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Parental Misperceptions of Children’s Underweight Status: A Meta-analysis

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Accurate parental perceptions of their children’s underweight status are needed to prevent overlooking potential disordered eating patterns or health conditions affecting growth.

Purpose

The aim of this study is to determine overall proportion of parents who misperceive children’s underweight status and correlates of such misperceptions.

Methods

Original studies published to January 2013 were chosen through a literature search in established databases. Studies included assessed parental perceptions of their children’s underweight and then compared perceptions to recognized standards for defining underweight based on anthropometric measures. Random- and mixed-effects models were used.

Results

Thirty-seven articles (representing 39 studies; N = 4,039) were included. Pooled effect sizes indicated that 46.58 % (95 % CI 40.90–52.35 %) of parents misperceive their children’s underweight status, though the extent of misperceptions depended on a number of moderators.

Conclusions

Nearly half of parents perceive their underweight children as weighing more than they actually do. Health care professionals are well positioned to take steps to remedy misperceptions and encourage healthy behaviors.

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References

  1. de Onis M, Blossner M, Borghi E, Frongillo EA, Morris R. Estimates of global prevalence of childhood underweight in 1990 and 2015. JAMA. 2004; 291: 2600-2606.

    Article  PubMed  Google Scholar 

  2. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007–2008. JAMA. 2010; 303(3): 242-249.

    Article  CAS  PubMed  Google Scholar 

  3. Chang SM, Walker SP, Grantham-McGregor S, Powell CA. Early childhood stunting and later behavior and school achievement. J Child Psychol Psych. 2002; 43: 775-783.

    Article  CAS  Google Scholar 

  4. Martinez-Vizcaino V, Sanchez-Lopez M, Moya-Martinez P, et al. Trends in excess weight and thinness among Spanish schoolchildren in the period 1992–2004: the Cuenca study. Public Health Nutr. 2009; 12: 1015-1018.

    Article  PubMed  Google Scholar 

  5. Bjomelv S, Lydersen S, Mykletun A, Holmen TL. Changes in BMI-distribution from 1966–1969 to 1995–1997 in adolescents. The Young–HUNT study, Norway. BMC Public Health. 2007; 7: 279-284.

    Article  Google Scholar 

  6. Sjoberg A, Lissner L, Albertsson-Wikland K, Marild S. Recent anthropometric trends among Swedish school children: evidence for decreasing prevalence of overweight in girls. Acta Paediatr. 2008; 97: 118-123.

    Article  PubMed  Google Scholar 

  7. Johnson JG, Cohen P, Kasen S, Brook JS. Eating disorders during adolescence and the risk for physical and mental disorders during early adulthood. Arch Gen Psych. 2002; 59: 545-552.

    Article  Google Scholar 

  8. Mendez M, Adair L. Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. J Nutr. 1999; 129: 1555-1562.

    CAS  PubMed  Google Scholar 

  9. Walker SP, Chang SM, Powell CA. Psychosocial consequences of early childhood growth retardation. In: Martorell R, Haschke R, eds. Nutrition and growth. Vevey: Nestec; 2001: 241-254.

    Google Scholar 

  10. Whaley SE, Sigman M, Espinoss MP. Infant predictors of cognitive development in an undernourished Kenyan population. Dev Behav Pediatr. 1998; 19: 169-177.

    Article  CAS  Google Scholar 

  11. Eriksson JG, Forsen T, Tuomilehto J, Osmond C, Barker DJ. Early growth and coronary heart disease in later life: longitudinal study. BMC. 2001; 332: 949-953.

    Article  Google Scholar 

  12. Combs JL, Pearson CM, Zapolski TC, Smith GT. Preadolescent disordered eating predicts subsequent eating dysfunction. J Pediatr Psychol. 2013; 38: 41-49.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Hernandez RG, Cheng TL, Serwint JR. Parents’ healthy weight perceptions and preferences regarding obesity counseling in preschoolers: pediatricians matter. Clin Pediatr. 2010; 49(8): 790-798.

    Article  Google Scholar 

  14. Lazzeri G, Casorelli A, Giallombardo D, et al. Nutritional surveillance in Tuscany: maternal perception of nutritional status of 8–9 y-old school-children. J Prev Med Hyg. 2006; 47: 16-21.

