Supplementary Material for: Parental Perceptions of Children’s Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017

<b><i>Introduction:</i></b> Parents can act as important agents of change and support for healthy childhood growth and development. Studies have found that parents may not be able to accurately perceive their child’s weight status. The purpose of this study was to measure parental perceptions of their child’s weight status and to identify predictors of potential parental misperceptions. <b><i>Methods:</i></b> We used data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative and 22 countries. Parents were asked to identify their perceptions of their children’s weight status as “underweight,” “normal weight,” “a little overweight,” or “extremely overweight.” We categorized children’s (6–9 years; <i>n</i> = 124,296) body mass index (BMI) as BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the distribution of children according to the WHO weight status classification, distribution by parental perception of child’s weight status, percentages of accurate, overestimating, or underestimating perceptions, misclassification levels, and predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with overweight (<i>including</i> obesity). Statistical analyses were performed using Stata version 15 1. <b><i>Results:</i></b> Overall, 64.1% of parents categorized their child’s weight status accurately relative to the WHO growth charts. However, parents were more likely to underestimate their child’s weight if the child had overweight (82.3%) or obesity (93.8%). Parents were more likely to underestimate their child’s weight if the child was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28–1.55); the parent had a lower educational level (adjOR: 1.41; 95% CI: 1.26–1.57); the father was asked rather than the mother (adjOR: 1.14; 95% CI: 0.98–1.33); and the family lived in a rural area (adjOR: 1.10; 95% CI: 0.99–1.24). Overall, parents’ BMI was not strongly associated with the underestimation of children’s weight status, but there was a stronger association in some countries. <b><i>Discussion/Conclusion:</i></b> Our study supplements the current literature on factors that influence parental perceptions of their child’s weight status. Public health interventions aimed at promoting healthy childhood growth and development should consider parents’ knowledge and perceptions, as well as the sociocultural contexts in which children and families live.

<b><i>引言：</i></b> 父母可成为推动儿童健康成长与发展的重要变革推动者与支持力量。已有研究显示，父母往往难以准确感知子女的体重状况。本研究旨在评估父母对子女体重状况的认知情况，并识别出父母产生认知偏差的预测因素。
<b><i>方法：</i></b> 本研究采用世界卫生组织（World Health Organization, WHO）欧洲儿童肥胖监测计划（European Childhood Obesity Surveillance Initiative）及22个国家的相关数据。研究要求父母将子女的体重状况归类为「体重过轻」「体重正常」「轻度超重」或「重度超重」。我们依据2007年世界卫生组织（WHO）推荐的生长参照标准，将6~9岁儿童（样本量n=124296）的身体质量指数（Body Mass Index, BMI）按照年龄别BMI Z评分进行分类。针对纳入分析的各个国家及国家层面的合并估算数据，我们通过多水平logistic回归分析，计算了按WHO体重状况分类的儿童分布、父母对子女体重状况的认知分布、准确认知、高估认知或低估认知的占比、错分程度，以及仅纳入超重（含肥胖）儿童的父母认知偏差的预测因素。统计分析采用Stata 15.1版本完成。
<b><i>结果：</i></b> 总体而言，64.1%的父母能够依据WHO生长图表准确判断子女的体重状况。然而，当子女存在超重（占比82.3%）或肥胖（占比93.8%）时，父母更易低估子女的体重状况。进一步分析显示，若子女为男性（校正比值比[adjOR]：1.41；95%置信区间[CI]：1.28~1.55）、父母受教育程度较低（adjOR：1.41；95% CI：1.26~1.57）、由父亲而非母亲参与调研（adjOR：1.14；95% CI：0.98~1.33），或家庭居住于农村地区（adjOR：1.10；95% CI：0.99~1.24），父母更可能低估子女的体重状况。总体而言，父母自身的BMI与低估子女体重状况的关联并不显著，但在部分国家中，二者的关联更为显著。
<b><i>讨论/结论：</i></b> 本研究补充了现有关于影响父母对子女体重状况认知的相关文献。旨在推动儿童健康成长与发展的公共卫生干预措施，应将父母的认知水平与认知状况，以及儿童与家庭所处的社会文化背景纳入考量范畴。