnotes
CONFLICTS OF INTEREST
Yong Hee Hong is an editorial board member of the journal. But she was not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflicts of interest relevant to this article were reported.
AUTHOR CONTRIBUTIONS
Study concept and design: JJ, YL, MS, ARS, and YHH; acquisition of data: JJ and ARS; analysis and interpretation of data: JJ, YL, MS, ARS, and YHH; drafting of the manuscript: JJ and ARS; critical revision of the manuscript: JJ, ARS, and YHH; statistical analysis: JJ; obtained funding: YL; administrative, technical, or material support: JJ and ARS; and study supervision: ARS and YHH.
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