Journal of General Internal Medicine

, Volume 30, Issue 1, pp 43–50 | Cite as

Size Misperception Among Overweight and Obese Families

  • Tracy K. PaulEmail author
  • Robert R. Sciacca
  • Michael Bier
  • Juviza Rodriguez
  • Sharon Song
  • Elsa-Grace V. Giardina
Original Research



Perception of body size is a key factor driving health behavior. Mothers directly influence children’s nutritional and exercise behaviors. Mothers of ethnic minority groups and lower socioeconomic status are less likely to correctly identify young children as overweight or obese. Little evaluation has been done of the inverse—the child’s perception of the mother’s weight.


To determine awareness of weight status among mother-child dyads (n = 506).


Cross-sectional study conducted in an outpatient pediatric dental clinic of Columbia University Medical Center, New York, NY.


Primarily Hispanic (82.2 %) mothers (n = 253), 38.8 ± 7.5 years of age, and children (n = 253), 10.5 ± 1.4 years of age, responding to a questionnaire adapted from the validated Behavioral Risk Factor Surveillance System.

Main Measures

Anthropometric measures—including height, weight, and waist circumference—and awareness of self-size and size of other generation were obtained.

Key Results

71.4 % of obese adults and 35.1 % of overweight adults underestimated size, vs. 8.6 % of normal-weight (NW) adults (both p < 0.001). Among overweight and obese children, 86.3 % and 62.3 % underestimated their size, vs. 14.9 % NW children (both p < 0.001). Among mothers with overweight children, 80.0 % underestimated their child’s weight, vs. 7.1 % of mothers with NW children (p < 0.001); 23.1 % of mothers with obese children also underestimated their child’s weight (p < 0.01). Among children with obese mothers, only 13.0 % correctly classified the adult’s size, vs. 76.5 % with NW mothers (p < 0.001). Among obese mothers, 20.8 % classified overweight body size as ideal, vs. 1.2 % among NW mothers (p < 0.001).


Overweight/obese adults and children frequently underestimate their size. Adults misjudge overweight/obese children as being of normal weight, and children of obese mothers often underestimate the adult’s size. Failure to recognize overweight/obesity status among adults and children can lead to prolonged exposure to obesity-related comorbidities.


Size misperception Intergenerational Families Underestimation 



This work is supported in part by the Department of Health and Human Services (1HHCWHO5003-01-11), Arlene and Joseph Taub Foundation, Paterson NJ, Edwina and Charles Adler Foundation, and by Columbia University’s CTSA grant UL1-RR024156 from the NCRR/NIH. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; or preparation, review, and approval of the manuscript. The content is the responsibility of the authors. The authors have no competing interests. This data was presented in part in poster format at the American Heart Association’s Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism Meeting on March 21, 2013 in New Orleans, LA.

Elsa-Grace V. Giardina and Tracy K. Paul had full access to all data in the study, and take responsibility for the integrity of the data and accuracy of the data analysis.

Conflict of Interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Tracy K. Paul
    • 1
    Email author
  • Robert R. Sciacca
    • 1
  • Michael Bier
    • 1
  • Juviza Rodriguez
    • 1
  • Sharon Song
    • 1
  • Elsa-Grace V. Giardina
    • 1
  1. 1.Center for Women’s Health, Division of Cardiology, Department of MedicineColumbia University Medical CenterNew YorkUSA

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