1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and procedures
  5. Results
  6. Discussion
  7. Disclosure
  8. Acknowledgments
  9. References

Objective: Examine the accuracy of parental weight perceptions of overweight children before and after the implementation of childhood obesity legislation that included BMI screening and feedback.

Methods and Procedures: Statewide telephone surveys of parents of overweight (BMI ≥ 85th percentile) Arkansas public school children before (n = 1,551; 15% African American) and after (n = 2,508; 15% African American) policy implementation were examined for correspondence between parental perception of child's weight and objective classification.

Results: Most (60%) parents of overweight children underestimated weight at baseline. Parents of younger children were significantly more likely to underestimate (65%) than parents of adolescents (51%). Overweight parents were not more likely to underestimate, nor was inaccuracy associated with parental education or socioeconomic status. African-American parents were twice as likely to underestimate as whites. One year after BMI screening and feedback was implemented, the accuracy of classification of overweight children improved (53% underestimation). African-American parents had significantly greater improvements than white parents (P < 0.0001).

Discussion: Parental recognition of childhood overweight may be improved with BMI screening and feedback, and African-American parents may specifically benefit. Nonetheless, underestimation of overweight is common and may have implications for public health interventions.


  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and procedures
  5. Results
  6. Discussion
  7. Disclosure
  8. Acknowledgments
  9. References

The prevalence of childhood obesity in the United States is high and has markedly increased over previous decades (1). Data from the most recent National Health and Nutrition Examination Survey indicate that over a third of American children aged 2–19 years are either at-risk-of-overweight or overweight. Overweight has increased significantly among both boys and girls over a relatively brief 6-year period, with rates of overweight among boys up from 14% in 1999–2000 to over 18% in 2003–2004 and rates among girls rising from 13.8 to 16% over the same period (2). This alarming and rapid increase in childhood obesity has been accompanied by escalating rates of obesity-related comorbidities previously uncommon in children, including type 2 diabetes, metabolic syndrome, hypertension, and dyslipidemia (3,4,5,6). Further, most overweight children will grow up to become overweight adults (7,8), and as overweight adults they will experience significantly elevated rates of diabetes, heart disease, and cancer (9). Consequently, there is great concern surrounding the impact obesity in this next generation will have on the already strained American health care system (3). With distressing medical and economic projections looming, efforts to address and prevent childhood obesity have become a major focus of the national agenda (10,11).

Despite the significant health risks presented by overweight among children, parents of overweight children often fail to accurately identify the weight status of their at-risk children, misclassifying their children as normal or healthy weight. The most common error is to underestimate the risk category, misclassifying overweight children as normal or healthy weight. In a recent study of a nationally representative sample of children aged 2–11 years (12), approximately, one-third of mothers identified their overweight child (≥95th BMI-for-age percentile) as “about the right weight.” Accuracy of maternal weight perceptions of at-risk-of-overweight (85–94% BMI-for-age percentile) children differed by child's gender. The majority (85%) of mothers classified sons who were at-risk-of-overweight as “about the right weight,” with only 14% accurately recognizing their sons as overweight. Mothers were more likely to accurately identify the correct weight category of daughters who were at-risk-of-overweight (29%), but a significant proportion (71%) were inaccurate in their perceptions of their daughter's weight category. Thus, although underestimation of overweight status is more common when the child is a boy, substantial numbers of mothers underestimate the weight risk status of their at-risk-of-overweight and overweight children regardless of gender.

Parents of very young children are particularly prone to underestimate weight risk of at-risk-of-overweight and overweight children (12,13). The large majority of mothers of toddlers (79–91%) inaccurately identify their at-risk-of-overweight child as being normal weight (14,15). Even obese mothers who accurately identify themselves as obese do not accurately perceive their young child as overweight (14). Mothers with a high school education or less are more likely to underestimate the weight category of their overweight toddler than mothers with higher education (14). Among slightly older children (4–8 years old), all parents of overweight (≥95th percentile) children underestimated their child's weight, with not one parent correctly identifying their child as extremely overweight (16). Most parents identified their child in the normal weight range, substantially underestimating the degree of excess weight in their youngster. Recent data examining parental classification of weight status and objective assessment of child's body fat by dual-energy X-ray porptiometry total body scan indicate that parents of overweight children frequently (77%) fail to recognize over-fatness in their young child (17).

