Body Size in Toddlers: Perception and Reality
Body Size in Toddlers: Perception and Reality
Hager ER, Candelaria M, Latta LW, et al
Arch Pediatr Adolesc Med. 2012;166: 417-422.
Early childhood weight predicts older childhood and even adult weight. A mother's perception of her child's weight can be very important in deciding whether a family is ready for a weight-related intervention. This study sought to expand what is known about parental perception of childhood weight by looking at perceptions of both under- and overweight status and by focusing on preschool children, who are relatively underrepresented in the literature on this topic. From a series of silhouette images of toddler body shape, parents were asked to choose the silhouette that best matched their child. The investigators tested the hypothesis that mothers of underweight or overweight toddlers are less likely to accurately rate their child's body size compared with mothers of normal-weight children. Also evaluated were associations between parental satisfaction with their child's shape and how that correlated with the accuracy of parental perception.
The study's participants were the mothers of children aged 12-32 months (born at term) who were recruited from 2 sites in Maryland. The silhouettes used for this study showed 7 different images representing toddler shapes from the lowest to the highest weight-for-length percentiles, in increments of 16 percentile units. Therefore, the lowest percentile depicted was "0" and the highest was "96." Whether the mother accurately assessed her child's body size was based on her answer to the question, "Which picture looks most like your child?" Mothers were given credit for accurate identification if their answers were within 1 silhouette (plus or minus) of the child's measured (actual) weight-for-length percentile.
A mother's satisfaction with her child's weight was determined according to her response to the question, "Which picture do you want your child to look like?" For this question, parental responses were categorized as wishing for the child to be larger, smaller, or within appropriate percentiles, in which case the parent was classified as being "satisfied."
The investigators obtained child weight and length using standardized instruments. Healthy weight was defined as weight-for-length between the 15th and 85th percentiles, with underweight being below the 15th percentile and overweight being above the 85th percentile. Maternal parameters were obtained to calculate whether mothers were overweight (body mass index [BMI] ≥ 25 kg/m) or obese (BMI ≥ 30 kg/m).
Investigators enrolled 281 mothers, 67% of whom were at or below the poverty level. The mean age of the toddlers was 20.2 months; 54% were boys, and 71% were black. The mean maternal BMI was 31.7 kg/m. Among the toddlers, 8.5% were underweight, 62.3% were healthy weight, and 29.2% were overweight. Accuracy of parental assessment was only 30% overall, with a striking difference in mothers of underweight children, who were more than 80% accurate in their assessment of their toddlers' weight status. Mothers of healthy-weight toddlers were only 35% accurate in assessing their child's weight. However, fewer than 10% of mothers of overweight toddlers perceived their child's weight accurately, all of whom perceived their children to be smaller than they were.
Mothers who were inaccurate were heavier than accurate mothers, with a mean BMI of 32.8 kg/m vs 29.1 kg/m. More than 70% of the mothers were satisfied with their toddler's body size, although 9% wanted their children to be smaller and nearly 20% wanted their children to be larger. Compared with mothers of healthy-weight children, the mothers of overweight children were 87% less likely to accurately choose their child's body size. The only factor associated with maternal accuracy was body weight.
Parental understanding of childhood weight goals is essential to obtain buy-in for any intervention to reduce a child's weight. Hager and colleagues suggest that clinicians should begin by teaching parents about healthy-weight parameters. Because this sample came from a very low-income and minority population, it is not clear how generalizable the findings are to other populations. This study also reminds me of one that I reviewed on the potential psychological impact of the weight terminology used by clinicians. In that study, parents greatly preferred the term "unhealthy weight" for children who were overweight rather than the terms "overweight" or "obese," which parents felt to be stigmatizing and less likely to lead to parental or child interest in working with the providers on weight management. So, while we are educating families, we should be mindful of the words we use.
Abstract
Maternal Perceptions of Toddler Body Size: Accuracy and Satisfaction Differ by Toddler Weight Status
Hager ER, Candelaria M, Latta LW, et al
Arch Pediatr Adolesc Med. 2012;166: 417-422.
Parent Perception of Child Weight
Early childhood weight predicts older childhood and even adult weight. A mother's perception of her child's weight can be very important in deciding whether a family is ready for a weight-related intervention. This study sought to expand what is known about parental perception of childhood weight by looking at perceptions of both under- and overweight status and by focusing on preschool children, who are relatively underrepresented in the literature on this topic. From a series of silhouette images of toddler body shape, parents were asked to choose the silhouette that best matched their child. The investigators tested the hypothesis that mothers of underweight or overweight toddlers are less likely to accurately rate their child's body size compared with mothers of normal-weight children. Also evaluated were associations between parental satisfaction with their child's shape and how that correlated with the accuracy of parental perception.
Study Summary
The study's participants were the mothers of children aged 12-32 months (born at term) who were recruited from 2 sites in Maryland. The silhouettes used for this study showed 7 different images representing toddler shapes from the lowest to the highest weight-for-length percentiles, in increments of 16 percentile units. Therefore, the lowest percentile depicted was "0" and the highest was "96." Whether the mother accurately assessed her child's body size was based on her answer to the question, "Which picture looks most like your child?" Mothers were given credit for accurate identification if their answers were within 1 silhouette (plus or minus) of the child's measured (actual) weight-for-length percentile.
A mother's satisfaction with her child's weight was determined according to her response to the question, "Which picture do you want your child to look like?" For this question, parental responses were categorized as wishing for the child to be larger, smaller, or within appropriate percentiles, in which case the parent was classified as being "satisfied."
The investigators obtained child weight and length using standardized instruments. Healthy weight was defined as weight-for-length between the 15th and 85th percentiles, with underweight being below the 15th percentile and overweight being above the 85th percentile. Maternal parameters were obtained to calculate whether mothers were overweight (body mass index [BMI] ≥ 25 kg/m) or obese (BMI ≥ 30 kg/m).
Investigators enrolled 281 mothers, 67% of whom were at or below the poverty level. The mean age of the toddlers was 20.2 months; 54% were boys, and 71% were black. The mean maternal BMI was 31.7 kg/m. Among the toddlers, 8.5% were underweight, 62.3% were healthy weight, and 29.2% were overweight. Accuracy of parental assessment was only 30% overall, with a striking difference in mothers of underweight children, who were more than 80% accurate in their assessment of their toddlers' weight status. Mothers of healthy-weight toddlers were only 35% accurate in assessing their child's weight. However, fewer than 10% of mothers of overweight toddlers perceived their child's weight accurately, all of whom perceived their children to be smaller than they were.
Mothers who were inaccurate were heavier than accurate mothers, with a mean BMI of 32.8 kg/m vs 29.1 kg/m. More than 70% of the mothers were satisfied with their toddler's body size, although 9% wanted their children to be smaller and nearly 20% wanted their children to be larger. Compared with mothers of healthy-weight children, the mothers of overweight children were 87% less likely to accurately choose their child's body size. The only factor associated with maternal accuracy was body weight.
Viewpoint
Parental understanding of childhood weight goals is essential to obtain buy-in for any intervention to reduce a child's weight. Hager and colleagues suggest that clinicians should begin by teaching parents about healthy-weight parameters. Because this sample came from a very low-income and minority population, it is not clear how generalizable the findings are to other populations. This study also reminds me of one that I reviewed on the potential psychological impact of the weight terminology used by clinicians. In that study, parents greatly preferred the term "unhealthy weight" for children who were overweight rather than the terms "overweight" or "obese," which parents felt to be stigmatizing and less likely to lead to parental or child interest in working with the providers on weight management. So, while we are educating families, we should be mindful of the words we use.
Abstract
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