Do Parents’ Shifts in Identifying Childhood Obesity Reflect the Normalization of Excess Bodyweight?
Hansen and colleagues report on how parents’ perceptions of childhood overweight have changed over 15 years. Comparing sampling periods from 1988-1994 with 2005-2010, the researchers found that the probability that parents correctly identify their child as overweight decreased by 16% between the two study periods, with more parents thinking that their overweight or obese child had a weight that was about right.
The data come from two nationally-representative datasets from the US that describe 6000 children aged 6-11, matched to whether their parents thought that they were overweight or obese. The authors also report that around three quarters of parents of overweight children and one third of parents of obese children think that their child is about the right weight. There was a clear shift between the two sampling periods such that parents were more likely to think that their overweight or obese child was of a normal weight in the more recent sample.
Rates of childhood overweight and obesity, defined as having a BMI greater than the 85th and 95th percentile for the child’s age and gender, have mirrored increases in adult overweight and obesity seen over the past decades. While we are unlikely to see extreme obesity becoming the “new normal”, as some newspapers have tried to frame the problem, recent US data from the CDC show that average BMIs for adults are now in the overweight range for all age categories, and historical data show that average BMIs have steadily increased over the past decades. On the other side of the pond, women (and men) are also getting larger. It is also clear for me as a consumer whose weight has not changed in the past 15 years that I am in an impractical minority: despite a BMI in the healthy weight range and average height, I find that mainstream clothing shops rarely stock my size. This is due to “size evolution”, in which clothing manufacturers adjust the sizing of their clothes to fit their average demographic. With the increasing size and weight of the average person, clothing has gotten larger to fit. Society is adjusting to the average person’s larger body weight.
Could the normalization of overweight be behind poorer parental estimation of childhood overweight? The authors criticize differences in how childhood obesity is defined between expert organizations. This is unlikely because few parents would be aware of these cut-off points or use the percentile charts when tracking their child’s weight. Parents may distrust growth charts that were based on a different ethnic group and misclassify their overweight child as “about right” compared to other children of the same ethnic group. There may be increasing stigma in labelling children as overweight. However, in the period of time that children’s average weight increased, so did that of their parents. Perhaps parents are more used to seeing overweight and obese children, and do not recognize their own children’s weight as being an issue. Or parents who are overweight may be more accepting of their overweight or obese child’s weight as being “about right”.
Regardless of parental perception, obesity is a health issue for both children and parents, and is inextricably linked between the generations. Obesity prevention programs should therefore not operate within closed walls of “childhood obesity” or “adult obesity”. Obese adults are more likely to have obese children, and obese children are at greater risk of becoming obese adults. Long term and sustainable reductions in obesity rates are only likely to be successful when adults, children and families are all considered in prevention programs.
Andrew R. Hansen, Dustin T. Duncan, Yelena N. Tarasenko, Fei Yan, and Jian Zhang. Generational Shift in Parental Perceptions of Overweight Among School-Aged Children. Pediatrics peds.2014-0012; published ahead of print August 25, 2014, doi:10.1542/peds.2014-0012
Amy Corderoy. Extreme obesity the new normal. The Australian. April 12, 2013. http://www.smh.com.au/national/health/extreme-obesity-the-new-normal-20130411-2ho3h.html
Centers for Disease Control and Prevention. Anthropometric Reference Data for Children and Adults: United States, 2007–2010. October 2012. http://www.cdc.gov/nchs/data/series/sr_11/sr11_252.pdf
Centers for Disease Control and Prevention. Mean Body Weight, Height, and Body Mass Index, United States 1960–2002. Advance Data from Vital and Health Statistics. Number 347, October 27, 2004. http://www.cdc.gov/nchs/data/ad/ad347.pdf