Mothers' Perceptions of Their Adolescents' Weight Status: Are They Accurate?
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Division of General Pediatrics and Adolescent Health, University of Minnesota, Gateway Alumni Building, 200 Oak Street SE, Suite 160, Minneapolis, MN 55455. E-mail: email@example.com
Objective: To evaluate the accuracy of mothers’ perceptions of adolescents’ weight status.
Research Methods and Procedures: Parent interviews and adolescent surveys (755) were conducted in an ethnically diverse sample from Project EAT (Eating among Teens).
Results: Adolescent weight status was accurately assessed by 60% of mothers, underestimated by 35% of mothers, and overestimated by 5% of mothers. In multivariate analyses, mothers of female adolescents were about half as likely to underestimate their adolescent's weight status as mothers of male adolescents. Nonoverweight mothers were about half as likely as overweight mothers to underestimate their adolescent's weight status.
Discussion: Most mothers are able to accurately assess their adolescent's weight status; however, adolescent gender and mothers’ weight status are related to accuracy. Mothers were more likely to underestimate their sons’ weights than their daughters’ weights, and overweight mothers were more likely to be inaccurate in their assessments than nonoverweight mothers. Findings suggest that the majority of parents do not need to be told that their children are overweight; instead, messages to parents of overweight teens should focus on how to provide support for healthy weight management.
In the United States, ∼20% of adolescents are considered overweight, and studies show that rates are increasing (1). Overweight youth are at risk for cardiovascular disease and mortality (2), and the risk of being overweight in adulthood is twice as high for overweight than nonoverweight children (3). Parents have an important role to play in preventing the onset of a broad array of weight-related problems in their teenagers. Parental perceptions of their teen's weight status may affect the messages in families regarding weight, eating, and exercise.
Little research has been published on parental accuracy of their adolescents’ weight status (7). It is not clear whether the accuracy of parents’ perceptions of adolescent weight status is affected by the parent's weight or by ethnicity. The present study objectives were to evaluate the accuracy of mothers’ perceptions about their adolescents’ weight status and to evaluate whether mothers’ misclassification of adolescent weight status varies by demographic factors.
Research Methods and Procedures
Subjects and Procedure
Participants included 755 adolescents (397 boys/358 girls) who completed the Project EAT (Eating among Teens)1 student survey and their mothers/female guardians who participated in telephone interviews. Participants were a subset of 4746 Project EAT participants. Details on Project EAT are available elsewhere (4,5). The 755 adolescents in this study included those who completed a classroom-based survey (study-wide response rate 81.5%) and whose female parent/guardian completed a telephone interview. Study procedures were approved by the University of Minnesota's and participating schools’ Human Subjects committees. Among the 755 adolescents, 47% were boys, 60% were in high school, 33% were white, 24% were black, 17% were Asian, 13% were Hispanic, and 13% were other/mixed; the mean age was 14.6 years (SD = 1.7). Female guardians (91% mothers) were interviewed by telephone (76.3% of those selected for parent interviews) and are referred to as “mothers” hereafter. Of the 755 mothers, 48% were white, 23% were black, 13% were Asian, 9% were Hispanic, and 7% were other/mixed; 63% were married; socioeconomic status (SES) was equally distributed; and 83% were working outside of the home.
Adolescents reported their gender, grade level, and race/ethnicity. BMI was calculated from measured height and weight taken from trained Project EAT staff; adolescents were classified as underweight (BMI < 15th percentile), average weight (15th percentile ≤ BMI < 85th percentile), at risk for overweight (85th percentile ≤ BMI < 95th percentile), and overweight (BMI ≥ 95th percentile) (6,7).
Mothers reported family demographic data and their own weight and height. BMI was calculated, and respondents were classified as either nonoverweight (BMI = 18.5 to 24.9) or overweight (BMI > 25.0) (8). Mothers were asked how they would describe their adolescent's current weight: very underweight, somewhat underweight, about right, somewhat overweight, or very overweight. The very underweight and somewhat underweight classifications were pooled, resulting in four categories for analysis. Accuracy of mothers’ perception of adolescents’ weight was calculated by comparing the mother's report of adolescent current weight status with the Centers for Disease Control and Prevention BMI weight classification. These comparisons resulted in three groups of mothers: mothers who underestimated their adolescent's weight status, mothers who accurately assessed their adolescent's weight status, and mothers who overestimated their adolescent's weight status.
All analyses were conducted using the Statistical Analysis System (SAS version 8.2) (9). χ2 analyses examined the relationships between demographics and mothers’ accuracy in classifying adolescent weight status. Significant bivariate predictors were included in multivariate logistic regression models to predict mothers’ accuracy in perceptions of adolescent overweight status. Confidence intervals were set at 95%. Mothers who accurately reported their adolescent's weight status were compared with mothers who underestimated their adolescent's weight status and mothers who overestimated their adolescent's weight status.
