Maternal Underestimation of Child’s Weight at Pre-School Age and Weight Development between Age 5 and 12 Years: The ABCD-Study

Abstract

Background: Healthcare monitoring of child growth reduces with age, which may increase parental influences on children’s weight development. This study aimed to examine the association between maternal underestimation of child’s weight at age 5/6 and weight development between 5 and 12 years. Methods: We performed univariate and multivariate linear regression analyses with data on maternal perception of child’s weight and weight development (∆SDS body-mass index; BMI) derived from the Amsterdam Born Children and their Development (ABCD) birth-cohort study. Underestimation was defined by comparing maternal perception of child’s weight with the actual weight status of her child. Associations were studied in two groups: children with overweight (n = 207) and children with normal weight (n = 1982) at baseline (children with underweight were excluded). Results: Underestimation was 5.5% in children with normal weight and 79.7% in children with overweight. Univariate analyses in children with normal weight and overweight showed higher weight development for children with underestimated vs. accurately estimated weights (respectively: β = 0.19, p < 0.01; β = 0.22, p < 0.05). After adjusting for child sex and baseline SDS BMI, the effect size became smaller for children with a normal weight (β = 0.15, p < 0.05) and overweight (β = 0.18, p > 0.05). Paternal and maternal BMI, ethnicity, and educational level explained the association further (remaining β = −0.11, p > 0.05 in children with normal weight; β = 0.06, p > 0.05 in children with overweight). Conclusions: The relationship between maternal underestimation of child’s weight and higher weight development indicates a need for promoting a realistic perception of child’s weight, this is also the case if the child has a normal weight.

Underestimation of overweight weight status in children and adolescents aged 0‐19 years: A systematic review and meta‐analysis

“… 63 , 89 , 91 Parents with a lower education were more likely to underestimate their child's weight than relatively well educated parents. 33 , 41 , 62 , 83 , 91 , 98 …”

“…Mothers with obesity were more likely to perceive their child's weight status incorrectly 61,67,83 . Both child and parent ethnicity were also positively associated with the overall underestimation of the children's weight status in two studies 63,89,91 . Parents with a lower education were more likely to underestimate their child's weight than relatively well educated parents 33,41,62,83,91,98 …”

“…found that the parents who had a high level of education were more likely to underestimate their child's overweight status. Ethnicity was also positively associated with the overall underestimation of child's weight status in two studies 63,89,91 . Molina et al.…”

“…Any future studies investigating the prevalence of the underestimation of overweight status in children, particularly among caregivers, should be justified in the light of this. At this stage, more useful approaches will be applied in investigating family characteristics that are associated with overweight status underestimation as this review has suggested the influence of children's age (younger children), 32,35,61,68,82,83 gender (male), 16,43,61,68,82,83,104 children's current BMI (higher BMI), 16,34,43,45,68 and parental weight status (higher BMI), 61,67,83 ethnicity 63,89,91 and parental education levels (lower) 33,41,83,91,98 . The way in which an individual perceives another individual is informed by their relationship, the perceived individual's characteristics, and the perceiving individual's characteristics.…”

“… 62 found no association between parent weight status and underestimation. Despite the suggestion that lower levels of maternal education are associated with the underestimation of overweight in children 41 , 44 , 48 , 62 , 83 , 91 , 98 there are some inconsistencies in the evidence by Adams et al. 17 Carnell et al.…”