Parental perception of child weight status and its association to overweight and obesity in children

Background

Childhood overweight and obesity remain major public health challenges. Municipal monitoring systems are essential to support evidence-based local policies. Parental perception of child weight is a key determinant for early identification and intervention. This study assessed the association between parental perception and objectively measured weight status in primary school children.

Methods

A cross-sectional study was conducted within a municipal monitoring system among primary school children (n = 523) in Porto, Portugal. Anthropometric measurements were collected and weight status classified using standard criteria. Parental perception and sociodemographic data were obtained through questionnaires. Associations were analyzed using chi-square tests and logistic regression models adjusted for child sex and parental education.

Results

The prevalence of overweight and obesity was 32.0%. A significant association was observed between parental perception and children’s weight status (χ²=111.1; p < 0.001). Children perceived as having excess weight were substantially more likely to be overweight or obese compared to those perceived as having normal weight. In logistic regression analysis, parental perception was strongly associated with overweight/obesity (crude OR = 47.2; 95% CI: 14.3–155.4; p < 0.001), remaining significant after adjustment (adjusted OR = 71.3; 95% CI: 16.9–300.1; p < 0.001). This association was consistent across genders, with similar effect sizes observed in both boys and girls.

Conclusions

Parental perception is strongly associated with child weight status, regardless of sociodemographic factors. However, it masks under-recognition, as many parents misclassify overweight children or identify it late, meaning the main challenge is not accuracy but detection. Raising parental awareness should be a priority in local strategies, especially within monitoring systems enabling early identification across the spectrum of nutritional status.

Key messages

• Parental perception is strongly linked to child weight status, but often fails to detect early overweight, highlighting detection as the key gap for timely prevention, rather than accuracy.

• Municipal monitoring systems enable early identification of childhood overweight and obesity, increasing parental awareness and informing targeted local prevention policies.