Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Pediatric Original Article
  • Published:

Ethnic differences in maternal underestimation of offspring's weight: the ABCD study

International Journal of Obesity volume 36, pages 53–60 (2012)Cite this article

Abstract

OBJECTIVE:

To determine the ethnic variation in maternal underestimation of their child's weight status and the explanatory role of socio-economic status (SES), acculturation and parental body mass index (BMI).

METHOD:

A multi-ethnic sample of 2769 normal or overweight/obese children (underweight children excluded) aged 5–7 years was examined (The Amsterdam Born Child and their Development study), comprising five ethnic subgroups: Dutch (n=1744), African descent (n=184), Turkish (n=86), Moroccan (n=161) and other non-Dutch (n=592). Data on mothers’ perception of their child's weight status (5-point scale from ‘too low’ to ‘too high’), SES, acculturation, parental BMI and the children's height and weight were collected. Underestimation was defined by comparing maternal perception with the actual weight status of her child (International Obesity Task Force guidelines). Ethnic differences in underestimation were calculated in the normal weight and overweight/obese categories.

RESULTS:

Underestimation ranged from 3.6 (Dutch) to 15.7% (Moroccan) in normal-weight children, and from 73.0 (Dutch) to 92.3% (Turkish) in overweight/obese children. After correction for ethnic differences in child's BMI, higher odds ratios (ORs) for underestimation were found in the Turkish (normal weight: OR 6.83; 95% confidence interval (CI) 2.33–20.05 and overweight: OR 2.80; 95% CI 1.12–6.98) and Moroccan (normal weight: OR 11.55; 95% CI 5.28–25.26) groups (reference is the Dutch group). Maternal educational level and immigrant generation largely explained the ethnic differences, with a minor contribution of maternal age. After correction, ORs remained higher in the Moroccan group (OR 4.37; 95% CI 1.79–10.62) among the normal-weight children.

CONCLUSION:

Mothers frequently underestimate the actual weight status of their child, especially mothers from Turkish or Moroccan origin. Having a lower SES, being first-generation immigrant and a young mother are important determinants in explaining these differences. As weight perceptions may affect weight gain and almost all mothers of overweight/obese children underestimate their child's weight, health professionals should help mothers (particularly those from ethnic minority groups) to acquire a realistic perception of their children's weight status.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Rennie KL, Jebb SA . Prevalence of obesity in Great Britain. Obes Rev 2005; 6: 11–12.

    Article  CAS  PubMed  Google Scholar 

  2. Saxena S, Ambler G, Cole TJ, Majeed A . Ethnic group differences in overweight and obese children and young people in England: cross sectional survey. Arch Dis Child 2004; 89: 30–36.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Singh AS, Chinapaw MJ, Brug J, Kremers SP, Visscher TL, van MW . Ethnic differences in BMI among Dutch adolescents: what is the role of screen-viewing, active commuting to school, and consumption of soft drinks and high-caloric snacks? Int J Behav Nutr Phys Act 2009; 6: 40.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Fredriks AM, Van BS, Sing RA, Wit JM, Verloove-Vanhorick SP . Alarming prevalences of overweight and obesity for children of Turkish, Moroccan and Dutch origin in The Netherlands according to international standards. Acta Paediatr 2005; 94: 496–498.

    Article  PubMed  Google Scholar 

  5. Kolsgaard ML, Andersen LF, Tonstad S, Brunborg C, Wangensteen T, Joner G . Ethnic differences in metabolic syndrome among overweight and obese children and adolescents: the Oslo Adiposity Intervention Study. Acta Paediatr 2008; 97: 1557–1563.

    Article  PubMed  Google Scholar 

  6. Lynch WC, Heil DP, Wagner E, Havens MD . Ethnic differences in BMI, weight concerns, and eating behaviors: comparison of Native American, White, and Hispanic adolescents. Body Image 2007; 4: 179–190.

    Article  PubMed  Google Scholar 

  7. Schokker DF, Visscher TL, Nooyens AC, van Baak MA, Seidell JC . Prevalence of overweight and obesity in the Netherlands. Obes Rev 2007; 8: 101–108.

    Article  CAS  PubMed  Google Scholar 

  8. Whitaker RC, Orzol SM . Obesity among US urban preschool children: relationships to race, ethnicity, and socioeconomic status. Arch Pediatr Adolesc Med 2006; 160: 578–584.

    Article  PubMed  Google Scholar 

  9. Freedman DS, Khan LK, Serdula MK, Dietz WH, Srinivasan SR, Berenson GS . Racial differences in the tracking of childhood BMI to adulthood. Obes Res 2005; 13: 928–935.

    Article  PubMed  Google Scholar 

  10. Freedman DS, Khan LK, Serdula MK, Ogden CL, Dietz WH . Racial and ethnic differences in secular trends for childhood BMI, weight, and height. Obesity (Silver Spring) 2006; 14: 301–308.

    Article  Google Scholar 

  11. Lloyd LJ, Langley-Evans SC, McMullen S . Childhood obesity and adult cardiovascular disease risk: a systematic review. Int J Obes (Lond) 2009; 34: 18–28.