Accuracy of weight status perceptions appears better among parents of older children. Parents of children over the age of six were more likely to accurately identify their at-risk-of-overweight and overweight child as overweight than were the parents of children aged 2–6 years (13). Further, parents expressed greater concern about the weight of their at-risk-of-overweight and overweight older children and adolescents than did parents of very young children (13). However, other studies indicate that underestimation of overweight is also very common among parents of both at-risk-of-overweight and overweight adolescents. Only 14% of mothers of overweight adolescents accurately identified their child's weight status in one large survey study, and only 28% of at-risk-of-overweight adolescents were accurately identified by their mothers (18). Overweight mothers were more likely to underestimate adolescent weight risk status (18). Across the total sample of adolescents, which included the full spectrum of weight, mothers were more likely to accurately assess the weight status of their adolescent daughter than son, and African-American and Hispanic mothers were more likely to underestimate weight category than white or Asian mothers (18). However, differences between race groups in the accuracy of parental weight perception have not been observed in all studies (12,19).

Accurate parental assessment of weight risk status may be a key element for successful childhood obesity prevention and treatment. Parents who perceive their child as overweight are significantly more likely to describe themselves as ready to make lifestyle changes to help their child lose weight than the parents who do not perceive their child to be overweight (20). Although there has been little research on the direct relationship between accurate parental perceptions of child overweight and parental practices to promote healthy dietary and physical activity habits (21), parental influences on childhood eating behaviors are considerable (22) and have been shown to be associated with accurate parental perceptions of their child's weight (23), as well as with weight gain in young children (24). Children who are already overweight are much more successful in making behavior changes that result in healthy weight when their parents are actively engaged in the process (25,26,27). Methods to improve the accuracy of parental perceptions of their overweight child may prompt active engagement in lifestyle changes. Provision of parental feedback about weight offers a possible option for improving the accuracy of parental recognition of weight risk status. Initial efforts indicate that offering parents of elementary school students objective information on a child's weight increases the accuracy of weight status identification (28). As part of a broad-reaching childhood obesity prevention policy, Arkansas enacted legislation in 2003, which required, among other things, annual assessment of BMI for all public school students and a health report to parents about the weight status of their child (29). Evaluation of the impact of this comprehensive statewide obesity prevention legislation included an assessment of the accuracy of parental identification of child weight status both before the implementation of BMI screening and health reports and 1 year afterwards (30,31). The current report examines the accuracy of parental weight perceptions and explores the effect of statewide efforts to provide parents with a child health report that includes weight classification information on the accuracy of parental weight status perceptions.

Methods and procedures

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and procedures
  5. Results
  6. Discussion
  7. Disclosure
  8. Acknowledgments
  9. References

Survey methodology

A multi-stage stratified design identified a sample representative of public school children in Arkansas in both years (32). Public schools in the state were stratified by geographic region (north, northwest, southwest, central, and east), type of school (elementary, middle, and high school), and size of school (small, medium, and large) to provide a sample representative of schools within the state. The geographic region delineations reflect demarcations commonly used in the state and provide a distribution of student enrollment that is comparable across regions. Schools with enrollment of <100 students were excluded, as were alternative and special schools. Households with listed phone numbers within a 15-mile radius of a selected school were sampled and contacted. Households with a child who attended the selected school were interviewed. If more than one eligible child resided in the household, a single child was selected randomly, and thereafter that child was the focus of the interview.

The baseline survey was implemented in the 2003–2004 school year, before the implementation of BMI screening in the Arkansas public schools (30). The baseline sampling frame included 1,064 schools, from which 113 were randomly selected. The follow-up survey was conducted in the 2004–2005 school year, ∼1 year after the first year of BMI screening and after a BMI health report (child health report) tailored to the child's weight status had been sent to parents (33). For this follow-up survey, the sampling frame was 1,062 schools, with 496 schools selected; targeted totals for interviews were ∼1% of each school's total enrollment in order to increase the sample size as compared to the baseline. Schools were sampled independently in each year, so the potential existed that schools might be included in the samples in both years, particularly in light of the increased sample size in the follow-up survey; 63 schools sampled for follow-up (13%) were also in the baseline sample.

