Parental perception of preschool child body weight

Determinants of child body weight categorization in parents and health care professionals: An experimental study

OBJECTIVES

Parents infrequently recognize childhood overweight/obesity and healthcare professionals (HCPs) also struggle to visually identify it, potentially limiting the offer and uptake of weight management support. This study examined perceptual and attitudinal/cognitive determinants of child weight judgements amongst parents and HCPs to identify targets for intervention.

DESIGN

We used a mixed experimental design with parents and HCPs as the between-participants factor. Stimulus gender, age and BMI centile were the within-participant repeated measures factors.

METHODS

One hundred and fifty-six HCPs and 249 parents of children aged 4-5 or 10-11 years viewed simulated child images. They estimated their relative size and categorized the weight status of each figure. Stimuli were photo-realistic figural scales based on 3D-scans of 4- to 5- and 10- to 11-year-old children varying in adiposity. Participants also reported their beliefs about causes, controllability and categorization of child weight.

RESULTS

Both groups accurately estimated the figures' relative size. However, categorization of higher weight figures was poor, demonstrating a mismatch between perceptual judgements of size and categorization of weight status. Lower levels of comfort with assigning 'overweight' categorizations to children, and a stronger belief that weight was controllable by the child/parent, predicted less accurate weight status categorizations.

CONCLUSIONS

Parental and HCP misperceptions when categorizing children's higher weight are related to attitudinal/cognitive factors, including reluctance to label a child's weight status as overweight and beliefs about whether a child's weight can be controlled by them or their family.

Obesity in childhood: associations with parental neglect, nutritional habits, and obesity awareness

Background

The relationships underlying the dynamic between obesity and parental neglect in terms of nutritional habits and obesity awareness are unclear. Parental neglect remains a significant subject of concern that needs to be examined in the context of obesity.

Methods

The aim was to examine the relationships between childhood obesity, parental neglect, children's eating habits and obesity. The study group consisted of 404 children and their parents from Ankara, Turkiye. As data collection tools, an Individual Information Form, Obesity Awareness Scale, the Parents Form of the Multidimensional Neglectful Behaviors Scale were administered. In addition, information on the children's body mass indexes was obtained by anthropometric measurements and the findings were recorded on the questionnaires of each child.

Results

It was found that 98 (24.3%) of the children included in the study were overweight and 63 (15.6%) were obese. The results of the multinomial logistic regression analysis indicated that in the underweight and overweight group, the parents' perception of their child's weight predicted body mass index in children, and in the obese group, along with the parents' perception of their child's weight, the age and gender of the child, eating fast, obesity in the family and parental neglect were also predictors.

Conclusion

Practitioners such as nurses, dietitians and child developmentalists working in schools should consider weight problems in children as one of the indicators of parental neglect and should implement interventive efforts to enhance parental supervision of children at risk.

How do looking patterns, anti-fat bias, and causal weight attributions relate to adults' judgements of child weight?

Prevailing weight-normative approaches to health pressure adults to visually categorise children's weight, despite little understanding of how such judgements are made. There is no evidence this strategy improves child health, and it may harm children with higher weights. To understand decision-making processes and identify potential mechanisms of harm we examined perceptual and attitudinal factors involved in adults' child weight category judgements. Eye movements of 42 adults were tracked while categorizing the weight of 40 computer-generated images of children (aged 4-5 & 10-11 years) varying in size. Questionnaires assessed child-focused weight bias and causal attributions for child weight. Participants' eye movement patterns resembled those previously reported for adult bodies. Categorisation data showed a perceptual bias towards the 'mid-range' category. For higher weight stimuli, participants whose category judgements most closely matched the stimulus's objective weight had higher child-focused anti-fat bias and weaker genetic attributions for child weight - i.e,. adults who 'label' higher weight in children in line with BMI categories report more stigmatising beliefs about such children, suggesting a possible mechanism of harm. Overall, adults' judgements reflect both unalterable perceptual biases and potentially harmful attitudinal factors, calling into question the feasibility and appropriateness of public health efforts to promote visual child weight categorisation.

Underestimation of overweight weight status in children and adolescents aged 0-19 years: A systematic review and meta-analysis

BACKGROUND

Perceptions of children's weight status may be important in obesity prevention and treatment.

AIMS

This review identifies the prevalence of the underestimation of overweight status in children by parents/main carers, children, and healthcare professionals (HCP). The review critically synthesized both quantitative and qualitative evidence to explore the factors associated with this underestimation. The diverse methods used to assess this phenomenon are reported.

METHODS

Pooled effect sizes were calculated using random-effects model. Published studies, up to 2020, were accessed using the following search engines: CINAHL, EMBASE, PUBMED, and Psych-Info and including the "Cited by" and "Related Articles" functions. Hand-searching was used to retrieve further articles. Publication language and location had no bearing on the nature of the included studies.

RESULTS

A total of 91 articles were included. In the quantitative studies, 55% (95% CI 49%-61%) of caregivers underestimated their child's level of overweight and obesity using a verbal scale and 47% (95% CI 36%-55%) using visual scales. Of the children studied, 34% (95% CI 25%-43%) underestimated their own level of overweight and obesity using both scales. In (n = 3) articles, HCPs reflected this misperception, but limited studies prevented meta-analysis. Underestimation was associated with the child's age, gender, BMI and parental weight status, ethnicity and education. In the qualitative studies, parents/main carers of children with overweight and obesity described their child's weight in terms other than overweight, for example, "big boned," "thick," and "solid."

CONCLUSION

The results confirm the prevalence of underestimation of child overweight status across international studies. Understanding the factors which lead to this inaccuracy may help to improve communication within the therapeutic triad and facilitate the recognition and management of children's overweight status.

Health belief model factors as predictors of parental misclassification of the weight of the preschool child

Background

Parental misperception and underestimation of their child’s weight are documented in studies. Demographic factors like age and gender have been linked to misclassification. However, modifiable factors that could potentially frame future intervention and prevention strategies have not been explored. This study aimed to assess factors that could predict parental misclassification of their preschool child’s weight.

