Accuracy of weight status perception in contemporary Australian children and adolescents

Aim: To explore weight status perception and its relation to actual weight status in a contemporary cohort of 5‐ to 17‐year‐old children and adolescents. Methods: Body mass index (BMI), derived from height and weight measurements, and perception of weight status (‘too thin’, ‘about right’ and ‘too fat’) were evaluated in 3043 participants from the Healthy Kids Queensland Survey. In children less than 12 years of age, weight status perception was obtained from the parents, whereas the adolescents self‐reported their perceived weight status. Results: Compared with measured weight status by established BMI cut‐offs, just over 20% of parents underestimated their child's weight status and only 1% overestimated. Adolescent boys were more likely to underestimate their weight status compared with girls (26.4% vs. 10.2%, P < 0.05) whereas adolescent girls were more likely to overestimate than underestimate (11.8% vs. 3.4%, P < 0.05). Underestimation was greater by parents of overweight children compared with those of obese children, but still less than 50% of parents identified their obese child as ‘too fat’. There was greater recognition of overweight status in the adolescents, with 83% of those who were obese reporting they were ‘too fat’. Conclusion: Whilst there was a high degree of accuracy of weight status perception in those of healthy weight, there was considerable underestimation of weight status, particularly by parents of children who were overweight or obese. Strategies are required that enable parents to identify what a healthy weight looks like and help them understand when intervention is needed to prevent further weight gain as the child gets older.     

Maternal prompts to eat, child compliance, and mother and child weight status

OBJECTIVE: To determine if there is a relationship between maternal prompting to eat, child compliance, and mother and child weight. STUDY DESIGN: Seventy-one 3- to 6-year-old children and their mothers were videotaped tasting four foods (two familiar, two novel). Maternal prompts to eat and the child's compliance with the prompts were coded. Multiple logistic regression evaluated demographic, anthropometric, and food characteristics that predicted prompting and compliance; and demographic, behavioral, and food characteristics that predicted child body mass index Z score (BMIz) in the children of obese and non-obese mothers. RESULTS: Obese mothers did not prompt more than non-obese mothers, but children of obese mothers were more compliant (70.2% +/- 19.4 v 59.6% +/- 21.2, P = .04). Low maternal education, a novel food, and younger child age predicted prompting. Maternal obesity, a familiar food, and older child age predicted compliance. In children of obese mothers, low maternal education, more prompts to eat novel foods, fewer prompts to eat familiar foods, and fewer child bites of familiar foods predicted child BMIz (R(2) = 64%). In children of non-obese mothers, none of the covariates predicted child BMIz. CONCLUSIONS: Children of obese mothers may be more responsive to environmental cues to eat.     

Maternal Depressive Symptoms and Child Obesity in Low-Income Urban Families

ObjectiveTo characterize the relationship between maternal depressive symptoms and child weight status, obesity-promoting feeding practices, and activity-related behaviors in low-income urban families.MethodsWe conducted a cross-sectional survey of mothers with 5-year-old children receiving pediatric care at a federally qualified community health center. We used regression analyses to examine the relationship between maternal depressive symptoms (trichotomized: none, mild, moderate to severe) and 1) child weight status; 2) obesity-promoting feeding practices, including mealtime practices and feeding styles; and 3) activity-related behaviors, including sleep time, screen time, and outdoor playtime.ResultsThe sample included 401 mother–child pairs (78.3% response rate), with 23.4% of mothers reporting depressive symptoms (15.7% mild, 7.7% moderate to severe). Mothers with moderate to severe depressive symptoms were more likely to have overweight and obese children than mothers without depressive symptoms (adjusted odds ratio 2.62; 95% confidence interval 1.02–6.70). Children of mildly depressed mothers were more likely to consume sweetened drinks and to eat out at restaurants and were less likely to eat breakfast than children of nondepressed mothers. Mothers with depressive symptoms were less likely to set limits, to use food as a reward, to restrict their child’s intake, and to model healthy eating than nondepressed mothers. Children with depressed mothers had less sleep and outdoor playtime per day than children of nondepressed mothers.ConclusionsMaternal depressive symptoms are associated with child overweight and obese status and with several obesity-promoting practices. These results support the need for maternal depression screening in pediatric obesity prevention programs. Further research should explore how to incorporate needed mental health support.     