Interview instrument

The interview focused on a wide range of knowledge, health behaviors, attitudes, and beliefs relevant to obesity prevention, as well as aspects of the school environment that might be affected by the legislative mandate or likely to be influenced by other school-focused efforts to curtail obesity. Particularly relevant for this report were the survey items that asked a parent to indicate child's age and gender, height (in inches), and weight (in pounds). Using parental report, gender-specific BMI percentile-for-age was calculated using Centers for Disease Control and Prevention growth charts (34). Children were then classified as overweight (≥95th percentile), at-risk-of-overweight (≥85th percentile but <95th), normal weight (≥5th and <85th percentile) or underweight (<5th percentile). Weight status classification based on parent-reported weight and height was considered to be the accurate weight status category.

Parents were asked if they considered their child to be overweight, at-risk-of-overweight, a healthy or normal weight, or underweight. This method of establishing parental perception of child weight status is similar to the approach utilized in other studies (14,19). Parental perceptions of weight status were compared with calculated weight status classifications. Parents of at-risk-of-overweight and overweight children were considered to be accurate in their perception of their child's weight status if they identified their child as being in one of the two categories of overweight (i.e., either at-risk-of-overweight or overweight). Parents were also asked to report their own weight and height, their education level, their race, and whether their child participated in the federal-free or reduced-lunch program (yes/no), which was used as a proxy for household income because it is linked to the federally established poverty level. BMI of parents was then calculated, and parent overweight (BMI ≥ 25) status was determined.

Child health report to parents

Child health reports were mailed in Spring 2004. Letters indicated children's gender-specific BMI percentile-for-age calculated from the Centers for Disease Control and Prevention guidelines based on the weight and height measurements conducted in schools. In addition, child health reports classified children as overweight, at-risk-of-overweight, normal weight, or underweight using the Centers for Disease Control and Prevention categories (35). This information was presented in both text and graphic forms, using a visual representation of whether the child was in the green (normal), yellow (at-risk-of-overweight), or red (overweight) zone on a weight risk continuum (36). Child health reports also offered recommendations for general healthy dietary and physical activity behaviors that were tailored to the child's weight risk category, as well as suggestions to follow up with a physician for questions or concerns.

Statistical analysis

All of the sampling, calculation of sampling weights, and analyses were performed with SASv9 (SAS Institute, Cary, NC). Responses were weighted to incorporate all design features and adjustments for non-response in order to create representative estimates. At-risk-of-overweight and overweight children were combined into a single weight status category (overweight) for the analyses of parental perceptions.

Equality of means and proportions between the years and subgroups were tested with the survey procedures available in SAS, which take into account sampling design and weights. Univariate equality of means between the groups was tested using the two-sample t-test. Equality of proportions was tested using the Rao-Scott χ2 test, and further adjusted with logistic regression models. All associations were considered significant at the 0.05α level.


  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and procedures
  5. Results
  6. Discussion
  7. Disclosure
  8. Acknowledgments
  9. References

Survey samples

A total of 1,551 parents were interviewed at baseline (76% cooperation rate). In the 1-year follow-up interviews, a larger sample of parents was interviewed (n = 2,508) with a similarly high interview cooperation rate (63%). Characteristics of parents interviewed at each time-point were similar with respect to gender, minority status, and child's weight status (Table 1). Parents of children aged 3–18 years were included in the two samples, with similar proportions of parents of adolescents included in both samples. In the year following the Child Health Report distribution, most parents (65%) reported that they received their child's health report, and the majority of those (93%) recalled reading the report.

Table 1. . Descriptive characteristics of survey samples
 Baseline 2003–2004 (n = 1,551)1-year follow-up 2004–2005 (n = 2,508)P value
  • NA, not applicable.

  • a

    BMI calculated based on parent-reported height and weight, and weigh status calculated according to Centers for Disease Control and Prevention tables.

  • b

    All public school students in the state of Arkansas with height and weight directly measured and BMI for gender and age calculated (37,38).

