Parents’ underestimation of their child’s weight status. Moderating factors and change over time: A cross-sectional study


Autoři: Emilie L. M. Ruiter aff001;  Jenneke J. E. H. Saat aff001;  Gerard R. M. Molleman aff001;  Gerdine A. J. Fransen aff001;  Koos van der Velden aff001;  Cornelia H. M. van Jaarsveld aff002;  Rutger C. M. E. Engels aff003;  Willem J. J. Assendelft aff003
Působiště autorů: Academic Collaborative Center AMPHI, Integrated Health Policy, Department of Primary and Community Care, ELG, Radboud university medical center, HB Nijmegen, the Netherlands aff001;  Department of Primary and Community Care, ELG, Radboud university medical center, HB Nijmegen, the Netherlands aff002;  Erasmus University Rotterdam, DR Rotterdam, the Netherlands aff003
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227761

Souhrn

Background

Parents’ underestimation of their child’s weight status can hinder active participation in overweight prevention programs. We examined the level of agreement between the parents’ perception of their child’s weight status and the child’s actual weight status, moderating factors, and change over time.

Methods

This cross-sectional study used data collected in 2009 (n = 8105), 2013 (n = 8844) and 2017 (n = 11,022) from a community-based survey conducted among parents of children age 2–12 years in the Netherlands. Parents classified their perception of their child’s weight status on a 5-point Likert scale. In 2009 and 2013, the child’s BMI was calculated from self-reported data by parents. The level of agreement between the parent’s perception of the weight status and the actual weight status was examined using Cohen’s kappa. The role of demographic factors on parents’ perception were examined using logistic regression.

Results

In 2009, 2013 and 2017, 6%, 6% and 5% of the parents, respectively, classified their child as heavy/extremely heavy. In 2009 and 2013, 64.7% and 61.0% of parents, respectively, underestimated the weight status of their overweight child. This was even higher among parents of obese children. Overall, the agreement between the parents’ perception and the actual weight status improved from 2009 (kappa = 0.38) to 2013 (kappa = 0.43) (p<0.05), but remained unsatisfactory. The parents’ underestimation of their child’s overweight/obesity status was associated with the child’s age in 2009 and 2013 (2–7 years; OR: 0.18), the child’s gender in 2009 (male; OR: 0.55), and the parents’ education level in 2009 (middle and high education; OR: 0.56 and 0.44 respectively).

Conclusions

Parents’ underestimation of their child’s weight status remains alarmingly high, particularly among parents of young, obese children. This underestimation is a barrier to preventing childhood overweight/obesity. Healthcare professionals should take this underestimation into consideration and should actively encourage parents to take steps to prevent overweight/obesity in their children.

Klíčová slova:

Body mass index – Educational attainment – Ethnicities – Child health – Childhood obesity – Children – Netherlands – Questionnaires


Zdroje

1. Organization WH. Prioritizing areas for action in the field of population-based prevention of childhood obesity: a set of tools for Member States to determine and identify priority areas for action. 2012.

2. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2014.

3. Zwiauer KF. Prevention and treatment of overweight and obesity in children and adolescents. European journal of pediatrics. 2000;159 Suppl 1:S56–68. Epub 2000/09/30. doi: 10.1007/pl00014367 11011956.

4. Must A, Strauss RS. Risks and consequences of childhood and adolescent obesity. International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity. 1999;23 Suppl 2:S2–11. Epub 1999/05/26. doi: 10.1038/sj.ijo.0800852 10340798.

5. Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes (Lond). 2011;35(7):891–8. Epub 2010/10/27. ijo2010222 [pii] doi: 10.1038/ijo.2010.222 20975725.

6. Buttitta M, Iliescu C, Rousseau A, Guerrien A. Quality of life in overweight and obese children and adolescents: a literature review. Quality of Life Research. 2014;23(4):1117–39. doi: 10.1007/s11136-013-0568-5 24249217

7. Daniels SR. Complications of obesity in children and adolescents. Int J Obes (Lond). 2009;33(1):S60–5. Epub 2009/04/14. ijo200920 [pii] doi: 10.1038/ijo.2009.20 19363511.

