Factors affecting perception of child weight

Background Parental misperception and underestimation of their child’s
weight are documented in studies. Demographic factors like age and gender
have been linked to misclassification. However, modifiable factors that
could potentially frame future intervention and prevention strategies have
not been explored. This study aimed to assess factors that could predict
parental misclassification of their preschool child’s weight. Methods This
was a cross-sectional study with 198 parents and their 2- to 5-year-old
children who attended standalone preschools or childcare centers with
preschools. Parents completed a questionnaire that asked about demographic
features, personal and family health, and the assessment of their child’s
weight using the three most frequently utilized measures. Logistic
regression was conducted to assess the association between parental
factors and child weight classification status. Instruments included the
Parental Self-Efficacy for Promoting Healthy Physical Activity and Dietary
Behaviors in Children Scale (PSEPAD), the Obesity Risk Scale (ORK-10), and
the Adolescent Obesity Risk Scale (AORK). Analyses included frequencies,
chi-square tests, Kappa coefficients, and logistic regressions. Results
Parents were least accurate (35.9%) identifying child weight when
selecting a picture (κ =-.028, p = .42). The pictorial and Likert method
(κ = -.032, p = .37) showed parental agreement with child weight was not
significantly better than chance. Statistically, a significant agreement
was found in the weight-reporting method (κ = .21). Two of the three
HBM-related measures were significantly related to accurate
classification. Logistic regression showed child sex, PSEPAD scores, and
ORK-10 scores were statistically significant predictors in the Likert
method. The model had no statistical significance for the pictorial or
weight-reporting method. Conclusion Results indicate parents support
intervening if aware of child weight problems. However, parents do not
accurately recognize healthy versus unhealthy weights and report that
health providers are not informing them of weight deviations. Further,
important relationships between the HBM variables were identified. Results
show barriers (self-efficacy) mediate the impact of perceived severity
(knowledge) regarding the parental ability to assess child weight
accurately. These relationships and incorporation of the HBM principles of
barriers and severity into prevention/intervention strategies need further
exploration.