    Article  Google Scholar 

  12. Reinehr T, Andler W, Denzer C, Siegried W, Mayer H, Wabitsch M . Cardiovascular risk factors in overweight German children and adolescents: relation to gender, age and degree of overweight. Nutr Metab Cardiovasc Dis 2005; 15: 181–187.

    Article  PubMed  Google Scholar 

  13. Boneberger A, von KR, Milde-Busch A, Bolte G, Rochat MK, Ruckinger S . Association between peer relationship problems and childhood overweight/obesity. Acta Paediatr 2009; 98: 1950–1955.

    Article  PubMed  Google Scholar 

  14. Kroke A, Strathmann S, Gunther AL . Maternal perceptions of her child's body weight in infancy and early childhood and their relation to body weight status at age 7. Eur J Pediatr 2006; 165: 875–883.

    Article  PubMed  Google Scholar 

  15. Manios Y, Kondaki K, Kourlaba G, Vasilopoulou E, Grammatikaki E . Maternal perceptions of their child's weight status: the GENESIS study. Public Health Nutr 2009; 12: 1099–1105.

    Article  PubMed  Google Scholar 

  16. Carnell S, Edwards C, Croker H, Boniface D, Wardle J . Parental perceptions of overweight in 3–5 y olds. Int J Obes (Lond) 2005; 29: 353–355.

    Article  CAS  Google Scholar 

  17. Etelson D, Brand DA, Patrick PA, Shirali A . Childhood obesity: do parents recognize this health risk? Obes.Res 2003; 11: 1362–1368.

    Article  PubMed  Google Scholar 

  18. Jeffery AN, Voss LD, Metcalf BS, Alba S, Wilkin TJ . Parents’ awareness of overweight in themselves and their children: cross sectional study within a cohort (EarlyBird 21). BMJ 2005; 330: 23–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Maynard LM, Galuska DA, Blanck HM, Serdula MK . Maternal perceptions of weight status of children. Pediatrics 2003; 111: 1226–1231.

    PubMed  Google Scholar 

  20. Warschburger P, Kroller K . Maternal perception of weight status and health risks associated with obesity in children. Pediatrics 2009; 124: e60–e68.

    Article  PubMed  Google Scholar 

  21. Eckstein KC, Mikhail LM, Ariza AJ, Thomson JS, Millard SC, Binns HJ . Parents’ perceptions of their child's weight and health. Pediatrics 2006; 117: 681–690.

    Article  PubMed  Google Scholar 

  22. Baughcum AE . Maternal perceptions of overweight preschool children. Pediatrics 2000; 106: 1380–1386.

    Article  CAS  PubMed  Google Scholar 

  23. Killion L, Hughes SO, Wendt JC, Pease D, Nicklas TA . Minority mothers’ perceptions of children's body size. Int J Pediatr Obes 2006; 1: 96–102.

    Article  PubMed  Google Scholar 

  24. Jain A, Sherman SN, Chamberlin LA, Carter Y, Powers SW, Whitaker RC . Why don’t low-income mothers worry about their preschoolers being overweight? Pediatrics 2001; 107: 1138–1146.

    Article  CAS  PubMed  Google Scholar 

  25. Rosas LG, Harley KG, Guendelman S, Fernald LC, Mejia F, Eskenazi B . Maternal Perception of Child Weight Among Mexicans in California and Mexico. Matern Child Health J 2009; 14: 886–894.

    Article  PubMed Central  Google Scholar 

  26. Sherry B, McDivitt J, Birch LL, Cook FH, Sanders S, Prish JL et al. Attitudes, practices, and concerns about child feeding and child weight status among socioeconomically diverse white, Hispanic, and African-American mothers. J Am Diet Assoc 2004; 104: 215–221.

    Article  PubMed  Google Scholar 

  27. Bennett GG, Wolin KY . Satisfied or unaware? Racial differences in perceived weight status. Int J Behav Nutr Phys Act 2006; 3: 40.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kuchler F, Variyam JN . Mistakes were made: misperception as a barrier to reducing overweight. Int J Obes Relat Metab Disord 2003; 27: 856–861.

    Article  CAS  PubMed  Google Scholar 

  29. Paeratakul S . Sex, race/ethnicity, socioeconomic status, and BMI in relation to self-perception of overweight. Obesity Res 2002; 10: 345–350.

    Article  Google Scholar 

  30. Kumanyika S, Wilson JF, Guilford-Davenport M . Weight-related attitudes and behaviors of black women. J Am Diet Assoc 1993; 93: 416–422.

    Article  CAS  PubMed  Google Scholar 

  31. Kumanyika S . Ethnicity and obesity development in children. Ann NY Acad Sci 1993; 699: 81–92.

    Article  CAS  PubMed  Google Scholar 

  32. Johnson-Taylor WL, Fisher RA, Hubbard VS, Starke-Reed P, Eggers PS . The change in weight perception of weight status among the overweight: comparison of III NHANES (1988–1994) and 1999–2004 NHANES. Int J Behav Nutr Phys Act 2008; 5: 9.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Eijsden van M, Vrijkotte TG, Gemke RJ, van der Wal MF . Cohort Profile: The Amsterdam Born Children and their Development (ABCD) Study. Int J Epidemiol 2010; e-pub ahead of print 2 September 2010; doi: 10.1093/ije/dyq128.

