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



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.


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.


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).


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


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