8. Hruby A, Hu FB. The Epidemiology of Obesity: A Big Picture. PharmacoEconomics. 2014:1–17. doi: 10.1007/s40273-013-0118-6

9. Biro FM, Wien M. Childhood obesity and adult morbidities. Am J Clin Nutri. 2010;91(5):1499S–505S. doi: 10.3945/ajcn.2010.28701B 20335542

10. Singh AS, Mulder C, Twisk JW, van Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9(5):474–88. Epub 2008/03/12. doi: 10.1111/j.1467-789X.2008.00475.x 18331423.

11. Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obesity reviews. 2004;5(s1):4–85.

12. Müller M, Mast M, Asbeck I, Langnäse K, Grund A. Prevention of obesity–is it possible? Obesity reviews. 2001;2(1):15–28. doi: 10.1046/j.1467-789x.2001.00012.x 12119633

13. Dehghan M, Akhtar-Danesh N, Merchant AT. Childhood obesity, prevalence and prevention. Nutr J. 2005;4:24. Epub 2005/09/06. 1475-2891-4-24 [pii] doi: 10.1186/1475-2891-4-24 16138930; PubMed Central PMCID: PMC1208949.

14. Kremers SP. Theory and practice in the study of influences on energy balance-related behaviors. Patient education and counseling. 2010;79(3):291–8. doi: 10.1016/j.pec.2010.03.002 20371159

15. Swinburn B, Egger G, Raza F. Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. Preventive medicine. 1999;29(6):563–70.

16. Towns N, D'Auria J. Parental perceptions of their child's overweight: an integrative review of the literature. Journal of pediatric nursing. 2009;24(2):115–30. doi: 10.1016/j.pedn.2008.02.032 19268233

17. Lundahl A, Kidwell KM, Nelson TD. Parental underestimates of child weight: A meta-analysis. Pediatrics. 2014:peds. 2013–690.

18. Rhee KE, De Lago CW, Arscott-Mills T, Mehta SD. Factors associated with parental readiness to make changes for overweight children. Pediatrics. 2005;116(1):e94–e101. doi: 10.1542/peds.2004-2479 15995022

19. Hager ER, Candelaria M, Latta LW, Hurley KM, Wang Y, Caulfield LE, et al. Maternal perceptions of toddler body size: Accuracy and satisfaction differ by toddler weight status. Archives of pediatrics & adolescent medicine. 2012;166(5):417–22.

20. Rietmeijer‐Mentink M, Paulis WD, Middelkoop M, Bindels PJ, Wouden JC. Difference between parental perception and actual weight status of children: a systematic review. Maternal & child nutrition. 2013;9(1):3–22.

21. De La O A, Jordan KC, Ortiz K, Moyer-Mileur LJ, Stoddard G, Friedrichs M, et al. Do parents accurately perceive their child's weight status? Journal of Pediatric Health Care. 2009;23(4):216–21. doi: 10.1016/j.pedhc.2007.12.014 19559989

22. Jansen W, Brug J. Parents often do not recognize overweight in their child, regardless of their socio-demographic background. The European Journal of Public Health. 2006;16(6):645–7. doi: 10.1093/eurpub/ckl100 16837515

23. Tschamler JM, Conn KM, Cook SR, Halterman JS. Underestimation of children's weight status: views of parents in an urban community. Clinical pediatrics. 2009.

24. Gerards SM, Gubbels JS, Dagnelie PC, Kremers SP, Stafleu A, de Vries NK, et al. Parental perception of child's weight status and subsequent BMIz change: the KOALA birth cohort study. BMC Public Health. 2014;14(1):291.