Body size preferences and food choice among mothers and children in Malawi

Overweight in mothers and children in sub‐Saharan Africa is rapidly increasing and may be related to body size perceptions and preferences. We enrolled 268 mother–child (6–59 months) pairs in central Malawi; 71% of mothers and 56% of children were overweight/obese, and the remainder were normal weight. Interviewers used seven body silhouette drawings and a questionnaire with open‐ and closed‐ended questions to measure mothers' perceptions of current, preferred and healthy maternal and child body sizes and their relation to food choices. Overweight/obese and normal weight mothers' correct identification of their current weight status (72% vs. 64%), preference for overweight/obese body size (68% both) and selection of an overweight/obese silhouette as healthy (94% vs. 96%) did not differ by weight status. Fewer overweight/obese than normal weight mothers' preferred body silhouette was larger than their current silhouette (74% vs. 29%, p < .001). More mothers of overweight than normal weight children correctly identified the child's current weight status (55% vs. 42%, p < .05) and preferred an overweight/obese body size for the child (70% vs. 58%, p < .01), and both groups selected overweight/obese silhouettes as healthy for children. More than half of mothers in both groups wanted their child to be larger than the current size. Mothers said that increasing consumption of fruits, vegetables, meat, milk, grains, fizzy drinks and fatty foods could facilitate weight gain, but many cannot afford to purchase some of these foods. Their desired strategies for increasing weight indicate that body size preferences may drive food choice but could be limited by affordability.     

How do parents of 4‐ to 5‐year‐old children perceive the weight of their children?

Introduction: A heavier weight in adults is becoming the norm rather than an abnormal weight. Whether the same trend is happening in children is unknown. Objective: To assess the perception of the weight of 4‐ to 5‐year‐old children and the recognition of overweight by both parents. Design: Population‐based survey. Participants: A questionnaire was sent to parents of 1155 4‐ to 5‐year‐old children. Results: In total, 439 questionnaires (35%) were returned. Of all, 90% of the children had a normal weight, 9.3% were overweight and 4.1% were obese. For all weight classes, the parents depicted the child as lighter on both the verbal and visual scale. Of all, 75% of mothers of overweight children stated that the child had a normal weight. In obese children, 50% of the mothers believed that the child had a normal weight. Conclusion: Children with a weight in the normal range were considered by their parents as a little too light or too light. Overweight was considered as normal weight, and obesity as normal or a little too heavy. The perception of a normal weight in children at 4–5 years is distorted.     

Family history and parental recognition of overweight in Croatian children

The aim of this study was to evaluate the perception of parents on the weight status of their offspring, particularly in relation to a family history of obesity and obesity-related illnesses. A cross-sectional study of 1,068 child-parent dyads sampled at school entry health examination was conducted (median age of the child 6.75 years, range 5.7-8.3 years, 50.3 % males). The parental perception of the weight status of their child was compared to the body mass index (BMI, kilogram per square meter), calculated from measured weight and height. Weight status (underweight, normal, overweight, and obese) was defined using the United States Centers for Disease Control and Prevention BMI for age reference charts. Backward multiple linear regression analysis was used to determine possible predictors of parental misclassification of overweight/obese children. Among this cohort of children, 12 % were overweight, 10.2 % obese, and 8.1 % were underweight. Only 24.8 % of obese children and 2.2 % of overweight children were considered "overweight" by their parents. A positive family history was not significantly associated with parental recognition of overweight. Parental misperception of overweight/obese children as being normal was related to the child BMI z-score (odds ratio (OR) 0.036; 0.012-0.111) and diabetes in family history (OR 3.187; 1.207-8.413). CONCLUSION: The majority of parents did not perceive their overweight/obese children as overweight. As having an obese family member or one who has suffered from an obesity-related illness does not increase the parental ability to recognize overweight in their children, strategies to increase public awareness about the importance of one's family medical history are needed.     

