Abstract
BackgroundParents’ underestimation of their child’s weight status can hinder active participation in overweight prevention programs. We examined the level of agreement between the parents’ perception of their child’s weight status and the child’s actual weight status, moderating factors, and change over time.MethodsThis cross-sectional study used data collected in 2009 (n = 8105), 2013 (n = 8844) and 2017 (n = 11,022) from a community-based survey conducted among parents of children age 2–12 years in the Netherlands. Parents classified their perception of their child’s weight status on a 5-point Likert scale. In 2009 and 2013, the child’s BMI was calculated from self-reported data by parents. The level of agreement between the parent’s perception of the weight status and the actual weight status was examined using Cohen’s kappa. The role of demographic factors on parents’ perception were examined using logistic regression.ResultsIn 2009, 2013 and 2017, 6%, 6% and 5% of the parents, respectively, classified their child as heavy/extremely heavy. In 2009 and 2013, 64.7% and 61.0% of parents, respectively, underestimated the weight status of their overweight child. This was even higher among parents of obese children. Overall, the agreement between the parents’ perception and the actual weight status improved from 2009 (kappa = 0.38) to 2013 (kappa = 0.43) (p<0.05), but remained unsatisfactory. The parents’ underestimation of their child’s overweight/obesity status was associated with the child’s age in 2009 and 2013 (2–7 years; OR: 0.18), the child’s gender in 2009 (male; OR: 0.55), and the parents’ education level in 2009 (middle and high education; OR: 0.56 and 0.44 respectively).ConclusionsParents’ underestimation of their child’s weight status remains alarmingly high, particularly among parents of young, obese children. This underestimation is a barrier to preventing childhood overweight/obesity. Healthcare professionals should take this underestimation into consideration and should actively encourage parents to take steps to prevent overweight/obesity in their children.
Highlights
In children, overweight and especially obesity are serious health issues [1, 2]
The data underlying the results presented in the study are available from the Municipal Health Services of the GelderlandSouth region, the Netherlands for researchers who meet the criteria for access to confidential data
In 2009 and 2013, 64.7% and 61.0% of parents, respectively, underestimated the weight status of their overweight child. This was even higher among parents of obese children
Summary
Overweight and especially obesity are serious health issues [1, 2]. Preventing the development of both overweight and obesity is important, given the complexity associated with treating these conditions [3] and their far-reaching, long-term consequences [4,5,6,7,8]. Results from international studies show that more than half of all parents of overweight/obese children 2–12 years of age either underestimate their child’s weight status or are not concerned regarding the risks associated with childhood overweight/obesity [16, 17, 19,20,21] This parental underestimation of the child’s weight status is alarming and can have several important consequences, including: i) hindering the parents’ motivation to address the problem [18, 22]; ii) hindering the parents’ active participation in intervention programs as well as participation of overweight/obese children; iii) causing overweight children to regard their weight status as “normal” and continue to engage in obesogenic behaviors; and iv) increasing the risk of non-overweight children becoming overweight in the future [23]. We examined the level of agreement between the parents’ perception of their child’s weight status and the child’s actual weight status, moderating factors, and change over time
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