Economic and educational factors do not explain racial differences in the accuracy of parental perception of overweight in their child

Minority parents have been shown to be more likely to underestimate the weight status of their overweight school-age children than Caucasian parents, but few studies have concurrently examined socioeconomic variables, which are associated with overweight and, often, with race. In 2003 and 2004 stratified random samples of parents of Arkansas public school children were surveyed as part of an evaluation of the impact of Arkansas Act 1220 of 2003, comprehensive legislation to combat childhood obesity. Parents were asked the gender, age, height, and weight of a randomly selected child in the household, and in which weight risk category they considered that child to be. Parents also reported their own education levels and whether their child participated in the federal free-or-reduced-price school lunch program. Children's actual weight classification was based on CDC gender-and-age-specific BMI percentiles calculated from parent-reported height and weight. Misclassification of overweight children was common regardless of racial group. However, the odds of African-American parents of overweight children accurately perceiving their overweight children as overweight were 31% less than the odds for Caucasian parents of overweight children (OR=0.691, p= 0.017). Adjustment for low income (using federal school lunch program participation as a proxy) and parent education did not modify the relationship. These findings suggest that cultural factors may be associated with accuracy of parental perception. Further delineation of cultural factors which affect parental recognition of overweight may lead to improved approaches of engaging parents to support diet and physical activity changes for their overweight children.