25. de Hoog ML, Stronks K, van Eijsden M, Gemke RJ, Vrijkotte TG. Ethnic differences in maternal underestimation of offspring's weight: the ABCD study. International Journal of Obesity. 2012;36(1):53–60. doi: 10.1038/ijo.2011.199 22005721

26. Bossink-Tuna H, L’hoir M, Beltman M, Boere-Boonekamp M. Parental perception of weight and weight-related behaviour in 2-to 4-year-old children in the eastern part of the Netherlands. European journal of pediatrics. 2009;168(3):333–9. doi: 10.1007/s00431-008-0787-x 18663474

27. Van der Star M. Regiorapport Kindermonitor 2009/2010: Gezondheid, welzijn en leefwijze van 0–12 jarigen in de regio Nijmegen. [Region report Child Monitor 2009/2010: Health, well-being and lifestyle of children 0 to 12 years of age in the Nijmegen region]. Nijmegen: GGD Gelderland-Zuid, 2010.

28. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320(7244):1240–3. Epub 2000/05/08. doi: 10.1136/bmj.320.7244.1240 10797032; PubMed Central PMCID: PMC27365 of child overweight and obesity, specifying the measurement, reference population, and age and sex specific cut off points. Data on body mass index (weight/height) were obtained from 6 large nationally representative cross sectional surveys on growth from Brazil, Great Britain, Hong Kong, the Netherlands, Singapore, and the US. The study included 97,876 males and 94,851 females from birth to 25 years of age. For each of the surveys, centile curves were drawn that at age 18 years passed through the widely used cut-off points of 25 and 30 kg/sq. m for adult weight and obesity. The resulting curves were averaged to provide age- and sex-specific cut-off points from 2 to 18 years. The proposed cut off points, which are less arbitrary and more internationally based than current alternatives, should help to provide internationally comparable prevalence rates of overweight and obesity in children.

29. Keij I. Hoe doet het CBS dat nou? Standaarddefinitie allochtonen [How does Statistics Netherlands that? Standard Definition immigrants]. CBS [Statistics Netherlands], 2000.

30. Eurostat. Task force on core social variables. Final report. Luxembourg: European Communities, 2007.

31. Oyeyemi G, Adewara A, Adeyemi R. Complex survey data analysis: a comparison of SAS, SPSS and STATA. Asian J Math Stat. 2010;3:33–9. doi: 10.3923/ajms.2010.33.39

32. Cohen J. A coefficient of agreement for nominal scales. Educational and Psychosocial Measurement, 20, 37–46. 1960.

33. Lowry R. Kappa as a Measure of Concordance in Categorical Sorting 2001–2015. Available from: http://vassarstats.net/kappa.html

34. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. Journal of clinical epidemiology. 2007;60(1):34–42. doi: 10.1016/j.jclinepi.2006.03.012 17161752

35. Cohen's Kappa: Index of Inter-rater Reliablity. Available from: http://psych.unl.edu/psycrs/handcomp/hckappa.PDF.

36. Scholtens S, Brunekreef B, Visscher TL, Smit HA, Kerkhof M, De Jongste JC, et al. Reported versus measured body weight and height of 4-year-old children and the prevalence of overweight. The European Journal of Public Health. 2007;17(4):369–74. doi: 10.1093/eurpub/ckl253 17124194

37. Davis H, Gergen PJ. Mexican-American mother's reports of the weights and heights of children 6 months through 11 years old. Journal of the American Dietetic Association. 1994;94(5):512–6. doi: 10.1016/0002-8223(94)90213-5 8176125

38. Akerman A, Williams ME, Meunier J. Perception versus Reality An Exploration of Children's Measured Body Mass in Relation to Caregivers' Estimates. Journal of Health Psychology. 2007;12(6):871–82. doi: 10.1177/1359105307082449 17956967

39. Brettschneider A-K, Ellert U, Schaffrath Rosario A. Comparison of BMI derived from parent-reported height and weight with measured values: results from the German KiGGS study. International journal of environmental research and public health. 2012;9(2):632–47. doi: 10.3390/ijerph9020632 22470314

40. Timmermans S, Mommers M, Gubbels J, Kremers S, Stafleu A, Stehouwer C, et al. Maternal smoking during pregnancy and childhood overweight and fat distribution: the KOALA Birth Cohort Study. Pediatric obesity. 2014;9(1):e14–e25. doi: 10.1111/j.2047-6310.2012.00141.x 23362054

41. Manios Y, Kondaki K, Kourlaba G, Vasilopoulou E, Grammatikaki E. Maternal perceptions of their child’s weight status: the GENESIS study. Public Health Nutrition. 2009;12(08):1099–105.

