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Peer-reviewedCC BY 4.0Nutrients

Parental Misperception of Preschool Children’s Weight Status in China: Verbal Versus Visual Assessment and Associations with Feeding Practices

  • Lan Shi1,2
  • Yujia Chen3
  • Xiaoxue Wei4
  • Xinyi Song1
  • Chenjun Wu1
  • Fangge Qu5
  • Xianqing Tang6
  • Daqiao Zhu1
6 affiliations
  1. 1School of Nursing, Shanghai Jiao Tong University, Shanghai 201318, China
  2. 2Department of Global Public Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden
  3. 3School of International Medical Technology, Nursing Department, Shanghai Sanda University, Shanghai 201209, China
  4. 4Department of Nursing, Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  5. 5School of Nursing and Health Management, Shanghai University of Medicine & Health Sciences, Shanghai 201318, China
  6. 6Department of Children’s Disease Prevention, Jinyang Community Health Service Center, Shanghai 201206, China
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Abstract

Background: Parental misperception of child weight status may influence feeding practices, with implications for early prevention of childhood obesity. This study compared verbal and visual assessments of parental perception and misperception of preschool children’s weight status and examined associations between method-specific parental weight underestimation and feeding practices. Methods: This cross-sectional study included 520 parent–child dyads in Shanghai, China. Parental perception was assessed using a verbal item and visual silhouettes and compared with objectively measured child weight status. Agreement with actual weight status, overall perception patterns, and differences in underestimation between methods were examined using kappa statistics, Bowker’s test, and McNemar’s test, respectively. Associations between method-specific underestimation and feeding practices were examined using multivariable linear regression with false discovery rate (FDR) correction. Results: Agreement with actual weight status was limited for both methods and lower for visual than verbal assessment (quadratic weighted κ = 0.21 vs. 0.37). Underestimation was more common with visual than verbal assessment in the overall sample (45.1% vs. 37.8%, p < 0.001), particularly among children with overweight or obesity (87.5% vs. 43.2%, p < 0.001). Verbal underestimation was associated with lower scores for content-restricted feeding (adjusted β = −0.159, 95% CI: −0.312 to −0.005, p = 0.043) and behavior-restricted feeding (adjusted β = −0.129, 95% CI: −0.252 to −0.007, p = 0.038), whereas visual underestimation was not consistently associated with feeding practices. However, neither verbal association remained statistically significant after FDR correction (both adjusted p = 0.203). Conclusions: Verbal and visual assessments showed different patterns of parental weight perception and misperception and different associations between parental underestimation and feeding practices. Appropriate tool selection may support parental recognition of children’s weight status and feeding-related guidance for early prevention of childhood obesity.

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Cite

BibTeXRIS
BibTeX
@article{shi2026parental,
  title = {{Parental Misperception of Preschool Children’s Weight Status in China: Verbal Versus Visual Assessment and Associations with Feeding Practices}},
  author = {Lan Shi and Yujia Chen and Xiaoxue Wei and Xinyi Song and Chenjun Wu and Fangge Qu and Xianqing Tang and Daqiao Zhu},
  journal = {Nutrients},
  year = {2026},
  month = oct,
  doi = {10.3390/nu18213505},
  url = {https://www.mdpi.com/2072-6643/18/21/3505},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Parental Misperception of Preschool Children’s Weight Status in China: Verbal Versus Visual Assessment and Associations with Feeding Practices
AU  - Lan Shi
AU  - Yujia Chen
AU  - Xiaoxue Wei
AU  - Xinyi Song
AU  - Chenjun Wu
AU  - Fangge Qu
AU  - Xianqing Tang
AU  - Daqiao Zhu
PY  - 2026
DA  - 2026/10/25
JO  - Nutrients
DO  - 10.3390/nu18213505
UR  - https://www.mdpi.com/2072-6643/18/21/3505
AB  - Background: Parental misperception of child weight status may influence feeding practices, with implications for early prevention of childhood obesity. This study compared verbal and visual assessments of parental perception and misperception of preschool children’s weight status and examined associations between method-specific parental weight underestimation and feeding practices. Methods: This cross-sectional study included 520 parent–child dyads in Shanghai, China. Parental perception was assessed using a verbal item and visual silhouettes and compared with objectively measured child weight status. Agreement with actual weight status, overall perception patterns, and differences in underestimation between methods were examined using kappa statistics, Bowker’s test, and McNemar’s test, respectively. Associations between method-specific underestimation and feeding practices were examined using multivariable linear regression with false discovery rate (FDR) correction. Results: Agreement with actual weight status was limited for both methods and lower for visual than verbal assessment (quadratic weighted κ = 0.21 vs. 0.37). Underestimation was more common with visual than verbal assessment in the overall sample (45.1% vs. 37.8%, p < 0.001), particularly among children with overweight or obesity (87.5% vs. 43.2%, p < 0.001). Verbal underestimation was associated with lower scores for content-restricted feeding (adjusted β = −0.159, 95% CI: −0.312 to −0.005, p = 0.043) and behavior-restricted feeding (adjusted β = −0.129, 95% CI: −0.252 to −0.007, p = 0.038), whereas visual underestimation was not consistently associated with feeding practices. However, neither verbal association remained statistically significant after FDR correction (both adjusted p = 0.203). Conclusions: Verbal and visual assessments showed different patterns of parental weight perception and misperception and different associations between parental underestimation and feeding practices. Appropriate tool selection may support parental recognition of children’s weight status and feeding-related guidance for early prevention of childhood obesity.
SN  - 2072-6643
ER  -