New research presented at the European Obesity Summit (Gothenburg, Sweden, June 1-4) shows that no matter what their actual weight, children who are perceived as overweight gain more weight than children whose parents perceive them to be normal weight. The study is by Dr Eric Robinson, University of Liverpool, UK, and Dr Angela Sutin, Florida State University College of Medicine, Tallahassee, FL, USA, and is published in Pediatrics.*
Parents of children who are overweight often fail to accurately identify their child’s weight status. Although these misperceptions are presumed to be a major public health concern, it is not known whether parental identification of child overweight is protective against weight gain across childhood or whether it may be associated with increased weight gain.
In this study, the authors used data from the Longitudinal Study of Australian Children to assess parental perceptions of child weight status and to examine changes in researcher measured child body mass index (BMI) ‘z scores’ across childhood, from 4 to 13 years old. A total of 3557 Australian children and their parents were included.
At baseline (age 4–5 years in 2004), 19.7% of children were overweight or obese and 75.4% were of “normal” weight. The sample was predominantly white. A substantial proportion of overweight children (80%) were perceived as being “normal weight” by their parents, whereas only 20% correctly identified their children as overweight. Children of parents who perceived their weight as being “overweight” tended to be in either the “normal” or overweight range, whereas children of parents who perceived their weight as being “underweight” tended to be in the underweight or “normal” weight range. (see table 2, full paper)
Children whose parents perceived their weight as being “overweight” as opposed to “about the right weight,” gained more weight (increase in BMI z score) from baseline to follow-up in all analyses. This finding did not depend on the actual weight of the child; the association between perceiving one’s child as being overweight and future weight gain was similar among children whose parents were correct or incorrect in believing their child was overweight.
The authors say: “Contrary to popular belief, parental identification of child overweight is notprotective against further weight gain, regardless of whether or not the child actually is overweight. Rather, it is associated with more weight gain across childhood. Further research is needed to understand how parental perceptions of child weight may counterintuitively contribute to obesity.”
They add: “The present findings have implications for childhood obesity initiatives. It has long been presumed that parental identification of overweight is important to obesity intervention efforts. For example, in the United Kingdom and United States, national measurement programs are in place to correct parental perceptions of child weight. Until now there has been little formal assessment of whether such interventions do in fact protect against further weight gain… there is now a greater need than ever to systematically assess the effectiveness of child measurement and obesity screening interventions delivered to parents.”
And on the reasons why these results may have occurred, the authors say: “Although these findings appear counterintuitive, a developing body of evidence suggests that the stigma attached to the label of overweight can be damaging and make self-regulation more difficult… experiencing stigma and feeling judged negatively because of one’s body size is associated with disordered eating and maladaptive coping responses, such as overeating.”
They also suggest “it is possible that the negative connotations attached to labelling a child as overweight could change the way parents interact with their child (for example providing food for comfort) or has an effect on child weight-related behaviours, resulting in a form of ‘self-fulfilling prophecy’.”
Dr Eric Robinson, University of Liverpool, UK. Please e-mail to arrange interview. E) Eric.Robinson@liverpool.ac.uk
Alternative contact: Tony Kirby in the European Obesity Summit Press Office. T) +44 7834 385827 E) firstname.lastname@example.org
Link to study for journalists only: