Parental Weight (Mis)Perceptions: Factors Influencing Parents’ Ability to Correctly Categorise Their Child’s Weight Status

Abstract

This study investigates parents' ability to correctly classify their child's weight status. The influence of parent and child socio-demographic and lifestyle factors on parental misclassification of their child's weight status is explored. A representative sample of Irish children (aged 5-12 (n = 596) years, aged 13-17 years (n = 441)) and their parents (n = 1885) were recruited to participate in a national dietary survey. Parental perceptions of their child's weight and their own weight were measured. Anthropometric measurements (weight and height) were objectively measured for parents and children. Body Mass Index (BMI) scores were derived and categorised as normal, overweight or obese using standard references. Over 80% of parents of overweight boys and 79.3% of parents of overweight girls reported their child's weight was fine for his/her height and age. Furthermore, 44.4% of parents of obese boys and 45.3% of parents of obese girls felt their child's weight was fine for their height and age. Parents were significantly less likely to be correct about their sons' weight status and more likely to be correct the older the child. Parents were over 86% less likely to be correct about their child's weight if their child was overweight and approximately 59% less likely to be correct if the child was obese, compared to parents of normal weight children. This research suggests that parents are failing to recognise overweight and obesity in their children with factors such as parental weight status, child's age and gender influencing this.

Full text

1 23
Maternal and Child Health Journal
ISSN 1092-7875
Matern Child Health J
DOI 10.1007/s10995-011-0927-1
Parental Weight (Mis)Perceptions: Factors
Influencing Parents’ Ability to Correctly
Categorise Their Child’s Weight Status
Eibhlin Hudson, Aileen McGloin & Aine
McConnon

1 23
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Parental Weight (Mis)Perceptions: Factors Influencing Parents’
Ability to Correctly Categorise Their Child’s Weight Status
Eibhlin Hudson •Aileen McGloin •Aine McConnon
ÓSpringer Science+Business Media, LLC 2011
Abstract This study investigates parents’ ability to cor-
rectly classify their child’s weight status. The influence of
parent and child socio-demographic and lifestyle factors on
parental misclassification of their child’s weight status is
explored. A representative sample of Irish children (aged
5–12 (n=596) years, aged 13–17 years (n=441)) and
their parents (n=1885) were recruited to participate in a
national dietary survey. Parental perceptions of their
child’s weight and their own weight were measured.
Anthropometric measurements (weight and height) were
objectively measured for parents and children. Body Mass
Index (BMI) scores were derived and categorised as nor-
mal, overweight or obese using standard references. Over
80% of parents of overweight boys and 79.3% of parents of
overweight girls reported their child’s weight was fine for
his/her height and age. Furthermore, 44.4% of parents of
obese boys and 45.3% of parents of obese girls felt their
child’s weight was fine for their height and age. Parents
were significantly less likely to be correct about their sons’
weight status and more likely to be correct the older the
child. Parents were over 86% less likely to be correct about
their child’s weight if their child was overweight and
approximately 59% less likely to be correct if the child was
obese, compared to parents of normal weight children. This
research suggests that parents are failing to recognise
overweight and obesity in their children with factors such
as parental weight status, child’s age and gender influ-
encing this.
Keywords Childhood weight Parents Perceptions 
Obesity
Introduction
Obesity in childhood is now recognised as a global public
health issue [1,2]. Studies have shown that obesity in
childhood is likely to continue into adulthood, with BMI
becoming relatively fixed by adolescence [3,4]. Identifi-
cation of children who are overweight or at risk of over-
weight is therefore important to prevent future ill-health.
