Cumulative residential greenness and childhood body mass index.

ObjectivesThis study examines the association between residential greenness, access to green space, and childhood Body Mass Index (BMI) on a national population of children in Wales. Using linked environmental and national surveillance data, we assess whether long-term exposure to greener environments is associated with children being overweight or obese. Methods BMI was calculated using height and weight records from the Child Measurement Programme for Wales (2012/13–2018/19). We used Landsat satellite imagery (30-meter resolution) to derive an annual Enhanced Vegetation Index (EVI) within 300m of each child's residence in Wales for 2008–2019. EVI values were averaged over four-years preceding their BMI measurement. Green space access was calculated using Ordnance Survey Open Greenspaces to create a count of green spaces within 800m of each child’s residence. Logistic regression was used to assess associations between EVI, green space, and BMI, adjusting for sociodemographic characteristics. ResultsThe study included 201,698 children aged 4–5 years old. After adjusting for covariates, every unit increase in EVI was associated with a 20% higher likelihood of a child being overweight or obese. For every additional green space within 800m of a child’s home, the likelihood of unhealthy weight increased by 0.3%. Findings suggest that higher EVI levels and greater green space availability do not necessarily translate into healthier BMI outcomes. ConclusionThis study explored associations between objective measures of ambient greenness, green space and BMI in a national population of children. Findings demonstrate that higher EVI was associated with greater odds of unhealthy weight, highlighting the complexity of the relationship. EVI should be interpreted carefully as it is a measure of vegetation health and may not capture how children use green environments. BMI is measured at a single time point in Wales (ages 4-5) when children are less independent and therefore these findings may not reflect greenspace’s health benefits in older childhood. Future studies should focus on objective exposures that can accurately reflect children’s interactions with their built environment.

The gold standard for categorisation of weight status is clinically measured body mass index (BMI), but this is often not practical in large epidemiological studies. To determine if a child's weight perception or a mother's perception of a child's weight status is a viable alternative to measured height and weight in determining BMI classification. Secondary outcomes are to determine the influence of a mother's BMI on her ability to categorise the child's BMI and a child's ability to recognise his/her own BMI. Cross-sectional analysis of the growing up in Ireland cohort study, a nationally representative cohort of 8568 9-year-old children. The variables considered for this analysis are the child's gender, BMI (International Obesity Taskforce grade derived from measured height and weight) and self-perceived weight status, and the mother's weight perception of the child, BMI (derived from measured height and weight) and self-perceived weight status. Cohen's weighted-kappa was used to evaluate the strength of the agreement between pairwise combinations of the BMI variables. Cumulative and adjacent categories logistic regression were used to predict how likely a person rates themselves as under, normal or overweight, based on explanatory variables. Mothers are more accurate at correctly classifying their child's BMI (κ=0.5; confidence intervals (CI) 0.38-0.51) than the children themselves (κ=0.25; CI 0.23-0.26). Overweight mothers are better raters of their child's BMI (κ=0.51; CI 0.49-0.54), compared with normal (κ=0.44; CI 0.41-0.47) or underweight mothers (κ=0.4; CI 0.22-0.58), regardless of whether the mother's BMI is derived from measured height and weight or self-perceived. The mother's perception of the child's weight status is not an influencing factor on the child's ability to correctly classify him/herself, but the child's self-perceived weight status influences the mother's ability to correctly classify the child. A mother's BMI classification of her child is a viable alternative to BMI measurement in large epidemiological studies.

Tackling parents' misperceptions about their children's weight issues needs careful handling.

