Parental Misperception of Preschool Children’s Weight Status in China: Verbal Versus Visual Assessment and Associations with Feeding Practices

Background: Parental misperception of child weight status may influence feeding practices, with implications for early prevention of childhood obesity. This study compared verbal and visual assessments of parental perception and misperception of preschool children’s weight status and examined associations between method-specific parental weight underestimation and feeding practices. Methods: This cross-sectional study included 520 parent–child dyads in Shanghai, China. Parental perception was assessed using a verbal item and visual silhouettes and compared with objectively measured child weight status. Agreement with actual weight status, overall perception patterns, and differences in underestimation between methods were examined using kappa statistics, Bowker’s test, and McNemar’s test, respectively. Associations between method-specific underestimation and feeding practices were examined using multivariable linear regression with false discovery rate (FDR) correction. Results: Agreement with actual weight status was limited for both methods and lower for visual than verbal assessment (quadratic weighted κ = 0.21 vs. 0.37). Underestimation was more common with visual than verbal assessment in the overall sample (45.1% vs. 37.8%, p < 0.001), particularly among children with overweight or obesity (87.5% vs. 43.2%, p < 0.001). Verbal underestimation was associated with lower scores for content-restricted feeding (adjusted β = −0.159, 95% CI: −0.312 to −0.005, p = 0.043) and behavior-restricted feeding (adjusted β = −0.129, 95% CI: −0.252 to −0.007, p = 0.038), whereas visual underestimation was not consistently associated with feeding practices. However, neither verbal association remained statistically significant after FDR correction (both adjusted p = 0.203). Conclusions: Verbal and visual assessments showed different patterns of parental weight perception and misperception and different associations between parental underestimation and feeding practices. Appropriate tool selection may support parental recognition of children’s weight status and feeding-related guidance for early prevention of childhood obesity.