PARENTAL PERCEPTIONS ON THEIR CHILD'S WEIGHT STATUS IN NORTH MACEDONIA
Keywords:
parental perception childhood obesity weight status WHO-COSIAbstract
Introduction: Obesity is a growing crisis, with onset in early childhood.
Aim: The purpose of this study was to explore parental perceptions of their child’s weight among a nationally representative sample of children living in North Macedonia.
Materials and Methods: From October to December 2022, a cross-sectional study was conducted including children and their parents/caregivers who were living in North Macedonia. The study was a part of the 6th round of the WHO Childhood Obesity Surveillance Initiative (COSI). Parental perceptions were assessed through record forms and compared in relation to objectively measured weight status using anthropometric standardized procedures. WHO 2007 cut-off definitions on overweight/obesity were used. Wald χ2-tests were used to explore relations between objectively measured weight status (i.e., body mass index - BMI) and parental perceptions of their child’s weight status. Statistical significance was set at p<0.05 a priori.
Results: The sample was composed of 2613 school children with equal male to female representation and majority living in urban areas, whilst 31.8% of the children were living with overweight (including obesity). Parents underestimated their child’s weight status, especially regarding children with overweight and obesity.
Conclusion: To the best of our knowledge, this is the first study in North Macedonia to explore parental perceptions of school children’s weight status and compare accuracy with objective measured children’s weight status. Our study further compliments previous evidence of parental underestimation of children living with overweight and obesity, which is a crucial factor in understanding and addressing childhood obesity.
References
WHO. Acceleration plan to stop obesity. World Health Organization, Geneva; 2022. Available at: https://www.who.int/publications/i/item/9789240075634 [Assessed on 15th March 2024].
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents and adults. The Lancet 2024; 403: 1027-50. doi: 10.1016/S0140-6736(23)02750-2.
World Health Organization. WHO European Regional Obesity Report 2022. World Health Organization. Regional Office for Europe, Copenhagen, 2022. Available at: https://iris.who.int/handle/10665/353747. [Assessed on 22nd October 2023].
Makkes S, Renders CM, Bosmans JE, van der Baan-Slootweg OH, Seidell JC. Cardiometabolic risk factors and quality of life in severely obese children and adolescents in the Netherlands. BMC Pediatr 2013; 13: 62. doi:10.1186/1471-2431-13-62.
Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. J Family Med Prim Care 2015; 4: 187-192. doi:10.4103/2249-4863.154628.
Salama M, Balagopal B, Fennoy I, Kumar S. Childhood obesity and cardiovascular disease risk. J Clin Endocrinol Metab. 2023; 108(12): 3051-3066. doi: 10.1210/clinem/dgad361.
Solmi M, Köhler C, Stubbs B, Koyanagi A, Bortolato B, Monaco F. Environmental risk factors and nonpharmacological and nonsurgical interventions for obesity: An umbrella review of meta-analyses of cohort studies and randomized controlled trials. Eur J Clin Invest 2018; 48(12): 12982. doi:10.1111/eci.12982.
Gee DG, Cohodes EM. Caregiving Influences on Development: A Sensitive Period for Biological Embedding of Predictability and Safety Cues. Curr Dir Psychol Sci 2021; 30(5): 376-383. doi:10.1177/09637214211015673.
Santos F.A., Martins C.M., Fernandes C., Bost K.K., Verissimo M. Relation between Attachment and Obesity in Preschool Years: A systematic Review of the Literature. Nutrients 2021; 13(10)3572. doi:10.3390/nu13103572.
Marco PL, Valério ID, Zanatti CL. de M, Gonçalves H. Systematic review: Symptoms of parental depression and anxiety and offspring overweight. Revista De Saúde Pública 2020; 54: 49. doi:10.11606/s1518-8787.2020054001731.
Tate EB, Wood W, Liao Y, Dunton GF. Maternal stress and child obesity. Obes Rev 2020; 16: 351-361.doi:10.1111/obr.12262.
Hemmingsson E, Johansson K, Reynisdottir S. Effects of childhood abuse on adult obesity: a systematic review and meta-analysis. Obes Rev 2014; 15(11): 882-893. doi: 10.1111/obr.12216.
Lusk JL, Ellison B. Who is to blame for the rise in obesity? Appetite 2013; 68: 14-20. doi: 10.1016/j.appet.2013.04.001.
Bensley J, Riley HO, Bauer KW, Miller AL. Weight bias among children and parents during very early childhood: A scoping review of the literature. Appetite 2023; 183: 106461. doi: 10.1016/j.appet.2023.106461.
Ma L, Chu M, Li Y, Wu Y, Yan AF, Johnson B, et al. Bidirectional relationships between weight stigma and pediatric obesity: A systematic review and meta-analysis. Obes Rev 2021; 22(6): e13178. doi: 10.1111/obr.13178.
an der Kruk JJ, Kortekaas F, Lucas C, Jager-Wittenaar H. Obesity: a systematic review on parental involvement in long-term European childhood weight control interventions with a nutritional focus. Obes Rev 2013; 14(9): 745-760. doi: 10.1111/obr.12046.
