The European Journal of Public Health Advance Access originally published online on July 12, 2006
The European Journal of Public Health 2006 16(6):645-647; doi:10.1093/eurpub/ckl100
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Overweight and obesity |
Parents often do not recognize overweight in their child, regardless of their socio-demographic background
Wilma Jansen1,2 and Johannes Brug2
1 Municipal Health Service for Rotterdam area, Rotterdam, The Netherlands
2 Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
Correspondence: W. Jansen, Municipal Health Service Rotterdam area, Youth Department, Mailbox 70032, 3000 LP Rotterdam, The Netherlands, tel: +31 10 433 9634, fax: +31 10 443 8989, e-mail: jansenw{at}ggd.rotterdam.nl
Received April 7, 2005, accepted June 9, 2006
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Abstract |
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To involve parents successfully in the treatment of overweight in their child, they first need to be aware of the problem and its accompanying health risks. Data on 1840 9–11 year olds from the Rotterdam Youth Health Monitor were analysed to investigate whether awareness of parents differs according to socio-demographic characteristics. In the case of overweight children, 50% of the parents do not recognize that their child is overweight. Except for age none of the investigated socio-demographic characteristics, including ethnicity and parental education, was associated with awareness. Parents of obese children show greater awareness than parents of overweight children.
Parents are of key importance in the prevention of childhood overweight. To involve parents in the prevention and treatment of obesity and overweight in their children successfully, awareness is of the utmost importance. Awareness that their child is at risk is an important prerequisite for the motivation to act.1
People tend to make self-assessments by comparing their own ‘performance’ to that of others.2 Since this may also be true for the weight status of children, awareness may differ according to the social group to which their parents belong. The prevalence of childhood overweight and obesity in The Netherlands, which reached a prevalence of >10% in 1997, is higher among children from ethnic minority groups and children of parents with lower education as compared with native Dutch children and children of parents with higher education.3
In order to explore awareness of children's weight status among parents, we analysed data that were collected in the framework of the Rotterdam Youth Health Monitor in grade 6 children (9–11 year olds). Two research questions were addressed: first, which proportions of parents are realistic, overly optimistic or pessimistic about their child's weight status? Second, do these proportions differ according to the socio-demographic characteristics of the parent, more specifically age, ethnicity as defined by the country of origin, and education?
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Methods |
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The Rotterdam Youth Health Monitor, from which the data were drawn, is a surveillance system that monitors the general health, well-being, behaviour, and related factors of youth aged 0–19 years living in the Rotterdam area in order to supply information for youth policy at the school, neighbourhood, and municipality level. The Rotterdam Youth Health Monitor is incorporated in the regular check-ups of the preventive youth health care system.
In the 2000/2001 survey 2669 parents were invited for a check-up of their grade 6 child by the school nurse. Together with the invitation parents received a questionnaire to fill in prior to the check-up. A total of 2163 (81%) parents attended the check-up with their child. A fully completed parent questionnaire and data on height and weight were available for 1819 (68%) children. Non-participants did not differ from participants in gender or country of origin. With regard to country of origin the sample was not fully representative of the total population of this age in Rotterdam. There was a slight over-representation of Moroccan and Turkish children and an under-representation of children from the category other country of origin. The parent questionnaire included the question ‘Is your child overweight’ with answer categories ‘not true’, ‘somewhat true’, and ‘very true’, as well as the following socio-demographic characteristics: gender, age, and country of origin of child, respondent (mother, father, other), family composition (both parents, single parents, unknown), highest education of mother, categorized as low (primary or pre-vocational education), medium (secondary or vocational training), or high (university education), highest education of father, and employment status of mother and father. The school nurse collected data on height and weight. Height was measured with SECA roll up measuring bands and reported to the nearest 0.1 cm; weight with calibrated SECA flat weighing scales to the nearest 0.5 kg. Weight was measured without heavy clothing and shoes and was, therefore, corrected for light clothing by subtracting 1 kg. Overweight was defined according to the IOTF guidelines.4
Descriptive analyses were conducted to describe the distribution of the parent-rated and measured weight status and parents were categorized as realistic (parent-rated status the same as measured status); optimistic (parent-rated status = not overweight; measured status = overweight), or pessimistic (parent-rated status = overweight; measured status = not overweight). Because of the recent trends in childhood overweight and obesity, we were especially interested in a comparison between optimistic and realistic parents. Multivariate logistic regression was used to explore the differences in socio-demographic characteristics between these groups.
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Results |
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Overweight and obesity were present in 21.4 and 7.4% of the children, respectively. Among parents of non-overweight children 97.2% rated their children as not overweight. Among parents of overweight children, 60.5% rated their children as not overweight. This was true for 20.0% of the parents of obese children.
In the sub-sample of overweight and obese children (n = 524) the differences between optimistic (50%) and realistic parents (50%) were further explored (Table 1). No differences were found between the optimistic and realistic parents regarding gender of child, ethnicity of the child, respondent to questionnaire (mother, father, or other), family composition (both parents, single parent, unknown), highest education of the child's mother, highest education of the father, or employment status of the mother or father. Parents of obese children appeared to be more realistic than parents of overweight children. Parents of older children also appeared to be more realistic than parents of younger children.
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Discussion |
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Although most parents are realistic about their children's weight status, more than half of the parents of overweight children did not recognize or admit this. Very few parents are pessimistic about the weight status of their children. The observed unawareness of overweight status was not dependent on ethnicity, level of education, or gender of the child.
The finding that many parents do not recognize or deny the overweight in their child has been reported before among different age groups,5–10 varying from 28 to 98% of the parents. These variations may partly depend on differences in definitions of overweight. In our study we applied the internationally recognized definitions proposed by Cole and others.4 and we explored possible socio-demographic correlates of unawareness.
The non-response rate in our study was 32% owing to non-attending the preventive check-up and missing data. Since important socio demographic characteristics (gender and country of origin) of non-participants and participants did not differ, the influence of non-response to our findings can be expected to be small.
An important implication of our findings in the prevention of childhood overweight, is that health professionals addressing the parent of an overweight or obese child should keep in mind that many parents may not be aware of or may deny the overweight in their child. Raising awareness should, therefore, be given first priority before making recommendations for changes in eating and physical activity behaviours. Our results suggest that this implication is true regardless of parental level of education, ethnicity, or occupational status.
Key points
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