    Race/ethnicity  0.26
        African American15%15% 
    Parent BMI, mean (s.e.)27.51 (0.165)27.81 (0.128)0.13
    Overweight (BMI ≥ 25) parent60%63%0.21
BMI report   
    Parent received BMI reportNA65% 
    Parent reported reading reportNA93% 
Selected child   
    Age, mean (s.e.)10.94 (0.082)11.08 (0.069)0.17
        Pre-adolescent aged 3–1264%60%0.06
        Adolescents, aged 13–1936%40% 
    Weight status categories by parent reporta  0.63
        Healthy weight55%53% 
Actual weight status categories of public school children in Arkansasb   
        Healthy weight60%60% 

The samples of children who were the focus of the surveys in the baseline and follow-up interviews were comparable with respect to age, gender, and the distribution across weight status categories. The distribution of weight status categories computed based on the parental report of child height and weight in the interviews corresponds closely to the distribution obtained from the actual statewide measurement of height and weight obtained during the BMI screenings (32,37,38). This correspondence between distributions of weight status calculated from parental report of anthropometrics and from objectively ascertained height and weight measurements of Arkansas public school students provides some reassurance that parent-reported heights and weights were reasonably accurate.

Parental weight classification of overweight children at baseline

The majority (60%) of parents of overweight children inaccurately identified their child as healthy weight or underweight in the baseline survey. Only 40% of parents correctly identified their overweight children. Parents of girls were no different in the accuracy of their weight perceptions than the parents of boys (P = 0.57). Overweight parents were no more likely to underestimate the weight of their overweight child, with 41% of overweight parents correctly identifying their child as overweight compared with 37% of normal and underweight parents accurately recognizing their child as overweight (P = 0.56). African-American parents tended to be more likely to underestimate the weight status classification of their child than were white parents (70% inaccurate vs. 57%, respectively, P = 0.08). After controlling for parent BMI, African-American parents were twice as likely to underestimate the weight of their overweight child compared with white parents (odds ratio (OR) = 2.09, 95% confidence interval (CI) (1.22, 3.55), P = 0.007). Parental education was not associated with the accuracy of child weight perception, nor was participation in the federal-free and reduced-lunch program. Parents of younger children were more likely to underestimate the weight status of their child than were the parents of adolescents. Almost two-thirds (65%) of parents of younger (<13) overweight children underestimated their overweight child's weight compared with about half (51%) of the parents of adolescents (P = 0.025).

Multivariate modeling that simultaneously considered child gender, child age (adolescent/younger), parent race (African American/white), parent weight (overweight/normal or underweight), parent education, and participation in the federal-free and reduced-lunch program indicated that the factors independently associated with the underestimation of weight status of overweight children were age of the child and race of the parent. African-American parents were twice as likely to underestimate overweight in their child compared with white parents (OR = 2.07, 95% CI (1.18, 3.64), P = 0.005), and parents of younger children were nearly twice as likely to underestimate as the parents of adolescents (OR = 1.77, 95% CI (1.18, 2.65), P = 0.012).

Parents who underestimated the weight status of their overweight children expressed significantly lower levels of concern about their child's weight. Only 26% of parents who inaccurately identified their overweight child as healthy or underweight indicated any concern about their child's weight, compared with 92% of parents who accurately identified their child as overweight or at-risk-of-overweight.

Change in accuracy of parental classification after the BMI health report

In the year after the Child Health Reports had been provided to parents, the accuracy of parental perceptions of overweight in their child improved. Forty-seven percent of parents of an overweight child accurately identified their child as overweight. This represents a greater proportion of parents accurately identifying the weight status of their overweight child compared to the baseline year, although the difference did not reach statistical significance (P < 0.09). Improvements in congruence between actual weight status and parental perception of weight status were evident among both white and African-American parents (Figure 1), but significantly greater improvements were noted among African American as compared with white parents (P < 0.0001). Specifically, African-American parents improved from 30% accurate classification before the BMI measurement to 44% accurate after the first Child Health Report was distributed.


Figure 1. : Proportion of parents accurately identifying their overweight child (BMI ≥ 85th percentile for gender and age) as overweight.

