To assess parental perception of weight status in 4-7 year children
Research type
Research Study
Full title
A study to assess the parental perception of weight status in 4-7 years old children.
IRAS ID
191330
Contact name
Susan Liebeschuetz
Contact email
Sponsor organisation
Barts health trust
Duration of Study in the UK
7 years, 4 months, 17 days
Research summary
Childhood obesity is a growing problem worldwide.According to the National Child Measurement Programme in UK, one in 5 children in reception (aged 4-5 y) is overweight or obese. As clinicians working in a very diverse , deprived borough of London we often come across families who are very concerned that their children are underweight and do not eat enough, when objectively their weight and body mass index are well within normal parameters. According to the 2013 profile produced by the Child and Maternal Health Observatory (ChiMat), Newham has worse than average levels of childhood obesity with 13% of children aged 4-5 years and 25.7% of children aged 10-11 years were classified as in risk of obesity. According to the literature, one third to half of the parents are unable to recognise when their own child is overweight. Our hypothesis is that while this misclassification about child's weight status affects all ethnic groups , it is particularly common in families with a South Asian background. We think that many South Asian parents, expecially among the deprived groups, do not adhere to the western child weight ideal and that their "ideal child good weight" is heavvier than the general ideal, therefore they are unable to recognise when their children are overweight or obese.
Summary of study results:
Parental perception of children’s weight. Does ethnicity make a difference? A pilot study in a multi-ethnic borough in London.
Research Summary
Childhood obesity is a growing concern in the UK. According to 2024-2025 National Child Measurement Programme data, 2.5 million children in England are affected by excess weight or obesity. 23.5% of children in Reception are overweight or obese. In year 6 the percentage of children who are overweight or obese increases to 36.2%.
Parental perception of their child's weight is key to addressing the issue (Royal College of Paediatrics and Child Health, 2020). Misjudging their child's weight can prevent parents from recognising the need for obesity prevention programmes. As clinicians, often we come across parents who worry about their children’s weight and we speculated if there were specific groups that were more prone to misclassification. This study examines how accurately parents of children aged from 4 to 7 years in a multi-ethnic London borough can identify the child's weight status.
The study had 2 phases: in phase 1, we recruited 26 children aged 4 to 7 years attending paediatric outpatient clinics, ward and staff members’ children. Anthropometric measurements for each child were taken (height, weight, and body mass index) by the research team together with standardised photographs according to the approved protocol.
Children were classified into three body mass index groups (5 underweight, 16 healthy weight and 5 overweight) and a portfolio including 26 pictures was made.
In phase 2, we recruited 200 parents attending paediatric outpatient clinics and the paediatric ward. They were asked to go through the portfolio and to classify each child in the photographs as underweight, healthy weight and overweight. In addition, they had to complete a questionnaire which included variables such as demographics and relevant family history like diabetes, obesity and cardiac problems.Summary of the results
Our department serves a multi-ethnic and deprived population with an Asian prevalence followed by white, black and mixed groups. Most of the respondents correctly identified children with a healthy weight: 87.5% of White respondents, followed by Black (85.9%) and Asians (82.4%). The difference between the three ethnic groups was statistically significant. For a child of a healthy weight, 15% of Asian respondents suggested that she/he was underweight. When it came to identifying overweight children, about 50% of the respondents got it right and there was no significant difference in terms of ethnicity using the chi-squared test.
Considering gender, female respondents (51.9%) tended to correctly identify the child as “overweight” more than male respondents (47.6%) however the difference was not statistically significant at the 5% level. 84.8% of all female respondents correctly identified children of a healthy weight as compared with 83.4% of all male respondents, but again the difference between the two groups was also not statistically significant.Conclusion
The literature shows that one third to half of the parents misclassify their children’s weight ((Regber et al., 2013). Many factors influence the accuracy of a parent’s child weight perception and among them ethnicity (Park, 2017). Evidence suggests that perception varies by ethnicity and misperception about their children’s weight is prevalent among Asian parents. Our results were in keeping with this body of literature even though it was a small sample. Parental perception of children’s weight status needs to be considered when developing prevention programmes for obesity ( NICE guidelines, 2025).References
NICE guidelines (2025). Overweight and obesity management. Reference number: NG246. https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fwww.nice.org.uk%252Fguidance%252Fng246%2FNBTI%2FFPnDAQ%2FAQ%2F1ac578c9-7b53-4401-a586-e1f7743fd739%2F1%2FYndKFpAuna&data=05%7C02%7Cberkshire.rec%40hra.nhs.uk%7C6135efcde8eb4ce89c0b08de80697478%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C639089387584457671%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=AhRPh1G79IHxNG5vn7e6sYYtcOdrk611LCwOsY0WZWc%3D&reserved=0
Park, S. H. (2017). Asian Parents’ Perception of child weight status: A Systematic Review. Journal of child and family studies. https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Flink.springer.com%252Farticle%252F10.1007%252Fs10826-017-0765-x%2523citeas%2FNBTI%2FFPnDAQ%2FAQ%2F1ac578c9-7b53-4401-a586-e1f7743fd739%2F2%2F8zov7VAR4O%23citeas&data=05%7C02%7Cberkshire.rec%40hra.nhs.uk%7C6135efcde8eb4ce89c0b08de80697478%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C639089387584478296%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=PxV26NoAJaogmXrs7AuGtBZ3pjyv5TrTktbgWlTY56U%3D&reserved=0
Regber, S., Novak, M., Eiben, G., et al. (2013). Parental perceptions of and concerns about child’s body weight in eight European countries-the IDEFICS study. Pediatr Obes. 2013 Apr;8(2):118-29. https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fonlinelibrary.wiley.com%252Fdoi%252F10.1111%252Fj.2047-6310.2012.00093.x%2FNBTI%2FFPnDAQ%2FAQ%2F1ac578c9-7b53-4401-a586-e1f7743fd739%2F3%2FvHmuUhZwCC&data=05%7C02%7Cberkshire.rec%40hra.nhs.uk%7C6135efcde8eb4ce89c0b08de80697478%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C639089387584493468%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=uV%2BuOQJk6d7V%2FVNbTx37Yj6IE5%2FTMVa8%2Bi3quYA55Do%3D&reserved=0
Royal College of Paediatrics and Child Health (2020). State of Child Health. London: RCPCH. https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fstateofchildhealth.rcpch.ac.uk%252F%2FNBTI%2FFPnDAQ%2FAQ%2F1ac578c9-7b53-4401-a586-e1f7743fd739%2F4%2Fxqtiv1CbOI&data=05%7C02%7Cberkshire.rec%40hra.nhs.uk%7C6135efcde8eb4ce89c0b08de80697478%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C639089387584505473%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=oajG3ZLiJzCM7cvsZ37AfQ6Ltp%2BsDEjJdCr7ozy4hCw%3D&reserved=0REC name
South Central - Berkshire Research Ethics Committee
REC reference
16/SC/0398
Date of REC Opinion
18 Aug 2016
REC opinion
Further Information Favourable Opinion