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Published on: September 19, 2019
Child BMI Over Time and Parent-Perceived Overweight
Melissa Wake1,2,3, Jessica A Kerr4,2, Pauline W Jansen4,5,6
1Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia; melissa.wake@mcri.edu.au.
Insights
Parental perception of child overweight is strongly influenced by the child's actual body mass index (BMI) z-score. While parental awareness of overweight may precede slight BMI increases, it does not significantly impact weight status.
Area of Science:
- Pediatric Health
- Obesity Research
- Developmental Psychology
Background:
- Parental perception of childhood overweight is often inaccurate.
- Accurate perception is traditionally seen as crucial for reducing child obesity.
- Emerging research questions whether this perception change promotes weight gain.
Purpose of the Study:
- To investigate the temporal relationship between child adiposity and parental perception of overweight.
- To determine the directionality of influence between BMI z-scores and perceived overweight status over time.
Main Methods:
- Utilized data from two cohorts of the Longitudinal Study of Australian Children.
- Employed cross-lagged regression models to analyze repeated measures of BMI z-scores and parental perceptions.
- Included large sample sizes with multiple waves of data collection across childhood and adolescence.
Main Results:
- Higher child BMI z-scores strongly predicted subsequent parental perception of overweight.
- The influence of BMI z-score on perception was significantly larger (3-12 times) than the reverse.
- Parental perception of overweight weakly preceded increases, but not decreases, in BMI z-scores.
Conclusions:
- Child's BMI status is a primary driver of parental perception of overweight.
- Parental awareness initiatives may have limited impact on improving children's BMI.
- Interventions should consider the strong influence of actual adiposity on parental perception.
Background And Objectives:
Parents often do not accurately perceive overweight and/or obesity in their children. Changing this is widely considered an essential first step to reducing child overweight, but recent research suggests that, in fact, this could promote greater weight gain. We aimed to determine the directionality over time between higher child adiposity and parental perception of child overweight.
Methods:
Participants were from 2 cohorts of the population-based Longitudinal Study of Australian Children followed biennially since 2004. Repeated measures of BMI z scores and parental perceptions of overweight were available for the kindergarten cohort at 6 waves (ages 4-5, 6-7, 8-9, 10-11, 12-13, and 14-15 years; n = 4632) and for the birth cohort at 4 waves (ages 2-3, 4-5, 8-9, and 10-11 years; n = 4445). Bidirectionality between overweight perception and BMI z score was examined by using cross-lagged regression models.
Results:
In both cohorts, wave-on-wave lagged effects were strong (all: P < .001) but much larger from BMI z score to parent perception. For every unit increase in the BMI z score, the odds of a child being perceived as overweight in the next wave ranged from 2.9 (birth cohort: age 2-3 years) to 10.4 (kindergarten cohort: age 6-7 years). These effects were ∼3 to 12 times larger than the reverse, whereby the perception of overweight predicted 0.2 to 0.5 higher BMI z score in the next wave.
Conclusions:
Higher child BMI z scores strikingly predicted a subsequent parental perception of child overweight. Parent-perceived overweight preceded rising (not falling) BMI, but these effects were small. Clinician efforts to make parents aware of overweight may not be harmful but seem unlikely to improve children's BMI status.
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