Download figure to PowerPoint

Despite these significant improvements in accurate identification of overweight children, there remained a significant number of parents who failed to accurately perceive their child as overweight. As in the baseline interview, parents of younger children remained more likely to underestimate their child's weight status (OR = 1.78, 95% CI (1.30, 2.43), P = 0.0003) in the follow-up interview. In the follow-up interview, parents of boys were twice as likely to underestimate weight status as the parents of girls (OR = 2.19, 95% CI (1.62, 2.96), P < 0.0001). Overweight parents were now significantly less likely to underestimate their overweight child's weight status, with underestimation about half as likely among overweight parents (OR = 0.59, 95% CI (0.41, 0.84), P = 0.003), and underestimation more likely among parents with higher education (OR = 1.40, 95% CI (1.02, 1.94), P = 0.04). Importantly, African-American parents were not more likely to underestimate their overweight child's weight in the follow-up interview, even in the fully adjusted model.

As at baseline, in the follow-up interview parents who accurately identified their overweight child's weight were more likely to express concern about the child's weight. The substantial majority of parents (89%) who recognized their overweight child to be overweight expressed concern about their child's weight. In contrast, only 36% of parents underestimating their overweight child's weight expressed concern (P < 0.0001).


  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and procedures
  5. Results
  6. Discussion
  7. Disclosure
  8. Acknowledgments
  9. References

In a representative statewide sample of the parents of public school students, most parents of overweight children perceived their child as healthy weight or even underweight. At baseline, 60% of parents underestimated the weight status category of their overweight child, with higher rates among parents of younger children. Our observed frequency of parental misperception of weight among younger overweight children (65%) is fairly comparable to the rates in other recent samples of younger children, which ranged from 70 to 89% (12,16,17). Other studies examining parental weight perceptions across a wider age range of children report 64% underestimation of weight status among the parents of overweight children (13), comparable to our observed overall misclassification rate of 60%. Although baseline rates of accurate weight status classification among parents of overweight adolescents in the current study were modest (49%), they were substantially higher than other reports in which only 14% of mothers accurately identified their overweight adolescent as overweight (18). Thus, although at baseline rates of accurate identification were low among Arkansas parents, they were higher than those observed in other recent samples, perhaps indicating heightened awareness due to the media attention to childhood overweight, which accompanied the passage of Act 1220 (30) and in the broader national press (31).

Provision of feedback on child weight status, delivered in the context of broader childhood obesity prevention policies, appears to be associated with increased accuracy of parental weight perceptions, replicating the findings of a smaller, controlled study (28). Statistically significant increases were evident among African-American parents, who had lower rates of accurate weight perceptions at baseline. Given the high risk for adult obesity and obesity-related conditions among African Americans (2,39) and the high rates of overweight among African-American children (1), greater accuracy in identification may initiate familial behavior changes. However, cultural acceptance of larger body sizes among African Americans has been noted, (40) and heavier children are more normative among African-American families so that visual comparison with peers is not a reliable indicator of overweight status for parents. One study indicates that even when parents do not select the appropriate weight status category for their overweight child, they may identify an overweight silhouette to describe their child (13), raising questions about whether parents have reservations about using certain labels rather than a lack of awareness about the degree of overweight in their child. Overweight and obese African-American adults are significantly more likely than white adults to categorize themselves as “about the right” weight (41,42), which could indicate either a hesitation to use the labels or a lack of awareness of overweight that spans generations. The strong positive associations observed here between accurate perception and concern about weight would suggest that weight perception accuracy is more than a reluctance to label, since parental concerns paralleled accurate classification, although the current analyses can not establish which came first, accurate classification or concern.

The current study has some limitations, including the use of parent-reported weight and height data for children. Accuracy of self-report data on weight among adults has been widely studied, and evidence indicates that adults tend to underestimate their weight. Furthermore, overweight adults are even more likely to under-report, although the overall underestimation is modest (43). Given the challenges of obtaining observed weights on participants in epidemiologic research and the minimal inaccuracies in self-reported weight, self-reported weight is considered appropriate for purposes of population-based studies, particularly among younger adults (44). Little is known about the accuracy of parental report of children's height and weight, although it appears that parental report may be more accurate than adolescent report (19). Further, the distribution of child weight categories in the current sample was very similar to the distribution calculated from observed values from the larger population of Arkansas public school students (32), suggesting that parental report of child height and weight offers a reasonable estimate of the child's actual weight.

