Two-thirds of mothers in a recent study did not perceive their toddler's… (Lawrence K. Ho / Los Angeles…)
A new study of low-income mothers of toddlers has found that two-thirds did not correctly perceive their children’s size. And most — including all of the misperceiving moms with kids who were overweight — thought their kids were too small, not too big.
The discovery, which echoes findings in older children, illustrates how perceptions about weight complicate doctors’ efforts to keep kids healthy, wrote Dr. Eliana Perrin in an invited commentary that accompanied the study, which was published Monday in the Archives of Pediatrics & Adolescent Medicine.
“Because of its high prevalence (33%), being overweight has become the norm for too many children and parents,” Perrin wrote.
To conduct their analysis of maternal perceptions of toddler weight, University of Maryland pediatrics professor Erin Hager and coauthors worked with 281 mother-toddler pairs. The children were ages 12-32 months and were classified into three categories by weight. Kids who were small enough to be below the 15th percentile for weight-to-length measurements were considered underweight. Kids in the 85thpercentile or higher were overweight. The rest of the children were considered normal weight.
Mothers in the study ranged in age from 18 to 46. Most of them — more than 70% — were overweight or obese, with a body mass index of 25 or more. Two-thirds were at or below the poverty level.
The researchers asked the mothers to identify, from a series of seven toddler silhouettes, which body size best matched their child’s. Responses were considered accurate if the mothers chose within one silhouette of their child’s actual body size and inaccurate if they were off by two or more silhouettes.
The mothers also pointed out to the researchers what body shape they would like their child to have. If they chose the child’s actual size, they were considered satisfied with their kid’s weight.
Analysis of the data showed that nearly 70% of the mothers did not identify their child’s body size accurately. These mothers had children who were larger on average than the children of accurate mothers. Among the mothers with overweight toddlers, 94% were wrong about their children’s size — all of them believing the kids were smaller than they actually were. The vast majority of inaccurate mothers of normal-weight children also thought their kids were smaller, not larger, than actual size.
Mothers of overweight toddlers had “difficulty recognizing discrepant sizes perhaps because they idealize their child to be of normal size. This may be because high-weight status is often regarded as a sign of successful parenting,” the researchers wrote.
A few mothers of overweight and normal weight kids — 4% and 21% — said they wished their children were one or more silhouette categories larger.
Mothers of underweight toddlers, on the other hand, were most likely to be accurate about, and dissatisfied with, their children’s size. Hager and colleagues argued that this probably reflects “the cultural value against underweight among toddlers” and “illustrates the critical role of accuracy in readiness to change.”
“Parents are more likely to adopt health-promoting strategies when they accurately perceive a concern and are not satisfied with the status quo,” they wrote.
Weighing too much as a young child can increase the risk of obesity and weight-related health problems later in life, they noted in the study.
One way to change the dangerous misperceptions? A public health campaign, Perrin wrote in her commentary.
“I am imagining posters showing photographs of children of all ages between the 5th and 85th percentiles saying ‘I’m at a healthy weight!’” she wrote.
Also Monday, the Centers for Disease Control and prevention released new obesity forecasts for the U.S., which predicted that the proportion of Americans who are obese is expected to climb to 42% by 2030. The Times’ Melissa Healy reported on the new statistics in Booster Shots (see related items, at left).