Perception vs. reality: Overweight in Latino children and Latina mothers' misclassification of children's weight status

Background: Latino boys are the most overweight and Latina girls the second most overweight racial/ethnic groups of US children, but the risk factors for overweight in Latinos are poorly understood. Effective interventions to decrease overweight among Latino children are urgently needed; yet, risk factors underlying this racial/ethnic disparity are poorly understood. Objective: To determine whether maternal characteristics, maternal perception of children's weight status, diet, and behavioral patterns are associated with overweight in Latino children. Methods: Face-to-face surveys (in English and Spanish) were conducted with mothers of Latino children 2-18 years old at an urban community health center. Surveys consisted of 62 Likert-scale, yes/no, multiple-choice, and open-ended questions on sociodemographics, diet, maternal acculturation (using the 12-item Short Acculturation Scale for Hispanics), and maternal perceptions of children's weight status. Results: 238 mothers were interviewed (response rate=96%). 27% of children were overweight, and 42% were overweight or at risk for overweight. Eating fried foods >once/week (p<.05) and fast foods >3 times/week (p=.006) were associated with overweight. Preparing breakfast at home was protective against overweight (p=.04). Maternal education, acculturation, birthplace, LEP, and work status were not associated with overweight. Among mothers of overweight children, 29% perceived their child's weight as healthy, 2% as underweight, and 69% as overweight (p<0.001). Among at-risk-for overweight children, 74% of mothers perceived their child's weight as healthy and 6% as underweight. Factors associated with misclassification of children's weight status included lower paternal educational attainment (p=.003) and poverty (p=.01). Conclusions: Latino children who frequently eat fried food and fast food are at significantly higher risk for overweight, while those eating breakfast prepared at home are at decreased risk. A substantial mismatch exists between Latina mothers' subjective perception and objective measures of childhood overweight. 80% of Latina mothers of children at risk for overweight and 31% of mothers of overweight children view their child's weight as healthy or underweight. Implications for Policy, Delivery, or Practice: Interventions to decrease overweight among Latino children should include efforts to educate Latina mothers about healthy childhood weight and nutrition. Mothers should be encouraged to decrease the consumption of fried foods/fast foods and to prepare healthy breakfasts at home. Since Latina mothers of overweight children often do not perceive their children as overweight, it is essential to educate them about healthy childhood body image in order to promote overweight prevention.