Advertisement

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

ABSTRACT

Background

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.

Objective

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

Design

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

Participants

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).

Conclusion

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.

KEY WORDS

Size misperception Intergenerational Families Underestimation 

Notes

ACKNOWLEDGMENTS

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.

REFERENCES

  1. 1.
    Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295(13):1549–55.PubMedCrossRefGoogle Scholar
  2. 2.
    Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307(5):491–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. JAMA. 2012;307(5):483–90.PubMedCrossRefGoogle Scholar
  4. 4.
    Wang Y, Liang H, Chen X. Measured body mass index, body weight perception, dissatisfaction and control practices in urban, low-income African American adolescents. BMC Public Health. 2009;9:183.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Killion L, Hughes SO, Wendt JC, Pease D, Nicklas TA. Minority mothers’ perceptions of children’s body size. Int J Pediatr Obes. 2006;1(2):96–102.PubMedCrossRefGoogle Scholar
  6. 6.
    Patrick H, Nicklas TA. A review of family and social determinants of children’s eating patterns and diet quality. J Am Coll Nutr. 2005;24(2):83–92.PubMedCrossRefGoogle Scholar
  7. 7.
    Davison KK, Birch LL. Obesigenic families: parents’ physical activity and dietary intake patterns predict girls’ risk of overweight. Int J Obes Relat Metab Disord. 2002;26(9):1186–93.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997;337(13):869–73.PubMedCrossRefGoogle Scholar
  9. 9.
    Olvera N, Suminski R, Power TG. Intergenerational perceptions of body image in hispanics: role of BMI, gender, and acculturation. Obes Res. 2005;13(11):1970–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Freedman DS, Khan LK, Serdula MK, Dietz WH, Srinivasan SR, Berenson GS. The relation of childhood BMI to adult adiposity: the Bogalusa Heart Study. Pediatrics. 2005;115(1):22–7.PubMedGoogle Scholar
  11. 11.
    Maximova K, McGrath JJ, Barnett T, O’Loughlin J, Paradis G, Lambert M. Do you see what I see? Weight status misperception and exposure to obesity among children and adolescents. Int J Obes (Lond). 2008;32(6):1008–15.CrossRefGoogle Scholar
  12. 12.
    US Department of Health & Human Services CfDCP. Centers for Disease Control & Prevention Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia.Google Scholar
  13. 13.
    Stunkard AJ, Sørensen T, Schulsinger F. Use of the Danish Adoption Register for the study of obesity and thinness. Res Publ Assoc Res Nerv Ment Dis. 1983;60:115–20.PubMedGoogle Scholar
  14. 14.
    Kronenfeld LW, Reba-Harrelson L, Von Holle A, Reyes ML, Bulik CM. Ethnic and racial differences in body size perception and satisfaction. Body Image. 2010;7(2):131–6.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Office of Management and Budget. Race and ethnic standards for federal statistics and administrative reporting. (Directive no, 15). Fed Regist. 1978;43(87):19269.Google Scholar
  16. 16.
    Bulik CM, Wade TD, Heath AC, Martin NG, Stunkard AJ, Eaves LJ. Relating body mass index to figural stimuli: population-based normative data for Caucasians. Int J Obes Relat Metab Disord. 2001;25(10):1517–24.PubMedCrossRefGoogle Scholar
  17. 17.
    Bhuiyan AR, Gustat J, Srinivasan SR, Berenson GS. Differences in body shape representations among young adults from a biracial (Black-White), semirural community: the Bogalusa Heart Study. Am J Epidemiol. 2003;158(8):792–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Collins ME. Body figure perceptions and preferences among preadolescent children. Int J Eat Disord. 1991;10(2):199–208.CrossRefGoogle Scholar
  19. 19.
    Williamson S, Delin C. Young children’s figural selections: accuracy of reporting and body size dissatisfaction. Int J Eat Disord. 2001;29(1):80–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Sørensen TI, Stunkard AJ, Teasdale TW, Higgins MW. The accuracy of reports of weight: children’s recall of their parents’ weights 15 years earlier. Int J Obes. 1983;7(2):115–22.PubMedGoogle Scholar
  21. 21.
    Paeratakul S, White MA, Williamson DA, Ryan DH, Bray GA. Sex, race/ethnicity, socioeconomic status, and BMI in relation to self-perception of overweight. Obes Res. 2002;10(5):345–50.PubMedCrossRefGoogle Scholar
  22. 22.
    Kuchler F, Variyam JN. Mistakes were made: misperception as a barrier to reducing overweight. Int J Obes Relat Metab Disord. 2003;27(7):856–61.PubMedCrossRefGoogle Scholar
  23. 23.