Maternal lifestyle during pregnancy may affect the development of overweight and obesity in the child. We examined whether maternal exercise during pregnancy is associated with offspring overweight and obesity in childhood. A secondary aim was to examine whether the association is affected by the child's physical activity level. This study is based on data from the Norwegian Mother, Father and Child Cohort Study (MoBa), including 44 352 pregnancies and children (n=32 304 in week 17 and n=32 419 in week 30 in the final adjusted model). Maternal exercise during pregnancy was self-reported in gestational weeks 17 and 30. We conducted linear and logistic regression separately for girls and boys, and outcomes were the child's body mass index (BMI) and weight status (overweight/obese) at age 7years. We further examined the additive joint association between maternal exercise during pregnancy and the child's leisure time physical activity on weight status at age 7years. In total, 12.4% of the children were classified as overweight or obese, and 1.7% as obese. The results suggest no association between maternal exercise in both gestational weeks 17 and 30 and the weight status of the child at age 7years. The association between maternal exercise and the child's weight status at age 7years appears not to be affected by the child's physical activity level. Maternal exercise level during pregnancy does not appear to be associated with the child's BMI or odds of being overweight or obese in childhood.

The purpose of this study was to examine the accuracy of Hispanic parents' perceptions of their preschool children's weight status. A cross-sectional descriptive design with Hispanic parent-child dyads (n = 83) from a Head Start setting was used to compare parents' perceptions of their children's weight status with their 2- to 5-year-old children's body mass index (BMI) and weight categories. Methods included a word choice from five response options, and varying body size silhouettes presented in a linear fashion and a random circular pattern. Parents' perceptions were compared with the children's BMI, and in relationship to parents' demographic characteristics and BMI. Approximately half of parents underestimated their child's weight status, and overweight/obese parents tended to underestimate their overweight/obese children's weight status. Eliciting parent perception of their child's weight is one way providers can engage in obesity prevention dialogue.

Pediatric obesity is multifactorial and difficult to treat. Parenting and feeding behaviors have been shown to influence a child's weight status. Most prior studies have focused on preschool-aged White children. Additional complicating factors include parents' inability to accurately identify their child's abnormal weight status. Parenting and feeding behaviors used by 176 African American and White parents of school-age children were examined. Assessment included (a) identifying what behaviors were reported when parent expressed concern with child's weight and (b) the relationship of these behaviors on child's body mass index percentile (BMI%), considering ethnicity, socioeconomic status (SES), and parent's body mass index (BMI). Findings included African American parents and parents concerned about their child's weight exhibited increased controlling/authoritarian parenting and feeding behaviors. Parents were able to accurately identify their child's weight status. Parenting and feeding behaviors played a significant role in the children's BMI% even when controlling for ethnicity, SES, and parent's BMI.

Obesity rates have continued to accelerate in the pediatric population. The accompanying co-morbidities of obesity have been recognized, yet the long term complications are not fully understood. The Health Belief Model is utilized in this study to evaluate parental perception of their child's weight status, related demographic factors, and food provision and consumption patterns associated with parental perception.;The purpose of this cross-sectional descriptive study was to examine the accuracy of parental perception of their child's weight status and to describe characteristics of those who accurately and inaccurately perceive their child's weight status. Chi-square analysis was used to determine relationships between parental perception of their child's weight status and the child's actual weight status. Relationships between parental perception of their child's weight status and demographic factors, as well as parental weight status, were also explored. Binary logistic regression was used to identify demographic predictors of parental accuracy of their child's weight status.;This study utilized data from the CARDIAC project which spanned from 2006-2009. Three cohorts of children from kindergarten (n= 957), second grade (n= 608), and fifth grade (n= 304) were evaluated from 16 counties in West Virginia. In addition, responses from an accompanying questionnaire were linked to the demographic and anthropometric data.;Parents of children in each cohort had a high level of accuracy in perceiving their child's weight status. Of the cohorts, parents of children in the fifth grade had the lowest accuracy in perceiving their child's weight status. Overall, parents were the least accurate in perceiving their child's weight status when the child was in the obese BMI category. More accurate parental perception was found in females than males in regard to their child's weight status.;Results indicate that parents in this study have a higher level of accurate parental perception of their child's weight status than in previous studies. Modifying factors were not a significant influence on accurate parental perception, nor did it impact the perceived threat of the child's BMI status. Without measurement of perceived threat, accurate parental perception of the child's weight status cannot be considered equivalent to perceived threat of the illness. Therefore, likelihood of action cannot be determined from this study. The Health Belief Model (HBM) was not helpful in this population with this particular problem. Likelihood of change in the food provision and consumption patterns depends on accurate perception of the problem and how the problem impacts their child. Recommendations for future studies include evaluating a broader, more ethnically diverse population. Additional studies should include the impact of perceived threat of illness.

