Parental Underestimation of Their Child’s Overweight and Obesity: Influence of Feedback From a Health Care Provider in a Nationally Representative Sample

Abstract

Objectives:

Parental misperception of a child’s weight status is common and may delay recognition and intervention for overweight and obesity. This study estimated the prevalence of parental underestimation of their child’s weight status among US children and adolescents with overweight or obesity and assessed whether health care provider (hereinafter, provider) feedback was associated with this underestimation.

Methods:

Data came from the 2012 National Youth Fitness Survey (n = 1571), a nationally representative cross-sectional survey of US children and adolescents aged 3 to 15 years. Parent-reported weight perception was compared with measured body mass index. Inaccurate parental perception (underestimation) was defined as a parent perceiving a child with measured overweight or obesity as “about the right weight” or “underweight.” Survey-weighted logistic regression was used to estimate the odds of underestimation by child sex, age group, and parental recall of provider feedback. Predicted probabilities were calculated using marginal standardization.

Results:

Most parents of children with overweight (82%) and nearly half of parents of children with obesity (44%) underestimated their child’s weight status. Parents who did not recall receiving provider feedback were substantially more likely to underestimate their child’s weight status than parents who recalled receiving feedback (78% vs 31%). The odds of underestimation were nearly 10 times higher among parents without provider feedback than among parents who received feedback (adjusted odds ratio = 9.65; 95% CI, 5.57-16.70). Underestimation was more common among younger children and among boys.

Conclusions:

Parental underestimation of their child’s overweight and obesity is widespread and strongly associated with the absence of provider feedback. Clinical communication may represent a low-cost, scalable strategy to improve parental perception of unhealthy weight and support early intervention.