Maternal misperceptions and smoking are major factors associated with overweight and obesity in 5-6 y-old low SES children

Objective: To identify risk-factors beyond the traditional predictors for obesity among low socioeconomic status (LSES) children. Methods: A cross-sectional survey was performed among twelve randomly selected LSES daycare centers. Children (aged 5-6y) and mothers were recruited, and anthropometric measurements were obtained. Age and sex-specific body mass index (BMI) z-scores were calculated. Mothers were interviewed about socioeconomic factors, health behaviors, perceptions and beliefs. Results: The prevalence of overweight and obesity (above the 85th percentile for BMI-z-score) was 29.8% for children (n=251) and 51.8% (BMI ≥25) for mothers (n=220). Mean age and sleeping hours, sex distribution and level of poverty were similar between the normal and overweight-obese children groups. Over 82% of mothers underestimated their child's weight status. Of the 62 overweight-obese children, 74.2% were defined by their mothers as having 'normal weight' and 8% were defined as 'thin'. Mothers defined 67 out of 158 normal weight children (42.4%) as 'thin' (p<0.001). In a multivariable logistic regression model including maternal obesity, living below poverty line, and daily child sedentary hours, maternal underestimation of the child's weight status (OR=8.3;95%CI:2.7-25,P<.0001) and parental smoking (OR=4.2;95%CI: 1.6-11.4,P=0.005) were the only significant factors associated with overweight and obesity in LSES children. Conclusions: Maternal perception of child's weight status and parental smoking may be determinants of the development of childhood obesity among LSES children. These associations should be confirmed in prospective studies but may be indicators of poor overall health habits. Health professionals should consider those behaviors in future planning of obesity prevention programs.