Obtaining written consent prior to any study enrolment is an ethical issue and especially
important when a study focuses on vulnerable population groups, such as children. However, parental willingness to participate in a study focused on children can significantly distort findings and lead to false conclusions. This is especially important for inflating childhood obesity rates, when interventions rely on such results could fail greatly.
We compared state of nourishment (based on IOTF criteria) and cardiometabolic risk of 226 children for which parental active consent (45.1%) or passive consent (54.9%) was provided. In the active consent group, state of nourishment for boys was underestimated, while for girls, underweight and normal weight were overestimated, and overweight and obesity were underestimated. Parents with obese children (p=0.019) and parents of a male child (p=0.017) were more likely to provide passive consent. In the passive consent group, children had higher cardiometabolic risk (p=0.017).
Unemployment (p<0.001) and high-school diploma, especially for mothers were indicators of passive consent. Interestingly, all parents with the lowest and the highest education level provided passive consent. Our findings clearly show distorted prevalence rates of overweight/obesity in children as a result of parental willingness to participate in the study, which are mediated with parental education and employment status. More effort is needed to obtain representative data on such an important public health problem like childhood obesity.
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