    CAS  PubMed  Google Scholar 

  15. Moschonis G, Iatridi V, Mavrogianni C, et al. Accuracy and correlates of visual and verbal instruments assessing maternal perceptions of children’s weight status: the Healthy Growth Study. Public Health Nutr. 2011; 14(11): 1979-1987.

    Article  PubMed  Google Scholar 

  16. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009; 151(4): 264-269.

    Article  PubMed  Google Scholar 

  17. Greenland S. Quality scores are useless and potentially misleading: reply to “Re: A critical look at some popular analytic methods”. Am J Epidemiol. 1994; 140(3): 300-301.

    Google Scholar 

  18. Abbott RA, Lee AJ, Stubbs CO, Davies PS. Accuracy of weight status perception in contemporary Australian children and adolescents. J Paediatr Child Health. 2010; 46: 343-348.

    Article  PubMed  Google Scholar 

  19. Akerman A, Williams ME, Meunier J. Perception versus reality an exploration of children’s measured body mass in relation to caregivers’ estimates. J Health Psych. 2007; 12(6): 871-882.

    Article  Google Scholar 

  20. Arcan C, Hannan P, Himes J, et al. American Indian parents’ assessment of and concern and their kindergarten child’s weight status, South Dakota 2005–2006. Prev Chron Dis. 2012; 9: 1-10.

    Google Scholar 

  21. Baughcum AE, Chamberlin LA, Deeks CM, Powers SW, Whitaker RC. Maternal perceptions of overweight preschool children. Pediatrics. 2000; 106(6): 1380-1386.

    Article  CAS  PubMed  Google Scholar 

  22. Binkin N, Spinelli A, Baglilo G, Lamberti A. What is common becomes normal: the effect of obesity prevalence on maternal perception. Nutr Metab Cardiovasc Dis. 2013. doi:10.1016/j.numecd.2011.09.006.

    PubMed  Google Scholar 

  23. Boa-Sorte N, Neri L, Leite M, et al. Maternal perceptions and self-perception of the nutritional status of children and adolescents from private schools. J Pediatr (Rio J). 2007; 83: 349-356.

    Google Scholar 

  24. Bossink-Tuna H, L’hoir M, Beltman M, Boere-Boonekamp M. Parental perception of weight and weight-related behaviour in 2- to 4-year-old children in the eastern part of the Netherlands. Eur J Pediatr. 2009; 168(3): 333-339.

    Article  CAS  PubMed  Google Scholar 

  25. Boutelle K, Fulkerson JA, Neumark‐Sztainer D, Story M. Mothers’ perceptions of their adolescents’ weight status: are they accurate? Obes Res. 2004; 12(11): 1754-1757.

    Article  PubMed  Google Scholar 

  26. Brannon JG, Ahlers-Schmidt CR, Harrison M. Perceptions of child weight status by parents of children on Medicaid. Kansas J Med. 2009; 2: 78-86.

    Google Scholar 

  27. de La OA, Jordan KC, Ortiz K, et al. Do parents accurately perceive their child’s weight status? J Pediatr Health Care. 2009; 23(4): 216-221.

    Article  Google Scholar 

  28. Esenay FI, Yigit R, Erdogan S. Turkish mothers’ perceptions of their children’s weight. J Spec Pediatr Nurs. 2010; 15(2): 144-153.

    Article  PubMed  Google Scholar 

  29. Fisher L, Fraser J, Alexander C. Caregivers’ inability to identify childhood adiposity: a cross‐sectional survey of rural children and their caregivers’ attitudes. Aust J Rural Health. 2006; 14(2): 56-61.

    Article  PubMed  Google Scholar 

  30. Garrett-Wright D. Parental perception of preschool child body weight. J Pediatr Nurs. 2011; 26(5): 435-445.

    Article  PubMed  Google Scholar 

  31. Genovesi S, Giussani M, Faini A, et al. Maternal perception of excess weight in children: a survey conducted by paediatricians in the province of Milan. Acta Paediatr. 2005; 94(6): 747-752.

    Article  PubMed  Google Scholar 

  32. Ha Y, Vann JCJ, Choi E. Prevalence of overweight and mothers’ perception of weight status of their children with intellectual disabilities in South Korea. J School Nurs. 2010; 26(3): 212-222.

