Mothers' perceptions of their adolescents' weight status: are they accurate?

Nutrition Research Newsletter, Jan, 2005

In the United States, ~20% of adolescents are considered overweight, and studies show that rates are increasing. Overweight youth are at risk for cardiovascular disease and mortality, and the risk of being overweight in adulthood is twice as high for overweight than nonoverweight children. Parents have an important role to play in preventing the onset of a broad army of weight-related problems in their teenagers. Parental perceptions of their teen's weight status may affect the messages in families regarding weight, eating, and exercise.

Little research has been published on parental accuracy of their adolescents' weight status. It is not clear whether the accuracy of parents' perceptions of adolescent weight status is affected by the parent's weight or by ethnicity. The objectives of the present study were to evaluate the accuracy of mothers' perceptions about their adolescents' weight status and to evaluate whether mothers' misclassification of adolescent weight status varies by demographic factors.

The participants included 755 adolescents (397 boys/358 girls) who completed the Project EAT (Eating among Teens) student survey and their mothers/female guardians who participated in telephone interviews. The participants were a subset of 4746 Project EAT participants. The 755 adolescents in this study included those who completed a classroom-based survey (study-wide response rate 81.5%) and whose female parent/guardian completed a telephone interview. Among the 755 adolescents, 47% were boys, 60% were in high school, 33% were white, 24% were black, 17% were Asian, 13% were Hispanic, and 13% were other/mixed; the mean age was 14.6 years (SD = 1.7). Female guardians (91% mothers) were interviewed by telephone (76.3% of those selected for parent interviews) and are referred to as "mothers" hereafter. Of the 755 mothers, 48% were white, 23% were black, 13% were Asian, 9% were Hispanic, and 7% were other/mixed; 63% were married; socioeconomic status (SES) was equally distributed; and 83% were working outside of the home.

Mothers were asked how they would describe their adolescent's current weight: very underweight, somewhat underweight, about right, somewhat overweight, or very overweight. The very underweight and somewhat underweight classifications were pooled, resulting in four categories for analysis. Accuracy of mothers' perception of adolescents' weight was calculated by comparing the mother's report of adolescent current weight status with the Centers for Disease Control and Prevention BMI weight classification. These comparisons resulted in three groups of mothers: mothers who underestimated their adolescent's weight status, mothers who accurately assessed their adolescent's weight status, and mothers who overestimated their adolescent's weight status.

Based on national reference data, approximately one-half (51.1%) of the mothers and 16.5% of the adolescents were considered overweight, and an additional 19.9% of adolescents were considered at risk for overweight. Adolescent weight status was accurately assessed by the majority of mothers (60.4%), underestimated by about one-third of mothers (35.3%), and overestimated by 5% of mothers.

Race/ethnicity of mothers and adolescents, weight status of mothers and adolescents, and adolescents' gender were significantly associated with the accuracy of mothers' perception of adolescent weight status. Higher rates of accuracy were evident for Asian and white mothers compared with African-American, Hispanic, and other mothers. Asian, white, and African-American teens were more likely to have their weight status accurately estimated by their mothers than Hispanic or other teens.

Compared with overweight mothers, nonoverweight mothers were significantly more likely to be accurate in their assessment of adolescent weight status. Similarly, parental accuracy was significantly higher for adolescents in the average weight range. The majority of overweight teens had mothers who underestimated their weight status. Significantly more mothers of adolescent girls were accurate in their assessment of adolescent weight status than mothers of adolescent boys.

This study evaluated mothers' perceptions of adolescents' weight status and compared them with the adolescents' weight status. Most mothers (60%) accurately assessed their adolescent's weight status; however, underestimates were common (35%). Mothers were more likely to overestimate their daughter's weight status than their son's weight status. Overweight mothers were more likely than normal-weight mothers to underestimate their adolescent's weight status. The gender difference in mothers' perceptions of adolescent weight status suggests that mothers may be more accepting of higher weights among their sons than among their daughters. Whether or not these inaccuracies serve as an impediment to parental support for healthy weight management or, conversely, shade boys from unhelpful pressures to lose weight warrants further exploration. In summary, findings suggest that the majority of parents do not need to be told that their children are overweight; instead, messages to parents of overweight teens should focus on how to provide positive support for behavioral change and healthy weight management.