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a University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
b Feinberg School of Medicine, Northwestern University and Children's Memorial Hospital, Chicago, Illinois
c Mary Ann and J. Milburn Smith Child Health Research Program, Children's Memorial Research Center, Chicago, Illinois
d College of Applied Health Sciences, University of Illinois, Chicago, Illinois
OBJECTIVE. This study explored parents' perceptions about their child's appearance and health and evaluated a tool to determine parents' visual perception of their child's weight.
METHODS. Parents of children aged 2 to 17 years were surveyed concerning their child's appearance and health and opinions about childhood overweight. They also selected the sketch (from 7 choices) that most closely matched the body image of their child using 1 of 8 gender–and age-range–specific panels of sketches. Children's height and weight were measured. Respondents were grouped by child body mass index (BMI) percentile (<5th, 5–84th, 85–94th [at risk for overweight (AROW)], and 
95th [overweight]). Those with BMI 5th percentile were analyzed. Logistic regression was used to examine factors influencing parental perceptions and levels of worry about their overweight or AROW child.
RESULTS. Of the 223 children, 60% were <6 years old, 42% were male, 17% were black, 35% were Hispanic, 42% were white, and 7% were other; 19% were AROW, and 20% were overweight. Few parents (36%) identified their overweight or AROW child as "overweight" or "a little overweight" using words, but more (70%) selected a middle or heavier sketch. Among parents of overweight and AROW children, 18% recalled a doctor’s concern and 26% were worried about their child’s weight. If the overweight or AROW child was age 6 years, parents were more likely to identify their child as "overweight" or "a little overweight" using words, select a middle or heavier sketch, and to be worried. Parents of older children were more likely to be worried if they perceived their child as less active/slower than other children or recalled a doctor’s concern.
CONCLUSIONS.Few parents of overweight and AROW children recognized their child as overweight or were worried. Recognition of physical activity limitations and physicians’ concerns may heighten the parent's level of concern. Sketches may be a useful tool to identify overweight children when measurements are not available.
Key Words: practice-based research • obesity • children • perception
Abbreviations: AROW—at risk for overweight • OR—odds ratio • CI—confidence interval
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