On one hand, health professionals urge that prevention of childhood overweight should begin early and focus on parents as the primary agents of change. On the other hand we know almost nothing about what weight parents consider to be a “warning sign” that they should engage in preventive weight management efforts with their children. Based on past research on parental risk perception, this study first explored parental perceptions of the right time for engaging in activities to prevent their child from being overweight, and second, analyzed which factors predict parents’ sensitivity to the degree of their child’s risk – e.g. whether they see a concrete need for action at a lower weight status, or only at a higher weight status. Within this context we further investigated parental risk perception as well as their dissatisfaction with their child’s weight.
Half of mothers correctly identified the overweight silhouettes as well as related health risks, but 16 - 20% of mothers only identified overweight and its associated health risks with silhouettes corresponding to BMIs in the 97th
percentile. These results are in agreement with other studies’ reports of low parental risk perceptions of children’s weight status [e.g. 6, 11]. The associated physical and mental health problems were correctly classified more often by mothers with higher educational attainment and already-overweight children. Maternal education as a factor influencing the ability to recognize overweight-related health problems was previously shown in our own [12
] and other studies [summarized in 11]. The child’s overweight status has so far only been examined as a factor increasing maternal tendencies to misclassify overweight in her own child [9
], but there were no associations in this study between the child’s weight and maternal misclassification of unrelated silhouettes [12
]. Therefore, for mothers of overweight children it may be easier to apply knowledge about the obesity-related health risks to unrelated children rather than their own. Further studies that focus on this question are needed.
Concerning maternal dissatisfaction with her own child’s silhouette, our results are in line with the work of Laraway and colleagues [21
]. More mothers preferred a slightly thicker than a thinner silhouette for their child, and the desire for a thinner silhouette increased with the child’s overweight status. This desire seems to make sense, since we did not explicitly focus on already-overweight children, and therefore most children were in the normal weight range. Mother’s own overweight status and the age of the child were associated with a maternal preference for a thinner silhouette. In our opinion these results can be interpreted as possible outcome of more experience with obesity in both cases. Even though there is a higher prevalence of overweight in older children [1
], the child’s weight status is not the underlying factor in this relation between the child’s age and maternal preference for thinner silhouettes. However, overweight mothers could be more aware of having an overweight child due to their own experiences with overweight. This view is supported by the observation that overweight mothers reported more concern about their child’s future weight status independent of the child’s current weight status [26
Half of the mothers see the need for action only on overweight silhouettes (90th
percentile). In addition, 20% of mothers are convinced that there is no need for prevention until the child’s BMI exceeds the 97th
percentile, i.e. when he or she is already obese. Taken together, these results emphasize the fact that the vast majority of parents do not share basic ideas of health promotion or primary prevention with health professionals, whose standards state that prevention should start early and before the child suffers from a weight problem. This observation is consistent with the low participation rates often reported in prevention studies [27
]. The only significant factor to predict this late parental engagement in preventive efforts (at the 97th
percentile) was maternal inability to identify physical health risks with overweight and obese silhouettes. This finding underscores the approach of common health-related psychological theories (e.g. the Health Action Process Approach of Schwarzer or the Theory of Reasoned Action of Ajzen; see [28
]) which stress the relevance of risk perception as a necessary basis for the construction of an intention to change behavior. Current empirical research reveals that parental identification of overweight, as well as parents’ beliefs that overweight constitutes a health problem, are highly significant influences [18
] in prevention and intervention. Since most mothers underestimate the health risks associated with overweight, there is an urgent need to sensitize parents to the health risks related to childhood obesity.
Maternal commitment to preventive activities at the 75th
weight percentile, on the other hand, is predicted by having a boy and by the identification of overweight at the 75th
percentile. Previous work has already reported the importance of early parental identification of overweight, as well as the identification of related health risks, as relevant factors affecting parental readiness for prevention activities with respect to maternal risk perception [summarizing 11]. Our finding that mothers see an earlier need for action for boys is unexpected. Since we controlled for several factors, this result could not be explained simply by the higher weight status of the boys, or by age differences. There are only a few studies that find significant sex differences regarding parental risk perception and these show the opposite results with respect to gender (in summary [11
]). In addition, we did not examine maternal perceptions of preventive activities for their own child, but in general for children in this age group. Therefore, we would not have expected any associations with the gender of the participant’s own child. We are not aware of any study using a similar approach to bring our results in line with other research. Further investigations are needed to explore the influence of the child’s gender on maternal risk perception.
Our study has several limitations. We used a cross-sectional design, which does not allow us to draw causal conclusions. Further prospective research is therefore required to confirm the effects of the child’s age, as well as maternal ability to recognize overweight and related health risks in unrelated children. Another limitation is that we used self-report data for weight status. This decision was supported by our assumption that maternal perception of the child’s weight status is more relevant to their perception of weight-related health risks than his or her objective weight.
Still, our study is the first to focus on the maternal perception of the need for overweight prevention. Our results underscore the relevance of parental risk perception to the construction of intentions to employ preventive strategies.