Parents' awareness of overweight in themselves and their children: cross sectional study within a cohort (EarlyBird 21)

Abstract

Obesity is a serious public health concern. More than half of British adults are overweight, and obesity among preschool children has increased by an alarming 70% in the past generation.1 2 We aimed to explore parents' awareness of overweight and obesity in themselves and their children, and their degree of concern about weight. Participants, methods, and resultsWe studied 277 healthy randomly recruited children (mean age 7.4 years) and parents from the EarlyBird study.3 Overweight and obesity were defined as body mass index at least 25 and 30 in adults, and at least 91st and 98th centiles of the UK 1990 body mass index reference curves for children. 4 Before we weighed them, parents completed a written questionnaire asking them to estimate their own and their child's weight on a five point scale ranging from "very underweight" to "very overweight." Responses indicating level of concern about weight were similarly ranked from "very worried about underweight" to "very worried about overweight."Children and parents were significantly heavier than UK norms (table): 52/277 (19%) children, 141/273 (52%) mothers, and 165/230 (72%) fathers were overweight (including obese). Among overweight parents, 40% mothers (45% fathers) judged their own weight "about right" and 27% (61%) were unconcerned about their weight.Only a quarter of parents recognised overweight in their child. Even when obese, 33% mothers (57% fathers) saw their child's weight as "about right." Parents were less likely to identify overweight in sons than daughters: only 27% of overweight or obese boys were classified as at least "a little overweight," compared with 54% of overweight girls (P = 0.01). More mothers than fathers correctly assessed their child's weight (84% v 76%, P = 0.06).Maternal weight status did not affect mothers' awareness of their chidren's weight: 82% of overweight mothers were correct compared with 82% of normal weight mothers (P = 0.50). However, only 74% overweight fathers were correct compared with 85% normal weight fathers (P = 0.08).More than half of the parents of obese children expressed some degree of concern about their child's weight, but only a quarter were even "a little worried" if their child was overweight. Most parents (86%) who were unaware that their child was overweight, were also unconcerned about their child's weight. One in ten parents expressed some concern about underweight in normal weight children.Prevalence of overweight in parents in the highest and lowest socioeconomic groups did not differ-59% in classes I and II were overweight compared with 62% in classes VI, VII, and VIII (P = 0.63; National Statistics Socioeconomic Classification 2001). Neither was there a difference in correct perception of the child's weight between socioeconomic groups (78% v 82%, P = 0.34).

Clinical efficacy of group-based treatment for childhood obesity compared with routinely given individual counseling

“…30 Many parents were obviously unaware that their children were overweight, as has been observed also by others. [31][32][33] In addition, some families were not ready, mainly due to time constraints, to be randomized into the group treatment. In our area, both fathers and mothers often work outside home, and they have limited time for recurrent group sessions and even for the daily household demands.…”

Overweight but unseen: a review of the underestimation of weight status and a visual normalization theory

“…more than one third of parents underestimating) are still observed across older childhood and adolescence 30, 32, 38. Likewise, although some studies have indicated that fathers are particularly likely to underestimate the weight status of their overweight child, studies repeatedly show that mothers of overweight children also frequently fail to identify that their child is overweight or obese 40, 41. Thus, as is the case with personal misperceptions of weight status, although some demographic factors have been reported to be associated with a particularly high prevalence of parental underestimation of child overweight, the failure of parents to identify adiposity is widespread 33, 38.…”

Does maternal concern about children's weight affect children's body size perception at the age of 6.5?—A community-based study

“…However, multiple reports (mainly studying mothers) have shown a striking picture of low rates of recognition; between 17-98% of parents do not recognize overweight in their overweight children. [7][8][9][10][11] The wide range may be attributed to study differences on factors such as the obesity cut points used, child age and the method of questioning. Mothers are more accurate with older and heavier children, 10 and better at estimating body size when pictorial or photographic figures, rather than the words 'overweight' and 'obese,' are used.…”

“…Mothers are more accurate with older and heavier children, 10 and better at estimating body size when pictorial or photographic figures, rather than the words 'overweight' and 'obese,' are used. 7 Postulated reasons for this low recognition include the normalization of overweight, denial, a genuine lack of concern or a belief that childhood 'puppy fat' is healthy; however, the evidence about the reasons remains scant. Concluding that 'the laypersons' perception of average weight and the clinical definition of overweight are now in conflict,' Jeffery reported 40% of overweight mothers and 45% of overweight fathers judged their own weight 'about right' and that a large proportion were unconcerned about their weight.…”