Beyond Oblivobesity: Seven Myths About Parental Misperception of Children's Weight.

[Author Affiliation]Arnaldo Perez. Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.Geoff D.C. Ball. Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.Address correspondence to: Geoff D.C. Ball, PhD, RD, Department of Pediatrics, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405m 87th Avenue, Edmonton, Alberta, Canada T6G IC9, E-mail: gdball@ualberta.caTo the Editor:In a recent editorial in Childhood Obesity, Katz commented on the phenomenon of parents' misperception of children's excess weight.1 Although the editorial focused on engaging children and their families in obesity management, he challenged a common belief in the weight misperception literature, which is to combat misperception of excess weight with objective information. Upon review of the misperception literature, we believe there is value in going "beyond oblivobesity" to consider a number of misunderstandings related to the conceptualization, interpretation, and attempt to address the discrepancy between perceived and actual weight status of children.1. Parents are unaware of their children's obesity. Most studies on parental weight misperception have relied on anthropometric measures (e.g., BMI) to determine children's weight status.2 Given that these metrics only provide an indirect estimate of obesity, parental unawareness of child obesity can only ever be estimated indirectly as well. Further, unawareness is just one aspect of weight misperception; the latter not only implies that parents are unaware of their children's actual weight status, but also that they assign to their children a weight status other than the actual status. Compared to unawareness, misperception may exert a greater influence on whether parents choose to "accept" objective data (e.g., BMI plotted on a growth chart) showing that their children meet the clinical definition for obesity.2. Parents fail to recognize their children's weight problem. Conceptually, it is important to differentiate between misclassifying the identity of a condition (which is the main focus of studies on perceived weight status) and being concerned about a condition (perceiving it as a problem). Health concern in general, and weight concern in particular, depend on (1) the severity attached to the consequences of the condition and (2) the perceived personal susceptibility to those consequences. In this regard, accurate recognition of excess weight is necessary, but not sufficient, to be concerned about obesity. For instance, both Genovesi and colleagues3 and Jain and colleagues4 found that most parents in their studies were aware of, but not concerned about, their children's excess weight.3. Parents will not take preventive actions to address obesity unless a weight problem is recognized. Compared to parents who failed to recognize their children's excess weight, Neumark-Sztainer and colleagues5 found that those who recognized it correctly were not more likely to promote healthier lifestyle behaviors for their children. Qualitative evidence has shown that children's psychosocial well-being and quality of life were more common reasons for parents to engage in pediatric weight management versus concerns about children's weight and physical health.6,7 It is sometimes forgotten in the dominant discourse about nutrition, physical activity, and obesity that individuals may perform healthy lifestyle behaviors not because a problem exists or because one is expected, but for the simple sake of living a healthy and enjoyable life.4. Parents who do not recognize their children's obesity are in denial. Given that children's excess weight is visually apparent, it is often assumed that parents should recognize it unless they are in denial. As a defense or coping mechanism, 8 denial denotes a causal attribution to account for weight misperception that cannot be demonstrated by simply comparing the perceived and actual weight status. …