Parental perception of overweight and underweight in children and adolescents

Aims: To compare the parental perception of overweight and underweight in their children to objective criteria, based on body mass index (BMI), waist circumference and triceps skinfold thickness, and to explore the effects of potential determinants. Methods: Logistic regression of anthropometric measurements, socio‐demographic characteristics and self‐reported parental height and weight on the parental perception of their child’s weight status in 3770 children aged 2–19. Results: Seventy per cent of overweight/obese children and 40.8% of underweight children were perceived having normal weight by parents. In 2‐ to 5‐year‐old overweight children, 91.2% were considered to have normal weight. For a given BMI, primary school age children, adolescents and girls had a higher probability to be assigned as overweight, whereas adolescents and girls had a lower probability to be assigned as underweight. Overweight parents more readily assigned their children as underweight, but there was no effect of parental educational level or parental underweight. Conclusion: Parental ability to recognize overweight or underweight in their offspring was generally poor. The findings emphasize the need for objective criteria based on physical measurements in the routine follow up of children, as parental ability to recognize weight problems in their children is nonreliable.     

Maternal prepregnancy body mass index in relation to Hispanic preschooler overweight/obesity

The aim of the current study was to examine the role of maternal prepregnancy body mass index (BMI) on overweight/obesity among US Hispanic children ages 2 and 4 years old. We used US nationally representative data from preschoolers enrolled in the Early Childhood Longitudinal Study-Birth Cohort study. The findings revealed that a significantly higher percent (41.6%) of Hispanic mothers were overweight/obese prior to pregnancy compared to white mothers (34.8%). At 2 years of age, 38.3% of the children born to Hispanic mothers were overweight/obese compared to 29.4% of children born to white mothers. By the age of 4, overweight/obesity increased significantly for both racial/ethnic groups with preschoolers whose mothers were Hispanic being more likely to be overweight/obese (44.6%) compared to children whose mothers were white (34.2%). Further, preschoolers born to overweight/obese Hispanic mothers were more than twice as likely [odds ratio = 2.74 (95% confidence interval (CI) 1.60, 4.69)] to be overweight/obese than those born to Hispanic mothers of normal prepregnancy BMI. Preschoolers born to overweight/obese white mothers were approximately 1.4 (95% CI 1.05, 1.93) times more likely to be overweight/obese in comparison to those born to mothers with a normal prepregnancy BMI. Maternal prepregnancy weight is potentially a modifiable risk factor for preschooler overweight/obesity. Study findings support the design of early and targeted interventions to reduce this risk to the long-term health of Hispanic maternal and child dyads.     

Hypercholesterolemia in Thai primary school children: Relation to maternal and nutritional factors

Background: There is evidence to show that atherosclerosis can occur in young children and that elevated total cholesterol and low density lipoprotein cholesterol concentrations are risk factors for atherosclerosis. The aim of the present cross-sectional study was to investigate the influence of maternal and nutritional factors on blood cholesterol in primary school children.
Methods: One hundred and ninety-five population-based mother–child pairs (obese child–overweight mother pairs, n = 60; obese child–normal-weight mother pairs, n = 48; wasted child–overweight mother pairs, n = 37; normal-weight child–normal-weight mother pairs, n = 50), were enrolled in the study. Various anthropometric parameters were measured and serum lipids of subjects were further determined. Biological data and children's eating behavior were obtained from the mothers through interviews.
Results: Hypercholesterolemia was found in 64.6–65% of obese children, 24.3% of wasted children and in 56% of the normal-weight children; whereas the proportion of children in all groups who had normal blood cholesterol levels was in the lower range. Multivariate logistic regression indicated that mother's serum cholesterol (odds ratio [OR], 2.41; 95% confidence interval [CI]: 1.12–4.78), child obesity defined by weight-for-height Z-score > +2SD (OR, 2.56; 95%CI: 1.33–4.98), and child's energy intake ≥75th percentile (OR, 2.59; 95%CI: 1.01–6.66) were the significant factors associated with hypercholesterolemia in children.
Conclusion: Hypercholesterolemia in school children is associated with familial factor, bodyweight and nutrient intake. Elevated blood cholesterol was also found in some of the normal-weight and wasted children. Effective family-based intervention programs are urgently needed to modify risk factors predisposing to coronary heart disease.     