    Article  Google Scholar 

  33. Hager ER, Candelaria M, Latta LW, et al. Maternal perceptions of toddler body size: accuracy and satisfaction differ by toddler weight status. Arch Pediatr Adolesc Med. 2012; 166(5): 417.

    Article  PubMed  Google Scholar 

  34. Harnack L, Lytle L, Himes JH, Story M, Taylor G, Bishop D. Peer reviewed: Low awareness of overweight status among parents of preschool-aged children, Minnesota, 2004–2005. Prev Chronic Dis. 2009;6(2):A47.

    Google Scholar 

  35. He M, Evans A. Are parents aware that their children are overweight or obese? Do they care? Can Family Phys. 2007; 53(9): 1493-1499.

    Google Scholar 

  36. Jones AR, Parkinson KN, Drewett RF, Hyland RM, Pearce MS, Adamson AJ. Parental perceptions of weight status in children: the Gateshead Millennium Study. Int J Obes. 2011; 35(7): 953-962.

    Article  CAS  Google Scholar 

  37. Júlíusson PB, Roelants M, Markestad T, Bjerknes R. Parental perception of overweight and underweight in children and adolescents. Acta Paediatr. 2011; 100(2): 260-265.

    Article  PubMed  Google Scholar 

  38. Lopes L, Santos R, Pereira B, Lopes V. Maternal perceptions of children’s weight status. Child Care Health Dev. 2012; 39(5): 728-736.

    Article  PubMed  Google Scholar 

  39. Mamun AA, McDermott B, O’Callaghan M, Najman JM, Williams GM. Predictors of maternal misclassifications of their offspring’s weight status: a longitudinal study. Int J Obes. 2007; 32(1): 48-54.

    Article  Google Scholar 

  40. Mathieu M, Drapeau V, Tremblay A. Parental misperception of their child’s body weight status impedes the assessment of the child’s lifestyle behaviors. Int J Pediatr. 2010; 2010: 9.

    Article  Google Scholar 

  41. Maynard LM, Galuska DA, Blanck HM, Serdula MK. Maternal perceptions of weight status of children. Pediatrics. 2003; 111: 1226-1231.

    PubMed  Google Scholar 

  42. Molina Mdel C, de Faria CP, Montero P, Cade NV. Correspondence between children’s nutritional status and mothers’ perceptions: a population-based study. Cad Saude Publica. 2009; 25(10): 2285-2290.

    Article  PubMed  Google Scholar 

  43. Muhammad NA, Omar K, Shah SA, Muthpalaniappen L, Arshad F. Parental perception of their children’s weight status, and its association with their nutrition and obesity knowledge. Asia Pacific J Clin Nutr. 2008; 17: 597-602.

    Google Scholar 

  44. Nazario Rodriguez IJ, Figueroa WI, Rosado J, Parrilla Idel C. Perception of parents regarding their children’s weight. Bol Asoc Med P R. 2008; 100(2): 33-38.

    PubMed  Google Scholar 

  45. Petricevic N, Puharic Z, Posavec M, Simetin IP, Franelic IP. Family history and parental recognition of overweight in Croatian children. Eur J Pediatr. 2012; 171(8): 1209-1214.

    Article  PubMed  Google Scholar 

  46. Regber S, Novak M, Eiben G, et al. Parental perceptions of and concerns about child’s body weight in eight European countries—the IDEFICS study. Pediatr Obes. 2012; 8(2): 118-129.

    Article  PubMed  Google Scholar 

  47. Rivera-Soto WT, Rodríguez-Figueroa L. Childhood obesity among Puerto Rican children: discrepancies between child’s and parent’s perception of weight status. Int J Environ Res Pub Health. 2012; 9(4): 1427-1437.

    Article  Google Scholar 

  48. Shrewsbury VA, Garnett SP, Campbell K, et al. Maternal misconceptions of weight status among Nepean adolescents. J Acad Nutr Diet. 2012; 112(12): 2007-2013.