Excessive weight gain in childhood is a result of a number
of factors, including poor dietary, eating and exercise
habits. Such habits are believed to be shaped early in
childhood and are influenced greatly by factors such as
family environment and parental practices [5,6]. Parents,
in particular mothers, have a large role to play in the
development of food and exercise behaviours in childhood
[7–9]. As a result the involvement of parents in efforts to
address childhood overweight is critical to their success
[10]. However, parents are unlikely to implement changes
to their child’s diet or lifestyle unless they recognise the
need for such changes or perceive their child at risk
[11,12]. Therefore, an important first step in addressing
childhood overweight and obesity is ensuring parents rec-
ognise unhealthy weight levels in their children. Knowing
whether or not parents can correctly classify their child’s
weight status is important for the development and
E. Hudson
School of Economics, Finance and Marketing, RMIT University,
Melbourne, Australia
A. McGloin
SafeFood, Block B Abbey Court, Dublin 1, Ireland
A. McConnon (&)
School of Public Health, Physiotherapy and Population Science,
University College Dublin, Dublin, Ireland
e-mail: aine.mcconnon@ucd.ie
123
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DOI 10.1007/s10995-011-0927-1
Author's personal copy

implementation of obesity prevention and treatment
programmes.
A number of studies have investigated the ability of
parents to correctly identify their child’s weight status
[13–26]. Previous research has suggested an association
between certain child and parent characteristics, such as
socio-demographic and lifestyle variables, and parental
ability to recognise overweight in their child. Huang et al.
reported that parental assessment of their child’s weight
status was mainly associated with child characteristics,
with younger children and more overweight children less
likely to be correctly classified by their parents [19]. He
and Evans reported that parents were more likely to mis-
classify their sons’ weight than their daughters’ weight
[20]. Similarly Maynard et al. reported that mothers were
almost three times more likely to classify their at-risk
([85th to \95th BMI-for-age percentile) daughters as
being ‘‘overweight’’ as compared with their at-risk sons
[18]. Mamum et al. reported that gender, child dissatis-
faction, child dieting and maternal overweight were par-
ticularly associated with maternal misclassification of their
overweight child [27]. In terms of parental characteristics
associated with ability to correctly identify their child’s
weight status, parental education and weight status of the
mother have been associated, with overweight mothers less
likely to correctly identify their child’s overweight status
than normal weight mothers [15,20]. It has been reported
that mothers with lower educational attainment were more
likely to misclassify their child’s weight status [15].
Despite this growing body of evidence, no clear expla-
nation for the misperception of child weight status or risk
of overweight exists. The majority of research to date has
focused on children under 12 years of age [28] and often
relied on self-reported weight status [15], or only recorded
the weight status of the child [29,30]. The importance of
parental perception of child weight status is equally rele-
vant in older children, as children start to gain more control
over their own eating habits and the incidence of over-
weight and obesity continues to rise during this life period.
In addition, most previous studies have only assessed
parental perceptions of overweight children, without con-
sidering how parents of normal weight children perceive
their child’s weight status.
Building upon this research, the current study hypoth-
esises that parents of overweight or obese children
1
will be
less likely to correctly classify their child’s body weight
status. In addition, this study will examine the influence of
parent and child socio-demographic and lifestyle factors on
parental misclassification of their child’s weight status in
Ireland.
Methods
Participants
Data presented in this paper were collected as part of the
National Children’s Food Survey (data collection March
2003–2004) and the National Teen Food Survey (data col-
lection September 2005–2006). A more detailed account of
the samples and methodologies used can be found at http://
www.iuna.net. Twenty-eight primary schools and 32 sec-
ondary schools were selected from a database obtained from
the Department of Education and Science in Ireland.
2
The
selection of schools was stratified by urban/rural location,
gender mix, size of school and the level of disadvantage.
Once consent was obtained from the school, information
packs were sent to the parents, and those parents who agreed
to participate were included in the study. These surveys were
cross-sectional and recruited nationally representative sam-
ples of children aged 5–12 years (n=596) and 13–17 years
(n=441), and their parents, in the Republic of Ireland. A
total of 1037 children and 1885 parents were sampled, with
both parents participating for 82% of the children. Ethical
permission was obtained from the Federated Dublin Vol-
untary Hospitals and St James’s Hospital Joint Research
Ethics Committee. The research was conducted in accor-
dance with prevailing ethical principles.
Anthropometric Measures
Anthropometric measurements of the children (n=1034)
and their parents (n=907 mothers, n=671 fathers) were
taken. Weight was measured in duplicate to the nearest
0.1 kg and height was measured to the nearest 0.1 cm.