    Intagliata V, Ip EH, Gesell SB, Barkin SL. Accuracy of self- and parental perception of overweight among Latino preadolescents. N C Med J. 2008;69(2):88–91.PubMedGoogle Scholar
  24. 24.
    Contento IR, Basch C, Zybert P. Body image, weight, and food choices of Latina women and their young children. J Nutr Educ Behav. 2003;35(5):236–48.PubMedCrossRefGoogle Scholar
  25. 25.
    Powell LM, Wada R, Krauss RC, Wang Y. Ethnic disparities in adolescent body mass index in the United States: the role of parental socioeconomic status and economic contextual factors. Soc Sci Med. 2012;75(3):469–76.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Saxton J, Hill C, Chadwick P, Wardle J. Weight status and perceived body size in children. Arch Dis Child. 2009;94(12):944–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Wartak SA, Friderici J, Lotfi A, Verma A, Kleppel R, Naglieri-Prescod D, et al. Patients’ knowledge of risk and protective factors for cardiovascular disease. Am J Cardiol. 2011;107(10):1480–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Sivalingam SK, Ashraf J, Vallurupalli N, Friderici J, Cook J, Rothberg MB. Ethnic differences in the self-recognition of obesity and obesity-related comorbidities: a cross-sectional analysis. J Gen Intern Med. 2011;26(6):616–20.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Xanthopoulos MS, Borradaile KE, Hayes S, Sherman S, Vander Veur S, Grundy KM, et al. The impact of weight, sex, and race/ethnicity on body dissatisfaction among urban children. Body Image. 2011;8(4):385–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Presnell K, Bearman SK, Stice E. Risk factors for body dissatisfaction in adolescent boys and girls: a prospective study. Int J Eat Disord. 2004;36(4):389–401.PubMedCrossRefGoogle Scholar
  31. 31.
    Wallander JL, Kerbawy S, Toomey S, Lowry R, Elliott MN, Escobar-Chaves SL, et al. Is obesity associated with reduced health-related quality of life in Latino, black and white children in the community? Int J Obes (Lond). 2013;37(7):920–5.CrossRefGoogle Scholar
  32. 32.
    Mirza NM, Mackey ER, Armstrong B, Jaramillo A, Palmer MM. Correlates of self-worth and body size dissatisfaction among obese Latino youth. Body Image. 2011;8(2):173–8.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Wallander JL, Taylor WC, Grunbaum JA, Franklin FA, Harrison GG, Kelder SH, et al. Weight status, quality of life, and self-concept in African American, Hispanic, and white fifth-grade children. Obesity (Silver Spring). 2009;17(7):1363–8.Google Scholar
  34. 34.
    Daniels SR, Arnett DK, Eckel RH, Gidding SS, Hayman LL, Kumanyika S, et al. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation. 2005;111(15):1999–2012.PubMedCrossRefGoogle Scholar
  35. 35.
    Lauer RM, Clarke WR. Childhood risk factors for high adult blood pressure: the Muscatine Study. Pediatrics. 1989;84(4):633–41.PubMedGoogle Scholar
  36. 36.
    Krauss RC, Powell LM, Wada R. Weight misperceptions and racial and ethnic disparities in adolescent female body mass index. J Obes. 2012;2012:205393.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Nader PR, O’Brien M, Houts R, Bradley R, Belsky J, Crosnoe R, et al. Identifying risk for obesity in early childhood. Pediatrics. 2006;118(3):e594–601.PubMedCrossRefGoogle Scholar
  38. 38.
    Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, Brody J, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med. 2005;352(11):1138–45.PubMedCrossRefGoogle Scholar
  39. 39.
    Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003;289(2):187–93.PubMedCrossRefGoogle Scholar
  40. 40.
    Fitzgibbon ML, Beech BM. The role of culture in the context of school-based BMI screening. Pediatrics. 2009;124(Suppl 1):S50–62.PubMedCrossRefGoogle Scholar
  41. 41.
    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):1138–46.PubMedCrossRefGoogle Scholar
  42. 42.
    Gable S, Chang Y, Krull JL. Television watching and frequency of family meals are predictive of overweight onset and persistence in a national sample of school-aged children. J Am Diet Assoc. 2007;107(1):53–61.PubMedCrossRefGoogle Scholar
  43. 43.
    Benson L, Baer HJ, Kaelber DC. Trends in the diagnosis of overweight and obesity in children and adolescents: 1999–2007. Pediatrics. 2009;123(1):e153–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Story M, Sallis JF, Orleans CT. Adolescent obesity: towards evidence-based policy and environmental solutions. J Adolesc Health. 2009;45(3 Suppl):S1–5.PubMedCrossRefGoogle Scholar
  45. 45.
    Ford ES, Capewell S. Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates. J Am Coll Cardiol. 2007;50(22):2128–32.PubMedCrossRefGoogle Scholar

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

Personalised recommendations