Parental perception of overweight in 3–5 y olds
To assess the accuracy of parents' perceptions of their 3 to 5 y old children's weight status in a large UK sample. Parental perception and concern about child weight, demographic variables, and children's height and weight were obtained for 564 parent-child dyads. Only 1.9% of parents of overweight children and 17.1% of parents of obese children described their child as overweight. The odds of parents perceiving the child as overweight were increased for overweight (2.7; 95% CI 0.4, 16.5) and obese (28.5; 7.1, 115.4) compared with normal weight children, but were not associated with parental weight or with any demographic factors. Although few parents perceived their overweight children as overweight, more (66.2%) expressed concern about their overweight child becoming overweight in the future. Odds of concern were progressively higher for overweight (2.5; 1.6, 3.9) and obese children (4.6; 2.2, 9.7), and were also higher for parents who were themselves overweight (1.9; 1.2, 2.9) or obese (2.5; 1.3, 4.8). These findings suggest that parents of 3-5 y olds show poor awareness of their child's current weight status. Reframing discussions in terms of preventing future overweight may be an effective way to engage parents.
Parental perceptions of overweight in 3–5 y olds
, C Edwards
, H Croker
, D Boniface
and J Wardle
Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, University College London,
OBJECTIVE: To assess the accuracy of parents’ perceptions of their 3 to 5 y old children’s weight status in a large UK sample.
METHOD: Parental perception and concern about child weight, demographic variables, and children’s height and weight were
obtained for 564 parent–child dyads.
RESULTS: Only 1.9% of parents of overweight children and 17.1% of parents of obese children described their child as
overweight. The odds of parents perceiving the child as overweight were increased for overweight (2.7; 95% CI 0.4, 16.5) and
obese (28.5; 7.1, 115.4) compared with normal weight children, but were not associated with parental weight or with any
demographic factors. Although few parents perceived their overweight children as overweight, more (66.2%) expressed
concern about their overweight child becoming overweight in the future. Odds of concern were progressively higher for
overweight (2.5; 1.6, 3.9) and obese children (4.6; 2.2, 9.7), and were also higher for parents who were themselves overweight
(1.9; 1.2, 2.9) or obese (2.5; 1.3, 4.8).
CONCLUSION: These findings suggest that parents of 3–5 y olds show poor awareness of their child’s current weight status.
Reframing discussions in terms of preventing future overweight may be an effective way to engage parents.
International Journal of Obesity (2005) 29, 353–355. doi:10.1038/sj.ijo.0802889
Keywords: childhood obesity, maternal perceptions, parents, preschool, perceived weight
Parents who do not recognise the weight status of
their overweight children may be less likely to provide
them with support to achieve a healthy weight. Recent
population and cohort studies in the US and Australia
have demonstrated underestimation of weight
among parents whose children were overweight
or obese. Others have shown very low levels of concern
about their child’s weight status.
Results from a
large sample of mothers of 3–5 y olds in the US suggest
that awareness of weight problems may be particularly
low for this child age group.
The present study aimed
to explore the generalisability of this finding to a socio-
economically diverse sample of parents of 3–5 y olds in the
UK. We also assessed concern about the child becoming
overweight in the future, as a more subtle index of parental
Subjects and methods
In all, 16 state-funded primary schools with nursery and
reception classes (3–5 y) in outer London were recruited to
represent a range of socioeconomic backgrounds. Socio-
economic deprivation was operationalised by the proportion
of pupils in each school who were eligible for free school
meals (a government benefit given to lower income
families). A total of 1082 3–5 y olds were present on the
days of data collection. Trained researchers weighed and
measured the children in class after removing shoes and any
outside clothing (eg coats). A questionnaire was distributed
to parents assessing attitudes towards their child’s weight
and eating, basic demographic information, and their own
weight and height. Measures of parental feeding styles were
also included and will be discussed in future work. Two
rounds of reminder questionnaires were sent to increase
Parents’ appraisal of their child’s weight was assessed
with the question: ‘How would you describe your
child’s weight at the moment? (very underweight, under-
weight, normal, overweight or very overweight)’, and
concern about future weight with: ‘How concerned are you
about your child becoming overweight in the future?
(unconcerned, a little concerned, concerned, fairly con-
cerned, very concerned)’.