In the USA, African American children residing in rural areas are disproportionately affected by childhood obesity. One strategy for preventing childhood obesity is helping caregivers to recognize their child is overweight or obese. The purpose of this study is to assess African American caregivers' perceived level of their child's obesity status and concordance between caregiver's reported height and weight of their children compared to the objective measure of their child's height and weight. Caregivers completed a paper-based survey about perceptions of their child's weight status including body silhouettes (n=119) and self-reported their child's body mass index status (n=68). Children's (n=71) height and weight were objectively measured. Spearman rho and independent sample t tests were calculated to assess the relationship between caregiver's self-reported and objective BMI status. Caregiver's visually perceived their child's weight status to be underweight; yet, self-reported that their child's body mass index status was obese. The Spearman's rho correlation indicated a significant relationship between caregiver's self-reported and objective body mass index (r=.39, p<.001). The independent sample t test reflected that the mean self-reported body mass index and objective body mass index were statistically significant with calculated body mass index perception. The investigation of three different methods for assessing body mass index perceptions may contribute to the development of tailored programs and interventions that include counseling strategies that increase parental education about their child's body mass index.

To determine the ethnic variation in maternal underestimation of their child's weight status and the explanatory role of socio-economic status (SES), acculturation and parental body mass index (BMI). A multi-ethnic sample of 2769 normal or overweight/obese children (underweight children excluded) aged 5-7 years was examined (The Amsterdam Born Child and their Development study), comprising five ethnic subgroups: Dutch (n=1744), African descent (n=184), Turkish (n=86), Moroccan (n=161) and other non-Dutch (n=592). Data on mothers' perception of their child's weight status (5-point scale from 'too low' to 'too high'), SES, acculturation, parental BMI and the children's height and weight were collected. Underestimation was defined by comparing maternal perception with the actual weight status of her child (International Obesity Task Force guidelines). Ethnic differences in underestimation were calculated in the normal weight and overweight/obese categories. Underestimation ranged from 3.6 (Dutch) to 15.7% (Moroccan) in normal-weight children, and from 73.0 (Dutch) to 92.3% (Turkish) in overweight/obese children. After correction for ethnic differences in child's BMI, higher odds ratios (ORs) for underestimation were found in the Turkish (normal weight: OR 6.83; 95% confidence interval (CI) 2.33-20.05 and overweight: OR 2.80; 95% CI 1.12-6.98) and Moroccan (normal weight: OR 11.55; 95% CI 5.28-25.26) groups (reference is the Dutch group). Maternal educational level and immigrant generation largely explained the ethnic differences, with a minor contribution of maternal age. After correction, ORs remained higher in the Moroccan group (OR 4.37; 95% CI 1.79-10.62) among the normal-weight children. Mothers frequently underestimate the actual weight status of their child, especially mothers from Turkish or Moroccan origin. Having a lower SES, being first-generation immigrant and a young mother are important determinants in explaining these differences. As weight perceptions may affect weight gain and almost all mothers of overweight/obese children underestimate their child's weight, health professionals should help mothers (particularly those from ethnic minority groups) to acquire a realistic perception of their children's weight status.

