Parental and Child Factors Associated with Under-Estimation of Children with Excess Weight in Spain.

Objective Understanding obesity misperception and associated factors can improve strategies to increase obesity identification and intervention. We investigate underestimation of child excess weight with a broader perspective, incorporating perceptions, views, and psychosocial aspects associated with obesity. Methods This study used cross-sectional data from the Spanish National Health Survey in 2011-2012 for children aged 2-14 years who are overweight or obese. Percentages of parental misperceived excess weight were calculated. Crude and adjusted analyses were performed for both child and parental factors analyzing associations with underestimation. Results Two-five year olds have the highest prevalence of misperceived overweight or obesity around 90%. In the 10-14 year old age group approximately 63% of overweight teens were misperceived as normal weight and 35.7 and 40% of obese males and females. Child gender did not affect underestimation, whereas a younger age did. Aspects of child social and mental health were associated with under-estimation, as was short sleep duration. Exercise, weekend TV and videogames, and food habits had no effect on underestimation. Fathers were more likely to misperceive their child´s weight status; however parent's age had no effect. Smokers and parents with excess weight were less likely to misperceive their child´s weight status. Parents being on a diet also decreased odds of underestimation. Conclusions for practice This study identifies some characteristics of both parents and children which are associated with under-estimation of child excess weight. These characteristics can be used for consideration in primary care, prevention strategies and for further research.