Methods

This was a cross-sectional study with 198 parents and their 2- to 5-year-old children who attended standalone preschools or childcare centers with preschools. Parents completed a questionnaire that asked about demographic features, personal and family health, and the assessment of their child’s weight using the three most frequently utilized measures. Logistic regression was conducted to assess the association between parental factors and child weight classification status. Instruments included the Parental Self-Efficacy for Promoting Healthy Physical Activity and Dietary Behaviors in Children Scale (PSEPAD), the Obesity Risk Scale (ORK-10), and the Adolescent Obesity Risk Scale (AORK). Analyses included frequencies, chi-square tests, Kappa coefficients, and logistic regressions.

Results

Parents were least accurate (35.9%) identifying child weight when selecting a picture (κ = -.028, p = .42). The pictorial and Likert method (κ = -.032, p = .37) showed parental agreement with child weight was not significantly better than chance. Statistically, a significant agreement was found in the weight-reporting method (κ = .21). Two of the three HBM-related measures were significantly related to accurate classification. Logistic regression showed child sex, PSEPAD scores, and ORK-10 scores were statistically significant predictors in the Likert method. The model had no statistical significance for the pictorial or weight-reporting method.

Conclusion

Results indicate parents support intervening if aware of child weight problems. However, parents do not accurately recognize healthy versus unhealthy weights and report that health providers are not informing them of weight deviations. Further, important relationships between the HBM variables were identified. Results show barriers (self-efficacy) mediate the impact of perceived severity (knowledge) regarding the parental ability to assess child weight accurately. These relationships and incorporation of the HBM principles of barriers and severity into prevention/intervention strategies need further exploration.

Concordance Between the Weight of Spanish Adolescent Soccer Players, Their Self-Perceived Weight, and Their Weight as Perceived by Their Parents

PURPOSE

In the context of soccer clubs, to analyze the concordance between players' actual weight, their self-perceived weight, and their weight as perceived by their parents; to determine which variables might explain the presence of concordance between parents' perception of adolescents' weight and their actual weight. Design and study: A cross-sectional study involving 330 soccer players aged between 13 and 16. Data on personal characteristics of adolescents and parents were analyzed, as well as parents' perceptions of adolescents' weight status and their self-perception. A descriptive analysis of the personal characteristics of the sample (adolescents and parents) and an analysis of the variables explaining the presence of concordance between the parents' perception of adolescents' weight and their actual weight were performed.

RESULTS

19% of the adolescents were overweight and 3.4% were obese. The concordance between parents' perceptions of players' weight and players' actual weight was weak. The concordance between adolescents' self-perceived weight and their actual weight was moderate. The difference in BMI scores according to presence or absence of concordance was statistically significant: these scores were higher in the absence of concordance. Discordance between adolescents' weight and their parents' perception of their weight was associated with parents having lower levels of education.

CONCLUSION

A high percentage of parents and players misperceived their actual weight. This discrepancy was associated with higher BMI scores for adolescents.

PRACTICE IMPLICATIONS

Nurses should include promotion of accurate weight perception in educational interventions on excess weight.

Making Childhood Obesity a Priority: A Qualitative Study of Healthcare Professionals' Perspectives on Facilitating Communication and Improving Treatment

In Romania, one in four children has excess weight. Because childhood obesity is a sensitive topic, many healthcare professionals find it difficult to discuss children's excess weight with parents. This study aims to identify barriers and facilitators in childhood obesity-related communication, as perceived by healthcare professionals in Romania. As part of the STOP project, healthcare professionals (family physicians, pediatricians, and dieticians) who treat children with excess weight were invited to a telephone interview. The semi-structured questions were translated from a questionnaire previously used at the Swedish study site of the STOP project. Interviews were transcribed and then used for thematic analysis. Fifteen doctors and three dieticians (16 females and 2 males), with average 18.2 ± 10.1 years of experience, were interviewed. Four main themes were identified. Professionals reported that when children began experiencing obesity-related stigma or comorbidities, this became the tipping point of weight excess, where parents felt motivated to begin treatment. Barriers in communication were part of several layers of distrust, recognized as tension between professionals and caregivers due to conflicting beliefs about excess weight, as well as lack of trust in medical studies. Most respondents felt confident using models of good practice, consisting of a gentle approach and patient-centered care. Nonetheless, professionals noted systemic barriers due to a referral system and allocation of clinical time that hinder obesity treatment. They suggested that lack of specialized centers and inadequate education of healthcare professional conveys the system does not prioritize obesity treatment and prevention. The interviewed Romanian doctors and dieticians identified patient-centered care as key to treating children with obesity and building trust with their caregivers. However

their efforts are hindered by healthcare system barriers, including the lack of specialized centers, training, and a referral system. The findings therefore suggest that, to improve childhood obesity prevention and treatment, systemic barriers should be addressed.

Trial Registration:ClinicalTrials.gov, NCT03800823; 11 Jan 2019.

Weight Misperception among African American Adolescents: The Jackson Heart KIDS Pilot Study

Background

Weight misperception is a common problem among adolescents; however, few studies have examined contributing factors among an exclusively African American population. The purpose of this study was to examine factors associated with weight misperception among 12- to 19-year-old participants in the Jackson Heart KIDS Pilot Study (JHS-KIDS).

Methods

Data were drawn from JHS-KIDS, a prospective, observational examination of cardiovascular-related risk factors among African American adolescents who were children or grandchildren of participants in the Jackson Heart Study. Adolescent weight misperception - discordance between measured weight status and perceived weight status - was the primary outcome of interest. Self-reported weight control behaviors, parent concerns about adolescents' weight, parent-perceived responsibility for adolescent's weight and daily hassles were the primary independent variables of interest.

Results

The analytic sample was equally divided by females (n=107) and males (n=105) and one third of study participants (33.5%) had discordance between their actual and perceived weight. Results from fully adjusted sex-stratified modified Poisson regression models indicated that weight behavior control was significant among females (PR = .66, 95%CI:1.20-2.30). Parental concerns about child weight were significant for males. Each additional point increase in the parent's concern about their weight score was associated with a 9% increase in the adjusted prevalence of weight misperception among males (95%CI: 1.03-1.16).

