Warschburger and Kröller BMC Public Health 2012, 12:295 http://www.biomedcentral.com/1471-2458/12/295 Perception of weight status and need for action To assess the perception of weight status, mothers were presented with a panel of silhouettes (described in more detail in [12]). These were based on relevant anthropo- metric measures of children in different age groups (2- to 4-years or 5- to 10-years old) and of different gen- ders (female or male). In each set, two silhouettes repre- sented underweight children (3rd and 10th percentile), three sketches represented normal weight children (25th, 50th and 75th percentile), and two represented an over- weight or obese child (90th and 97th percentile). A previ- ous study validates these silhouettes as a tool for the assessment of weight perceptions across the represented age and gender groups [25]. Mothers were asked to answer the following questions in relation to the age- and gender-relevant set of silhou- ettes for their own child: “Which of the silhouettes do you think represent overweight children?” (identification of overweight silhouettes), “Which silhouette best repre- sents the weight status of your child?” (perception of their own child) and “Which of the silhouettes do you prefer for your child?” (preferred body size). The differ- ence between the current and preferred weight status was operationalized as a measure of weight dissatisfac- tion. Additionally, mothers were questioned about their perception of risks of physical and mental health pro- blems associated with overweight (e.g. “Which silhou- ettes do you think bear an increased risk for physical/ mental health problems?”), as well as their perception of the need for action to prevent obesity (“Which of the sil- houettes signals your readiness to employ strategies to prevent overweight in your child?”). Mothers were able to answer all of these questions by indicating multiple silhouettes, except for the perceived current weight Table 1 Sample description Page 3 of 8 status and the preferred body size of their child. In the analyses we report, we consider the first mark set as a lower bound. Sample A total of 482 mother-child pairs fulfilled the inclusion cri- teria (age range of 2 to 10 years, with no diet-related health problems). 130 participants were excluded because their questionnaires were more than 5% incomplete. There were no significant differences in demographic and weight vari- ables between non-completers and completers. The final sample for statistical analysis consisted of 352 participants (151 (43%) mothers who filled in the online questionnaire, and 201 (57%) mothers who filled in the paper version, in which 32% were recruited from child-care centers and 68% from children’s health clinics). 95.4% of the mothers were German citizens and 78.3% lived in a partnership. Their children averaged 5.67 years of age (range from 2 to 10 years), and their distribution of sexes was almost equal. Table 1 summarizes the demographic aspects and the weights of the participants. Preliminary analyses revealed differences between mothers who filled in the online ques- tionnaire and those who were recruited from clinics or child-care centers: mothers who were recruited from child- care centers had younger children on average than those who filled in the online version or were recruited from chil- dren’s health clinics (F(1, 349) = 24.68, p < .01). Additionally, mothers who filled in the online questionnaire reported lower weights for their child (F(1, 349) = 8.91, p < .01) and for themselves (F(1, 349) = 12.54, p < .01) as well as a higher level of education (F(1, 349) = 22,89, p < .01) than mothers who were recruited from clinics. These variables were included as covariates in the regression reported below. Sex Age BMI-SDS (mother’s report) Age Per capita income (per month) educational level (years in school) BM I(self report) Children (n = 352) Mothers (n = 352) 168 (47%) female; 184 (53%) male M = 5.67 years, SD = 1.97 (2 – 10 years of age) - 40 (12%) under 3 years of age - 159 (45%) between 3 and 6 years of age - 153 (33%) over 6 years of age M = −0.26, SD = 1.30 (− 5.41 – 4.07) - 57 (16%) underweight (BMI-SDS < 10th perc.) - 261 (74%) normal weight (10th perc. ≥ BMI-SDS ≤ 90th perc.) - 34 (10%) overweight or obese (BMI-SDS > 90th perc.) M = 34.48 years, SD = 5.20 (20 – 50 years of age) M = 739.57 Euro, SD = 295.53 (220 – 2667 Euro) M = 10.89 school years, SD = 1.40 (6 – 12 years of school) BMI = 24.37 kg/m2, SD = 5.60 (15.89 – 50.77 kg/m2) 2 - 20 (6%) underweight (BMI < 18.5 kg/m ) - 214 (61%) normal weight (18.5 kg/m2 ≥ BMI ≤ 25 kg/m2) - 118 (33%) overweight or obese (BMI > 25 kg/m2)