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Am Fam Physician. 2008;77(12):1746

Background: Excessive body weight in childhood is associated with several potentially serious short- and long-term health consequences, including type 2 diabetes, hyperlip-idemia, and hypertension. Excessive weight in childhood also is highly predictive of overweight or obesity in adulthood. Effective interventions for childhood obesity depend on lifestyle changes, particularly a healthy diet and exercise. The first stage in any intervention is parental recognition of the child's overweight or obesity. Studies of several populations, mainly in Europe, suggest that parents of children who are overweight or obese may not perceive their child's weight as excessive or related to health problems. He and Evans evaluated parents' perception of their child's weight status compared with their child's actual weight.

The Study: Parents of children in fourth to sixth grades in Canada were surveyed. The 487 participating children were measured for height and weight to calculate age- and sex-specific body mass indices (BMIs). The 406 participating parents completed self-administered surveys that included questions about parental perception of the child's weight compared with other children of the same age and about the degree of parental concern about the child becoming overweight. The survey also collected data about family structure, socioeconomic status, and parental weight and height. Parental perception of the child's weight status was compared with the child's calculated BMI.

Results: Parents were significantly more likely to perceive their child as underweight or of normal weight than obese. Although only 1.4 percent of children were clinically underweight (i.e., BMI less than the 5th percentile), 17.2 percent of parents perceived their child as underweight. Conversely, 16.1 percent of children were overweight (i.e., BMI between the 85th and 95th percentiles) and 13.5 percent were obese (i.e., BMI greater than the 95th percentile); however, 14.9 percent of parents perceived their child as overweight and only 3.4 percent perceived their child as obese. Sixty-three percent of parents with an overweight child perceived the child to be of normal weight. About 26 percent of parents of an overweight child and 15 percent of parents of an obese child were not concerned about the child's weight. Statistical analysis showed that male sex of the child, nonwhite ethnicity, and maternal overweight were significantly associated with underrecognition of weight issues in children. Parental education, family income, and the child's age were not associated with inaccurate weight perceptions.

Conclusion: The authors conclude that at least one third of parents do not accurately identify their child's weight category, and about two thirds of parents of overweight children do not recognize the condition or perceive it to be a serious health problem. The authors recommend that family physicians adopt the stages-of-change model to address childhood weight issues, especially the first stage of change (i.e., recognition of the problem).

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