2.2 Measures

BMI z-score and waist circumference were the primary outcomes for this study. Adolescents’ height and weight were used to calculate BMI and were collected by trained research personnel, using a Shorr Height Measuring Board (Olney, MD) and Seca 770 Model scale (Vogel and Halke, Hamburg, Germany), respectively. Participants removed their shoes and excess clothing (e.g., jackets, sweaters), and measurements were taken twice and averaged to ensure accuracy. In accordance with the Childhood Obesity Working Group of the International Obesity Taskforce, crude BMI was calculated (BMI = weight in kilograms / height in meters²) and transformed to z-scores using the lambda-mu-sigma (LMS) method (Flegal & Cole, 2013; Vidmar, Carlin, Hesketh, & Cole, 2004). Using the 2000 Centers for Disease Control and Prevention Growth Charts as reference (Kuczmarski et al., 2002), z-scores (zBMI) were standardized by age and sex.

Waist circumference was measured in triplicate to the nearest tenth of a centimeter using a Tech-Med Model #4414 fiberglass measuring tape (Hauppage, NY), and averaged for precision. After loosening or adjusting their own clothing, participants pointed to their navel to guide accurate measurement of their waist. Measurements were taken at the level of the navel while the participant stood, breathing normally.

The Child Feeding Questionnaire (CFQ; Birch et al., 2001) is 31-item self-report measure of caregivers’ perceptions and concerns related to child obesity and their use of controlling feeding practices. The questionnaire comprises seven subscales, each rated on a corresponding 5-point (0–4) Likert-type scale. Subscale scores represent the mean of each respective domain, with higher scores indicating greater endorsement of the domain: (1) perceived responsibility, 3 items measuring caregiver’s perceived responsibility for quality and quantity of food served to their child; (2) concerns about child weight, 3 items measuring caregiver’s concerns about child’s risk for obesity; (3) monitoring, 3 items assessing caregiver oversight and tracking of child’s intake of unhealthy foods (e.g., high fat snacks); (4) restriction, 8 items assessing caregiver’s regulation of unhealthy foods (e.g., sweets) that may contribute to obesity risk; (5) pressure to eat, 4 items measuring caregiver insistence that their child eat enough food; (6) perceived parent weight, 4 items querying caregiver’s perception of their own weight status; (7) perceived child weight, 6 items assessing caregiver’s perception of child’s weight status. The present study did not use the perceived parent weight or perceived child weight subscales. The remaining subscales demonstrated acceptable internal consistency (Cronbach’s alphas range .71–.93).

Basic demographic information was obtained in a brief interview conducted with the caregiver at the JHS-KIDS clinic site. Information obtained included child age, sex, race/ethnicity, and medical history. Additionally, caregiver’s highest level of education completed and relationship to the adolescent participant were collected.