Social and health behavioural determinants of maternal child‐feeding patterns in preschool‐aged children

Parental child‐feeding attitudes and practices may compromise the development of healthy eating habits and adequate weight status in children. This study aimed to identify maternal child‐feeding patterns in preschool‐aged children and to evaluate their association with maternal social and health behavioural characteristics. Trained interviewers evaluated 4724 dyads of mothers and their 4–5‐year‐old child from the Generation XXI cohort. Maternal child‐feeding attitudes and practices were assessed through the Child Feeding Questionnaire and the Overt/Covert Control scale. Associations were estimated using linear regression [adjusted for maternal education, body mass index (BMI), fruit and vegetables (F&V) intake and child's BMI z‐score]. Principal component analysis defined a three‐factor structure explaining 58% of the total variance of maternal child‐feeding patterns: perceived monitoring – representing mothers with higher levels of monitoring, perceived responsibility and overt control; restriction – characterizing mothers with higher covert control, restriction and concerns about child's weight; pressure to eat – identifying mothers with higher levels of pressure to eat and overt control. Lower socioeconomic status, better health perception, higher F&V intake and offspring cohabitation were associated with more ‘perceived monitoring’ mothers. Higher maternal F&V intake and depression were associated with more ‘restrictive’ mothers. Younger mothers, less educated, with poorer health perception and offspring cohabiting, were associated with higher use of ‘pressure to eat’. Maternal socioeconomic indicators and family environment were more associated with perceived monitoring and pressure to eat, whereas maternal health behavioural characteristics were mainly associated with restriction. These findings will be helpful in future research and public health programmes on child‐feeding patterns.     

Effect of the amount of food as a visible external stimulus on the eating behavior of obese children

In our study we investigated the influence of different amounts of food, offered to obese children. We compared the food intake of 15 obese children (8 girls, 7 boys mean overweight: 41 +/- 7%) aged 10 to 12 years (mean age: 11,3 +/- 0,8) with matched normal weight children: Obese children consumed significantly more food than the control group, independently of the amount of food offered. Offering higher amounts of food, obese children tended to eat more and increased their food intake significantly. Therefore we suggest, that obese children are more dependent on external stimulus concerning the amounts of offered food than normal weight children.     

Parents underestimate their child`s overweight

Aim: The aim of this study was to evaluate parents’ ability to perceive the weight status of their children. Methods: This cross‐sectional study was performed on 5 (n = 310) and 11‐year‐old (n = 296) children. The height, weight and waist circumference were measured. Body mass index (BMI, kg/m²) was calculated. The International Obesity Task Force criteria and the British cut‐off points were used to classify BMI and waist circumference. Parents filled out a questionnaire concerning their perception of the weight class of their child. The parents and the 11‐year‐old children estimated their own weight class. For analysis, the measured and perceived weight classes were divided into two categories; normal weight (including underweight) and overweight or obese. To measure the agreement cross‐tabulation with Cohen’s Kappa was used. Explanatory variables associated with misclassification of overweight children as normal weight were examined by logistic regression modelling. Results: The prevalence of overweight (including obese) was 17.4% and 21.6% in 5‐ and 11‐year‐old children in this study. Only a few parents misclassified their normal weight children as overweight. By contrast, a majority of parents to the 5‐year‐old children and about half of the parents to the 11‐year‐old children misclassified them as normal weight. Using waist circumference for body size classification did not improve parents’ performance. Mothers performed best when estimating own weight class. Conclusion: A majority of parents fail to recognize overweight or obesity in their 5‐ and 11‐year‐old children. The underestimation of overweight may impair the motivation of the parents to adopt weight control.     

