As role models and caregivers, parents’ lifestyles play a key role in the formation of their children’s dietary behaviours and physical activity habits (Scaglioni, Arrizza, Vecchi, & Tedeschi, 2011; Sleddens et al., 2014; Yao & Rhodes, 2015; Zecevic, Tremblay, Lovsin, & Michel, 2010). Particularly in childhood, parents have control over their children’s nutrition in diverse ways, such as parental monitoring, restrictive control over certain food choices or pressure to eat certain foods (Cislak, Safron, Pratt, Gaspar, & Luszczynska, 2012; Loth, Fulkerson, & Neumark-Sztainer, 2014; Towner, Reiter-Purtill, Boles, & Zeller, 2015). Recent research shows that parents, as role models of healthy eating behaviours, are positively associated with children’s healthy dietary habits (Draxten, Fulkerson, Friend, Flattum, & Schow, 2014).
With regard to physical activity, parents also have the ability to enhance children’s physical activity by providing exercise equipment at home or walking/cycling facilities (Millstein et al., 2011), limiting screen time spent on watching TV and playing video games (Carlson et al., 2010) and encouraging children to be active. Zecevic, Tremblay, Lovsin and Michel (2010) point out that children who receive greater support from their parents to engage in physical activity were 6 times more likely to be physically active than inactive children. Parents also model healthy physical activity by being active
themselves and incorporating regular exercise in their daily lives as a family (Zecevic, Tremblay, Lovsin, & Michel, 2010).
A longitudinal study demonstrated that parental practices in early childhood significantly contributed to children’s lifestyles and body weight in late childhood (Rutherford et al., 2015). Therefore, most child obesity intervention programs tend to involve a parent as a vital component in programs aimed to modify children’s behaviour (Boutelle, Cafri, & Crow, 2012; Collins et al., 2011; Dulin Keita, Risica, Drenner, Adams, Gorham & Gans, 2014; Knowlden & Sharma, 2012; Kruk, Kortekaas, Lucas & Jager‐ Wittenaar, 2013; Magarey et al., 2011; Niemeier, Hektner & Enger, 2012). Olstad and McCargar (2009) stated that the engagement of parents in child obesity prevention programs is essential to ensure the success of the program. Heinberg et al. (2009) identified that children who have lower parental involvement were less likely to reduce their weight. Heinberg et al. (2009) identified lower parental engagement in a weight intervention trial to the child’s gender and weight. These authors found that girls of African background and adolescents with higher BMIs were less likely to attend weight intervention.
In general, parents are aware of the factors that contribute to child obesity (Pocock, Trivedi, Wills, Bunn, & Magnusson, 2010), and they acknowledge the importance of healthy food and physical activity in relation to their children’s weight (Pocock, Trivedi, Wills, Bunn & Magnusson, 2010). However, they are less likely to recognise signs of overweight or obesity in their own children (De La, 2009; Doolen, Alpert, & Miller, 2009). Hence, they are often unwilling to take part in programs aiming to reduce overweight and obesity because they do not recognise the need (Chaparro, Langellier,
Kim, & Whaley, 2011; Doolen, Alpert, & Miller, 2009; Vuorela, Saha, & Salo, 2010). Gerards et al. (2012) identified that parental denial that their child has an overweight problem is one of the major obstructions to engaging parents of overweight children in intervention programs. Similarly, Tschamler, Conn, Cook and Halterman (2009) conclude that parental misperception of their children’s weight is one of the barriers to preventing or managing child obesity.
Several studies have focused on parental perception of children’s weight (Abbott et al., 2010; Aljunaibi, Abdulle, & Nagelkerke, 2013; Black et al., 2015; Chen et al., 2014; De La, 2009; Doolen, Alpert, & Miller, 2009; Hernandez, Cheng, & Serwint, 2010; Manios et al., 2010; Spargo & Mellis, 2014; Towns & D’Auria, 2009; Vanhala et al., 2011; Warschburger & Kröller, 2012). Overwhelmingly, parents misclassify their children’s weight. In particular, it was more common for parents to underestimate their child’s weight (Abbott et al., 2010; Black et al., 2015; Chen et al., 2014; Regber et al., 2013; Spargo & Mellis, 2014) than to overestimate it (Abbott, Lee, Stubbs, & Davies, 2010; Chen et al., 2014; Spargo & Mellis, 2014). With respect to gender, parents were more likely to overestimate the weight of girls and underestimate the weight of boys (Abbott et al., 2010; Jeffery et al., 2014 ; Manios, Kondaki, Kourlaba, Vasilopoulou, &
Grammatikaki, 2009; Vanhala et al., 2011).
The findings of a literature review conducted by Towns and D’Auria (2009) show that the parents of overweight children were not concerned about the risks associated with overweight and were more likely to underestimate the degree to which their child was overweight. Doolen, Alpert and Miller (2009) point out that parents were more likely to perceive the weight of a normal-weight child correctly than an overweight child. Not
surprisingly, a study found that 7,191 out of 11,530 overweight children were perceived by their parents to be of a normal weight (Rietmeijer‐ Mentink, Paulis, Middelkoop, Bindels, & Wouden, 2013).