Conclusions

The sex-specific patterns in this study highlight heterogeneity among African American adolescents and an urgent need to consider sex and gender when developing targeted interventions for youth who are at high risk for weight misperceptions and unhealthy weight control practices.

Association of a Single-Item Self-Rated Diet Construct With Diet Quality Measured With the Alternate Healthy Eating Index

Background: A single-item self-rated diet measure (SRD) may provide a quick, low-burden screener. However, assessment of its validity is limited. This study aimed to evaluate the association of an SRD construct with measured diet quality among adults in Puerto Rico (PR). Methodology: Participants (30-75 years old; n = 247) of the PR Assessment of Diet, Lifestyle, and Diseases (PRADLAD) cross-sectional study reported SRD with a single question ("How would you describe your current dietary habits and diet quality?") with a five-point scale: excellent to poor. More complete diet quality was calculated using the Alternate Healthy Eating Index-2010 (AHEI), with 11 food and nutrient components assessed by the food frequency questionnaire. Multivariable general linear models were used to test associations between SRD with AHEI and its components. Associations were also tested between recall SRD in youth and current AHEI. Results: Most participants (35.2%) self-rated diet as "good," 13.8% as "excellent," and 4.1% as "poor," with the remainder split between middle scale points. SRD was not significantly associated with AHEI, although participants with "excellent" vs. "poor" SRD had marginally higher AHEI (P = 0.07). SRD was significantly associated with higher fruit intake (P = 0.02) and marginally associated with intakes of vegetables (P = 0.07) and long-chain fatty acids (P = 0.07). Unexpectedly, AHEI was significantly higher among those reporting "poor" SRD in young adulthood (P = 0.01) or childhood (P = 0.05). Conclusions: SRD may capture current diet quality at extreme intakes. Larger studies should confirm these findings and replicate them in other underrepresented populations. Further research should clarify the inverse associations between adult AHEI and earlier reported SRD.

Factors that Influence Parental Misperception of Their Child's Actual Weight Status in South Carolina

Objectives Studies suggest that parents tend to misperceive their child's actual weight status and typically underestimate their child's weight. Since few studies examine the factors that influence parental misperception, this study aims to assess the influence of parent and child factors with parental misperception of their child's actual weight status who were either at their recommended weight or overweight/obese in South Carolina in 2013 and 2014. Methods Secondary data were obtained from the Behavioral Risk Factor Surveillance System (BRFSS) and the Children's Health Assessment Survey (CHAS) in 2013 and 2014 in SC. Parental misperception of child's actual weight status was measured by comparing parental perception to their child's actual weightstatus measured via BMI. Logistic regression was conducted to assess the association between parental and child factors with parental misperception of child's weight status. Results In the adjusted multivariate analysis, only child's age was significantly and positively associated with parental misperception of their child's actual weight status. Conclusions for Practice This cross sectional analysis showed an association between child's age and parental misperception of child's actual weight status. It is essential to educate parents about their children's weight status, especially among young children.

Do mothers accurately identify their child's overweight/obesity status during early childhood? Evidence from a nationally representative cohort study

Background

Maternal recognition of overweight/obesity during early childhood is a key determinant in achieving healthy weight status in children. The aim of this study is to 1) investigate maternal perceptions of their child weight, focusing on whether or not mothers accurately identify if their child is overweight or obese at three years old and five years old; 2) identify the factors influencing maternal misperceptions regarding their child’s weight at three years old and five years old, 3) ascertain if a failure to recognize overweight/obesity at three years old is associated with the likelihood of doing so at five years old.

Methods

Using two waves of the longitudinal Growing Up in Ireland study data regarding child, maternal, and household characteristics as well as healthcare access and utilization variables were obtained for mothers when their children are three and five years old respectively. Multivariate logistic analysis was used to examine the factors associated with mothers inaccurately perceiving their child to be of normal weight status when the child is in fact either clinically overweight or obese.

Results

In wave 2, 22% of mothers failed to accurately identify their child to be overweight or obese. This inaccuracy decreased to 18% in wave 3. A failure of mothers to identify their child’s overweight/obesity was more likely to occur if the child was a girl (OR: 1.25) (OR: 1.37), had a higher birth weight (OR:1.00), if the mother was obese (OR: 1.50), (OR: 1.72) or working (OR:1.25) (OR:1.16) in wave 2 and wave 3, respectively. Other factors affecting the odds of misperceiving child’s weight include gestation age, income and urban living.

Conclusion

These findings suggest that mothers of overweight or obese three and five year olds show poor awareness of their child’s weight status. Both child and mother characteristics play a role in influencing this awareness. Mothers unable to accurately identify their child’s overweight or obesity status at three years old are likely to do again when the child is five years old. This study highlights the need for increased support to help improve mothers’ understanding of healthy body size in preschool aged children.

Clinic and Home-Based Behavioral Intervention for Obesity in Preschoolers: A Randomized Trial

OBJECTIVE

To test the hypotheses that an innovative skills-based behavioral family clinic and home-based intervention (LAUNCH) would reduce body mass index z score (BMIz) compared with motivational interviewing and to standard care in preschool-aged children with obesity.

STUDY DESIGN

Randomized controlled trial with children between the ages of 2 and 5 years above the 95^th percentile for body mass index for age and sex recruited from 27 pediatrician offices across 10 recruitment cycles between March 12, 2012 and June 8, 2015. Children were randomized to LAUNCH (an 18-session clinic and home-based behavioral intervention), motivational interviewing (delivered at the same frequency as LAUNCH), or standard care (no formal intervention). Weight and height were measured by assessors blinded to participant assignment. The primary outcome, BMIz at month 6 after adjusting for baseline BMIz, was tested separately comparing LAUNCH with motivational interviewing and LAUNCH with standard care using regression-based analysis of covariance models.

RESULTS

A total of 151 of the 167 children randomized met intent-to-treat criteria and 92% completed the study. Children were 76% White and 57% female, with an average age of 55 months and BMI percentile of 98.57, with no demographic differences between the groups. LAUNCH participants demonstrated a significantly greater decrease in BMIz (mean = -0.32, SD = ±0.33) compared with motivational interviewing (mean = -0.05, SD = ±0.27), P < .001, ω² = 0.74 and compared with standard care (mean = -0.13, SD = ±0.31), P < .004, ω² = 0.75.

