Determinants of child body weight categorization in parents and health care professionals: An experimental study.

Objectives: Parents infrequently recognize childhood overweight/obesity and healthcare professionals (HCPs) also struggle to visually identify it, potentially limiting the offer and uptake of weight management support. This study examined perceptual and attitudinal/cognitive determinants of child weight judgements amongst parents and HCPs to identify targets for intervention.

Design: We used a mixed experimental design with parents and HCPs as the between-participants factor. Stimulus gender, age and BMI centile were the within-participant repeated measures factors.

Methods: One hundred and fifty-six HCPs and 249 parents of children aged 4-5 or 10-11 years viewed simulated child images. They estimated their relative size and categorized the weight status of each figure. Stimuli were photo-realistic figural scales based on 3D-scans of 4- to 5- and 10- to 11-year-old children varying in adiposity. Participants also reported their beliefs about causes, controllability and categorization of child weight.

Results: Both groups accurately estimated the figures' relative size. However, categorization of higher weight figures was poor, demonstrating a mismatch between perceptual judgements of size and categorization of weight status. Lower levels of comfort with assigning 'overweight' categorizations to children, and a stronger belief that weight was controllable by the child/parent, predicted less accurate weight status categorizations.

Conclusions: Parental and HCP misperceptions when categorizing children's higher weight are related to attitudinal/cognitive factors, including reluctance to label a child's weight status as overweight and beliefs about whether a child's weight can be controlled by them or their family.