• Aleksandra Stamenova Ss. Cyril and Methodius University in Skopje, School of Doctoral Studies, Faculty of Medicine, Skopje, North Macedonia
  • Lorraine Silver Wallace The Ohio State University, College of Medicine, Columbus, Ohio
  • Katerina Mihajlova Ss. Cyril and Methodius University in Skopje, School of Doctoral Studies, Skopje, North Macedonia
  • Igor Spiroski Institute of Public Health of the Republic of North Macedonia, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia


parental perception childhood obesity weight status WHO-COSI


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.


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