In the US, Sylvetsky-Meni, Gillepsie, Hardy and Welsh (2015) studied parental (N = 1811) perceptions of the weight of their children aged 4–15 years. This study found that 95% of parents agreed, in general terms, that overweight and obesity in children can cause serious health complications. However, 42.4% of these parents failed to recognise obesity in their own children. This may result in a failure to promote healthy behaviours in their children and increase the incidence of obesity. Another cross-sectional study of US children aged 5–12 years and their parents (N = 576) examined parents’ perceptions by asking parents to classify their child’s weight on a Likert scale from ‘extremely underweight’ to ‘extremely overweight’. The parent’s answers were compared to their child’s weight measurement. Approximately 75% of overweight children were
misclassified as underweight or about the right weight and this misclassification was higher for boys (29%) than girls (21%) (De La O et al., 2009). The authors cited the following factors that influence parental perceptions, including a parental lack of education, denial of obesity and distrust of the current child growth chart guidelines.
In eight European countries (Germany, Italy, Belgium, Sweden, Cyprus, Estonia, Hungary and Spain) questionnaires were used to assess parental perceptions of the weight of their children aged 2–9 years (N = 16,220), using a 5-point Likert scale ranging from ‘much too underweight’ to ‘much too overweight’. The findings show that 29.9% of parents were concerned about their children’s weight and that they may become overweight children in the future, while in contrast, 63% of parents
underestimated the weight of their children (Regber et al., 2013). Interestingly, Regber et al. (2013) cited more accurate parental perceptions in Central and Northern Europe than in southern Europe. The authors refer to regional differences in relation to the variances in health care systems and environments. In contrast, in Northern Finland 75% of parents (N = 120) classified their overweight children as normal-weight children (Vanhala, Keinänen-Kiukaanniemi, Kaikkonen, Laitinen, & Korpelainen, 2011).
In Australia, Spargo and Mellis (2014) surveyed 93 parents of children aged 2–17 years to evaluate the degree to which parents accurately assessed their child’s weight
category. Their findings show that 25% of children and adolescents were overweight or obese, but nearly 89% of parents underestimated the weight of their children and adolescents.
A longitudinal study conducted in Australia recorded the BMI of 13-year-old adolescents and followed up at age 15. Their mothers (N = 224) were surveyed to determine the accuracy of their perceptions regarding their adolescent’s weight. The findings indicate that approximately 25% of mothers misclassified their adolescent’s weight status (Shrewsbury et al., 2012). Another study in Australia that supports the findings of Spargo and Mellis (2014) and Shrewsbury et al. (2012) found that 20% of parents (N = 3043) underestimated the overweight/obesity of their children and adolescents, and 1% of parents overestimated their child’s weight status. It was more common for adolescent boys’ weight to be underestimated (26.4%) compared to girls (10.2%), whereas it was more common to overestimate the weight of adolescent girls (11.8%) than adolescent boys (3.4%) (Abbott et al., 2010).
Wen and Hui (2011) conducted a study in China to assess parental perceptions of their adolescents’ weight. A total of 1,869 parents were asked to assess their children’s weights by choosing one of the following answers: very underweight, slightly
underweight, normal, slightly overweight or very overweight. The results indicate that approximately 40% of parents classified their overweight adolescents as either
underweight or normal weight. In contrast, about 42% of parents classified their
normal-weight children in the underweight category. Another study in China found that 143 of 176 mothers of overweight children underestimated their child’s weight (Yao & Hillemeier, 2012).
Aljunaibi, Abdulle and Nagelkerke (2013) conducted a study in the UAE to assess parental perceptions of the weight of their children aged 6–19 years (N = 1440). The parents were asked to classify their children’s weight under one of the following categories: underweight, normal, overweight or obese. Overall, 33.8% of parents misclassified their children’s weight (27.4% underestimated and 6.3% overestimated). The parents’ accurate identification of their children’s weight was associated with the BMI percentile classification charts from CDC, but parent’s failed to recognise the accurate weight of children according to the child’s age, sex and parental education or income (Aljunaibi, Abdulle, & Nagelkerke, 2013).
In Saudi Arabia, Hashemi (2009) conducted a study to examine parents’ awareness of obesity among children aged 7–12 years. Parents completed a questionnaire that included questions about whether they considered their child to be underweight, about the right weight, overweight or very overweight. Their findings indicated that parents misclassified their children’s weight by either underestimating or overestimating.
Hashemi (2009) revealed that parents overestimated their overweight children’s weight (9% actual weight compared to 30% perceived weight) while for obese children, parents underestimated their children’s weight (36% actual weight compared to 3% perceived weight). The data in this study were self-reported, including the children’s
height/weight. However, as indicated by the author, Saudi culture plays an important role in parental perceptions of their child’s weight, as they prefer their child’s to be overweight rather than underweight. As a result of this perspective, most Saudi families rated their children as being overweight or obese (Hashemi, 2009).
Hussin, Mohammad, Al-Hamad, Makboul and Elshazly (2011) conducted a study in Kuwait using a purposive sample of overweight and obese children aged 8–12 years (N = 106), where 94.3% of the participants were obese and 5.7% were overweight. Their parents’ perceptions were recorded, showing 29.2% of parents perceived their child to be of normal weight, 42.5% perceived their child to be overweight and 28.3% perceived their child to be obese. More parents (50%) underestimated their female child’s weight as normal compared to their male child (13.3%) (Hussin et al., 2011).
The extensive body of data gathered from these studies indicate that it is very common for parents to misclassify their children’s weight by either overestimating or
underestimating, and they are more likely to misclassify girls’ weight than boys’ weight. This could be a significant contributing factor for childhood overweight and obesity. Therefore, accurate parental awareness of their children’s weight is a critical component in the strategy to prevent overweight and obesity in children. For this reason, the current study assesses parental perceptions of overweight and obesity in boys and girls.