Elsevier

Journal of Pediatric Nursing

Volume 37, November–December 2017, Pages 57-61
Journal of Pediatric Nursing

Parents' Underestimations of Child Weight: Implications for Obesity Prevention

https://doi.org/10.1016/j.pedn.2017.06.005Get rights and content

Highlights

  • Over one third of parents in this sample had limited health literacy.

  • The majority of parents underestimated the weight of their children.

  • 96% of parents underestimated their overweight children.

  • 72% of parents underestimated their obese children.

  • Parent underestimation was not associated with social determinants of health.

Abstract

Purpose

Obesity prevention efforts may be ineffective if parents lack awareness of their children's overweight status.

This study examined the factors that predicted parents' underestimation of child weight status.

Design and Methods

Using a cross sectional design, researchers recruited children and parents in a local children's museum. Parents completed a demographic questionnaire, the Newest Vital Sign, and the Child Body Image Scale. Children's height and weight were measured to calculate child BMI. Random effects modeling examined the association between predictor variables (parent race/ethnicity, income, education, and health literacy, and child BMI percentile, gender, and age) and the dependent variable, parent underestimation of child weight status.

Results

Participants included 160 parents (213 children aged 7–12 years) representing a racially and ethnically diverse sample who were affluent, educated, and with 36.6% of parents assessed with limited health literacy. Although 45.1% of children were overweight/obese, only 7.5% of parents chose this weight status; 80% of parents underestimated the weight of their normal weight children, 96% underestimated their overweight children, and 72% underestimated their obese children. Parents were more likely to underestimate weight of older children and those under 81st percentile of BMI. No other predictors were significant.

Conclusions

Parent underestimation of child weight status appears to be a widespread phenomenon in this sample, regardless of race, ethnicity, income, education, and health literacy.

Practice Implications

The consistent underestimation of child weight suggests that parents' misperception of weight status represents a critical pathway for intervention. Methods to improve parents' perception of child weight need be developed and tested.

Introduction

Approximately 1 in 5 children in the United States are obese, a trend that has remained steady over the last 10 years (Ogden et al., 2016). Given the increasing incidence of type 2 diabetes in children (Lipman et al., 2013) and the increased risk of hypertension, heart disease, arthritis, sleep apnea and premature death in adulthood associated with obesity (Hirko et al., 2015, Karnik and Kanekar, 2015), obesity prevention remains a public health challenge for nurses. Although national childhood obesity rates have somewhat leveled off, progress is frustratingly slow (Segal, Rayburn, & Martin, 2016). One reason for this delay may be that parents lack awareness of their child's overweight or obesity status. Previous studies have documented that over 60% of parents underestimated their child's weight status (Lundahl et al., 2014, Rietmeijer-Mentink et al., 2013, Tompkins et al., 2015), a trend that appears to be increasing over time (Foster and Hale, 2015, Parry et al., 2008). Because parental engagement is central to effective interventions around weight management, parents' underestimation of their child's weight may be a barrier. When parents fail to recognize their child as overweight, they are less likely to participate in healthy lifestyle behaviors with their children (Lundahl et al., 2014).

The contextual factors that influence why parents underestimate the weight of their overweight or obese children are not well known (Foster & Hale, 2015). Recent studies have reported varied results for how social determinants of health including parental race, ethnicity, income, education, and child age and gender predict parents' underestimation of child weight status. Some studies reported significant associations between race, income (Black et al., 2015), and education (Towns & D'auria, 2009) and parent underestimation of child weight, while others did not find such associations (Doolen et al., 2009, Eckstein et al., 2006, Lundahl et al., 2014, Towns and D'auria, 2009, Warschburger and Kroller, 2009). Evidence on the relationship between child age and parent underestimation of child weight status is also mixed. Some have reported that parents were more likely to underestimate weight status when the child was younger (Lundahl et al., 2014, Rietmeijer-Mentink et al., 2013), while others reported more underestimation of weight status in older children (Black et al., 2015). Parents were more likely to underestimate overweight status in their boys, incorrectly classifying them as underweight or normal weight (Black et al., 2015, Lundahl et al., 2014, Towns and D'auria, 2009).

In one study, Garrett-Wright (2011) added parent health literacy as a predictor variable, finding that lower parent health literacy was significantly associated with parent's inaccurate estimation of child weight status. This first study to include health literacy was conducted using a sample of parents with preschool age children. Further exploration of how health literacy and other social determinants of health affect parent perception of child weight status in older, school age children extend upon the findings of this earlier study. Because parents presumably have influence over the healthy lifestyle behaviors for their family, the school-age years may present a critical time to target weight reduction or overweight/obesity prevention efforts.

The purpose of this study was to examine how health literacy and other social determinants of health predicted parents' underestimation of child weight status. Influenced by the ecological model proposed by Bronfenbrenner (1986), we hypothesized that parent factors (race, ethnicity, income, education, and health literacy) interacting with child factors (age, gender, and weight status) may influence parent underestimation of child weight status. A model of parent underestimation of child weight status was presented with both parent and child factors as predictor variables (Fig. 1).

Section snippets

Sample

A convenience sample of children and their parent/guardian were recruited from a local children's museum of science and history. Inclusion criteria were children 7–13 years old and their parent/guardian who spoke sufficient English to participate in research activities. Exclusion criteria included children or parents who were not cognitively or physically able to participate in the research activities. The research team recruited participating children and parents on Tuesday evenings and

Data Analysis

Descriptive statistics included the frequency and percentages for categorical variables and means (SD) for continuous variables. Because the dataset is assumed to have a two-level data structure: Level 1 (child) and Level 2 (parent) and parents have different number of children, a mixed-effects linear model was conducted using random effects modeling. Random effects modeling examined the association between selected predictor variables (parent race, ethnicity, income, education, and health

Results

Participants included 160 parents and 213 children; 53 parents had more than one child participate in the study. Because almost all parents underestimated child weight, the one parent who overestimated their child's weight was removed from the sample. Parents' mean age was 39 years, and they were 28.7% non-White and 32.5% Hispanic. Over half of parents were college educated or higher, and almost half reported annual incomes over $70,000 (see Table 1). More Hispanic parents were assessed with

Discussion

The focus of this study was to explore the potential factors that may contribute to this trend of parent underestimation of their children's weight status. Our results support the trend reported in the literature that increasing numbers of parents underestimate the weight of their children, failing to recognize child overweight and obesity (Tompkins et al., 2015). The primary findings from our study suggest higher percentages of parents underestimated the weight status of their overweight and

Nursing Practice and Research Implications

Nurses should be aware that many parents underestimate the weight status of their children, and the findings from this study indicate consistent underestimation of overweight children in particular. Whether parents respond to public health messaging by engaging their children in healthy behaviors such as increasing consumption of nutrient-dense foods and physical activity may be a function of how they perceive their child's weight status. Campaigns such as MyPlate and Let's Move! may not

Funding

This work was supported by the Alma and Robert D. Moreton Research Award. The funding source had no involvement in the study design, data collection, analysis, or interpretation or in the writing of this manuscript or in the decision to submit the article to JPN for publication consideration.

Acknowledgements

Thank you to Debbie Cockerham, the Managing Director, Research and Learning Center Fort Worth Museum of Science and History for her support of our research at the museum site; to the nursing, nutrition, and psychology undergraduate students who helped with data collection, entry, and editorial assistance; and to the children and parents for their time and energy to participate in this study.

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