Generational Shift in Parental Perceptions of Overweight Among School-Aged Children

Abstract

WHAT'S KNOWN ON THIS SUBJECT:There is a generational shift in social norms related to body weight among adult population; little is known about the secular change of paternal perceptions of their child' s weight. WHAT THIS STUDY ADDS:A shift in body norms toward heavier weight statuses exists among parents of children, presenting a vast challenge to family-based childhood obesity prevention. Primary care providers can play a more active role in identifying the children with increased weight. abstract BACKGROUND: Parental perceptions of child' s weight status may influence family readiness to foster healthy behaviors. This study investigated the generational shifting of parental perceptions about children' s weight.METHODS: Data were collected in the NHANES 1988-1994 (n = 2871) and 2005-2010 (n = 3202). Parents, mainly mothers, were asked whether they considered their child, ages 6 to 11 years, to be overweight, underweight, or just about the right weight. The Centers for Disease Control and Prevention 2000 growth chart was used for reference. We ran Poisson regression to estimate the probability ratio between the 2 surveys for parents perceiving their child as overweight after controlling for actual weight. RESULTS:The 10th percentile of BMI z scores for children who were parentally perceived as overweight shifted with statistical significance from 84th percentile of reference population in the early survey to 91st percentile of reference population in the recent survey (P , .05). The mean z score of children parentally perceived as overweight also increased between surveys with the largest increase among children from poor families (from 1.60 [SE: 0.20] to 1.98 [0.08], P , .05), followed by African Americans (from 1.65 [0.09] to 2.02 [0.05], P , .05). The probability of overweight/obese children being correctly perceived as overweight by the parents declined by 24% between surveys (probability ratio = 0.76 [95% confidence interval: 0.67-0.87]).CONCLUSIONS: Overweight/obese children were less likely to be perceived as overweight in the recent survey compared with peers of similar weight but surveyed 10+ years earlier. The declining tendency among parents to perceive overweight children appropriately may indicate a generational shift in social norms related to body weight.

All in the Family? Parental Roles in the Epidemic of Childhood Obesity

“…And desensitization may be occurring as excess weight becomes more of a cultural norm. This is consistent with research showing that parents are more likely to classify normal weight children as 'thin or underweight' than in the past (Luttikhuis, Stolk and Sauer 2010), and are now less accurate in their predictions than parents were a generation ago (Hansen et al 2014). Further, some parents believe their child's size is biologically determined and beyond their control, thus making pediatric growth charts 'irrelevant' (Jain et al 2001).…”

The Relationship between Childhood Obesity, Low Socioeconomic Status, and Race/Ethnicity: Lessons from Massachusetts

“…14 Moreover, low-income families are less likely to realize that their child is overweight or believe that they should interfere with the child's eating and activity behaviors. 15 Low-income communities face a host of barriers to improving health statuses. 16,17 Efforts to understand the underpinnings of childhood obesity have been increasingly successful in identifying associated factors that appear to substantially correlate with childhood obesity.…”

Fitwits TM Leads to Improved Parental Recognition of Childhood Obesity and Plans to Encourage Change

“…The study authors surmised a generational shift in mismatched parent perceptions with current heavier child weights and a related growing challenge to prevent childhood obesity. 33 Correct recognition by parents of their child's BMI percentile after the intervention showed an overall improvement, most notably for obese and overweight children. However, some parents continued to incorrectly identify their child's BMI.…”

“…28,35 The new childhood "norm" of excess body weight makes it difficult for parents and youth to know what healthy children look like. 33,36 Although the Institute of Medicine (2005) and the American Academy of Pediatrics (2007) endorsed the term obesity in child BMI percentile determinations, 34,37,38 some of the pediatric literature finds it pejorative or insensitive for family discussions and shows preference for terms such as unhealthy weight. 22,39 -41 Providers agree on healthsupporting, culturally attuned, and motivating discussions.…”

“…This highlights the difficulties of educating parents to identify BMI status in the new "normal" environment of heavier children, even with a dedicated intervention. 33 The behavioral management suggestions for nutrition, portion size, and activity changes built in to the Fitwits flashcards were reflected in the 2 goals most often chosen by the parent-child dyads. The majority of comments by parents were appreciative of the physician interaction, Fitwits flashcards, and information.…”