Previous studies have explored people's perceptions of weight-related terminology; however, to date, limited data has explored the emotional response to weight-related terms used by healthcare professionals (HCPs). This study explored the preferences and emotional responses of terms used by HCPs to describe body weight and of parents to describe their children's weight. A total of 2911 adults completed an online cross-sectional survey, with 1693 living with overweight or obesity (mean age 49.2 years [SD 12.5], female (96%), median body mass index (BMI) 31.4kg/m2 [28.1, 36.5]). The survey explored preferences of 22 weight-related terms using a 5-point Likert scale and their emotional response to these terms (using 7-core emotions). Parents also indicated preferences and emotional responses to terms used to describe their children's weight. Respondents completed the modified weight bias internalization scale to examine how this may impacted preferences. 'Weight', "unhealthy weight" and "overweight" were the three preferred terms, while "super obese", "chubby", and "extra-large" were least preferred in people living with overweight and obesity. Parents preferred 'weight', "unhealthy weight" and "body mass index", and least preferred "fat", "extra-large" and "extremely obese" when describing their children's weight. All terms elicited a negative emotional response. The most commonly emotion was sadness for terms to describe adult's bodyweight, and anger for terms used to describe children's weight. All BMI categories reported disgust with terms incorporating "obese". Our results offer novel insight into the preferred terminology and emotional responses to terminology used by HCPs for both adults and parents to describe their children's weight.

BackgroundParents 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.MethodsWe 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.ResultsEighty-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.ConclusionsChildren 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.

BackgroundA better understanding of the link between eating behavior and maternal feeding practices with childhood and maternal weight status is of great interest.ObjectiveTo assess the association between childhood anthropometric measures with mothers' Body Mass Index (BMI) and their feeding practices toward preschool children in Chile.Methods1029 children (504 boys, 4.3 ± 0.3 years) and their mothers were selected from public nurseries located in low income neighborhoods in Santiago. Mothers' BMI, children's BMI and waist-to-height ratios were registered. Maternal feeding practices towards their children's nutritional habits were measured using an adapted version of the Child Feeding Questionnaire (CFQ).ResultsWe found a direct correlation (p < 0.001) between children's BMI z-score and their mothers' BMI, both in boys (Spearman rho = 0.26) and girls (rho = 0.30). A direct association was also found between children's BMI z-score with scores of the subscale "concern for child's weight" (Spearman rho = 0.26 in boys and rho = 0.37 in girls; p < 0.001) and "food restriction" (rho = 0.19 in boys and rho = 0.27 in girls; p < 0.001). A reverse significant association was found between children's BMI z-score with scores of "pressure to eat" (rho = -0.30 in boys and rho = -0.36 in girls; p < 0.001). Analyses of the combined categories of childhood obesity and/or maternal obesity showed an important influence of children's weight status on CFQ scores.ConclusionMothers' BMI and children's BMI z-scores are highly correlated. We found significant associations between mothers' behaviour subscales and children's BMI z-score. It is not possible to establish a causal link between mother's CFQ scores and children's nutritional status, given the cross-sectional nature of this study and the bidirectional influences that exist between mothers and their children.

Fathers' feeding practices and children's weight status in Mexican American families

Childhood obesity has increased rapidly in China, but understanding is limited on how parents perceive their child's weight status and how this perception affects weight-related parenting practices. We examined maternal perception of her child's weight status and its association with demographics, subsequent weight-related parenting practices, the child's health behaviours and weight change. Design/Setting/Subjects Maternal perception of child's weight status and health behaviours from the China Health and Nutrition Surveys were assessed at baseline and in follow-up surveys for 816 children aged 6-18 years during 2004-2011. Associations were tested using mixed models. Overall, maternal and child perceptions of the child's weight status were fairly consistent (κ w=0·56), 63·8 % of mothers had correct perception. While 9·6 % of mothers perceived their child as overweight, 10·9 % of children did so, and 13·6 % of children were indeed overweight. Compared with mothers who viewed their children as normal weight, mothers who thought their children were overweight were more likely to encourage their children to increase their physical activity (OR; 95 % CI: 1·8; 1·0, 3·3) and to diet (4·3; 2·3, 7·8). Children perceived as overweight by their mothers were more likely to have insufficient physical activity (2·8; 1·6, 4·7) and gain more weight during follow-up (BMI Z-score, β (se): 1·0 (0·1); P<0·01) than children perceived by their mothers as normal weight. In China, mothers who perceive their child as overweight are more likely to encourage their child to exercise and modify their diet for weight management, but this encouragement does not seem to improve the child's health behaviours and weight status.

Parents' perception of their child's weight status and intention to intervene: a Western Australian cross‐sectional population survey, 2009–12