Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia;
Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
Pediatrics. 2018 Dec;142(6). doi: 10.1542/peds.2017-3985. Epub 2018 Nov 8.
Parents often do not accurately perceive overweight and/or obesity in their children. Changing this is widely considered an essential first step to reducing child overweight, but recent research suggests that, in fact, this could promote greater weight gain. We aimed to determine the directionality over time between higher child adiposity and parental perception of child overweight.
Participants were from 2 cohorts of the population-based Longitudinal Study of Australian Children followed biennially since 2004. Repeated measures of BMI scores and parental perceptions of overweight were available for the kindergarten cohort at 6 waves (ages 4-5, 6-7, 8-9, 10-11, 12-13, and 14-15 years; = 4632) and for the birth cohort at 4 waves (ages 2-3, 4-5, 8-9, and 10-11 years; = 4445). Bidirectionality between overweight perception and BMI score was examined by using cross-lagged regression models.
In both cohorts, wave-on-wave lagged effects were strong (all: < .001) but much larger from BMI score to parent perception. For every unit increase in the BMI score, the odds of a child being perceived as overweight in the next wave ranged from 2.9 (birth cohort: age 2-3 years) to 10.4 (kindergarten cohort: age 6-7 years). These effects were ∼3 to 12 times larger than the reverse, whereby the perception of overweight predicted 0.2 to 0.5 higher BMI score in the next wave.
Higher child BMI scores strikingly predicted a subsequent parental perception of child overweight. Parent-perceived overweight preceded rising (not falling) BMI, but these effects were small. Clinician efforts to make parents aware of overweight may not be harmful but seem unlikely to improve children's BMI status.
父母通常无法准确感知孩子是否超重或肥胖。改变这种情况被广泛认为是减少儿童超重的必要第一步，但最近的研究表明，事实上，这可能会促进体重进一步增加。我们旨在确定儿童肥胖程度较高与父母对儿童超重的认知之间随时间的变化方向。
参与者来自自 2004 年以来每两年进行一次的基于人群的澳大利亚儿童纵向研究的两个队列。幼儿园队列在 6 个波次（4-5 岁、6-7 岁、8-9 岁、10-11 岁、12-13 岁和 14-15 岁）和出生队列在 4 个波次（2-3 岁、4-5 岁、8-9 岁和 10-11 岁）中提供了 BMI 得分和父母超重认知的重复测量值（=4632）。通过交叉滞后回归模型检查超重认知与 BMI 得分之间的双向关系。
在两个队列中，波与波之间的滞后效应都很强（均<0.001），但从 BMI 得分到父母认知的效应更大。BMI 得分每增加一个单位，下一个波次中孩子被认为超重的几率从 2.9（出生队列：2-3 岁）到 10.4（幼儿园队列：6-7 岁）不等。这些效应是相反方向的 3 到 12 倍，即超重的认知在下一个波次中预测 BMI 得分增加 0.2 到 0.5。
儿童 BMI 得分的升高明显预测了随后父母对儿童超重的认知。父母感知到的超重先于（而非随着）BMI 的上升，但这些效应很小。临床医生努力让父母意识到超重可能不会造成伤害，但似乎不太可能改善儿童的 BMI 状况。
