Parents Underestimate Their Kids' Weight

Understanding of Obesity Risk Is High, but Survey Suggests a Disconnect

From the WebMD Archives

Nov. 21, 2003 -- Parents are concerned about the health risks associated with childhood obesity, and most have basic knowledge of healthy eating patterns. But they are not good at recognizing the problem in their own children, new research suggests.

When surveyed during well-child pediatric visits, parents of both normal-weight and overweight young children scored high in their knowledge of nutrition and the health risks of obesity. But when asked to assess their own child's weight, only 10% of the parents of overweight and obese children did so accurately, compared with about 60% of other parents.

"No matter what their knowledge base with regard to healthy eating and the risks of being overweight, there seemed to be this disconnect when it came to their own children," says New York pediatrician Debra Etelson, MD, who was the study's lead investigator."

Obesity Epidemic

According to the American Academy of Pediatrics, the number of overweight and obese children in the U.S. has doubled in the last two decades, with roughly 15% of kids and adolescents falling at or above the 95th percentile for body mass index (BMI -- a measure of weight for height).

BMI is the most widely used tool for assessing weight. Children whose weight falls at or above the 95th percentile for their age are considered overweight or obese.

Several studies have suggested that parents tend to have unrealistic perceptions of their children's weight, but Etelson and New York Medical College colleagues are among the first to try to quantify these perceptions numerically.

In an effort to avoid potential biases, parents of 4- to 8-year-olds who completed the anonymous survey were not told that it was designed to assess their understanding of excess weight as a health risk and obesity in their own children. The questionnaire was presented as a general survey of risk assessment, and including questions about smoking, home safety, and other non-weight related issues.

Of the 83 parents surveyed, 19 had overweight children. These parents expressed the same level of concern about excess weight as a health risk and the same knowledge of nutrition as parents of children who were not overweight.


Seventy-eight percent of those surveyed said they would be "quite" or extremely" concerned about excess weight, and two-thirds understood that fruit juice should be limited because it has so much sugar. Almost all recommended limiting fast-food meals to once a week or more.

But almost all of the parents of overweight and obese children, those in the highest weight percentile, underestimated their children's weight. Parents of overweight and obese children were much more likely to misjudge their children's weight than were parents of children who were not overweight.

The findings are reported in the November issue of the journal Obesity Research.

In Denial?

In a survey conducted three years ago, obesity expert Judith Stern, ScD, found that parents tended to have a poor understanding of the dangers of childhood obesity. She says she is not surprised that the newly published study found otherwise, and credits the media's focus on the childhood obesity epidemic with raising the consciousness America's parents.

But the University of California, Davis, nutrition professor says she is not optimistic that a greater awareness will translate into thinner children.

"Parents may know more than they did a few years ago, but when it comes to their own children they still tend to be either in denial or defensive," she tells WebMD. "And even if they recognize the problem, there is still not a lot of help out there for kids and adults who are overweight because the health-care system continues to stonewall the problem. They pay for diabetes and heart disease and other conditions caused by obesity, but they don't pay for treatments to help people lose weight."

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SOURCES: Etelson, D. Obesity Research, Nov. 11, 2003; vol 11: pp 1362-1368. Debra Etelson, MD, assistant professor, New York Medical College, Valhalla, N.Y. Judith Stern, ScD, RN, professor of nutrition, University of California, Davis.
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