Most Appropriate Mechanism to Understand the Parental Classification of Child’s Weight Status

Research Article

Ann Nurs Res Pract. 2019; 4(1): 1033.

Most Appropriate Mechanism to Understand the Parental Classification of Child’s Weight Status

Woods T1* and Dr. Nies MA2

¹Graduate Teaching Assistant and PhD Candidate, Idaho State University, Pocatello, USA

²Director of Nursing Research and College of Nursing Professor, Idaho State University, Pocatello, USA

*Corresponding author: Tanna Woods, Idaho State University, Graduate Teaching Assistant, W Eurasian Crane Road, Clinton, UT, 921 South State Street, Stop 8101, Pocatello, ID 83209-8101, USA

Received: April 15, 2019; Accepted: May 17, 2019; Published: May 24, 2019


Background: Childhood obesity is a problem with long-term health risks. Preschool ages are an ideal period for prevention and intervention strategies but requires parental support. With the frequency of parental misclassification of child weight between 20% and 29% and as high as 81.4% for clinically obese, this is problematic.

Objectives: This study examined the three most used methods for determining accurate classification: the Likert scale where parents select a written description, a pictorial method where a visual image is selected, and a written method where parents write the child weight.

Method: This cross-sectional study involving 198 parents and children aged 2 to 5, in standalone preschools or child care centers with preschools. Parents completed a questionnaire that included their assessment of their child’s weight by all three methods.

Results: Highest classification accuracy was found with the Likert method at 53.3% while weight-reporting had 50.3% and the pictorial method had 35.9% accuracy. Kappa values showed that the pictorial method (κ = -0.028, p = 0.42) and Likert scale method (κ = -0.032, p = 0.37) was not significantly better than chance alone. Meanwhile, slight statistically significant agreement was observed with the weight-reporting method (κ = 0.21).

Discussion: It is clear that parents are not good at discriminating weight deviation in their children by any method. The disconnect between the parental perception of child weight and the reality of weight needs researched further so appropriate intervention and prevention strategies can be formed for preschool children.

Keywords: Obesity; Preschool; Parents; Perception; Misclassification; Weight


Obesity and its comorbid conditions are no longer isolated to adulthood. The National Institute of Health reports that 1 in 6 youth ages 2 to 19 is considered obese [1]. Meanwhile, 1 in 3 adults has obesity [1].

Physical inactivity, poor eating habits, genetics, screen time, inadequate sleep, medications, and access to healthy food or safe places are among factors linked to the trend of increasing rates of weight problems at all ages [2-5]. For youth, their ability to understand the problem and mechanisms to prevent or correct weight problems are linked to their parents.

Initiation of healthy lifestyles, regulation of child diet and exercise for prevention as well as intervention and its success relies on parental influence [6-8]. The ability to provide a positive influence on child weight and appropriate lifestyle, activity, and eating can be hindered or helped by parental awareness of weight-related issues and realistic recognition of child weight [9].

Therefore, it is critical to understand how parents perceive their child’s weight status. Research on parental ability to correctly perceive weight has generally shown that parents underestimate child weight [10-12]. Misperception of weight has consistently been identified as a discrepancy between how a parent describes their child versus the actual weight of the child [10,11,14,15]. However, the method of determining the parent view of child weight has varied.

Three different methods for gauging perception have been identified in the literature: use of a Likert scale, use of a pictorial scale, and parental report of child-weight. The Likert scale method of having parents select a written description of their child’s weight has been used in most studies, though the visual scale has been used as well. Both were identified as the most common methods found in two large meta-analyses [13,16] and another literature review [17]. Neither visual or non-visual assessments were deemed a significant moderator of parental underestimation of child weight in obese and overweight children, though it was significant in normal-weight children when looking at 69 articles encompassing 78 samples, n = 15,791 [16]. Meanwhile, Gordon and Mellor [11] were one of a handful of studies that used parental self-report of child weight to determine the accuracy of parental perception.

Despite the prevalent research examining parental misperception, no original research was identified that used a single sample to compare the perception of weight using all three methods and determine if one has improved accuracy and validity for use in research. This study’s purpose was to mirror how these tools have been implemented in research to examine the differences in perception across the measures and determine if one is more accurate and precise.

Materials and Methods

Study design and population

This study used a cross-sectional design to survey parents of 2 to 5-year-old children. Recruitment occurred at both standalone preschools and daycares with preschools with a total of 17 sites. Parents were defined as a person who is legally responsible for the child, whether there is a biological connection or not because this person performs everyday care for the child who is participating in the study [18].

For inclusion, participants needed to read and speak English and be a self-identified legal guardian for the participating child who was within the identified age group. If multiple siblings attended the daycare or preschool and were in the 2 to 5 age range, only one of the children could participate. Similarly, only one parent in a family could be included. People were excluded if a 2- to a 5-year-old child already had a sibling involved in the study or if the child had a disease known to affect weight/size such as pituitary and thyroid conditions.

Once the parent filled out the survey and provided written consent for the child, the investigator assessed all weight and heights of participating children. Standing height and weight of the child was measured using an electronic digital body weight scale with a step on technology and a stable stadiometer, following World Health Organization guidelines [19]. Scale calibration was done at each site using a 2-pound weight to verify accuracy before weighing children. Children were asked to remove their shoes, jackets, and anything in their pockets, which is the conventional method [20]. They were asked not to wear extra layers of clothing, such as jackets to keep measurement consistent. Weight was also measured to the nearest 0.1 kilograms for accuracy as done by others [21,22].

Between either the daycare sending surveys home with parents and the investigator handing out surveys, 415 questionnaires were distributed. A total of 198 of 415 questionnaires were returned making the response rate 47.7%. This response rate is consistent with the projected less than a 50% return rate for surveys that are associated with unsolicited surveys with no face-to-face request [23]. Response rates where the investigator spoke with individuals and asked if they would participate had higher response rates ranging from 71.4% to 77%. Participant characteristics are displayed in Table 1.