Adiposity was assessed using Body Mass Index (BMI),
which was calculated by weight (kg) divided by height
squared (m
2
). Parental BMI were categorised as normal
weight (\25 kg/m
2
), overweight (25.0–29.9) or obese
(C30) based on World Health Organisation (WHO) cut-
offs. The UK 1990 BMI reference curves for boys and girls
were used to define BMI category for the children. A BMI
between the 91st and 98th percentile is classified as over-
weight and a BMI on or above the 98th percentile is
classified as obese [31].
Questionnaire Measures
Parents’ perceptions of their child’s weight and parents’
perceptions of their own weight were recorded in a ques-
tionnaire. They were asked to indicate if they agreed with
the statement ‘‘My child/teenager’s weight is fine for
1
The terms child and children are used to refer to those aged
5–17 years old.
2
This is the government body responsible for education in Ireland.
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his/her age and height’’. Parents were also asked if they
thought their own weight was fine for their age.
Data on age, gender, marital status, education level and
occupation of the parents as well as number of people
living in the household and the type of area the family live
in (urban/rural) were collected in the study and used in the
current analysis. From the dietary data collected, the per-
centage energy from fat was used as a marker for healthy
eating and mean hours of physical activity per week as a
marker of physical activity level.
Statistical Analysis
Statistical analysis was performed using Stata for Windows
version 9.2 (Stata Corp, Texas, USA). Descriptive statistics
on parents’ perception of both their child and their own
weight were examined in relation to actual body weight
status. Factors influencing parental ability to correctly
identify their child’s weight status were investigated using a
logistic model. This model included demographic variables,
variables which may influence child weight status (markers
of diet and physical activity level) and maternal variables.
Parental misperception regarding their child’s weight is
modelled in the equation below using logistic regression:
d
Correct ¼b0þb1Overweight þb2Obese þb3SES
þb2Education þb3Xþb4Z
where X includes other parental and household variables
(such as maternal weight status, maternal age, household
size and the type of area) and where Z includes child
characteristics (such as child age, gender, weight status,
diet and activity levels). Marginal effects rather than raw
coefficients are reported as the latter are not directly
interpretable. Following this analysis a Receiver Operator
Characteristic (ROC) curve was produced. This procedure
produces a measure called the area under the curve (AUC)
[32]. This measures the predictive power of the logistic
model in discriminating between parents that can and
cannot correctly evaluate their child’s weight.
Parental misclassification of child’s weight, the binary
dependent variable, was constructed using responses to the
question on (1) whether the parent thinks their child’s weight
is fine for the child’s age and height and (2) BMI classifi-
cation of the child. A parent was classified as correct if their
child’s BMI was categorised as normal and the parent said
that their child’s weight was fine or if their child was over-
weight/obese and the parent said that their child’s weight was
not fine. However, a parent was classified as incorrect if their
child was of normal weight and they said that their child’s
weight was not fine or if the parent said their child’s weight
was fine and their child was overweight/obese.
3
A variable was also constructed to investigate whether
parents accurately perceived their own weight based on (1)
responses to the question ‘‘My weight is fine for my age’’ and
(2) their BMI score. Parents were classified as correct if their
BMI was normal and they thought their weight fine for their
height and age or their BMI was not normal and they said
their weight was not fine. Conversely, a parent was classified
as incorrect if their BMI was normal and they said their
weight was not fine or if their BMI was not normal and they
said their weight was fine. Child BMI was controlled for in
the analysis to account for the influence of child body size.
Results
Descriptive Statistics
The characteristics of the respondents are presented in
Table 1. Most of the children (79.4%, n=823) were of
normal weight. However, 50.4% (n=457) of mothers and
75.3% (n=512) of fathers were overweight or obese.
Most parents completed second level education, with
76.3% (n=756) of mothers and 70.1% (n=620) of
fathers having attained Leaving Certificate.
4
Over half
(51.3%, n=522) of the sample was classified as being of
high socioeconomic status based on occupation.
5
Parental Perceptions
Table 2shows how parents perceived their child’s weight
by gender and measured weight status. While only 6.3%
(n=26) of parents of normal weight boys and 2.5%
(n=10) of parents of normal weight girls incorrectly state
that their child’s weight was not fine for his/her height and
age, 83.3% (n=45) of parents of overweight boys and
79.3% (n=46) of parents of overweight girls (incorrectly)
state their child’s weight was fine for his/her height and
age. Furthermore, 44.4% (n=20) of parents of obese boys
and 45.3% (n=24) of parents of obese girls said their
child’s weight was fine for their height and age. In sum, a
substantial number of parents of overweight/obese children
did not recognise that their child’s weight was not fine for
their height and age. In addition, 13.3% (n=6) of parents
of obese boys compared to only 3.8% (n=2) of parents of
obese girls didn’t know if their weight was fine or not.
Although the cell sizes are too small to perform analysis,
3
No children in the sample were underweight.
4
This is the qualification obtained on the successful completion of
exams at the end of second level education (or high-school) in
Ireland, usually at the age of 18.
5
However, this category included Professional, Managerial and
Technical occupations.
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this finding may suggest that another aspect of weight
perception related to gender. Reiterates the gender differ-
ence that exists in parental perceptions of their children’s
weight status and may suggest that weight problems are
more difficult to identify in boys.
Table 3shows how parents perceived their own weight.
In contrast to their perception of their child’s weight, the
majority of mothers were accurate in their judgement of
their own weight. Almost 62% (n=160) of overweight
mothers and 95.2% (n=120) of obese mothers recognised
that their weight was not fine for their age. These results
suggest that although parents fail to recognise overweight/
obesity in their children, mothers are more likely to rec-
ognise overweight/obesity in themselves. However, less
than a third of overweight fathers (28.6%, n=32) recog-
nised that their weight was not fine for their age, suggesting
that overweight fathers may have difficulty recognising
overweight in themselves.
Multivariate Logistic Regression
Table 4shows the factors affecting the probability of a
parent being correct about their child’s weight status for all
children in Column 1.
6
The results of a separate analysis
for overweight and obese children are presented in Column
2. Results based on analysis of all children are discussed
first. The AUC based on our logistic regression is 0.92.
7
This is illustrated in Fig. 1. This is a positive indicator of
Table 1 Characteristics of the study sample
All Boys Girls
Children Parents Children Parents Children Parents
All
(n=1037)
Mothers
a
(n=998)
Fathers
(n=887)
Boys
(n=519)
Mothers
(n=501)
Fathers
(n=454)
Girls
(n=518)
Mothers
(n=497)
Fathers
(n=433)
Age (mean) 11.7
(n=1037)
42.6
(n=998)
43.6
(n=887)
11.8
(n=519)
42.95
(n=501)
43.83
(n=454)
11.66
(n=518)
42.27
(n=497)
43.38
(n=433)
BMI category (%)
Normal 79.4
(n=823)
49.6
(n=450)
24.7
(n=166)
80.54
(n=418)
49.11
(n=221)
25.3
(n=84)
78.34
(n=405)
50.11
(n=229)
24.19
(n=82)
Overweight 11
(n=114)
33.6
(n=305)
51.6
(n=346)
10.6
(n=55)
33.33
(n=150)
49.7
(n=165)
11.41
(n=59)
33.92
(n=155)
53.39
(n=181)
Obese 9.6
(n=99)
16.8
(n=152)
23.7
(n=159)
8.86
(n=46)
17.56
(n=79)
25
(n=83)
10.25
(n=53)
15.97
(n=73)
22.42
(n=76)
Education level (%)
Leaving certificate
or equivalent
76.3
(n=756)
70.1
(n=620)
75.56
(n=374)
70.67
(n=318)
77.02
(n=382)
69.43
(n=302)
Socioeconomic status (%)
Low SES (semi-skilled
and unskilled)
11.8
(n=120)
11.64
(n=59)
11.96
(n=61)
Medium SES (non-
manual and skilled
manual)
36.9
(n=375)
37.48
(n=190)
36.27
(n=185)
High SES (professional,
managerial and
technical)
51.3
(n=522)
50.89
(n=258)
51.76
(n=264)
Area (%)
Urban 59.69
(n=619)
57.42
(n=298)
61.97
(n=321)
Rural 40.31
(n=418)
42.58
(n=221)
38.03
(n=197)
a
Underweight mothers were included with those of normal weight as the number of cases was very small
6
A general power analysis was performed using the powerreg
function in Stata. Though this analysis assumes a continuous
dependent variable it should give a reasonable indication of the
sample size required. The power analysis suggests that the sample
size in this study should be adequate for conducting the current
analysis.