    Article  PubMed  Google Scholar 

  49. Webber L, Hill C, Cooke L, Carnell S, Wardle J. Associations between child weight and maternal feeding styles are mediated by maternal perceptions and concerns. Eur J Clin Nutr. 2010; 64(3): 259-265.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  50. Wen X, Hui S. Chinese parents’ perceptions of their children’s weights and their relationship to parenting behaviours. Child Care Health Dev. 2011; 37(3): 343-351.

    Article  CAS  PubMed  Google Scholar 

  51. Yao N, Hillemeier MM. Weight status in Chinese children: maternal perceptions and child self-assessments. World J Pediatr. 2012; 8(2): 129-135.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977; 1977: 159-174.

    Article  Google Scholar 

  53. Lipsey MW, Wilson D. Practical meta-analysis. Thousand Oaks: Sage; 2000.

    Google Scholar 

  54. Hedges LV. Fitting categorical models to effect sizes from a series of experiments. J Educ Behav Stat. 1982; 7(2): 119-137.

    Article  Google Scholar 

  55. Bakermans-Kranenburg MJ, Van Ijzendoorn MH, Juffer F. Less is more: meta-analyses of sensitivity and attachment interventions in early childhood. Psychol Bull. 2003; 129(2): 195.

    Article  PubMed  Google Scholar 

  56. Duval S, Tweedie R. Trim and fill: a simple funnelplot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000; 56: 455-463.

    Article  CAS  PubMed  Google Scholar 

  57. Duval S, Tweedie R. A nonparametric “trim and fill” method of accounting for publication bias in meta-analysis. J Am Stat Assoc. 2000; 95(449): 89-98.

    Google Scholar 

  58. Jain A, Sherman SN, Chamberlin LA, Carter Y, Powers SW, Whitaker RC. Why don’t low-income mothers worry about their preschoolers being overweight? Pediatrics. 2001; 107(5): 1138-1146.

    Article  CAS  PubMed  Google Scholar 

  59. Brewis A. Biocultural aspects of obesity in young Mexican schoolchildren. Am J Hum Biol. 2003; 15(3): 446-460.

    Article  PubMed  Google Scholar 

  60. Jezewski MA, Poss J. Mexican American’s explanatory model of type 2 diabetes. Western J Nurs Res. 2002; 24: 840-858.

    Article  Google Scholar 

  61. Story M, Stevens J, Himes J, et al. Obesity in American-Indian children: prevalence, consequences, and prevention. Prev Med. 2003; 37: 3-12.

    Article  Google Scholar 

  62. Singh GK, Kogan MD, van Dyck PC. Changes in state-specific childhood obesity and overweight prevalence in the United States from 2003 to 2007. Arch Pediatr Adoles Med. 2010; 164: 598-607.

    Google Scholar 

  63. Bordo S. Unbearable weight: feminism, western culture, and the body (10th ed). Berkeley: University of California Press; 2003.

    Google Scholar 

  64. Al-Sendi AM, Shetty P, Musaiger AO. Body weight perception among Bahraini adolescents. Child Care Health Dev. 2004; 30: 369-376.

    Article  CAS  PubMed  Google Scholar 

  65. Davison KK, Birch LL. Weight status, parent reaction, and self-concept in five-year-old girls. Pediatrics. 2001; 107: 46-53.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  66. Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Arch Gen Psych. 2010; 67: 1025.

    Article  Google Scholar 

  67. Weaver L, Sit L, Liebman R. Treatment of anorexia nervosa in children and adolescents. Current Psych Rep. 2012; 14: 96-100.

    Article  Google Scholar 

  68. Krebs NF, Jacobson MS. Prevention of pediatric overweight and obesity. Pediatrics. 2003; 112(2): 424-430.

    Article  PubMed  Google Scholar 

  69. Glacken M, Evans DS. Measuring height and weight in school children as a public health indicator. Department of Public Health, Health Service Executive West, Galway, Ireland.2006. Available at: http://lenus.ie/hse/bitstream/10147/44887/1/6540.pdf, 2006.

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Correspondence to Alyssa Lundahl BA.

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Lundahl, A., Kidwell, K.M. & Nelson, T.D. Parental Misperceptions of Children’s Underweight Status: A Meta-analysis. ann. behav. med. 48, 184–193 (2014). https://doi.org/10.1007/s12160-013-9587-2

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