Parental misperception of child’s body weight: cross-sectional survey in an Italian sample of pre-schoolers.

Background. In the literature, observational and intervention studies, as well as reviews, suggested that parents tend to misperceive the actual weight status of their children, typically underestimating it. The inability to identify overweight in infancy and early childhood might increase the likelihood of subsequent obesity. Aims. In 2017, a cross-sectional survey has been aimed at assessing the proportion of parent’s underestimating the actual children’s weight status and at verifying the association between misperception and influencing factors on the basis of the literature. Methods. A sample of 186 children (57.0% Females, aged 4.6 ± 1.0 years on average) has been recruited into three kindergartens of Ascoli Piceno province (Central Italy). Pupils’ anthropometric measurements were collected by the health professionals and a self-assessment questionnaire was used to evaluate the parents' profile. The prevalence of overweight and obesity based on international cut-offs [Cole & Lobestein, 2012] resulted, respectively, 22.6% and 12.4% in children, 14.4% and 5.1% in mothers, 34.7% and 8.0% in fathers. The 40.3% of parents have fallen into an underestimation error (39.8% of mothers and 46.7% of fathers). Specifically, the totality (100.0%) of overweight children and the 73.9% of obese were classified as ‘normal-weight’. In the oldest (5 years and above) the prevalence of underestimation resulted higher than in the youngest (below 4 years), respectively 49.3% vs 28.8% (p<0.05). Focusing on the mother's judgment, the proportion of misperception increases with her own overweight (p <0.05) and her own age (n.s.). Moreover, it resulted lower in foreign mothers as well as in lower educated, but not at a significant level. In the adjusted multivariate analysis, only the children's age and mother's weight status were significantly and positively associated with maternal misperception (p <0.05, for both independent variables). Discussion. The prevalence of overweight or obese children resulted much higher than in other surveys, e.g. more than double compared to the European Toy-Box Study (35.2% vs 14.1%) [Pinket et al, 2016]. The level of misperception varies noticeable in the recent literature, nevertheless, a metanalysis revealed that 50.7% (95% C.I. 31.1%–70.2%) of parents underestimate their overweight/obese children’s weight [Lundhal, 2014], so our results are consistent with this proportion. Regarding the determinant of misperception other studies revealed a significant association with children age and mother’s BMI, but in opposite direction [de Reuiter, 2017; AlHasan et al, 2019]. The major limits are the small sample size that impairs the statistical power and the absence of other determinant considered in the literature, e.g. birth weight, food habits, sleep, family affluence, attitudinal variables, exercise and sedentary behavior. Conclusions. Longitudinal studies highlighted a declining accuracy among parents in perceiving overweight children appropriately [Duncan, 2015], as our study confirmed. Since parents play a key role in the prevention and treatment of childhood obesity, particularly in the early age, effective educational strategies are essential to improve their awareness. Health promoting schools are an appropriate setting to implement intervention targeted to the families, starting early in the school career. This approach allows addressing cultural and socio-economic factors, so overcoming inequalities.