Utility of the waist-to-height ratio as an instrument to measure parental perception of body weight in children and its use in a population-based survey of children

Abstract

ObjectiveTo investigate which anthropometric measure of overweight status, BMI or waist-to-height ratio (WHtR), is most closely associated with parents’ perception of their child's overweight status.DesignThe sensitivity and specificity of parental perception against child-specific BMI and WHtR definitions of overweight were tested.SettingPrimary schools in Queensland, Australia.SubjectsBoys and girls aged 9·00–11·99 years (n 1431).ResultsOf the 138 boys and 202 girls who were classified as overweight according to BMI, only 27·5 % (boys) and 22·7 % (girls) were also perceived as overweight by their parents. Using WHtR, 206 boys and 333 girls were classified as overweight, of whom only 21·9 % and 13·8 %, respectively, were perceived as overweight. Perception of overweight was underestimated in approximately 15 % of boys and 21 % of girls when compared with BMI. Underestimation was higher when compared with WHtR: 25 % (boys) and 39 % (girls). Overweight prevalence was significantly lower according to perception than according to BMI or WHtR. Mother's education level was significantly associated with accurate perception of overweight status (P < 0·001).ConclusionsThe sensitivity of parental perception of child overweight was higher when BMI was used. However, emphasis needs to be placed on using WHtR as an actual measure of overweight because high central adiposity is associated with increased risk of CVD. The combined use of WHtR, body-shape images rather than word responses regarding perception and public health messages that educate parents and children about body shape and associated health risks may be the best combination in improving parents’ perception of their child's overweight status.

Comparison of direct measures of adiposity with indirect measures for assessing cardiometabolic risk factors in preadolescent girls

“…Hence, the use of waist-to-height ratio (WHtR) for predicting risk in children has been suggested in order to control for the height variablility [ 9 ]. Whether WHtR is superior to other adiposity measures for assessing cardiometabolic risk in children is unclear [ 10 ].…”