Mother's “altered” representation of children's weight: How culture creates shared patterns of social evaluation

Objective. An altered representation of parents regarding the weight status of their children may foretell difficulties in implementing effective policies against obesity. 

Study design. The OBEY-AD is a cross-sectional study realized in 9 countries enrolling 2635 children aged 3-11 years. Children’s BMI CDC z-scores have been computed and categorized as Normal, Overweight, Obese and Underweight. Mothers have been asked to judge the weight status of their children according to these categories.

Results. 567 children resulted as obese or overweight (21%). Out of them, 22% (413) were not recognized by mothers as suffering from an excess of weight. Such figures range from up to 38% in Italy down to 14% in Germany. Overall agreement between perceived and actual weight status of children was very poor (Kappa 0.19,p<0.001). Surprisingly, 5% of the overweight/obese children were considered as underweight by their mothers (up to 12% in Brazil). Misperception of children’s weight status seemed to be significantly related to family socio-economic status and in particular to parents’ education.

Conclusions. This study quantifies the extent of the so-called social desirability bias, namely mother’s unconscious attitude to adapt empirical evidence to more culturally legitimized ideal-types of what their children’s weight status is expected to be. Considered than mothers are most often responsible for family care and nutrition choices, in particular in lower socio-economic strata of the population, there’s a potential for undermining effectiveness of policies against obesity.  If parents do not recognize their childs’ physical condition, they can’t intervene to target their children obesity.