CONCLUSIONS

In preschool-age children, an intensive 6-month behavioral skills-based intervention is necessary to reduce obesity.

TRIAL REGISTRATION

Clinicaltrials.gov NCT01546727.

Validity of informed birth weight. Study of Cardiovascular Risk in Adolescents (ERICA) - Rio de Janeiro

Abstract Objectives: to verify the agreement between birth weight information referred by the guardians of the adolescents who participated in the Study of Cardiovascular Risks in Adolescents (Portuguese acronym ERICA) and the birth weight data of the adolescents identified in the National Information System on Live Births (Portuguese acronym Sinasc). Methods: probabilistic record linkage of 1,668 records was conducted between the ERICA databases and the Sinasc databases from 1996 to 2002, both from the state of Rio de Janeiro. The agreement between the informed birth weight and the one registered in Sinasc was estimated by the Intraclass Correlation Coefficient (ICC), BlandAltman plot, Cohen's Kappa index, and Gwet's agreement coefficient. Results: the ICC was = 0.89; CI95% =0.880.90 and the higher the mother's educational level was, the higher it became. There was also an elevated agreement between the birth weight classification in the low (< 2,500 g), adequate (2,500 to 3,999 g) and elevated (≥ 4,000 g) birth weight categories, Gwet's Agreement Coefficient = 0.91; CI95%= 0.890.92. Conclusions: the results showed satisfying agreement between the birth weight referred by the parent/guardian of the adolescents, and the ones registered in SINASC, this agreement being directly proportional to the mother's educational level.

Parents' Underestimations of Child Weight: Implications for Obesity Prevention

PURPOSE

Obesity prevention efforts may be ineffective if parents lack awareness of their children's overweight status. This study examined the factors that predicted parents' underestimation of child weight status.

DESIGN AND METHODS

Using a cross sectional design, researchers recruited children and parents in a local children's museum. Parents completed a demographic questionnaire, the Newest Vital Sign, and the Child Body Image Scale. Children's height and weight were measured to calculate child BMI. Random effects modeling examined the association between predictor variables (parent race/ethnicity, income, education, and health literacy, and child BMI percentile, gender, and age) and the dependent variable, parent underestimation of child weight status.

RESULTS

Participants included 160 parents (213 children aged 7-12years) representing a racially and ethnically diverse sample who were affluent, educated, and with 36.6% of parents assessed with limited health literacy. Although 45.1% of children were overweight/obese, only 7.5% of parents chose this weight status; 80% of parents underestimated the weight of their normal weight children, 96% underestimated their overweight children, and 72% underestimated their obese children. Parents were more likely to underestimate weight of older children and those under 81st percentile of BMI. No other predictors were significant.

CONCLUSIONS

Parent underestimation of child weight status appears to be a widespread phenomenon in this sample, regardless of race, ethnicity, income, education, and health literacy.

PRACTICE IMPLICATIONS

The consistent underestimation of child weight suggests that parents' misperception of weight status represents a critical pathway for intervention. Methods to improve parents' perception of child weight need be developed and tested.

Implicações da pouca preocupação e percepção familiar no sobrepeso infantil no município de Curitiba, PR, Brasil

Resumo O presente trabalho propôs relacionar o sobrepeso infantil com a percepção familiar da silhueta da criança e a preocupação com o excesso de peso na infância. Foi realizado um estudo transversal com crianças de 20 a 48 meses de idade usuárias de Unidades de Saúde ou centros de ensino infantil de Curitiba, no período de junho a dezembro de 2014. Fez-se uso de questionário para coletar dados referentes a renda familiar, peso, altura, percepção da silhueta da criança e verificar a preocupação com o excesso de peso. O sobrepeso e a obesidade não foram percebidos corretamente pelos responsáveis (kappa =0,11) e grande parte destes não sabiam o peso e altura da crianças e nem estavam preocupados com excesso de peso. Na população estudada, as crianças de famílias de menor renda apresentaram mais chance de desenvolver sobrepeso na infância (p = 0,02). Se faz necessário investir na sensibilização das famílias, pois é de extrema importância a atenção à obesidade desde a infância prevenindo assim novos casos e evitando agravos na vida adulta.

Preschool-Age Chinese Children's Weight Status: WHO Classification, Parent Ratings, Child/Family Characteristics

PURPOSE

We aimed to compare preschool-age Chinese children's weight status based on the WHO guidelines with parental ratings on their children's body type, and child/family demographic characteristics.

METHOD

The sample included 171 preschool-age children (M=60.5months, SD=6.7; boys: 46.8%) randomly selected from 23 classrooms. Based on BMIs from their height and weight from physical examinations, the children were divided into three groups using the 2006 WHO guidelines: underweight (n=46), normal weight (n=65), and overweight (n=60). Data on the parental ratings of children's current body type, ideal body type and child/family demographic characteristics were collected with surveys.

RESULTS

Parents' accurately classified 91.1% of the underweight children, 52.3% of the normal weight children, and 61.7% of the overweight children. In terms of ideal body shape for their children, parents typically wanted their children to have normal weight or to remain underweight. Most of the child and family demographic characteristics were not different across children who were underweight, had normal weight, and were overweight.

CONCLUSION

Because parents tended to underestimate their children's weight status, it is important to increase Chinese parents' knowledge on what constitutes healthy weight, as well as the potential harm of overweight status for children's development. Training healthcare providers in kindergartens and pediatric clinics to work with parents to recognize unhealthy weight status in children is valuable.