42. Young‐Hyman D, Herman LJ, Scott DL, Schlundt DG. Care giver perception of children's obesity‐related health risk: a study of African American families. Obesity research. 2000;8(3):241–8. doi: 10.1038/oby.2000.28 10832767

43. Genovesi S, Giussani M, Faini A, Vigorita F, Pieruzzi F, Grazia Strepparava M, et al. Maternal perception of excess weight in children: a survey conducted by paediatricians in the province of Milan. Acta paediatrica. 2005;94(6):747–52. doi: 10.1111/j.1651-2227.2005.tb01975.x 16188779

44. Maynard LM, Galuska DA, Blanck HM, Serdula MK. Maternal perceptions of weight status of children. Pediatrics. 2003;111(Supplement 1):1226–31.

45. Puhl RM, Heuer CA. The stigma of obesity: a review and update. Obesity. 2009;17(5):941–64. doi: 10.1038/oby.2008.636 19165161

46. Campbell MWC, Williams J, Hampton A, Wake M. Maternal concern and perceptions of overweight in Australian preschool‐aged children. Medical Journal of Australia. 2006;184(6):274–7. 16548831

47. Jones AR, Parkinson KN, Drewett RF, Hyland RM, Pearce MS, Adamson AJ. Parental perceptions of weight status in children: the Gateshead Millennium Study. International journal of obesity. 2011;35(7):953. doi: 10.1038/ijo.2011.106 21673651

48. Fisher L, Fraser J, Alexander C. Caregivers’ inability to identify childhood adiposity: A cross‐sectional survey of rural children and their caregivers’ attitudes. Australian Journal of Rural Health. 2006;14(2):56–61. doi: 10.1111/j.1440-1584.2006.00764.x 16512790

49. Baughcum AE, Burklow KA, Deeks CM, Powers SW, Whitaker RC. Maternal feeding practices and childhood obesity: a focus group study of low-income mothers. Archives of Pediatrics & Adolescent Medicine. 1998;152(10):1010–4.

50. West DS, Raczynski JM, Phillips MM, Bursac Z, Gauss CH, Montgomery BE. Parental recognition of overweight in school‐age children. Obesity. 2008;16(3):630–6. doi: 10.1038/oby.2007.108 18239596

51. Gubbels JS, Kremers S, Stafleu A, de Vries SI, Goldbohm RA, Dagnelie PC, et al. Association between parenting practices and children’s dietary intake, activity behavior and development of body mass index: the KOALA Birth Cohort Study. Int J Behav Nutr Phys Act. 2011;8(1):18.

52. Gerards SM, Dagnelie PC, Jansen MW, van der Goot LO, de Vries NK, Sanders MR, et al. Lifestyle Triple P: a parenting intervention for childhood obesity. BMC Public Health. 2012;12(1):1.

53. West F, Sanders MR, Cleghorn GJ, Davies PS. Randomised clinical trial of a family-based lifestyle intervention for childhood obesity involving parents as the exclusive agents of change. Behaviour research and therapy. 2010;48(12):1170–9. doi: 10.1016/j.brat.2010.08.008 20883981

54. Ruiter EL, Fransen GA, Molleman GR, van der Velden K, Engels RC. The effectiveness of a web-based Dutch parenting program to prevent overweight in children 9–13 years of age: study protocol for a two-armed cluster randomized controlled trial. BMC public health. 2015;15(1):148.

55. van Koperen MT, van der Kleij RM, Renders CC, Crone MM, Hendriks A-MA, Jansen MM, et al. Design of CIAO, a research program to support the development of an integrated approach to prevent overweight and obesity in the Netherlands. BMC Obesity. 2014;1(1):5.


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