7
The maximum value for AUC is 1.
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our model’s ability to discriminate between parents who
can and cannot correctly evaluate their child’s health.
Parents were significantly less likely to be correct about
their sons’ weight status compared to their daughters’
weight status. Parents are more likely to be correct about
the weight status of older children. Parents were over 86%
less likely to be correct about their child’s weight if their
child was overweight and approximately 59% less likely to
be correct if the child was obese compared to parents of
normal weight children. In households with a greater
number of people, parents were more likely to be correct
about their child’s weight status. Parents of medium or high
socioeconomic status were more likely to be correct about
their child’s weight than parents of low socioeconomic
status. Parents were also less likely to be correct the higher
the fat content in the child’s diet and the more active their
child was. However, the latter variable was only significant
at the 10% level.
The age of the mother, mother’s education level,
mother’s weight status, marital status of the parents and
whether the family live in an urban or rural area did not
appear to affect the accuracy of the parent’s perception of
their child’s weight status. Results did not differ signifi-
cantly when disaggregated by gender. In addition, we
created a variable to denote whether the mother correctly
categorised her own weight status and included it in the
model. However, this variable was not included in the final
model as it was not found to be statistically significant and
may be endogenous.
The second column in Table 4contains results for
overweight or obese children only. These results are
qualitatively similar to the analysis including all children
(first column in Table 4). However, gender and activity
level of the child and number of people living in the
household were no longer significant. It was found that
parents of obese children are more likely than parents of
overweight children to correctly identify their child’s
weight status. This is consistent with the results of the full
model.
Table 2 Parental perception of child’s weight by weight status
Is child’s weight
fine for height
and age?
Body mass index categories (UK 1990 cut-offs)
Normal
(%)
Overweight
(%)
Obese
(%)
Total (%)
Boys
Weight not fine 6.3
(n=26)
9.3
(n=5)
42.2
(n=19)
9.8
(n=50)
Weight fine 88.8
(n=364)
83.3
(n=45)
44.4
(n=20)
84.3
(n=429)
Don’t know 4.9
(n=20)
7.4
(n=4)
13.3
(n=6)
5.9
(n=30)
Total 100
(n=410)
100
(n=54)
100
(n=45)
100
(n=509)
Girls
Weight not fine 2.5
(n=10)
12.1
(n=7)
50.9
(n=27)
8.7
(n=44)
Weight fine 93.1
(n=366)
79.3
(n=46)
45.3
(n=24)
86.5
(n=436)
Don’t know 4.3
(n=17)
8.6
(n=5)
3.8
(n=2)
4.8
(n=24)
Total 100
(n=393)
100
(n=58)
100
(n=53)
100
(n=504)
Table 3 Parents’ perception of
their own weight by WHO
weight status
WHO body mass index categories
Underweight
(\18.5)
Normal weight
(18.5–24.9)
Overweight
(25–29.9)
Obese (C30) Total
%(n=2) % (n=382) % (n=259) % (n=126) % (n=769)
Does mother think her weight is fine for her age?
Weight not fine 0
(n=0)
11.3
(n=43)
61.8
(n=160)
95.2
(n=120)
42
(n=323)
Weight fine 100
(n=2)
88.7
(n=339)
38.2
(n=99)
4.8
(n=6)
58
(n=446)
Total 100
(n=2)
100
(n=382)
100
(n=259)
100
(n=126)
100
(n=769)
Does father think his weight is fine for his age?
Weight not fine 0
(n=0)
1.9
(n=1)
28.6
(n=32)
79.3
(n=46)
35.4
(n=79)
Weight fine 0
(n=0)
98.1
(n=52)
71.4
(n=80)
20.7
(n=12)
64.6
(n=144)
Total 0
(n=0)
100
(n=53)
100
(n=112)
100
(n=58)
100
(n=223)
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Discussion
The results from this study confirm that a large proportion
of parents of overweight and obese children do not rec-
ognise their child’s overweight status. Approximately half
of parents of obese children and 81% of parents of over-
weight children reported that their child’s weight was fine
for their age and height. Parental inability to recognise
overweight and obesity (or risk of) in their children is
believed to negatively impact on obesity treatment [16]. In
the current study parents whose children were overweight
or obese were 86 and 59%, respectively, less likely to
correctly perceive their child’s weight.