A second limitation of this investigation is the lack of a randomized study design and the absence of a control group, both of which must temper conclusions about the impact of parental feedback on a child's weight status on the accuracy of parental weight perceptions. This is an observational evaluation that included assessment before and after implementation of parental feedback, but cannot establish direct cause and effect. Furthermore, the Child Health Report was provided in the context of broader, and often substantial, implementation of obesity prevention strategies. Therefore, we cannot conclude that the Child Health Report alone increased the accuracy of parental perception. Nonetheless, this is the first report on parental perceptions of overweight before and after the provision of weight risk feedback to parents of school students statewide, including the full range of grades (elementary, middle, and high school students). As other states and communities begin to consider similar strategies as part of pediatric obesity prevention programs, these data and experiences may prove informative. Further, this study extends the existing literature on parental weight perceptions by including a population that spans the age range of 3–18 years. Most studies to date have been limited to younger children (12,16,17) or focused specifically on adolescents (18,19), and they did not allow comparisons between the age groups using comparable methodologies.

The significant interest in parental perception of weight status among overweight children rests on the presumption that parents who appropriately recognize overweight in their child, and are concerned about it, will be more likely to institute appropriate health behavior changes. Parental involvement has consistently been demonstrated to be critical in successful programs to change diet and physical activity behaviors in children and adolescents (25,26,27,45,46). Further, there has been an explosion of interest in parental perceptions of overweight, as indicated by the number of studies in this area in the past few years alone. Finally, it is not only parents who frequently underestimate the weight status of overweight children, but pediatricians also underestimate the weight of overweight children in their practice (47). Clearly, more research on the implications of accurate parental weight perceptions is necessary, and methods to promote greater accuracy among African-American parents who are particularly likely to underestimate weight status would be of special interest given the higher rates of obesity within this subgroup.

In summary, parental perceptions of weight classification of their overweight child frequently underestimate weight risk. In Arkansas, providing parents with feedback on BMI percentile-for-age-and-gender and identifying their child's weight classification in the context of broader obesity prevention policies appears to have increased the accuracy of parental perceptions. In particular, the child health report may have assisted with elevating the accuracy of weight perceptions by African-American parents to a par with white parents. As other states consider implementing a similar obesity prevention strategy of BMI feedback or health report to parents, it will be of considerable interest to see if such patterns are replicated. Nonetheless, these data suggest that a substantial proportion of parents continue to underestimate the weight of their overweight child, even after the provision of feedback; and further exploration of methods to increase accuracy may play a role in childhood obesity prevention efforts. Such calls for providing parents with information to assist in accurately identifying their overweight child are increasingly global as the international public health community begins to address prevention of pediatric obesity (17), and data from the United States indicate that the majority of individuals surveyed (57%) support sending parents information on their child's weight as an intervention to reduce childhood obesity (48).


  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and procedures
  5. Results
  6. Discussion
  7. Disclosure
  8. Acknowledgments
  9. References

Funded by Robert Wood Johnson Foundation grant number 051737.