Learning about Activity and Understanding Nutrition for Child Health (LAUNCH): Rationale, design, and implementation of a randomized clinical trial of a family-based pediatric weight management program for preschoolers

Obesity affects nearly 2 million preschool age children in the United States and is not abating. However, research on interventions for already obese preschoolers is limited. To address this significant gap in the literature, we developed an intervention targeting obesity reduction in 2 to 5year olds, Learning about Activity and Understanding Nutrition for Child Health (LAUNCH). This paper describes the rationale, design, participant enrollment, and implementation of a 3-arm randomized, parallel-group clinical trial comparing LAUNCH to a motivational-interviewing intervention (MI) and standard care (STC), respectively. Whereas LAUNCH was designed as a skills based intervention, MI focused on addressing the guardian's motivation to make changes in diet and activity and providing tools to do so at the guardian's level of readiness to implement changes. Child body mass index z-score was the primary outcome, assessed at pretreatment, posttreatment (Month 6), and 6 and 12month follow-ups (Months 12 and 18). Mechanisms of weight change (e.g., dietary intake, physical activity) and environmental factors associated with weight (e.g., foods available in the home, caregiver diet) were also assessed. This study is unique because it is one of the few randomized controlled trials to examine a developmentally informed, clinic and home skills based behavioral family intervention for preschoolers who are already obese. Being obese during the preschool years increases the likelihood of remaining obese as an adult and is associated with serious health conditions; if this intervention is successful, it has the potential to change the health trajectories for young children with obesity.

Child obesity cut-offs as derived from parental perceptions: cross-sectional questionnaire

BACKGROUND

Overweight children are at an increased risk of premature mortality and disease in adulthood. Parental perceptions and clinical definitions of child obesity differ, which may lessen the effectiveness of interventions to address obesity in the home setting. The extent to which parental and objective weight status cut-offs diverge has not been documented.

AIM

To compare parental perceived and objectively derived assessment of underweight, healthy weight, and overweight in English children, and to identify sociodemographic characteristics that predict parental under- or overestimation of a child's weight status.

DESIGN AND SETTING

Cross-sectional questionnaire completed by parents linked with objective measurement of height and weight by school nurses, in English children from five regions aged 4-5 and 10-11 years old.

METHOD

Parental derived cut-offs for under- and overweight were derived from a multinomial model of parental classification of their own child's weight status against school nurse measured body mass index (BMI) centile.

RESULTS

Measured BMI centile was matched with parent classification of weight status in 2976 children. Parents become more likely to classify their children as underweight when they are at the 0.8th centile or below, and overweight at the 99.7th centile or above. Parents were more likely to underestimate a child's weight if the child was black or South Asian, male, more deprived, or the child was older. These values differ greatly from the BMI centile cut-offs for underweight (2nd centile) and overweight (85th).

CONCLUSION

Clinical and parental classifications of obesity are divergent at extremes of the weight spectrum.

Influence of early-life and parental factors on childhood overweight and obesity

PURPOSE

We recently reported that a high BMI and high waist circumference prevalence is present in Sicilian children and that the male gender is associated with a significant risk of obesity. Early-life and parent-related risk factors were investigated 1521 Sicilian children (752 females and 769 males, aged 9.0-14.0 years) to identify biological and environmental factors that can contribute to obesity onset.

METHODS

Anthropometric measurements of children, their urban vs rural area provenience, birth weight and neonatal feeding were collected. In addition, the BMI and educational level of their parents and the perception of their child weight status were investigated.

RESULTS

In the study cohort, the prevalence of overweight and obesity was 27.2 and 14.1 %, respectively, significantly (p < 0.05) higher in males than in females. Breastfeeding emerged as a protective factor (OR 0.64; p < 0.0005), while risk factors for developing childhood obesity were a birth weight ≥4.0 kg (OR 1.83; p < 0.05), an overweight or obese mother (OR 2.33; p < 0.0001) or father (OR 1.68; p < 0.0001) and a mother with a low/medium education level (OR 1.72; p < 0.005).

CONCLUSION

Understanding risk factors for pediatric obesity is a prerequisite to identify children at highly risk of being obese and to predispose early intervention strategies.

Maternal perceptions of underweight and overweight for 6-8 years olds from a Canadian cohort: reporting weights, concerns and conversations with healthcare providers

OBJECTIVES

The majority of mothers do not correctly identify their child's weight status. The reasons for the misperception are not well understood. This study's objective was to describe maternal perceptions of their child's body mass index (BMI) and maternal report of weight concerns raised by a health professional.

DESIGN

Prospective, community-based cohort.

PARTICIPANTS

Data were collected in 2010 from 450 mothers previously included in a longitudinal birth cohort. Mothers of children aged 6-8 years reported their child's anthropometric measures and were surveyed concerning their opinion about their child's weight. They were also asked if a healthcare provider raised any concerns regarding their child's body weight. Child BMI was categorised according to the WHO Growth Charts adapted for Canada. Descriptive statistics and bivariate analyses were used to evaluate mothers' ability to correctly identify their children's body habitus.

RESULTS

74% of children had a healthy BMI, 10% were underweight, 9% were overweight and 7% were obese. 80%, 89% and 62% of mothers with underweight, overweight and obese children, respectively, believed that their child was at the right weight. The proportion of mothers who recalled a health professional raising concerns about their child being underweight, overweight, and obese was low (12.5%).

CONCLUSIONS

The majority of mothers with children at unhealthy weights misclassified and normalised their child's weight status, and they did not recall a health professional raising concerns regarding their child's weight. The highest rates of child body weight misclassification occurred in overweight children. This suggests that there are missed opportunities for healthcare professionals to improve knowledge exchange and early interventions to assist parents to recognise and support healthy weights for their children.

Brazilian Maternal Weight Perception and Satisfaction With Toddler Body Size: A Study in Primary Health Care

Maternal perception and satisfaction with child's weight status are important to detect early and to successfully treat the extremes in weight, especially during early childhood, when the child is more dependent on maternal care.

OBJECTIVES

To assess the inaccuracy of maternal perception of toddler body size and its associated factors and to analyze maternal dissatisfaction with toddler body size.

METHODS

Cross-sectional study with 135 mother-toddler dyads attending Primary Health Care Facilities, São Paulo, Brazil. Children's actual weight status was classified using body mass index-for-age. Inaccuracy and dissatisfaction were assessed using an image scale. We used logistic regression to identify the factors associated with inaccuracy of maternal perception of toddler body size.