Successful behaviour change relies on recognition of the
problem that underlies the need for this change [25]. Lack
of parental recognition of the problem may be the first
barrier to successful treatment of childhood overweight.
Towns and D’Auria and Doolen et al. summarise the
possible explanations for parent’s tendency to misclassify
their child’s weight status [13,28]. Parents may not want to
recognise their child’s overweight or label their child as
overweight in case their child is stigmatised or to avoid
being blamed by health professionals for their child’s
overweight problem [33]. It has also been suggested that
parents may not recognise overweight in their children to
avoid acknowledging and taking responsibility for their
own overweight [28]. The theory of cognitive dissonance
proposes that people may try to reduce uncomfortable
beliefs by rationalising them [34] so it is also possible that
parents may choose to believe that their child will simply
‘‘grow out of it’’. One qualitative study has suggested that
parents find children’s visual or hearing problems easier to
accept than excess body weight and response by parents to
information about their child’s excessive weight was both
angry and defensive [35]. This gives some indication of the
sensitivity of the issue of childhood overweight for parents.
Given the growing rate of obesity among children it is also
possible that changing social norms mean that parents
simply don’t recognise overweight in their children.
In contrast to their assessment of their children’s weight
status, the results of this study suggest that parents are more
accurate in classifying their own weight status. This finding
was particularly true for mothers, with only 4.8% (n=6)
of obese mothers and 38.2% (n=99) of overweight
mothers reporting that their weight was fine for age/height.
Table 4 Marginal effects and standard errors of parental misper-
ception of their child’s weight status
All children
Marginal
effect/(Std. Err.)
Overweight/obese
children
Marginal
effect/(Std. Err.)
Age (child) 0.009** 0.025**
-0.004 -0.011
Male (child) -0.062** -0.053
-0.026 -0.07
Overweight (child) -0.856***
-0.024
Obese (child) -0.589*** 0.368***
-0.073 -0.078
Rural area 0.009 0.084
-0.027 -0.07
Leaving cert. (mother) -0.025 -0.068
-0.024 -0.092
No. in household 0.019** 0.054
-0.01 -0.033
Medium SES 0.109*** 0.439***
-0.026 -0.159
High SES 0.077** 0.289*
-0.033 -0.172
Percent fat -0.005*** -0.026***
-0.002 -0.008
Very active -0.043* -0.098
-0.022 -0.073
Overweight (mother) -0.013 -0.028
-0.022 -0.077
Obese (mother) -0.077 -0.116
-0.057 -0.073
Married 0.009 -0.147
-0.056 -0.179
Mother’s age 0.001 0.003
-0.002 -0.005
Observations 756 152
Pseudo R
2
0.4 0.3
Standard errors clustered by school. Paternal variables not included
due to large amount of missing data on fathers
*P\0.10, ** P\0.05, *** P\0.01
Fig. 1 ROC curve
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This finding suggests that although mothers may not rec-
ognise weight problems in their children, overweight
mothers are able to recognise overweight in themselves.
This finding is consistent with previous research [15,22].
In relation to the theory of cognitive dissonance, discussed
above, it may be that parents are more willing to accept a
weight problem in themselves than in their children as they
are less uncomfortable if the problem relates to themselves.
However, it is also worth noting that fathers were less
likely to recognise overweight in themselves compared
with mothers (28% vs. 62%). This finding may suggest that
if fathers are less likely, than mothers, to recognise over-
weight in themselves, they may also be less likely to rec-
ognise overweight in their children. Efforts to address
parental misperceptions need to account for this difference
between mothers and fathers.
While several other parental factors were investigated
including the age of the mother, mother’s education level,
marital status of the parents and whether the family live in
an urban or rural area, these were not predictive of a par-
ent’s ability to correctly identify their child’s weight status.