  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods and procedures
  5. Results
  6. Discussion
  7. Disclosure
  8. Acknowledgments
  9. References
  • 1
    Headley AA, Ogden CL, Johnson CL et al. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 2006; 291: 28472850.
  • 2
    Ogden CL, Carroll MD, Curtin LR et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006; 295: 15491555.
  • 3
    Hill JO, Trowbridge FL. Childhood obesity: future directions and research priorities. Pediatrics 1998; 101: 570574.
  • 4
    American Diabetes Association. Type 2 Diabetes in Children and Adolescents. Diabetes Care 2000; 23: 381389.
  • 5
    Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet 2002; 360: 473482.
  • 6
    Weiss R., Dziura, J., Burgert TS et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004; 350: 23622374.
  • 7
    Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997; 337: 869873.
  • 8
    Magarey AM, Daniels LA, Boulton TJ, Cockington RA. Predicting obesity in early adulthood from childhood and parental obesity. Int J Obes Relat Metab Disord 2003; 27: 505513.
  • 9
    Field AE, Coakley EH, Must A. et al. Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med 2001; 161: 15811586.
  • 10
    Krisberg K.. Institute of Medicine plan takes on childhood obesity. Nations Health 2004; 34: 110.
  • 11
    U.S. Department of Health and Human Services. Healthy People 2010. Government Printing Office: Washington, DC, 2000.
  • 12
    Maynard LM, Galuska DA, Blanck HM, Serdula MK. Maternal perceptions of weight status of children. Pediatrics 2003; 111: 12261231.
  • 13
    Eckstein KC, Mikhail LM, Ariza AJ et al. Parent's perceptions of their child's weight and health. Pediatrics 2006; 117: 681690.
  • 14
    Baughcum AE, Chamberlin LA, Deeks CM, Powers SW, Whitaker RC. Maternal perceptions of overweight preschool chidren. Pediatrics 2000; 106: 13801386.
  • 15
    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: 353355.
  • 16
    Etelson D., Brand DA, Patrick PA, Shirali A.. Childhood obesity: do parents recognize this health risk? Obes Res 2003; 11: 13621368.
  • 17
    Miller JC, Grant AM, Drummond BF et al. DXA measurements confirm that parental perceptions of elevated adiposity in young children are poor. Obesity (Silver Spring) 2007; 15: 165171.
  • 18
    Boutelle K., Fulkerson JA, Neumark-Sztainer D., Story M.. Mothers' perceptions of their adolescents' weight status: are they accurate? Obes Res 2004; 12: 17541757.
  • 19
    Goodman E., Hinden BR, Khandelwal S.. Accuracy of teen and parental reports of obesity and body mass index. Pediatrics 2000; 106: 5258.
  • 20
    Rhee KE, DeLago CW, Arscott-Mills T., Mehta SD, Davis RK. Factors associated with parental readiness to make changes for overweight children. Pediatrics 2005; 116: e94e101.
  • 21
    Hodges EA. A primer in early childhood obesity and parental influence. Pediatr Nurs 2003; 29: 1316.
  • 22
    Birch LL, Davison KK. Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight. Pediatr Clin North Am 2001; 48: 893907.
  • 23
    Birch LL, Fisher JO, Grimm-Thomas K. et al. Confirmatory factor analysis of the Child Feeding Questionnaire: a measure of parental attitudes, beliefs and practices about child feeding and obesity proneness. Appetite 2001; 36: 201210.
  • 24
    Faith MS, Berkowitz RI, Stallings VA et al. Parental feeding attitudes and styles and child body mass index: prospective analysis of a gene-environment interaction. Pediatrics 2004; 114: e429e439.
  • 25
    Golan M., Crow S.. Targeting parents as the exclusive agents of change in the treatment of childhood obesity: long term results. Obes Res 2004; 12: 357361.
  • 26
    Wrotniak BH, Epstein LH, Paluch RA, Roemmich JN. The relationship between parent and child self reported-adherence and weight loss. Obes Res 2005; 13: 10891096.
  • 27
    Wadden TA, Stunkard AJ, Rich L. et al. Obesity in black adolescent girls: a controlled clinical trial of treatment by diet, behavior modification and parental support. Pediatrics 1990; 85: 345352.
  • 28
    Chomitz VR, Collins J., Kim J., Kramer E., McGowan R.. Promoting healthy weight among elementary school children via a health report card approach. Arch Pediatr Adolesc Med 2003; 157: 765772.
