The findings from this study support and validate previous findings about weight related perceptions among overweight children [13
]. We found that African-American children were less likely to report that they were overweight than other children. African American children also reported being less concerned about their weight posing a risk to their health compared to other children.
Boyington and colleagues explored the cultural attitudes and perceptions toward body image, food, and physical activity among 12 overweight African American girls, aged 12-18 years. The girls reported that "a healthy body size was one with which an individual felt comfortable" [18
]. Subjects reported that weight and body size was determined by the individual and influenced by the opinions of family and peers. Each girl's reference for body size was their family and cultural group which suggest that weight and body size are influenced by culturally based perceptions [18
]. This qualitative study found that these girls tolerated heavier body weight and perceived less social pressure to lost weight, resulting in infrequent pursuit of healthy lifestyle changes.
We found that African-American parents were more likely to report their overweight child's weight as underweight or normal and less likely to report they felt their child's weight was unhealthy. This is consistent with perceptions reported in other studies, where a common finding is that parents of overweight children often perceive their child as being at an appropriate weight [13
Burnet and colleagues assessed weight related beliefs in urban African American youth and their parents prior to developing a family based intervention to prevent childhood obesity and type 2 diabetes. They found that African American parents defined overweight in functional terms than by measurement or charts. The parents reported that "bigger people are built differently; charts do not always apply". The parents also reported that "larger-framed people would appear unhealthy if they conformed to standardized body mass index charts" [19
]. Children relied on physical appearance to define overweight, describing a healthy weight as "medium sized, not too skinny, not too thick" [19
These findings are concerning because excess weight in childhood is associated with increased risk of adult obesity and diabetes. Parental perceptions of a child's weight may influence a parent's efforts to encourage lifestyle changes for their child [3
]. Lifestyle behaviors of African American parents and children may be responses to historical, social, and cultural influences that affect their personal health beliefs, attitudes and perceptions [20
]. Identification of health beliefs must be targeted in order to provide a supportive environment to promote healthy behaviors in families.
Limitations to this study include the use of a questionnaire that was not tested for reliability and validity. Some self-reported data may be inaccurate because the subjects may have reported what reflected positively on their own abilities, knowledge, and health beliefs. Children younger than 10 years of age may have experienced difficulty interpreting the questions.
Though the small sample size limits the study's generalizability, the perceptions reported point to key areas for further study. In this sample of children and parents, the findings imply that perception of weight and healthy lifestyle may be influenced by cultural beliefs and personal influences.