Abstract
BackgroundPerceptions of children's weight status may be important in obesity prevention and treatment.AimsThis review identifies the prevalence of the underestimation of overweight status in children by parents/main carers, children, and healthcare professionals (HCP). The review critically synthesized both quantitative and qualitative evidence to explore the factors associated with this underestimation. The diverse methods used to assess this phenomenon are reported.MethodsPooled effect sizes were calculated using random‐effects model. Published studies, up to 2020, were accessed using the following search engines: CINAHL, EMBASE, PUBMED, and Psych‐Info and including the “Cited by” and “Related Articles” functions. Hand‐searching was used to retrieve further articles. Publication language and location had no bearing on the nature of the included studies.ResultsA total of 91 articles were included. In the quantitative studies, 55% (95% CI 49%–61%) of caregivers underestimated their child's level of overweight and obesity using a verbal scale and 47% (95% CI 36%–55%) using visual scales. Of the children studied, 34% (95% CI 25%–43%) underestimated their own level of overweight and obesity using both scales. In (n = 3) articles, HCPs reflected this misperception, but limited studies prevented meta‐analysis. Underestimation was associated with the child's age, gender, BMI and parental weight status, ethnicity and education. In the qualitative studies, parents/main carers of children with overweight and obesity described their child's weight in terms other than overweight, for example, “big boned,” “thick,” and “solid.”ConclusionThe results confirm the prevalence of underestimation of child overweight status across international studies. Understanding the factors which lead to this inaccuracy may help to improve communication within the therapeutic triad and facilitate the recognition and management of children's overweight status.
Highlights
Levels of childhood overweight and obesity continue to increase globally.[1]
Given that part of the aim of this systematic review was to examine the diversity of methods used to evaluate underestimations of children's overweight status, data on the verbatim questions that were asked of participants, verbatim response options, stated justifications for questions and/or responses, whether the participants were aware of weight status before answering, and whether participants were told of weight status, were extracted
This review has shown that children's overweight status is frequently underestimated and is consistent with the earlier reviews conducted by Parry et al.[12]
Summary
Levels of childhood overweight and obesity continue to increase globally.[1]. Approximately 41 million children aged 0–5 years are classified as overweight or obese, while 340 million children aged 5– 19 years can be categorized as overweight or obese.[2]. Aims: This review identifies the prevalence of the underestimation of overweight status in children by parents/main carers, children, and healthcare professionals (HCP). 55% (95% CI 49%–61%) of caregivers underestimated their child's level of overweight and obesity using a verbal scale and 47% (95% CI 36%–55%) using visual scales. 34% (95% CI 25%–43%) underestimated their own level of overweight and obesity using both scales. Parents/main carers of children with overweight and obesity described their child's weight in terms other than overweight, for example, “big boned,” “thick,” and “solid.” Conclusion: The results confirm the prevalence of underestimation of child overweight status across international studies. Understanding the factors which lead to this inaccuracy may help to improve communication within the therapeutic triad and facilitate the recognition and management of children's overweight status
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