RESULTS

Inaccuracy in maternal perception was observed in 34.8% of participants. Mothers of excessive weight children were more likely to have inaccurate perceptions (OR=4.6; 95% CI 2.0-10.7), and mothers of children who attended well-child care were less likely to have inaccurate perceptions (OR=0.3, 95% CI 0.1-0.9). More than half of mothers (52.6%) were dissatisfied with their toddler's size and desired a larger child (75.0% of mothers of underweight children, 25.0% of mothers whose children were at risk for overweight and 23.0% of mothers of overweight children).

CONCLUSION

The majority of mothers were inaccurate in their perception and was dissatisfied with their toddler's body size. Maternal inaccuracy and dissatisfaction differed by the weight status of the toddler. Attendance at well-child visits was an effective way to decrease maternal inaccuracy, which reinforces the importance of the influence of health professionals.

Uncertainty: A little bit not sure. Parental concern about child growth or development

Delays in child growth or development are significant problems for children, their families and population health. Eliciting parental concerns as early as possible to promote child growth and development requires close collaborative working with parents. There is evidence that parents delay expressing concern and that health-care professionals are not always effective at eliciting and attending to parental concerns. The aim of this study was to understand the experiences of parents of preschool children who had expressed a child growth or development concern. An Interpretative Phenomenological Analysis (IPA) study design was used with a purposive sample of parents of 15 preschool children in Ireland. Data were collected by semi-structured interviews and analysed using IPA. One key superordinate theme - Uncertainty - 'a little bit not sure' captured how parents made sense of their concerns about their child's growth and development. In addition to watching, comparing and wondering, parents assessed whether their child could 'do other things' or if something in particular could have caused the growth or development problem. Parents, particularly mothers, grapple with uncertainty associated with unfamiliar cues in the complex and multifaceted nature of child growth and development in their efforts to make sense of what is happening with their child.

Make a Move Intervention to Reduce Childhood Obesity

Guided by the social cognitive theory, this randomized controlled trial tested the “Make a Move,” a provider-led intervention for Head Start parents aimed to produce changes in the outcomes of knowledge, attitude, and behavior of physical activity and healthy eating. Participants were parents of children ages 3–5 years enrolled in a Head Start program. Participants completed a 57-item questionnaire at baseline and postintervention. The Wilcoxon rank-sum test revealed a statistically significant difference between the intervention and control groups in scores on knowledge of healthy eating ( z = 1.99, p = .05), attitude of physical activity ( z = 2.71, p < .01), and behavior of physical activity ( z = 2.03, p = .04). Ten participants (77%) completed all four intervention sessions. This study provided new insights into the relationship of a provider-led intervention with respect to knowledge, attitude, and behaviors in healthy eating and physical activity.

'Croque&bouge': A feasible and acceptable programme for obesity prevention in preschoolers at risk and their parents

OBJECTIVES

To conceptualize and pilot test a programme of three workshops aiming to prevent the development of overweight in susceptible preschool children.

METHODS

Three workshops were conducted, targeting both parents and children. The curriculum for parents included discussions on feeding responsibilities, healthy eating, taste development, neophobia and physical activity recommendations. Children participated in various play activities with fruits and vegetables and read stories about hunger and satiety feelings. Recruitment was organized through paediatricians and child-care centres. Evaluation of the programme focused on feasibility, adequacy for children's age, parents' perception of impact and, for children, change of the ability to recognize and willingness to taste fruits and vegetables.

RESULTS

A total of 21 children and one of their parents participated in the programme. The programme was found to be feasible and adequate for the targeted community. Parents reported perceiving a positive impact of the intervention; however, this finding was not statistically significant. The major difficulty was identifying and recruiting families and engaging the parents in a discussion about weight.

CONCLUSIONS

This short programme aiming to improve parents' ability to offer healthy environment and promote healthy eating behaviour was feasible and acceptable for families with young children. When developing and implementing such programmes, close collaboration with paediatricians and other health providers should be sought in order to identify and reach children at risk of obesity and their family.

The association between maternal perceptions of own weight status and weight status of her child: results from a national cohort study

OBJECTIVES

To examine the relationship between maternal self-reported and measured height and weight, maternal perceived weight status and measured body mass index (BMI), and maternal perceived child weight status and measured child BMI.

SETTING AND DESIGN

Population-representative National Longitudinal Study of Children Growing Up in Ireland.

METHODS

Height and weight of 7655 mothers and their 9-year-old children were objectively measured using standard measurement techniques. Mothers' perceptions of their own weight status and the weight status of their child were reported. The association between accurate perceptions of the mother for herself and her child was tested.

RESULTS

Mothers overestimated their height by a mean of 0.5 cm (SD=2.9), underestimated their weight by a mean of 1.4 kg (SD=3.8), consequently underestimating their BMI by a mean of 0.6 kg/m(2) (SD=1.7). The majority (60%) of obese mothers correctly categorised their own weight status. Only 17% of mothers of obese children correctly categorised the weight status of their child. Overweight/obese mothers who correctly categorised their own weight status were more likely to correctly categorise their overweight/obese child compared with those who incorrectly categorised their own weight status (44% vs 23%, 95% CI for difference 13% to 28%, p<0.001 for girls; 37% vs 27%, 95% CI 2% to 18%, p=0.02 for boys; significantly greater difference for girls compared with boys, p=0.04).

CONCLUSIONS

Maternal perceptions of their own weight status tend to be more accurate than maternal perceptions of their overweight or obese child. Overweight/obese mothers who correctly categorised their own weight status were more likely to correctly categorise their overweight/obese child.

Parental feeding behaviour and motivations regarding pre-school age children: A thematic synthesis of qualitative studies

Poor childhood diet is a major risk factor for disease and obesity, and parents of pre-school children are in a powerful position to influence diet for life. The technique of thematic synthesis (Thomas & Harden, 2008) was used to synthesise recent qualitative research on parental feeding of pre-school age children (18 months-6 years). The aim was to inform development of nutrition advice by gaining a comprehensive picture of parental feeding behaviours and motivations. Six key parental feeding behaviours were identified: modelling, rewards, pressure and encouragement, repeated exposure, creativity, and limiting intake. Four overarching themes regarding motivations were identified: promoting good health (balance and variety, and weight control); building positive relationships (child involvement, and parental engagement and responsiveness); practicalities and constraints (time, cost, and lack of culinary skill, and pressure and flexibility); and emotional motivations (problem avoidance, and emotional investment). Practicalities and constraints, and emotional motivations impacted more significantly on low income parents. In order to be effective, nutrition advice ought to tap into parents' strong desire to build positive relationships and promote good health while remaining sensitive to the significant constraints and practicalities faced.

