Higher body mass index (BMI) z scores in children strongly predicted parental perception that their child was overweight 2 years later, reflecting an awareness of already rising BMI, according to study results published in Pediatrics. Therefore, clinician efforts to increase parental awareness of overweight may not be truly beneficial in reducing children’s BMI.

A common principle of obesity treatment and prevention in children is that parents should be aware of and concerned about their child’s overweight status in order for the child to successfully lose weight, but this assumption has recently been challenged. In fact, data suggest that parental awareness of child overweight could have the opposite effect and promote greater weight gain. In this study, researchers sought to determine the association between higher child adiposity and parental perception of the child being overweight.

The study included participants from 2 cohorts of the population-based Longitudinal Study of Australian Children who had been followed biennially since 2004. A total of 4445 children from the birth cohort (age 0 to 1 at recruitment) and 4632 children from the kindergarten cohort (age 4 to 5 at recruitment) were included. Repeated measures of BMI and parental perceptions of overweight collected through interviews were available for the kindergarten cohort in 6 waves (age 4 to 5, 6 to 7, 8 to 9, 10 to 11, 12 to 13, and 14 to 15) and for the birth cohort in 4 waves (age 2 to 3, 4 to 5, 8 to 9, and 10 to 11).

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The results showed that parental perception of overweight predicted a similar perception in subsequent waves (ie, in the kindergarten cohort, parental perception of child overweight at age 4 to 5 was associated with 10.1 times higher odds of reporting the child as overweight at age 6 to 7). For every unit increase in the BMI z score, the odds of being perceived as overweight for the following wave ranged from 2.9 (birth cohort, age 2 to 3) to 10.4 (kindergarten cohort, age 6 to 7).

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“There are strikingly large predictive associations from child BMI z score to parental perception of child overweight 2 years later. These far outweigh the consistent but small predictions from parental perception of overweight to higher BMI [and] seemed mainly to reflect an awareness of an already rising trajectory of BMI,” concluded the researchers. “Taken in concert with other recent literature, clinician and public health efforts to make parents aware of the actual BMI status of their child seem unlikely to be harmful, but equally seem unlikely to reduce childhood obesity.”

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Wake M, Kerr JA, Jansen PW. Child BMI over time and parent-perceived overweight. Pediatrics. 2018;142(6):e20173985.