Based on national reference data, approximately one-half (51.1%) of the mothers and 16.5% of the adolescents were considered overweight, and an additional 19.9% of adolescents were considered at risk for overweight. Adolescent weight status was accurately assessed by the majority of mothers (60.4%), underestimated by about one-third of mothers (35.3%), and overestimated by 5% of mothers.
Race/ethnicity of mothers and adolescents, weight status of mothers and adolescents, and adolescents’ gender were significantly associated with the accuracy of mothers’ perception of adolescent weight status (Table 1). Higher rates of accuracy were evident for Asian and white mothers compared with African-American, Hispanic, and other mothers. Asian, white, and African-American teens were more likely to have their weight status accurately estimated by their mothers than Hispanic or other teens.
Table 1. Demographic and weight status differences by accuracy of mothers’ perception of adolescents’ weight status
|Mothers’ race/ethnicity|| || || ||0.041|
| White||62.5||5.3||32.2|| |
| African- American||59.8||1.2||39.0|| |
| Hispanic||53.7||3.0||43.3|| |
| Asian||65.5||6.7||27.8|| |
| Other||46.4||5.4||48.2|| |
|Mothers’ weight status|| || || ||<0.0001|
| Overweight||53.0||3.4||43.6|| |
| Nonoverweight||68.1||5.3||26.6|| |
|Adolescents’ gender|| || || ||<0.01|
| Female||66.5||3.9||29.6|| |
| Male||53.7||4.8||41.5|| |
|Adolescents’ race/ethnicity|| || || ||<0.01|
| White||62.7||5.7||31.6|| |
| African-American||61.0||1.6||37.4|| |
| Hispanic||54.1||3.0||42.9|| |
| Asian||66.3||8.6||25.0|| |
| Other||52.5||2.0||45.5|| |
|Adolescents’ weight status (BMI %*)|| || || ||<0.0001|
| <15%||37.9||62.1||0.0|| |
| 15% to 85%||85.4||2.7||11.9|| |
| 85% to 95%||28.1||1.4||70.5|| |
| >95%||13.8||0.0||86.2|| |
Compared with overweight mothers, nonoverweight mothers were significantly more likely to be accurate in their assessment of adolescent weight status. Similarly, parental accuracy was significantly higher for adolescents in the average weight range. The majority of overweight teens had mothers who underestimated their weight status.
Significantly more mothers of adolescent girls were accurate in their assessment of adolescent weight status than mothers of adolescent boys. Parent marital status, SES, and adolescent grade level were not significantly associated with mothers’ accuracy of weight status (data not shown).
In multivariate logistic regression analyses with mothers’ and adolescents’ race/ethnicity, mothers’ weight status, and adolescent gender in the model, nonoverweight mothers were one-half as likely as overweight mothers to underestimate adolescent weight status (odds ratio = 0.5, 0.34 to 0.65). Female adolescents were about one-half as likely as male adolescents to have their mother underestimate their weight status (odds ratio = 0.6, 0.40 to 0.76). Neither adolescent race/ethnicity nor maternal race/ethnicity was significantly related to mothers’ assessments of adolescent weight status.
This study evaluated mothers’ perceptions of adolescents’ weight status and compared them with the adolescents’ weight status. Most mothers (60%) accurately assessed their adolescent's weight status; however, underestimates were common (35%). Mothers were more likely to overestimate their daughter's weight status than their son's weight status. Overweight mothers were more likely than normal-weight mothers to underestimate their adolescent's weight status.
The gender difference in mothers’ perceptions of adolescent weight status suggests that mothers may be more accepting of higher weights among their sons than among their daughters. Whether or not these inaccuracies serve as an impediment to parental support for healthy weight management or, conversely, shade boys from unhelpful pressures to lose weight warrants further exploration.
Only 5% of the mothers overestimated their adolescents’ weight status. This finding is important because health care providers may be hesitant to raise weight concerns with adolescents and their parents for fear of putting too much pressure on children to lose weight or of initiating an eating disorder. Although weight concerns should always be discussed in a sensitive manner, our findings suggest that the majority of parents do not overestimate their teens’ weight status.
Strengths of this study include the size and diversity of the population in terms of gender, ethnicity, and SES; reports from adolescents and parents; and the objective assessment of adolescent anthropometry. However, study limitations such as the self-report nature of the data and the cross-sectional study design should be considered when interpreting these results. Furthermore, we recognize that the approach that we used to assess parent perceptions of their adolescent's weight status may not map precisely with Centers for Disease Control and Prevention criteria for defining weight status.
In summary, findings suggest that the majority of parents do not need to be told that their children are overweight; instead, messages to parents of overweight teens should focus on how to provide positive support for behavioral change and healthy weight management.
This work was supported by Grant MCJ-270834 (D.N.-S., principal investigator) from the Maternal and Child Health Bureau (Title V, Social Security Act), the Health Resources and Service Administration, and the U.S. Department of Health and Human Services.
Nonstandard abbreviations: EAT, Eating among Teens; SES, socioeconomic status.