Perceptions of low-income mothers about the causes and ways to prevent overweight in children

BACKGROUND

Childhood overweight and obesity remain major health conditions, affecting nearly one-third of children in the USA. Multiple factors have been identified that contribute to children becoming overweight; however, little is known regarding what low-income mothers perceive to be the causes of and the ways to prevent children from becoming overweight.

METHODS

Low-income mothers (n = 286) with children aged 4-8 years participated in semi-structured interviews, during which they were asked for their opinions about the causes of and ways to prevent children from becoming overweight. After themes were identified, interviews were coded for the presence or absence of each theme.

RESULTS

The majority of mothers were non-Hispanic White (69.2%) and overweight or obese (77.3%). Additionally, many of the children (41.9%) were overweight or obese. Six causes of children becoming overweight were identified by mothers: types or quantities of food eaten (90.9%); parenting behaviours (44.9%); lack of activity (42.3%); genetics, slow metabolism or medical issues (24.5%); stress or emotion (5.2%); and limited access to resources (3.5%). Five ways to prevent children from becoming overweight identified by mothers included the following: healthy eating (84.9%), more activity (54.8%), limiting screen time (19.9%), limiting sugar-sweetened beverages (12.2%) and drinking more water (6.6%). The majority of mothers (77.1%) reported that they carried out their suggestions to prevent their children from becoming overweight.

CONCLUSION

Within this cohort with a high prevalence of maternal and child overweight, most mothers identified many of the evidence-based strategies for childhood obesity prevention. Future intervention development may benefit from focusing on content areas that were less commonly identified by mothers as well as helping mothers translate knowledge to implementation.

Parental misperceptions of children's underweight status: a meta-analysis

BACKGROUND

Accurate parental perceptions of their children's underweight status are needed to prevent overlooking potential disordered eating patterns or health conditions affecting growth.

PURPOSE

The aim of this study is to determine overall proportion of parents who misperceive children's underweight status and correlates of such misperceptions.

METHODS

Original studies published to January 2013 were chosen through a literature search in established databases. Studies included assessed parental perceptions of their children's underweight and then compared perceptions to recognized standards for defining underweight based on anthropometric measures. Random- and mixed-effects models were used.

RESULTS

Thirty-seven articles (representing 39 studies; N = 4,039) were included. Pooled effect sizes indicated that 46.58 % (95 % CI 40.90-52.35 %) of parents misperceive their children's underweight status, though the extent of misperceptions depended on a number of moderators.

CONCLUSIONS

Nearly half of parents perceive their underweight children as weighing more than they actually do. Health care professionals are well positioned to take steps to remedy misperceptions and encourage healthy behaviors.

The relationship of obesity and weight gain to childhood teasing

This article examines the relationship between weight gain and childhood teasing in children. Anthropometric data and self-reported teasing experiences were collected on a sample of second and third graders at a local elementary school in a disadvantaged suburban community. The study model uses bio-ecological development theory in which child development is understood in context: the child's physical characteristics influence the social environment, which interact and influence the behaviors that result in physical development and characteristics such as weight gain. Results suggest that teasing influences BMI change and that the relationship is more complex than simply stating that obese children are teased.

Parental perception of child's weight status and subsequent BMIz change: the KOALA birth cohort study

Background

Parents often fail to correctly perceive their children’s weight status, but no studies have examined the association between parental weight status perception and longitudinal BMIz change (BMI standardized to a reference population) at various ages. We investigated whether parents are able to accurately perceive their child’s weight status at age 5. We also investigated predictors of accurate weight status perception. Finally, we investigated the predictive value of accurate weight status perception in explaining children’s longitudinal weight development up to the age of 9, in children who were overweight at the age of 5.

Methods

We used longitudinal data from the KOALA Birth Cohort Study. At the child’s age of 5 years, parents filled out a questionnaire regarding child and parent characteristics and their perception of their child’s weight status. We calculated the children’s actual weight status from parental reports of weight and height at ages 2, 5, 6, 7, 8, and 9 years. Regression analyses were used to identify factors predicting which parents accurately perceived their child’s weight status. Finally, regression analyses were used to predict subsequent longitudinal BMIz change in overweight children.

Results

Eighty-five percent of the parents of overweight children underestimated their child’s weight status at age 5. The child’s BMIz at age 2 and 5 were significant positive predictors of accurate weight status perception (vs. underestimation) in normal weight and overweight children. Accurate weight status perception was a predictor of higher future BMI in overweight children, corrected for actual BMI at baseline.

Conclusions

Children of parents who accurately perceived their child’s weight status had a higher BMI over time, probably making it easier for parents to correctly perceive their child’s overweight. Parental awareness of the child’s overweight as such may not be sufficient for subsequent weight management by the parents, implying that parents who recognize their child’s overweight may not be able or willing to adequately manage the overweight.

In the parents' view: weight perception accuracy, disturbed eating patterns and mental health problems among young adolescents

BACKGROUND

An accurate weight perception has been associated with motivation to change eating habits in the case of under- or overweight. However, recent studies have reported frequent misperceptions among parents and their offspring, both in the form of under- and overestimation of weight status. The aim of the present study was to investigate weight perception accuracy among parents of young adolescents in relation to reports on disturbed eating patterns and mental health problems.

METHODS

Weight perception accuracy was assessed among parents of young adolescents (N = 5,781, aged 11 - 13 years) who participated in the ongoing Bergen Child Study (BCS). Parental weight perception was classified in overestimation, underestimation and accurate. Other measures included demographic variables, the parents' evaluations of disturbed eating patterns and mental health problems among their offspring as well as the adolescents' own weight perception accuracy.

