Parents Underestimate Weight of Their Obese Children

cute babies. CREDIT: Dreamstime.

Most parents don't realize if their preschool-age child is overweight or obese, a new study suggests.

The results show 71 percent of participating parents with overweight or obese toddlers misperceived their child's weight, identifying it as either a healthy weight or lighter than healthy weight. 

The parents were more likely to underestimate their child's weight if a pediatrician had never discussed the issue with them. In fact, fewer than 8 percent of parents reported hearing from a pediatrician that their child was overweight or gaining weight too fast.

"Pediatricians have to really embrace this idea that talking to families about toddlers' weight is important," said study researcher Dr. Raquel Hernandez, assistant professor of pediatrics at the University of South Florida. Although doctors might find it difficult to bring up toddlers' weight issues, "it does pay off, because families who have the provider talk about it are much less likely to misperceive their child, and therefore much more likely to make healthy behavioral changes," she said.

While making a fuss over baby fat might seem a little extreme, obesity at a young age does matter, Hernandez said.

"We shouldn't neglect the very young kids just because they're cute and chubby and no one wants to do anything," Hernandez said, adding that toddler-hood is a critical time when good habits can be set so kids have a better chance of being healthy throughout life.

Why it matters

A number of studies have found that being overweight at a young age, even as young as 2, can increase a child's risk for obesity in school age and adolescence up to five-fold, Hernandez said.

"The concept that kids outgrow their weight at some point or another, may have been true maybe 10 or 15 years ago, but more and more we're seeing that once the kid falls into that category, it really tends to be predictive long term," she said. Modern-day tendencies toward less exercise and an overabundance of food might be the culprit behind this shift, she said.

The American Academy of Pediatrics recommends that doctors start screening for overweight and obesity at age 2. Body mass index, or BMI, (an indicator of body fatness calculated from height and weight) is used to assess each individual. Children are considered overweight if they fall in the 85th to 94th percentiles of the BMI growth charts and obese if they are in the 95th percentile or higher.

Currently, about 33 percent of preschoolers in the United States are overweight, and 12 to 15 percent are obese, Hernandez said.

Parents' misperceptions

Hernandez and her colleagues interviewed 150 parents with children between the ages of 2 and 5. The parents were asked "Do you feel your child is…"(very underweight, a little underweight, about the right weight, a little overweight or very overweight).

They were also ask asked to view sketches of children with various body sizes and circle the image that most closely matched their own child's size. Such sketches are considered a better way to gauge parents' perceptions of their child's weight because parents are often hesitant to identify their child in a negative way.

"It's much easier for a parent to circle a bigger picture than to actually say that their child is overweight or obese," Hernandez said.

Among the findings:

• About a third of preschoolers in the study were overweight or obese.
• 83 percent of all parents reported their children as "about the right weight," and 55 percent of parents with obese children said their child was "about the right weight."
• Using the sketches, parents of overweight preschoolers were much more likely to underestimate their children's weight than parents of obese children (89.6 percent vs. 45.5 percent).
• 20 percent of parents with overweight or obese kids actually chose an image that was smaller than the healthy weight image to indicate their own child's size.

Hernandez finds the last result particularly disturbing.

"Imagine the risk that those kids are at, where their parents think that they're too thin and they're already overweight or obese," she said. "Those are the kids that are going to get more portions; they're going to get more high-calorie, dense foods. And then you're really tipping the scales at that point with those kids."

The pediatrician's role

It's understandable that parents would not realize their young child has a weight issue, Hernandez said. They can't be expected to calculate BMI at home, and there tends to be a perception in society that a big toddler is a healthy toddler, she said.

Pediatricians might be reluctant to measure BMI and discuss weight issues both because they are afraid of offending the parents and because there are relatively few guidelines for how to go about modifying a young child's diet and exercise habits, Hernandez said.

Nevertheless, such discussions are important if parents are to take action early on, she said.

"With no one commenting, then certainly parents aren't going to have any idea if they're not hearing anything from the person who would theoretically know the most about the child's weight," she said.

The results were published this month in the journal Clinical Pediatrics.

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