Pathways of the association between maternal employment and weight status among women and children: Qualitative findings from Guatemala

The double burden of malnutrition, defined by the coexistence of undernutrition and overweight, is well documented in low‐ and middle‐income countries. However, the mechanisms by which employment may be related to maternal and child weight status in low‐ and middle‐income countries are not well understood. We conducted in‐depth interviews among 20 mothers who participated in Project MIEL, a contemporary trial which evaluated the effects of an integrated micronutrient supplement and parenting intervention in rural Guatemala. We utilized semi‐structured interviews to explore the pathways by which maternal employment might influence bodyweight. Interviews were structured to explore the factors that mothers considered when deciding whether or not to participate in the labor force and how mothers perceived the influence of employment on determinants of their own bodyweight and that of their children. Themes were used to develop a conceptual framework. Mothers described four pathways through which employment could lead to changes in weight status: changes in food purchasing; improved household well‐being; changes in time allocation; and psychological effects. Mothers described purchasing increased quantities and more varied types of food, as well as the purchase of energy‐dense foods. Less time to devote to food preparation resulted in mothers preparing quicker meals and relying on substitute childcare. Mothers also expressed feelings of worry and neglect in relation to being employed, and perceived that these feelings would affect weight. A better understanding of these mechanisms is important for developing policies and programs to support women in the workplace and also reducing maternal and child overweight in Guatemala.     

Family-focused behavioral approach to weight control in children

To treat the obese child or the child who is becoming obese appropriately, the clinician must determine if the adiposity is temporary or the beginning of a permanent trend that requires intervention. The concept of the "adiposity rebound" helps with this decision. The child's family is important and contributes to his or her body adiposity through both nature--an inherited metabolic tendency towards obesity--and nurture--the eating and activity environment and the family functioning. The activity level and energy intake, which although out of balance for the obese child, may not be low or excessive when compared to recommended amounts for children of that age or to that of peers. A child-family pattern can be defined in overweight children based on presence of a metabolic tendency, energy intake, activity level, and family functioning. In looking at the pattern rather than just the child's weight, the clinician can be much more effective with a weight control program, and with proper referral for changing family functioning prior to such a program if necessary.     

Parental perception of weight and weight-related behaviour in 2- to 4-year-old children in the eastern part of the Netherlands

Parental perception of weight status and weight-related behaviour of their toddler was determined through a questionnaire survey in child health care centres (CHCs). Complete data on weight, length, sex and age were available for 635 of 682 children (93.1%). The median age of the children was 37.0 months (range 24–56 months). Of all 635 children, 76.5% were normal weight, 16.2% underweight and 7.2% overweight. Parents’ perception of the weight of their child compared with their peers was moderately related to the actual weight status. Of the parents of overweight and underweight children, 87.0% and 89.3%, respectively, were not concerned. Only the parents’ perception of the amount of food eaten by their child was significantly related to the weight status. The primary goal of CHC workers should be to create parental awareness in case of their child being overweight or underweight and to support them in accomplishing a healthy lifestyle. An erratum to this article can be found at     

Can mothers influence their child's eating behavior?

