Objective To examine the longitudinal trajectories of maternal weight perception bias toward preschool children, to identify distinct trajectory groups, and to explore their associated sociodemographic characteristics. Methods In this longitudinal study, 176 mothers and their preschool children from eight public kindergartens in Shanghai were followed at three time points over a 2-year period, beginning in December 2020. Group-based trajectory modeling was used to identify trajectories of maternal weight perception bias, and multinomial logistic regression was performed to examine associated sociodemographic factors. Results Maternal misperception of children's weight status was predominantly characterized by underestimation. Across the three follow-up assessments, the proportions of accurate maternal perception were 64.2%, 63.1%, and 55.1%, respectively. Four trajectory groups were identified: persistent underestimation (n=29, 16.5%), underestimation-to-accurate perception (n=17, 9.6%), persistent accurate perception (n=88, 50.0%), and accurate perception-to-underestimation (n=42, 23.9%). Multinomial logistic regression showed that, compared with the persistent accurate perception group, a higher baseline BMI-for-age Z score (BAZ) was associated with a lower likelihood of persistent underestimation (OR=0.130, 95%CI: 0.059 - 0.289). In addition, compared with mothers of girls, mothers of boys were more likely to shift from accurate perception to underestimation (OR=4.793, 95%CI: 1.959 - 11.725). Conclusions Maternal weight perception bias toward preschool children follows distinct trajectories over time.Children's gender and early BAZ are important factors associated with trajectory patterns of maternal weight perception bias.
Key words
overweight /
obesity /
weight perception /
perception bias /
preschool children /
group-based trajectory model
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Phelps NH, Singleton RK, Zhou B, et al. Worldwide trends in underweight and obesity from 1990 to 2022: A pooled analysis of 3 663 population-representative studies with 222 million children, adolescents, and adults[J]. Lancet, 2024, 403(10431): 1027-1050.
[2] Ramos Salas X, Buoncristiano M, Williams J, et al. Parental perceptions of children's weight status in 22 countries: The WHO European childhood obesity surveillance initiative: COSI 2015/2017[J]. Obes Facts, 2021, 14(6): 658-674.
[3] Xiang C, Zhang Y, Yong C, et al. Association between parents' perceptions of preschool children's weight, feeding practices and children's dietary patterns: A cross-sectional study in China[J]. Nutrients, 2021, 13(11): 3767.
[4] 孙欣鑫, 陈荣, 杭琳, 等. 学龄前儿童家长体重认知现状及影响因素分析[J]. 现代预防医学, 2021, 48(13): 2379-2382.
Sun XX, Chen R, Hang L, et al. Investigation on the status of parental perception of preschool children's weight and analysis of influencing factors[J]. Mod Prev Med, 2021, 48(13): 2379-2382. (in Chinese)
[5] 杨可欣, 苏凤华, 孙靓, 等. 家长对4～6岁儿童体重感知偏差情况调查[J]. 预防医学, 2021, 33(2): 200-203.
Yang KX, Su FH, Sun L, et al. Parents' perception bias on 4-6-year-old children's weight[J]. Prev Med, 2021, 33(2): 200-203. (in Chinese)
[6] Chen Y, Qu F, Song X, et al. Parental weight perception and non-responsive feeding practices in Chinese preschoolers: A prospective longitudinal study[J]. Eur J Pediatr, 2025, 184(9): 538.
[7] 王健, 朱大乔. 父母对学龄前儿童体重感知偏差的影响因素[J]. 解放军护理杂志, 2019, 36(11): 50-53.
Wang J, Zhu DQ. Parents' perception bias of preschool children's weight and its influencing factors[J]. Nurs J Chin PLA, 2019, 36(11): 50-53. (in Chinese)
[8] He M, Evans A.Are parents aware that their children are overweight or obese? Do they care?[J]. Can Fam Physician, 2007, 53(9):1493-1499.
[9] Rodrigues D, Machado-Rodrigues AM, Padez C. Parental misperception of their child's weight status and how weight underestimation is associated with childhood obesity[J]. Am J Hum Biol, 2020, 32(5): e23393.
[10] Yang J, Zhou L, Chen L, et al. Parental perceptions of preschool children's weight status in China: A cross-sectional study[J]. Obes Facts, 2025, 18(3): 296-304.
[11] Esteban-Vasallo MD, Galán I, Ortiz-Pinto MA, et al. Accuracy of anthropometric measurements and weight status perceptions reported by parents of 4-year-old children[J]. Public Health Nutr, 2020, 23(4): 589-598.
[12] Robinson E. Overweight but unseen: A review of the underestimation of weight status and a visual normalization theory[J]. Obes Rev, 2017, 18(10):1200-1209.
[13] Latner JD, Stunkard AJ, Wilson GT. Stigmatized students: Age, sex, and ethnicity effects in the stigmatization of obesity[J]. Obes Res, 2005, 13(7): 1226-1231.
[14] Hansen AR, Duncan DT, Tarasenko YN, et al. Generational shift in parental perceptions of overweight among school-aged children[J]. Pediatrics, 2014, 134(3): 481-488.
[15] Guendelman S, Fernald LCH, Neufeld LM, et al. Maternal perceptions of early childhood ideal body weight differ among Mexican-origin mothers residing in Mexico compared to California[J]. J Am Diet Assoc, 2010, 110(2): 222-229.
[16] 郑丽霞, 宋道平, 陈楚琳, 等. 中文版儿童喂养问卷在学龄前儿童家长中的信效度分析[J]. 中国儿童保健杂志, 2016, 24(10): 1019-1023.
Zheng LX, Song DP, Chen CL, et al. Reliability and validity of a Chinese version of Child Feeding Questionnaire among parents of preschoolers[J]. Chin J Child Health Care, 2016, 24(10): 1019-1023. (in Chinese)
[17] 伍茹星, 魏晓雪, 王健, 等. 祖辈与父辈家长对学龄前儿童体重感知及其影响因素差异性分析[J]. 中国预防医学杂志, 2022, 23(6): 424-429.
Wu RX, Wei XX, Wang J, et al. Parental misperception on bodyweight of preschool children and its influencing factors[J]. Chin Prev Med, 2022, 23(6): 424-429. (in Chinese)
[18] 张晨旭, 谢峰, 林振, 等. 基于组轨迹模型及其研究进展[J]. 中国卫生统计, 2020, 37(6): 946-949.
[19] Costa A, Hetherington MM, Oliveira A. Maternal perception, concern and dissatisfaction with child weight and their association with feeding practices in the Generation XXI birth cohort[J]. Br J Nutr, 2022, 127(7): 1106-1116.
[20] Duncan DT, Hansen AR, Wang W, et al. Change in misperception of child's body weight among parents of American preschool children[J]. Child Obes, 2015, 11(4): 384-393.
[21] 伍茹星, 朱大乔. 体重感知的概念与测评方法[J]. 解放军护理杂志, 2019, 36(7): 54-58.
Wu RX, Zhu DQ. The concept and evaluation method of weight perception[J]. Nurs J Chin PLA, 2019, 36(7): 54-58. (in Chinese)
PDF(896 KB)