Received 24 June 2004; revised 9 October 2004; accepted 4 November
*Correspondence: Professor J Wardle, Cancer Research UK Health
Behaviour Unit, Department of Epidemiology and Public Health,
University College London, Gower Street, London WC1E 6BT, UK.
International Journal of Obesity (2005) 29, 353–355
2005 Nature Publishing Group All rights reserved 0307-0565/05
We calculated body mass index (BMI) using weight (kg)/
. Children’s weight and height centiles were
based on 1990 UK reference curves.
TaskForce cutoffs were used to generate weight status
Ethical approval was obtained from the Joint
University College London/University College London
Hospital Ethics Committee.
Overall, parental response rate was 52% (n ¼ 564), but varied
from 16 to 80%, with lower rates in schools with higher
proportions of pupils receiving free school meals and for
whom English was not the first language. Average parental
age was 34.9 y, 94.5% of respondents were mothers, 72.7%
were white, and 10.5% had no educational qualifications.
Table 1 gives child and parent characteristics together with
data on weight perceptions and concern by child weight
status category. In total, 501 parents gave their own weights
and heights, which put 26.9% in the overweight category
and an additional 8.8% in the obese category. In line with
current UK population data,
18.4% of children were over-
weight and an additional 7.3% obese. There were no
differences in height and weight between children whose
parents returned (M ¼ 16.6, s.d. 1.88) or did not return
(M ¼ 16.5, s.d. 2.03) the questionnaire (t ¼1.36, df 1080,
P ¼ 0.18).
Only 1.9% (2/104) of parents with overweight children
and 17.1% (7/41) of those with obese children described
their child as overweight. No parent described their child as
‘very overweight’. Logistic regression showed that the odds
of the child being perceived as overweight were higher for
overweight (2.7; 95% CI 0.5, 16.5) and obese (28.6; 7.1,
115.4) children compared with normal weight children.
Perception of overweight was not associated with the child’s
age or sex, or with the parent’s age, weight status, educa-
tional level, or ethnicity. Adjustment for these demographic
factors did not change the results.
Almost two thirds (62.5%) of parents with overweight
children and three quarters (75.6%) of those with obese
children, compared with 40.1% of parents with normal
weight children, expressed concern about their child
becoming overweight in the future. The odds of parents
being concerned were higher in overweight (2.5; 1.6–3.9)
and obese children (4.6; 2.2–9.7). Additionally, odds were
higher for parents who were overweight (1.9; 1.2–2.9) or
obese (2.5; 1.3–4.9) themselves. There were no significant
associations with other demographic factors, and adjust-
ment for these factors did not affect the results.
Although 145 children were classified as overweight or obese
using the IOTF reference data, only nine (6%) of their
parents described them as ‘overweight’ and none described
them as ‘very overweight’. Odds of classification as over-
weight were increased for heavier children, but the over-
whelming majority of parents of overweight or obese
children (94%) did not classify them correctly. Misclassifica-
tion was markedly higher than in two large surveys in the
One source of this discrepancy might be our use of
IOTF cutoff points, which assign a greater proportion of
children to the overweight group than some other methods,
thus increasing the likelihood of misclassification by
mothers. However, using the same cutoff point as other
studies did not significantly increase accuracy in perception:
only 9% (8/85) of mothers with children over the 95th
percentile for BMI classified them as overweight, compared
Table 1 Child and parent characteristics by child weight status (IOTF criteria)
Child weight status
Normal weight (n ¼ 419) Overweight (n ¼ 104) Obese (n ¼ 41)
Age (y) 4.4 (4.3–4.4) 4.3 (4.2–4.5) 4.4 (4.3–4.6)
) 15.8 (15.7–15.9) 18.1 (18.0–18.2) 21.2 (20.5–21.9)
BMI centile 53.5 (51.1–55.8) 93.9 (93.3–94.6) 99.6 (99.4–99.7)
Weight (kg) 17.7 (17.5–17.9) 20.9 (20.4–21.4) 25.7 (24.2–27.2)
Weight centile 56.0 (53.5–58.5) 89.7 (87.2–92.2) 98.5 (97.6–99.4)
Height (cm) 105.7 (105.2–106.3) 107.2 (106.0–108.5) 109.8 (107.7–111.9)
Height centile 55.6 (52.9–58.4) 68.4 (63.3–73.5) 76.3 (69.5–83.1)
35.0 (34.5–35.6) 34.5 (33.4–35.6) 34.9 (32.9–36.9)
23.7 (23.3–24.1) 26.4 (25.6–27.3) 26.3 (24.5–28.1)
% white 74.3 (69.7–78.5) 72.6 (62.8–80.9) 56.4 (39.6–72.2)
% no educational qualifications 9.5 (6.8–12.7) 14.7 (8.5–23.1) 10.3 (2.9–24.2)
% perceiving child as overweight 0.7 (0.1–2.1) 1.9 (0.2–6.8) 17.1 (7.2–32.1)
% concerned child will become overweight 40.1 (35.4–45.0) 62.5 (52.5–71.8) 75.6 (59.7–87.6)
Values are mean (95% CI) for child and parent age and anthropometrics, and percentages (95% CI) for frequency data.