    Article  PubMed  Google Scholar 

  34. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Cole TJ, Flegal KM, Nicholls D, Jackson AA . Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ 2007; 335: 194.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Reilly JJ, Dorosty AR, Emmett PM . Identification of the obese child: adequacy of the body mass index for clinical practice and epidemiology. Int J Obes Relat Metab Disord 2000; 24: 1623–1627.

    Article  CAS  PubMed  Google Scholar 

  37. Buuren van S, Groothuis-Oudshoorn K . MICE: Multivariate Imputation by Chained Equations in R. J Stat Software 2010; 10: 1–68.

    Google Scholar 

  38. Harrell Jr FE, Lee KL, Mark DB . Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 1996; 15: 361–387.

    Article  PubMed  Google Scholar 

  39. Harnack L, Lytle L, Himes JH, Story M, Taylor G, Bishop D . Low awareness of overweight status among parents of preschool-aged children, Minnesota, 2004–2005. Prev Chronic Dis 2009; 6: A47.

    PubMed  PubMed Central  Google Scholar 

  40. Bossink-Tuna HN, L’Hoir MP, Beltman M, Boere-Boonekamp MM . Parental perception of weight and weight-related behaviour in 2- to 4-year-old children in the eastern part of the Netherlands. Eur J Pediatr 2009; 168: 333–339.

    Article  CAS  PubMed  Google Scholar 

  41. Muhammad NA, Omar K, Shah SA, Muthupalaniappen LA, Arshad F . Parental perception of their children's weight status, and its association with their nutrition and obesity knowledge. Asia Pac J Clin Nutr 2008; 17: 597–602.

    PubMed  Google Scholar 

  42. Tschamler JM, Conn KM, Cook SR, Halterman JS . Underestimation of children's weight status: views of parents in an urban community. Clin Pediatr (Phila) 2010; 49: 470–476.

    Article  Google Scholar 

  43. Francis LA, Hofer SM, Birch LL . Predictors of maternal child-feeding style: maternal and child characteristics. Appetite 2001; 37: 231–243.

    Article  CAS  PubMed  Google Scholar 

  44. Crawford D, Timperio A, Telford A, Salmon J . Parental concerns about childhood obesity and the strategies employed to prevent unhealthy weight gain in children. Public Health Nutr 2006; 9: 889–895.

    Article  PubMed  Google Scholar 

  45. Genovesi S, Giussani M, Faini A, Vigorita F, Pieruzzi F, Strepparava MG et al. Maternal perception of excess weight in children: a survey conducted by paediatricians in the province of Milan. Acta Paediatr 2005; 94: 747–752.

    Article  PubMed  Google Scholar 

  46. Arends-Toth J, Vijver van de FJR . Domains and dimensions in acculturation: implicit theories of turkish-dutch. Int J Intercultural Relations 2004; 19–35.

    Article  Google Scholar 

  47. Esenay FI, Yigit R, Erdogan S . Turkish mothers’ perceptions of their children's weight. J Spec Pediatr Nurs 2010; 15: 144–153.

    Article  PubMed  Google Scholar 

  48. Campbell MW, Williams J, Hampton A, Wake M . Maternal concern and perceptions of overweight in Australian preschool-aged children. Med J Aust 2006; 184: 274–277.

    PubMed  Google Scholar 

  49. Martin MA, Frisco ML, May AL . Gender and race/ethnic differences in inaccurate weight perceptions among US. adolescents. Womens Health Issues 2009; 19: 292–299.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This work would not have been possible without the input from the participants, primary schools, students and youth health care centres in Amsterdam. The ABCD study was financially supported by the Academic Medical Centre (AMC), Amsterdam; the Public Health Services (GGD), Amsterdam; and the Netherlands Organization for Health Research and Development (ZonMw), The Hague.

Author information

Authors and Affiliations

  1. Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

    M L A de Hoog, K Stronks & T G M Vrijkotte

  2. Department of Epidemiology, Documentation and Health Promotion, Public Health Service, Amsterdam, The Netherlands

    M L A de Hoog & M van Eijsden

  3. Department of Paediatrics, EMGO Institute, Institute of Cardiovascular Research, VU University Medical Centre, Amsterdam, The Netherlands

    R J B J Gemke

Authors
  1. M L A de Hoog
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K Stronks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M van Eijsden
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R J B J Gemke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T G M Vrijkotte
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M L A de Hoog.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

de Hoog, M., Stronks, K., van Eijsden, M. et al. Ethnic differences in maternal underestimation of offspring's weight: the ABCD study. Int J Obes 36, 53–60 (2012). https://doi.org/10.1038/ijo.2011.199

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2011.199

Keywords

This article is cited by

Search

Advanced search

Quick links