# 20.31: Parental Recognition of Child Obesity

Skills to Develop

• To study the parents' perception of their children's weight status

### Research conducted by

Debra Etelson, Donald A. Brand, Patricia A. Patrick, and Anushree Shirali

### Case study prepared by

Robert F. Houser and Georgette Baghdady

### Overview

With increasing public awareness of child obesity as a major public health problem, studies are showing that it has not translated into an increased awareness of obesity in one’s own child.  Dietary patterns and weight status in childhood tend to carry into adolescence and adulthood, promoting the onset of chronic and other diseases.  A key ingredient for combating childhood obesity is parental involvement and commitment.  However, this is predicated on whether or not parents can recognize overweight and obesity in their children.

This study examined parents’ perceptions of their children’s weight status, their understanding of the health risks of obesity relative to other conditions they may perceive as health risks, and their knowledge of some healthy eating practices.  Children’s actual weight status was expressed as their body mass index (BMI) percentile, as determined by the CDC growth charts based on age and sex.  According to the CDC growth charts for children, a child with a BMI percentile less than the $$5^{th}$$ percentile is underweight; from the $$5^{th}$$ to less than the $$85^{th}$$, a child is at a healthy weight; from the $$85^{th}$$ to less than the $$95^{th}$$ percentile, a child is overweight; and a BMI percentile equal to or greater than the $$95^{th}$$ percentile, a child is considered to be obese.

A visual analog scale was used to measure parents’ perceptions of their child’s weight.  The visual analog scale consisted simply of a $$10$$-cm straight line anchored at the left end by the label “extremely underweight” and at the right end by the label “extremely overweight.”  A parent placed a mark along the line to indicate where they perceived their child’s weight to be.  The researchers interpreted the marks as percentiles in their analysis.

### Questions to Answer

Do parents recognize when their children are overweight or obese?  Do parents who make incorrect judgments about healthy food practices also make incorrect judgments about their child’s weight status?

### Design Issues

This study defines a parent’s perception of their child’s BMI percentile as “accurate” if their score on a visual analog scale fell within $$30$$ points of the child’s true BMI percentile.  This wide range defining accuracy potentially allows for misclassification of a child’s weight status among normal, overweight, and obese categories.  For example, a parent who perceives their child’s weight status as being at the $$80^{th}$$ percentile, i.e., in the normal range, when in reality the child is obese with a BMI percentile of $$98$$, the parent’s assessment would be considered accurate by the operational definition used in this study.  The authors explain that they chose this definition to give parents as much leeway as possible in assessing their child’s weight on the visual analog scale.

### Descriptions of Variables

Table $$\PageIndex{1}$$: Description of Variables

 Variable Description Sex The sex of the participating parent’s child Overwt_Obese Whether or not a child’s body mass index (BMI) is equal to or greater than the 85th percentile for the child’s age and sex, which means that the child is either overweight (85th to less than 95th percentile) or obese (95th percentile or above) PA_overwt Parental attitude expressing level of concern if their child were overweight, measured on a 4-point Likert Scale.  In data analysis, the four categories were condensed into two categories: 0 = “not at all” or “a little” concerned 1 = “quite” or “extremely” concerned PA-TV Parental attitude expressing level of concern if their child watched >20 hours of TV per week, measured on a 4-point Likert Scale. In data analysis, the four categories were condensed into two categories: 0 = "not at all" or "a little" concerned 1 = "quite" or "extremely" concerned Accurate Whether or not the parent's perception of their child's weight status was accurate. Parent's perception was considered accurate if the BMI percentile it corresponded to fell within 30 points of the child's actual BMI percentile Juice_boxes The amount of juice that a parent thinks is healthy for their child to drink each day (a juice box contains eight ounces). We condensed the original four response categories into two categories: 0 = "1 or 2 juice boxes per day" 1 = "3 to 8 juice boxes per day" Fast_food_meals How often a parent feels it is okay to eat at fast-food restaurants. We condensed the original four response categories into two categories: 0 = "once a month"

### References

• Debra Etelson, D., Brand, D. A., Patrick, P. A., Shirali, A. (2003). Childhood obesity: Do parents recognize this health risk? Obesity Research, 11, 1362-1368

### Contributor

• Online Statistics Education: A Multimedia Course of Study (http://onlinestatbook.com/). Project Leader: David M. Lane, Rice University.