Age data were missing in 13 cases and
parent BMI in 63 cases. Means use data from the remaining parents.
Parental perceptions of overweight
S Carnell et al
International Journal of Obesity
with 67% in Maynard et al’s
sample and 29% in Baughcum
sample. Another explanation for our lower rates
might be differences in samples. Maynard et al assessed
mothers with children of a much wider age range (2–11 y),
and Baughcum et al recruited over half of their families from
paediatric clinics participating in WICFa program that
supplies supplemental food and nutrition counselling to
low-income women and their children. Each of these
samples might be expected to display higher awareness than
parents of 3–5 y olds drawn from community primary
There are some limitations to our study design. The
generalisability of our results is limited by the response rate
to the parental questionnaire, but the similarity in children’s
BMI between respondents and nonrespondents makes it
unlikely that there was a response bias related to the child’s
weight. Even if the parents of overweight children among
the nonresponders were better aware of their children’s
weight status, the results would still represent considerable
lack of awareness overall. Our sample was more ethnically
diverse and more educated than UK population averages, but
nevertheless broadly representative of the urban areas from
which we recruited.
Notwithstanding the limitations, the results indicate a
notable lack of awareness in UK parents of overweight 3–5 y
olds about their children’s weight status. This appears to be
equally evident across all levels of parental education,
ethnicity and weight, and for both male and female
children. The finding may reflect a general shift in parents’
perceptions of what constitutes a ‘normal weight’ child,
following recent population increases in the prevalence of
overweight. Alternatively, parents may hold distorted per-
ceptions unique to their child, while still being capable of
recognising overweight in other children. It is also possible
that parents are privately aware of their child’s weight
problem, but reluctant to acknowledge it, particularly within
the context of a parental feeding survey.
The lack of awareness may be particularly evident for 3–5 y
olds because the prevailing health message to mothers of
young children is to encourage growth and keep pace with
centile charts. Results from a qualitative study of low-income
mothers in the US suggest that heaviness may be viewed as a
reflection of inherited build, or even as an indicator of good
health. Mothers may put greater emphasis on other factors
such as physical activity and social participation, when
deciding if their child is overweight.
While the extent of parents’ failure to categorise their
children’s weight according to medically defined definitions
of overweight is noteworthy, it may be unreasonable to
expect lay definitions to coincide with those of health
professionals. The lack of awareness is only important to the
extent that it affects parents’ engagement with weight
control for their children. Despite describing their children
as normal weight, two thirds of parents of overweight/obese
children expressed concern about their child becoming
overweight in the future. It is possible that a normative
tendency to choose the mid-point of a scale inflated scores
on the unipolar concern scale relative to the bipolar
perceived weight scale. However, there was little evidence
for this, with over half of parents indicating they were
‘unconcerned’ about their child becoming overweightFthe
lowest possible score on the scale.
Data on parental height and weight were self-report only
and therefore will underestimate BMI. However, the ordering
of BMI within the distribution is likely to be approximately
correct, and logistic regression demonstrated that concern
was more likely if parents were heavier themselves. This
indicates some awareness of a potential or current weight
problem, particularly among overweight parents. It suggests
that reframing discussions of weight in terms of preventing
future overweight rather than tackling current overweight
might be a way to engage parents while avoiding the stigma
of parental blame. Alternatively, greater use of school- and
community-wide interventions would eliminate the need to
raise the potentially sensitive issue of a particular child’s
weight, and would have the added advantage of promoting
healthy eating and exercise patterns in currently normal
weight children who may go on to become overweight.
The research was funded by the Medical Research Council
and Cancer Research UK.
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International Journal of Obesity