This study evidences the high prevalence of overweight among Puerto Rican children and the failure of both parents and children themselves to correctly assess children’s weight status. We found significant discrepancies between children’s real weight status and perceptions among parents and children themselves of children’s weight, particularly for obesity/overweight.
Parents of overweight/obese girls were more accurate in perceiving their child’s weight status compared to parents of overweight/obese boys. This tendency needs further attention as males tend to have a higher prevalence of obesity-related conditions, particularly cardiovascular diseases [25
], at a younger age compared to women. On the other hand, parental recognition of girls’ overweight/obesity status represents a good opportunity for parental and child education on the prevention of obesity-related conditions more prevalent among women, such as breast cancer [26
]. An elevated underestimation of overweight was also observed among overweight parents. However, it was more evident among parents of boys compared to parents of girls.
Consistent with previous studies, certain socio-economic characteristics among parents seem to predict these discrepancies. There was a tendency among less-educated parents to underestimate their children’s overweight/obesity status. A higher percentage of parents with more than a high school education tended to recognize children’s overweight or obesity than parents with less than a high school education. These tendencies were also seen among their own children. A greater percentage of children of higher-educated parents correctly estimated their own overweight status.
This study also shows that a higher percentage of parents of children from private schools tended to underestimate their children’s weight status compared to parents of children in public schools, particularly regarding obesity or overweight. Similarly, parents of children from private schools tended to overestimate underweight among their children. These contradictory findings are of concern since children from private schools tend to come from families with higher income levels, and therefore have access to more economic resources to purchase food at the school cafeteria. Despite the fact that in Puerto Rico competitive foods are prohibited by law to be sold in schools and nearby environments, these products could still be available for sale in fund-raising activities within the school setting.
Girls themselves classified their weight more correctly than boys. A higher percentage of obese/overweight boys misclassified themselves as normal weight compared to girls. These findings could be associated to the fact that mass media campaigns are targeted to women’s weight control compared to men. On the other hand, it rises up a concern of whether men are less concerned about overweight/obesity problems, thus increasing their chances of developing associated chronic diseases early in life.
A noteworthy contribution of this study is the analysis of the concordance between children’s real weight compared to parents’ and children’s perceptions of weight status. In general, we found that only half of children and their parents were in agreement with each other regarding weight classification. These discrepancies in perception were even more notable among overweight/obese subjects. Only half of the parents of overweight children correctly perceived their children’s overweight status. The other 50% of parents of overweight/obese children considered their children to be at a normal weight. A considerable percentage of children who perceived themselves as overweight were perceived by their parents as being of normal weight. The same tendency was seen among overweight children. In general they leaned to underestimate their weight status. Almost half of overweight children considered themselves to be at a normal weight.
Parents of underweight children also were inclined to misclassify their children’s weight. Less than half of parents of underweight children recognized the weight status of their children. On the other hand almost two thirds of children and their parents perceived the children to be in normal weight whereas only one third of both parents and children perceived children to be underweight.
Parents’ own weight status seems to play an important role on their perceptions of children’s weight status. In general, parental weight status seemed to influence the parent’s classification of their child’s weight status. However, there were some exceptions. A considerable percentage of both overweight and normal weight parents underestimated their child’s overweight status. However, to our surprise, this tendency was higher among normal and underweight parents. A higher percentage of normal weight parents were unable to classify their child as overweight compared to obese parents. The same tendency was seen among underweight parents who tended to misclassify their children’s weight status. Nevertheless, obese parents also showed a limitation to estimate their child’s weight status. Almost a third of obese parents with obese children misclassified their children as normal weight. This represents a public health concern, since parents provide food environments for their children’s early experiences with food and eating.
Parents also influence children’s own perceptions of their weight, and thus their recognition and response to education and opportunities to modify their diet and/or physical activity. Parental recognition and acceptance that their child is overweight is vital if interventions are to be initiated and successfully.
This is the first study conducted in a representative sample in Puerto Rico that explores perceptions of both children and parents about children’s weight status, particularly for overweight and obesity. This study showed a higher misperception of children’s overweight and obesity among less-educated parents compared to parents with higher education level. Therefore, it underscores the need for the design and development of education interventions targeted particularly to lower socio-economic families addressing the issues around overweight and obesity. Our results are consistent with the literature, reflecting that less-educated parents, children from less-educated families, children of overweight parents and parents of boys tend to underestimate overweight or obesity situations.
This study underscores the need to monitor children’s BMI for age and to share this information with parents so that tendencies toward overweight or obesity and even underweight could be identified on time. It is important to help parents understand their children’s weight status in order for parents to make better decisions for their children. It is also important to help children understand their nutritional and physiological needs in order to help them make better food selection and eat healthier.
Despite of these novel findings there were some limitations in our study. Although a considerably good response rate was obtained from children (63%), there was a low response rate from parents of children (44%), thus limiting comparison analyses among parental and children’s weight status and respective weight perceptions. Parental BMI was calculated from reported weight and height from parents which represents a limitation in terms of potential underreporting or imprecision of data provided. Children’s interviews were conducted in school settings which limited the time for the interviews, given the heavy workload of schools. Having more time for interviewing children would have given us more time to develop a more confident and truthful environment between the child and the interviewer in order to obtain more accurate responses from the child. Our study included very young age children who may have had limitations understanding and therefore assessing their own weight status.
In spite of these limitations, this research represents a significant contribution to the study of social factors associated to childhood obesity in Puerto Rico, since it assesses for the first time the perceptions of Puerto Rican parents about the weight status of their children. More importantly, our study brings an interesting dimension in this assessment when comparing parental perceptions with children’s own perceptions of children’s weight status. Studies confirm the influence that parents exert over children lifestyle characteristics, but to our knowledge, this is the first study that establishes an association among parents and children’s perceptions of weight conditions in a Hispanic population. A particular contribution is the finding that both parents and children with overweight and obesity had difficulties understanding children’s weight status. Thus, more attention should be given to help both parents and children to comprehend and accept their weight status in order to facilitate the adoption of healthy lifestyles.