- A N Jeffery, senior research nurse ()1,
- L D Voss, senior research fellow1,
- B S Metcalf, statistician/data manager1,
- S Alba, assistant statistician1,
- T J Wilkin, professor of endocrinology and metabolism1
- Correspondence to: A N Jeffery
- Accepted 25 September 2004
Obesity is a serious public health concern. More than half of British adults are overweight, and obesity among preschool children has increased by an alarming 70% in the past generation.1 2 We aimed to explore parents' awareness of overweight and obesity in themselves and their children, and their degree of concern about weight.
Participants, methods, and results
We studied 277 healthy randomly recruited children (mean age 7.4 years) and parents from the EarlyBird study.3 Overweight and obesity were defined as body mass index at least 25 and 30 in adults, and at least 91st and 98th centiles of the UK 1990 body mass index reference curves for children.4
Before we weighed them, parents completed a written questionnaire asking them to estimate their own and their child's weight on a five point scale ranging from “very underweight” to “very overweight.” Responses indicating level of concern about weight were similarly ranked from “very worried about underweight” to “very worried about overweight.”
Children and parents were significantly heavier than UK norms (table): 52/277 (19%) children, 141/273 (52%) mothers, and 165/230 (72%) fathers were overweight (including obese). Among overweight parents, 40% mothers (45% fathers) judged their own weight “about right” and 27% (61%) were unconcerned about their weight.
Only a quarter of parents recognised overweight in their child. Even when obese, 33% mothers (57% fathers) saw their child's weight as “about right.” Parents were less likely to identify overweight in sons than daughters: only 27% of overweight or obese boys were classified as at least “a little overweight,” compared with 54% of overweight girls (P = 0.01). More mothers than fathers correctly assessed their child's weight (84% v 76%, P = 0.06).
Maternal weight status did not affect mothers' awareness of their chidren's weight: 82% of overweight mothers were correct compared with 82% of normal weight mothers (P = 0.50). However, only 74% overweight fathers were correct compared with 85% normal weight fathers (P = 0.08).
More than half of the parents of obese children expressed some degree of concern about their child's weight, but only a quarter were even “a little worried” if their child was overweight. Most parents (86%) who were unaware that their child was overweight, were also unconcerned about their child's weight. One in ten parents expressed some concern about underweight in normal weight children.
Prevalence of overweight in parents in the highest and lowest socioeconomic groups did not differ—59% in classes I and II were overweight compared with 62% in classes VI, VII, and VIII (P = 0.63; National Statistics Socioeconomic Classification 2001). Neither was there a difference in correct perception of the child's weight between socioeconomic groups (78% v 82%, P = 0.34).
Overweight goes largely unrecognised; parents are poor at identifying overweight in themselves and their children, and less likely to identify overweight in sons. The reasons for poor awareness might include denial, reluctance to admit a weight problem, or desensitisation to excess weight because being overweight has become normal. Obesity is now a problem across all social groups. Our data confirm recent findings indicating that the longstanding inverse relationship between social class and obesity has been lost, at least in the United Kingdom.5
Acknowledgment of excess weight and an understanding of its health consequences are essential first steps in tackling obesity. The layperson's perception of average weight, however, now conflicts with the clinical definition of normal weight, and a label of overweight from a health professional may be insufficient motivation for a change in lifestyle. The apparent lack of parental concern about their child being overweight probably stems from a lack of awareness. Until this is resolved, we are missing critical partners in our efforts to stem an impending health crisis.
What is already known on this topic
Obesity in British children is increasing—prevalence rose by 150% between 1984 and 1998
Lay definitions of ideal weight and overweight deviate from clinical definitions in adults
What this study adds
Many parents are unaware, and thus unconcerned, that their children are overweight
This article was posted on bmj.com on 26 November 2004: http://bmj.com/cgi/doi/10.1136/bmj.38315.451539.F7
Contributors AJ designed the study, collected the data, analysed the results, and wrote the paper. LV supervised the study design and edited drafts of the paper. BM and SA helped with data management and statistical analyses. TW helped with interpretation of the results and is director of the EarlyBird Study. TW is guarantor.
Funding Diabetes UK, Smith's Charity, S&SW NHS Executive R&D, Child Growth Foundation, Beatrice Laing Foundation, Abbott, Astra Zeneca, GlaxoSmithKline, Ipsen, Unilever, Diabetes Foundation, and EarlyBird Diabetes Trust.
Competing interest None declared.
Ethical approval Plymouth local research ethics committee of the South and West Devon Health Authority (1999).