RESULTS

The parents accurately perceived more than 80% of normal weight adolescents, but nearly 60% of the underweight adolescents were overestimated, and a substantial proportion of overweight girls (34. 8%) and boys (12.8%) were underestimated. In general, parents who were aware of deviations from average weight in their child also reported higher levels of disturbed eating patterns, emotional problems, and behavioral problems. After controlling for demographic factors, the risk of parental over- and underestimation was significantly predicted by weight status, the adolescents' weight perception accuracy as well as disturbed eating patterns reported by the parents (p < .05).

CONCLUSIONS

Adolescents with under- or overweight proved most likely to be misperceived by their parents in this study. The pattern of perceptually correcting deviations from normal weight was interpreted as a positivity bias among the parents. These results suggest that weight perception accuracy should be targeted in family-focused interventions in order to strengthen adequate weight control among young adolescents.

Parental underestimates of child weight: a meta-analysis

BACKGROUND AND OBJECTIVE

Parental perceptions of their children's weight play an important role in obesity prevention and treatment. The objective of this study was to determine the proportion of parents worldwide who underestimate their children's weight and moderators of such misperceptions.

METHODS

Original studies published to January 2013 were chosen through literature searches in PUBMED, PSYCHINFO, and CINAHL databases. References of retrieved articles were also searched for relevant studies. Studies were published in English and assessed parental perceptions of children's weight and then compared perceptions to recognized standards for defining overweight based on anthropometric measures. Data were extracted on study-level constructs, child- and parent-characteristics, procedural characteristics, and parental underestimates separately for normal-weight and overweight/obese samples. Pooled effect sizes were calculated using random-effects models and adjusted for publication bias. Moderators were explored using mixed-effect models.

RESULTS

A total of 69 articles (representing 78 samples; n = 15,791) were included in the overweight/obese meta-analysis. Adjusted effect sizes revealed that 50.7% (95% confidence interval 31.1%-70.2%) of parents underestimate their overweight/obese children's weight. Significant moderators of this effect included child's age and BMI. A total of 52 articles (representing 59 samples; n = 64,895) were included in the normal-weight meta-analysis. Pooled effect sizes indicated that 14.3% (95% confidence interval 11.7%-17.4%) of parents underestimate their children's normal-weight status. Significant moderators of this effect included child gender, parent weight, and the method (visual versus nonvisual) in which perception was assessed.

CONCLUSIONS

Half of parents underestimated their children's overweight/obese status and a significant minority underestimated children's normal weight. Pediatricians are well positioned to make efforts to remedy parental underestimates and promote adoption of healthy habits.

A health literate approach to the prevention of childhood overweight and obesity

OBJECTIVE

To describe a systematic assessment of patient educational materials for the Growing Right Onto Wellness (GROW) trial, a childhood obesity prevention study targeting a low health literate population.

METHODS

Process included: (1) expert review of educational content, (2) assessment of the quality of materials including use of the Suitability Assessment of Materials (SAM) tool, and (3) material review and revision with target population.

RESULTS

12 core modules were developed and assessed in an iterative process. Average readability was at the 6th grade reading level (SMOG Index 5.63 ± 0.76, and Fry graph 6.0 ± 0.85). SAM evaluation resulted in adjustments to literacy demand, layout & typography, and learning stimulation & motivation. Cognitive interviews with target population revealed additional changes incorporated to enhance participant's perception of acceptability and feasibility for behavior change.

CONCLUSION

The GROW modules are a collection of evidence-based materials appropriate for parents with low health literacy and their preschool aged children, that target the prevention of childhood overweight/obesity.

PRACTICE IMPLICATIONS

Most trials addressing the treatment or prevention of childhood obesity use written materials. Due to the ubiquitous prevalence of limited health literacy, our described methods may assist researchers in ensuring their content is both understood and actionable.

Parental perceptions of and concerns about child's body weight in eight European countries--the IDEFICS study

OBJECTIVES

To evaluate parental perceptions of and concern about child's body weight and general health in children in a European cohort.

DESIGN

Cross-sectional multi-centre study in eight European countries.

PARTICIPANTS

16,220 children, ages 2-9 years.

METHODS

Parents completed a questionnaire regarding children's health and weight and concern about overweight and underweight. Objective children's weight categories from the International Obesity Task Force were used. Logistic regression models were utilized to identify predictors of accurate weight perception.

RESULTS

Parental weight perception corresponded overall to children's mean body mass index (BMI) z-scores, with important exceptions. About one-third of the total indicated concern about underweight, paradoxically most often parents of children in the overweight or obesity categories. In 63%, parents of children in the overweight category marked 'proper weight'. The strongest predictor for accurate parental weight perception for children with overweight and obesity was BMI z-score (odds ratio [OR] = 7.2, 95% confidence interval [CI] 6.1-8.7). Compared to Southern Europe, ORs for accurate parental weight perception were 4.4 (95% CI 3.3-6.0) in Northern Europe and 3.4 (95% CI 2.7-4.2) in Central Europe.

CONCLUSION

Parents of children categorized as being overweight or obese systematically underestimated weight. Parents differed regionally regarding accurate weight perception and concern about overweight and underweight.

Predictors of parental perceptions and concerns about child weight

Appropriate levels of parental perception and concern about child weight are important components of successful obesity treatment, but the factors that contribute to these attitudes need clarification. The aim of this study was to identify child and parent characteristics that best predict parental perceptions and concerns about child weight. A cross-sectional design was used to assess characteristics of parents (e.g. age, income, and feeding attitudes) and children (e.g. body composition, ad libitum intake, and reported physical activity). Results are reported for 75, 4-6year-olds from diverse ethnicities. Perceived child weight and concern were measured with the Child Feeding Questionnaire (CFQ). Multiple linear regression was used to identify the best models for perceived child weight and concern. For perceived child weight, the best model included parent age, children's laboratory intake of sugar-sweetened beverages (SSBs) and palatable buffet items, and two measures of child body composition (ratio of trunk fat-to-total fat and ratio of leg fat-to-total fat). For concern, child android/gynoid fat ratio explained the largest amount of variance, followed by restrictive feeding and SSB intake. Parental perceptions and concerns about child weight are best explained by models that account for children's eating behavior and body fat distribution.