Generational shift in parental perceptions of overweight among school-aged children

BACKGROUND: Parental perceptions of child's weight status may influence family readiness to foster healthy behaviors. This study investigated the generational shifting of parental perceptions about children's weight.

METHODS: Data were collected in the NHANES 1988-1994 (n = 2871) and 2005-2010 (n = 3202). Parents, mainly mothers, were asked whether they considered their child, ages 6 to 11 years, to be overweight, underweight, or just about the right weight. The Centers for Disease Control and Prevention 2000 growth chart was used for reference. We ran Poisson regression to estimate the probability ratio between the 2 surveys for parents perceiving their child as overweight after controlling for actual weight.

RESULTS: The 10th percentile of BMI z scores for children who were parentally perceived as overweight shifted with statistical significance from 84th percentile of reference population in the early survey to 91st percentile of reference population in the recent survey (P < .05). The mean z score of children parentally perceived as overweight also increased between surveys with the largest increase among children from poor families (from 1.60 [SE: 0.20] to 1.98 [0.08], P < .05), followed by African Americans (from 1.65 [0.09] to 2.02 [0.05], P < .05). The probability of overweight/obese children being correctly perceived as overweight by the parents declined by 24% between surveys (probability ratio = 0.76 [95% confidence interval: 0.67-0.87]).

CONCLUSIONS: Overweight/obese children were less likely to be perceived as overweight in the recent survey compared with peers of similar weight but surveyed 10+ years earlier. The declining tendency among parents to perceive overweight children appropriately may indicate a generational shift in social norms related to body weight.