Mothers’ weight status was shown to influence perception,
with obese mothers less likely to be correct about their
child’s weight compared to normal weight mothers. Chil-
dren with obese parents are at increased risk of being
overweight or obese [3], which together with the finding
that obese parents are less likely to correctly classify their
child’s weight could have significant implications for those
children to avail of opportunities for behaviour change and
obesity treatment. Although maternal education was not
shown to be a significant predictor of correctness in this
analysis, socioeconomic status was. Parents with a medium
or high socioeconomic status were more likely to be cor-
rect, suggesting that children from a low socioeconomic
status family may be at greatest risk of their excess weight
going unnoticed or ignored.
Child characteristics including gender, weight and age
were all found to be associated with parental ability to
correctly classify their child’s body weight. With regard to
gender, similar to the findings of other studies, parents
were more likely to incorrectly classify, as fine, their obese/
overweight sons than daughters [14,18,36]. Although this
may simply reflect gender differences in body composition,
it is generally believed more likely to be explained by
social norms and pressures relating to ideal body size for
girls and boys [36]. Parents may be influenced by the social
desirability for lower weight for girls, whereas larger body
size for boys is generally more acceptable.
Age was also found to be significantly associated with
the correctness of the parent. Parents were found to be less
likely to be correct about their child’s weight if the child
was younger. Maynard et al. [18] suggested that the finding
that mother’s are more likely to misclassify younger
children may be because mothers believe that their child
will outgrow being overweight. Failure to identify exces-
sive body weight in early childhood has serious implica-
tions for future health. Daniels et al. suggested that obesity
that begins in childhood may exacerbate the damage
obesity causes to body systems [37]. Equally, a growing
body of research has emphasised how interventions later in
the life-cycle build on interventions that have taken place
earlier [38–41]. Therefore, early identification of over-
weight and obesity and early interventions may present a
key opportunity for both obesity treatment and prevention.
Efforts to address the mismatch between reality and
perception in relation to parental perception of child
weight need to focus on de-stigmatising overweight as well
as identifying and addressing parental issues underlying
this mismatch. To date interventions with families of
overweight and obese children have not specifically
addressed body weight misperceptions. However, suc-
cessful interventions from other public health arenas, such
as HIV or eating disorders, which have focused on
addressing stigma or reducing cognitive dissonance [42,
43], could inform the development of educational tools
and communications programmes to address body weight
misperceptions.
This study has many strengths including a nationally
representative sample, measured body weights in children
and parents, and the measurement of key characteristics in
both parents and children. However, a number of limita-
tions of this study must be acknowledged. Firstly, BMI is
often criticised as an imperfect measure of adiposity, yet it
is one of the best measures available for large scale use.
Although a BMI reference chart has not been developed for
Irish children, O’Neill et al. found that the the BMI ref-
erence curves for the UK 1990 are most appropriate for
Irish children [44]. In addition, dueto lack of data, parental
variables were excluded from the analysis which meant
that a more complete analysis of parental variables was
restricted.
Parents in this study were asked whether they thought
their child’s weight was fine for his/her age. The wording
of this question leads to subjective interpretation of the
word ‘‘fine’’. It would be useful to know whether the parent
meant that the child was overweight or underweight. In the
case of the normal weight children it is quite possible that
the parents may have been concerned with the child being
underweight.
It is recommended that future research collect longitu-
dinal data to allow for unobserved factors relevant to the
analysis to be controlled for and to examine the effect of
changes in weight on ability to perceive weight over time.
In addition, it would be interesting to conduct a detailed
analysis of parental weight perception using a much larger
sample of overweight and obese children.
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Conclusion
Despite an increased emphasis on obesity prevention in
children, obesity as a potential health problem for children,
may fail to resonate with parents. The current study has
shown that a large proportion of parents of overweight and
obese children do not recognise unhealthy weight status in
their children. This study examined key parental and child
characteristics to gain insight into predictors of parental
inability to correctly classify their child’s weight status.
However, it is clear that further research is required to
elucidate these findings and to examine the more emotive
issues that may be involved for parents.
Acknowledgments This project was funded by the Irish Government
under the National Development Plan 2000–2006. We acknowledge
the Irish Department of Agriculture, Fisheries and Food, for funding
this analysis. The authors also acknowledge Professor Mario Cleves for
his valuable advice on the analysis.
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