The prevalence of overweight and obesity in the United States continues
to increase for both adults and children. Prevalence of childhood overweight
has increased in all sociodemographic groups; however, disparities
do exist. Particularly at risk for childhood overweight are African-American
girls, Hispanic girls and boys, and children from low-income households.
Many factors contribute to the development of overweight in children;
however, recent literature suggests several factors that need further exploration,
including parents’ child feeding practices, parents’ perceptions of
children’s weight status, and parents’ personal eating behaviors. Previous
studies addressing these factors have included primarily Caucasian and
middle to upper income participants. This study adds to the existing literature
by including participants from a low-income, primarily African-American
population.
Three primary objectives of the current research were to determine (1) the
accuracy of parents’ perceptions of their children’s weight status, (2) the
relationship of parents’ child feeding practices to their children’s weight status,
and (3) the relationships among parents’ personal eating behaviors, their
child feeding practices, and their children’s weight status. A cross-sectional
descriptive study design was used to address each of the research objectives.
Participants were recruited and data collected during the fall 2004
orientation session held for parents of children attending Head Start
centers in one south Mississippi county. Parents and/or caregivers of children
completed surveys assessing their child feeding practices (as measured
by the Child Feeding Questionnaire), perceptions of their children’s weight
status (assessed with culturally appropriate body image silhouettes developed
for this study), and personal dietary behaviors (as measured by the
Three Factor Eating Questionnaire). Children’s measured height and weight
were obtained from Head Start records, and their weight status was classified
as underweight, normal weight, at risk of overweight, or overweight
based on current Centers for Disease Control and Prevention criteria. The
final sample used for analyses in this study included 281 mother/child pairs.
Statistical analyses included Chi-Square, Spearman correlations, multivariate
analysis of covariance, and regression analyses.
One of the most important findings in this study was the significant
degree of misclassification of children’s weight status by their mothers.
Results clearly suggested that mothers’ perceptions of their children’s
weight status did not correspond with the definitions of weight status in
children established by the scientific and medical communities. These
discrepancies may partly reflect cultural differences with respect to acceptable
or desirable body size, an idea supported by the large number of
mothers in this study only recognizing the largest figures in a body image
silhouette scale as depicting an overweight child. These results suggest the
need for educational interventions that emphasize the potential health consequences
of children’s body mass index-for-age percentiles, while respecting
and working within the context of cultural body size preferences. A focus on
accurate perceptions of children’s weight status by mothers for the sake of
health is warranted, with an emphasis on promoting healthy eating behaviors
in all children, regardless of their body sizes.
Other results demonstrated that mothers’ child feeding practices differed
with respect to their children’s weight status. However, results varied
depending on whether the statistical analyses were based on children’s
actual weight status or mothers’ perceptions of their children’s weight
status. The variation becomes a concern when the large degree of children’s
weight misclassification by these mothers is taken into account. Further,
results from the study suggest that promoting dietary restriction may not be
an appropriate focus in efforts to prevent overweight, as mothers of overweight
children (based on actual weight status) reported a significantly
greater degree of restriction of their children’s food intake when compared
with mothers of underweight children or mothers of children classified as at
risk of overweight.
Head Start is in a unique position to stem the upward trend in childhood
obesity through its mandated nutrition services and education for children
and their families. Head Start programs often emphasize building quality
parent-child relationships. Results of this study suggest that, within this
context, addressing aspects of parent-child feeding relationships is also
important, although additional research is needed to further clarify the role
of mothers’ child feeding practices in the development of overweight in
low-income, primarily minority children.
The cross-sectional nature of this study only allows the identification of
relationships among factors rather than the establishment of cause and
effect. Mothers’ child feeding practices may be in response to children’s
weight status, rather than predicting children’s weight status. However, this
study is an important starting point in that the results may inform other
larger and longitudinal studies related to the role that maternal perceptions
and behaviors may play in development of childhood overweight in similar
populations.