Wang Y, Wu Y, Wilson RF, Bleich S, Cheskin L, Weston C, et al. Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US) 2013. Report No: 13-EHC081-EF. PMID: 23865092.
WHO. Childhood Obesity Surveillance Initiative (COSI). Protocol. World Health Organization Regional Office for Europe in Denmark, 2016. Available at: https://iris.who.int/handle/10665/354793 [Assessed on 3rd November 2023]
Breda J, McColl K, Buoncristiano M, Williams J, Abdrakhmanova S, Abdurrahmonova Z, et al. Methodology and implementation of the WHO European Childhood Obesity Surveillance Initiative (COSI). Obes Rev 2021; 22(Suppl 6): e13215. doi: 10.1111/obr.13215.
WHO. International ethical guidelines for health-related research involving humans. World Health Organization, Geneva, 2002. Available at: https://pubmed.ncbi.nlm.nih. gov/14983848/ [Assessed on 25th May 2024].
de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007; 85(09): 660-667. doi: 10.2471/blt.07.043497.
Buoncristiano M, Williams J, Simmonds P, Nurk E, Ahrens W, Nardone P, et al. Socioeconomic inequalities in overweight and obesity among 6- to 9-year-old children in 24 countries from the World Health Organization European region. ObesRev 2021; 22(S6): e13213. doi: 10.1111/obr.13213.
Ramos Salas X, Buoncristiano M, Williams J, Kebbe M, Spinelli A, Nardone P, et al. Parental Perceptions of Children's Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017. Obes Facts 2021; 14(6): 658-674. doi:10.1159/000517586.
Sumińska M, Podgórski R, Bogusz-Górna K, Skowrońska B, Mazur A, Fichna M. Historical and cultural aspects of obesity: From a symbol of wealth and prosperity to the epidemic of the 21st century. Obes Rev 2022; 23(6): e13440. doi: 10.1111/obr.13440.
Rietmeijer-Mentink M, Paulis WD, van Middelkoop M, Bindels PJ, van der Wouden JC. Difference between parental perception and actual weight status of children: a systematic review. Matern Child Nutr 2013; 9(1): 3-22. doi: 10.1111/j.1740-8709. 2012.00462.x.
Lundahl A, Kidwell KM, Nelson TD. Parental underestimates of child weight: a meta-analysis. Pediatrics 2014; 133(3): e689-e703. doi: 10.1542/peds.2013-2690.
Doolen J, Alpert PT, Miller SK. Parental disconnect between perceived and actual weight status of children: a metasynthesis of the current research. J Am Acad Nurse Pract 2009; 21(3): 160-166. doi: 10.1111/j.1745-7599.2008.00382.x.
Wang J, Zhu D, Cheng X, Liuzhou Y, Zhu B, Montgomery S, et al. Maternal perception of child weight and concern about child overweight mediates the relationship between child weight and feeding practices. Public Health Nutr 2022; 25(7): 1-10. doi: 10.1017/S1368980022000040.
Blanchet R, Kengneson CC, Bodnaruc AM, Gunter A, Giroux I. Factors Influencing Parents' and Children's Misperception of Children's Weight Status: a Systematic Review of Current Research. Curr Obes Rep 2019; (4): 373-412. doi: 10.1007/ s13679-019-00361-1.
Tschamler JM, Conn KM, Cook SR, Halterman JS. Underestimation of children's weight status: views of parents in an urban community. Clin Pediatr (Phila) 2010; 49(5): 470-476. doi: 10.1177/0009922809336071.
O'Brien K, Agostino J, Ciszek K, Douglas KA. Parents' perceptions of their child's weight among children in their first year of primary school: a mixed-methods analysis of an Australian cross-sectional (complete enumeration) study. Int J Obes (Lond) 2022; 46(5): 992-1001. doi: 10.1038/s41366-022-01068-5.
Loth KA, Mohamed N, Trofholz A, Tate A, Berge JM. Associations between parental perception of- and concern about-child weight and use of specific food-related parenting practices. Appetite 2021; 160: 105068. doi: 10.1016/j.appet.2020.105068.
Suligowska K, Buczny J. Obesity in Polish Children and Parents' Perception of Their Children's Weight Status: The Results of the SOPKARD-Junior Study. Int J Environ Res Public Health 2022; 19(8): 4433. doi: 10.3390/ijerph19084433.
Pudney EV, Puhl RM, Halgunseth LC, Schwartz MB. An Examination of Parental Weight Stigma and Weight Talk Among Socioeconomically and Racially/Ethnically Diverse Parents. Fam Community Health 2024; 47(1): 1-15. doi: 10.1097/FCH. 0000000000000384.