  • 29
    Arkansas General Assembly. An Act of the Arkansas General Assembly to Combat Childhood Obesity. 2003. In; Arkansas Act 1220; Arkansas Annotated Code.
  • 30
    Raczynski J., Phillips M., Bursac Z. et al. Establishing a Baseline to Evaluate Act 1220 of 2003: An Act of the Arkansas General Assembly to Combat Childhood Obesity. University of Arkansas for Medical Sciences College of Public Health: Little Rock, AR, 2005, pp 132.
  • 31
    Ryan KW, Card-Higginson P., McCarthy SG, Justus MB, Thompson JW. Arkansas fights fat: translating research into policy to combat childhood and adolescent obesity. Health Aff (Millwood) 2006; 25: 9921004.
  • 32
    Bursac Z., Phillips M., Gauss C. et al. Arkansas Act 1220 Evaluation: Multi-stage Stratified Surveys with PPS Sampling. In: 2005 American Statistical Association Proceedings of the Joint Statistical Meetings, Section on Health Policy Statistics, Alexandria, VA, August 2005, 15291531.
  • 33
    Raczynski J., Phillips M., Bursac Z. et al. Year 2 Evaluation Arkansas Act 1220 to Combat Childhood Obesity. University of Arkansas for Medical Sciences College of Public Health: Little Rock, AR, 2006, pp 136.
  • 34
    Kuczmarski RJ, Ogden CL, Grummer-Stawn LM et al. CDC growth charts: United States. Adv Data 2000; 314: 127 <http:www.cdc.govgrowthcharts>.
  • 35
    Kuczmarski RJ, Ogden CL, Guo SS et al. 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 11 2002; 246: 1190.
  • 36
    Arkansas Health Report Working Group. Sample Child Health Report to Parents. http:www.achi.netcurrentinitiativesBMI_InfoDocs2006200620CHR20All20Classifications20English.pdf(2007). Arkansas Center for Health Improvement, Little Rock, AR.
  • 37
    Arkansas Center for Health Improvement. The Arkansas Assessment of Child and Adolescent Obesity, 20032003. http:www.achi.netcurrent_initiativesBMI_InfoDocs2004Results04Arkansas_BMI_State_Report_School_Year_2003_2004.pdf (2004). Arkansas Center for Health Improvement. Little Rock, AR.
  • 38
    Arkansas Center for Health Improvement. The 2005 Arkansas Assessment of Child and Adolescent Obesity. http:www.achi.netcurrent_initiativesBMI_InfoDocs2005Results05BMI_2004_2005_State_Report_High_resolution.pdf (2005). Arkansas Center for Health Improvement.
  • 39
    Kumanyika S.. Obsity treatment in minorities. In: Wadden T., Stunkard A. (eds). Handbook of Obesity Treatment. The Guilford Press: New York, NY, 2002, pp 416446.
  • 40
    Smith DE, Thompson JK, Raczynski JM, Hilner JE. Body image among men and women in a biracial cohort: the CARDIA Study. Int J Eat Disord 1999; 25: 7182.
  • 41
    Paeratakul S., White MA, Williamson DA, Ryan DH, Bray GA. Sex, race/ethnicity, socioeconomic status and BMI in relation to self-perception of overweight. Obes Res 2002; 10: 345350.
  • 42
    Bennett GG, Woling KY. Satisfied or unaware? Racial differences in perceived weight status. Int J Behav Nutr Phys Act 2006; 3: 40.
  • 43
    Stewart AL. The reliability and validity of self-reported weight and height. J Chronic Dis 1982; 35: 295309.
  • 44
    Kuczmarski MF, Kuczmarski RJ, Najjar M.. Effects of age on validity of self-reported height, weight and body mass index: findings from the Third National Health and Nutrition Examination Survey, 1988–1994. J Am Diet Assoc 2001; 101: 2834.
  • 45
    Nader PR, Sellers DE, Johnson CC et al. The effect of adult participation in a school-based family intervention to improve Children's diet and physical activity: the Child and Adolescent Trial for Cardiovascular Health. Prev Med 1996; 25: 455464.
  • 46
    Haerens L., Deforche B., Maes L. et al. Body mass effects of a physical activity and healthy food intervention in middle schools. Obesity (Silver Spring) 2006; 14: 847854.
  • 47
    Barlow SE, Bobra SR, Elliott MB, Brownson RC Haire-Joshu D. Recognition of childhood overweight during health supervision visits: Does BMI help pediatricians? Obesity (Silver Spring) 2007; 15: 225232.
  • 48
    Evans WD, Finkelstein EA, Kamerow DB, Renaud JM. Public perceptions of childhood obesity. Am J Prev Med 2005; 28: 2632.