Comment on “Misaligned Attitudes and Perceptions Among Adolescents Living With Obesity, Caregivers and Healthcare Professionals: <scp>ACTION</scp> Teens Australia Survey Study”

Cathy Kwok et al.'s article, “Misaligned Attitudes and Perceptions Among Adolescents Living With Obesity, Caregivers and Healthcare Professionals: ACTION Teens Australia Survey Study”, [1] highlights key perspectives on adolescent obesity. Conversely, the low adolescent-caregiver pairing, however, does not permit inferences about actual within-family perception differences, which are key to guided interventive efforts. The percentage of matched pairs reported among adolescents and caregivers is 11 and 12 respectively. Nevertheless, the authors often compare the adolescent and caregiver views by treating them as relational dyads. This poses a significant threat of ecological fallacy, in which the comparison of the groups is incorrectly equated to discordance at the individual level. As an example, comparing adolescent-reported concerns about future health (69%) with misalignment compared with caregiver-reported perception (50%) may not indicate any reality within the particular adolescent and caregiver relationships. A clearer approach is given by Rhee et al. (2005), who assigned parents deliberately to their own children and discovered a substantial variance in the comprehension and concern of obesity when evaluated within the pairs—an observation that inspired the development of communicational involvement procedures among family members [2]. In a study based in the UK, Lucas et al. (2020) applied matched adolescent parent responses to obtain concordance scores, which permitted valid deductions regarding intra-family disagreement [3]. Although a large sample allows ACTION Teens to generalise, this advantage is associated with the disadvantage of internal validity when explaining interpersonal misalignments. The shortcoming is recognised by the authors themselves; still, they construct the main part of the discussion and suggestions regarding caregiver miscommunication with adolescents without having an in-depth analysis of a dyad. One possible solution available to future variations of the ACTION Teens study or other studies of this nature would be to implement a dyad-based study design in which paired answers would be obtained and the intra-dyad perceptual difference would be calculated. Albeit logistically more complicated, this method provides granular and clinically applicable information to improve family-centred interventions [4, 5]. The study by ACTION Teens Australia identifies key impediments to successful adolescent obesity management, but the interpretation derived would greatly benefit from the use of the dyadic methodology. Without knowing who is mismatched with whom, any interventions that intend to close the perception gaps cannot be developed. The authors declare that the research presented in this manuscript adheres to the ethical principles outlined by the Institutional Review Board of United Medical and Dental College, Karachi, Pakistan. All procedures involving human participants were conducted in accordance with the ethical standards of United Medical and Dental College, Karachi, Pakistan, and the Declaration of Helsinki (1964), as revised in 2013. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.