This study examined the relationship between general maternal parenting style, maternal eating cues, and a child's eating behavior during mealtime. We expected that the general style would relate to the number of specific eating cues and that mothers who used more eating prompts would have children that ate more and at a faster rate. Seventy-seven children (39 girls, 38 boys), aged 3.5 years, visited the laboratory with their mothers for a videotaped lunch. Videotapes of each laboratory visit were coded for the child's eating rate and maternal parenting style, which was measured as the level of maternal control and support and the number and type of eating prompts given during a meal. Caloric intake was also calculated. The number and rate of verbal and physical encouragements and discouragements were significantly related to measures of general maternal parenting style and meal duration. The rates of food offers, food presentations, and total prompts were all significantly related to the child's rate of calorie intake. However, a mother's level of support or control was not related to the child's eating behavior. Although general maternal parenting style did not predict the child's eating behavior, these behaviors were related to the frequency of maternal eating prompts, which in turn were significantly related to the number of calories eaten and the time spent eating by the child. Children who ate the fastest had mothers who delivered eating prompts at a higher frequency. These findings may have implications for the development of obesity later in childhood, as a function of rapid eating or of poor self-regulation.     

Influence of parental obesity on the physical constitution of preschool children in Japan

The objective of this study was to assess the influence of parental obesity on the physical constitution of preschool children. A total of 3187 children aged between 1–6 years and their parents were studied. A child whose per cent obesity (%OB; per cent overweight for age, height and sex) was greater than 15%, and a parent whose body mass index (BMI; kg/m²) was greater than the 95th percentile were defined to be obese (27.40 and 25.97 for a father and a mother, respectively). We found that the incidence of obesity in children with obese fathers (11.5%) was significantly higher than in those with non-obese fathers (6.2%), and a similar difference was obtained between children with obese mothers (14.5%) and with non-obese mothers (6.2%), respectively. The incidence of obesity in children was 6.0% if both parents were non-obese; this incidence rose to 22.7% if one parent was obese, and to 30.8% if both were obese. The %OB of children was more markedly correlated with the mothers' BMI (r = 0.219) than the fathers' BMI (r = 0.165). The %OB of children correlated significantly with fathers' BMI, but only from the age of 3–6 years, whereas mothers' BMI correlated from the age of 1–6 years. We concluded that parental obesity was of significance in determining the development of juvenile obesity even in the preschool period.     

Association between school children's overweight and maternal obesity and perception of their children's weight status

AIM: To determine the association between overweight children and a) other components of the mothers' metabolic syndrome, such as body mass index (BMI), waist circumference (WC), HDL-cholesterol, triglycerides, glucose, HOMA-IR, blood pressure (BP), and age; and b) the mothers' perception of their children's overweight. METHODS: Six hundred and twenty children (297 M) aged 9 +/- 2 years and their mothers aged 37.7 +/- 7 years were examined between April and August 2006. BMI, BP, fasting glucose and lipids and children's Tanner stage were determined. Questionnaires were filled in about the mothers' perceptions of their children's eating habits and of their children's shape. RESULTS: Ninety-five (17.4%) of the children were obese (> 95th percentile), 108 (15.3%) overweight (> 85th percentile) and 418 (67.3%) normal. One hundred and twelve (18%) of the mothers were obese and 183 (29.5%) overweight. Mean values for measures in mothers differed between normal vs overweight/obese children: z-BMI (-0.19 vs 0.42), triglycerides (84 vs 105 mg/dl), cholesterol (147 vs 157 mg/dl), glucose (78 vs 82 mg/dl) and insulin resistance (HOMA-IR 1.34 vs 1.72). There were significant differences in the proportion with distorted perception of shape (2.2% vs 47.5%) and eating habits (11.2% vs 37%) between mothers of normal versus overweight/ obese children. Logistic regression analysis using BMI > or = 85th percentile as the dependent variable showed that the mothers' perceptions of their children's shape (OR: 18.84; 95% CI: 5.0-69.6), eating habits (OR: 3.82; 95% CI: 1.5-9.5) and mothers' BMI (OR: 2.1; 95% CI: 1.3-3.4) were associated with children's overweight. CONCLUSIONS: There was an association between mothers' distorted perception of their children's shape and eating habits and mothers' obesity and their children's overweight. This observation provides clues for obesity prevention programs.