Examining Mexican-Heritage Mothers' Perceptions of Their Children's Weight: Comparison of Silhouette and Categorical Survey Methods

Abstract

Background: Failure to recognize children's overweight status by parents may contribute to children's risk for obesity. We examined two methods of measuring mothers' perceptions of children's weight and factors associated with weight perception inaccuracy. Methods: Cross-sectional analyses of clinical and self-report data from 287 Mexican-heritage mother-child dyads. Mothers identified their child's weight category using a scale (e.g., "normal/overweight/obese") and a visual silhouette scale (11 child gender-specific weight-varying images). Children's height and weight were measured to calculate body mass index (BMI). Chi-square tests examined associations between categorical, silhouette, and BMI percentile categories of children's weight. Bivariate logistic regression analyses examined factors associated with mothers' inaccuracy of their children's weight. Results: Only 13% of mothers accurately classified their child as obese using the categorical scale, while 78% accurately classified their child as obese using the silhouette scale. Mothers were more likely to underestimate their child's weight using BMI categories (62%) compared to using the silhouette scale (23%). Predictors of mothers' underestimation using the categorical method were child sex [female] (adjusted odds ratio [AOR] = 1.99; 95% CI: 1.02-3.86), child age [younger age] (AOR = 10.39; 95% CI: 4.16-25.92 for ages 5-6 years), and mother's weight status (overweight AOR = 2.99; 95% CI: 1.05-8.51; obese AOR = 5.19; 95% CI: 1.89-14.18). Child BMI was the only predictor of mothers' overestimation (AOR = 0.89; 95% CI: 0.85-0.94) using the silhouette method. Conclusions: Using silhouette scales to identify children's body weight may be a more accurate tool for clinicians and interventionists to activate parents' awareness of unhealthy weight in children compared to using traditional categorical weight-labeling methods.

Keywords: Hispanic; Latino; childhood obesity; parental perceptions; weight perceptions.

Figure 1.

Mothers' selected weight-based categories compared with child's measured BMI categories (n = 287). Perceived child weight categories originally included five response options, including “markedly underweight.” This category was combined with the “underweight” category due to the small number of responses. Mothers' selected weight categories: underweight, normal, overweight, obese. BMI categories: normal (5.0–84.99), overweight (85.0–94.99), and obese (≥95.0). Fisher's exact test p value 0.00.

Figure 2.

Mothers' selected silhouette-based weight with child's measured BMI categories (n = 287). Mother's selected silhouette-based weight categories: underweight, normal, overweight, and obese. BMI categories: normal (5.0–84.99), overweight (85.0–94.99), and obese (≥95.0). Fisher's exact test p value 0.00.

Figure 3.

Comparison of accuracy of mothers' selected silhouette-based weight with weight based categories (n = 287). C, category-based weight accuracy; S, silhouette-based weight accuracy. Fisher's exact test p value 0.00.