BACKGROUND: Perception of body size is a key factor driving health behavior. Mothers directly influence children's nutritional and exercise behaviors. Mothers of ethnic minority groups and lower socioeconomic status are less likely to correctly identify young children as overweight or obese. Little evaluation has been done of the inverse-the child's perception of the mother's weight. OBJECTIVE: To determine awareness of weight status among mother-child dyads (n=506). DESIGN: Cross-sectional study conducted in an outpatient pediatric dental clinic of Columbia University Medical Center, New York, NY. PARTICIPANTS: Primarily Hispanic (82.2 %) mothers (n= 253), 38.8±7.5 years of age, and children (n=253), 10.5± 1.4 years of age, responding to a questionnaire adapted from the validated Behavioral Risk Factor Surveillance System. MAIN MEASURES: Anthropometric measures-including height, weight, and waist circumference-and awareness of self-size and size of other generation were obtained. KEY RESULTS: 71.4 % of obese adults and 35.1 % of overweight adults underestimated size, vs. 8.6 % of normal-weight (NW) adults (both p < 0.001). Among overweight and obese children, 86.3 % and 62.3 % underestimated their size, vs. 14.9 % NW children (both p<0.001). Among mothers with overweight children, 80.0 % underestimated their child's weight, vs. 7.1 % of mothers with NW children (p<0.001); 23.1 % of mothers with obese children also underestimated their child's weight (p < 0.01). Among children with obese mothers, only 13.0 % correctly classified the adult's size, vs. 76.5 % with NW mothers (p<0.001). Among obese mothers, 20.8 % classified overweight body size as ideal, vs. 1.2 % among NW mothers (p<0.001). CONCLUSION: Overweight/obese adults and children frequently underestimate their size. Adults misjudge overweight/obese children as being of normal weight, and children of obese mothers often underestimate the adult's size. Failure to recognize overweight/obesity status among adults and children can lead to prolonged exposure to obesity-related comorbidities.

SUMMARY Background It is not known whether cardiovascular disease (CVD) risk level is related to knowledge of the leading cause of death of women, or heart attack symptoms. Hypothesis Women with higher CVD risk estimated by Framingham Risk Score (FRS) or Metabolic Syndrome (MS) have lower CVD knowledge. Methods Women visiting primary care clinics completed a standardized behavioral risk questionnaire. Blood pressure, weight, height, waist size, fasting glucose and lipid profile were assessed. Women were queried regarding CVD knowledge. Results Participants (n=823) were Hispanic women (46%), Non-Hispanic White (37%), Non-Hispanic Black (8%). FRS was determined in 278: low (63%), moderate (29%), and high (8%); 24% had ≥3 components of MS. The leading cause of death was answered correctly by 54%, heart attack symptoms by 67%. Knowledge was lowest among racial/ethnic minorities and those with less education (both p<0.001). Increasing FRS was inversely associated with knowing the leading cause of death (low 72%, moderate 68%, high 45%, p=0.045). After multivariable adjustment, moderate/high FRS was inversely associated with knowing symptoms (moderate OR 0.52, 95% CI 0.28–0.98, high OR 0.29, 95% CI 0.11–0.81), but not the leading cause of death. MS was inversely associated with knowing the leading cause of death (p<0.001) or heart attack symptoms (p=0.018), but not after multivariable adjustment. Conclusions Women with higher FRS were less likely to know heart attack symptoms. Efforts to target those at higher CVD risk must persist or the most vulnerable may suffer disproportionately, not only because of risk factors, but also inadequate knowledge.

Effective prevention strategies for at-risk populations need to target CVD knowledge and awareness among overweight and obese Hispanic women.

Background Inadequate CVD knowledge has been cited to account for the imperfect decline in CVD among women over 2 decades. Hypothesis Due to concerns that at-risk women might not know the leading cause of death or symptoms of a heart attack, our goal was to assess the relationship between CVD knowledge race/ethnicity, education and BMI. Methods Using a structured questionnaire, CVD knowledge, socio-demographics, risk factors, and body mass index(BMI) were evaluated in 681 women. Results Participants included Hispanic, 42.1 %(n=287); non-Hispanic white(NHW) 40.2% (n=274); non-Hispanic black(NHB) 7.3% (n=50) and Asian/Pacific Islander(A/PI) 8.7% (n=59). Average BMI was 26.3±6.1 kg/m2. Hypertension was more frequent among overweight (45%) and obese (62%) than normal weight (24%), p<0.0001; elevated total cholesterol was more frequent among overweight (41%), and obese (44%) than normal weight (30%) (p<0.05 and p<0.01 respectively); and diabetes was more frequent among obese (25%) than normal weight (5%) (p<0.0001). Knowledge of the leading cause of death and symptoms of a heart attack varied by race/ethnicity and education (p<0.001), but not BMI. Concerning the leading cause of death among US women: 87.6% (240/274) NHW answered correctly compared to 64% (32/50) NHB (p<0.05); 28.3% (80/283) Hispanics (p<0.0001) and 55.9% (33/59) A/PI (p<0.001). Among participants with ≤ 12 years of education, 21.2% knew the leading cause of death and 49.3% heart attack symptoms vs. 75.7% and 75.5%, respectively for > 12 years (both p <0 .0001). Conclusions Effective prevention strategies for at-risk populations need to escalate CVD knowledge and awareness among the under-educated and minority women.

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