Food Insecurity Associated With Underestimation of Weight Status in Children With a Healthy Weight

Published:April 25, 2019DOI:



      Accurate parental weight perception of one's child is an important step in addressing healthy behaviors, but its associations with socioeconomic status (SES) and household food insecurity (HFI) are unclear. We aimed to assess the association of parental weight perception with HFI.


      This was a secondary data analysis of a cross-sectional study of 284 children ages 2 to 8 years whose parents completed surveys about weight perception, SES, and HFI. Height and weight were measured to determine the children's body mass index scores and were self-reported by parents. We performed chi-square tests to compare HFI and accuracy of parental weight perception and used logistic regression to assess accuracy, adjusting for significant covariates and stratifying by child weight category.


      Approximately two thirds of children had healthy weight, 18% had overweight, and 15% had obesity. About one third of parents inaccurately identified their child's weight category, almost always underestimating weight status. Twenty-eight percent of the families were food insecure. HFI was not associated with parental weight perception in bivariate analysis. When stratified by weight status, food insecure families with children at healthy weight had 0.16 times the odds of accurately perceiving their children's weight status. There was no association between HFI and accuracy of weight perception in children with overweight or obesity.


      Food insecurity was associated with a decrease in the accuracy of parental weight perceptions in children with healthy weight. Pediatricians should clearly communicate about weight status, as families with HFI may adopt unhealthy eating behaviors under the incorrect assumption that their child is underweight.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lundahl A
        • Kidwell KM
        • Nelson TD
        Parental underestimates of child weight: a meta-analysis.
        Pediatrics. 2014; 133: e689-e703
        • Rietmeijer-Mentink M
        • Paulis WD
        • Middelkoop M
        • et al.
        Difference between parental perception and actual weight status of children: a systematic review.
        Matern Child Nutr. 2013; 9: 3-22
        • Chung C-J
        • Huang Y-G
        Predictive factors for accuracy of perception of parents regarding their overweight or obese children in Taiwan.
        Asia Pac J Clin Nutr. 2016; 25: 571-577
        • Jones AR
        • Parkinson KN
        • Drewett RF
        • et al.
        Parental perceptions of weight status in children: the Gateshead Millennium Study.
        Int J Obes (Lond). 2011; 35: 953-962
        • Gauthier KI
        • Gance-Cleveland B
        Hispanic parental perceptions of child weight in preschool-aged children: an integrated review.
        Child Obes. 2015; 11: 549-559
        • Francescatto C
        • Santos NS
        • Coutinho VF
        • et al.
        Mothers’ perceptions about the nutritional status of their overweight children: a systematic review.
        J Pediatr (Rio J). 2014; 90: 332-343
        • Black JA
        • Park M
        • Gregson J
        • et al.
        Child obesity cut-offs as derived from parental perceptions: cross-sectional questionnaire.
        Br J Gen Pract. 2015; 65: e234-e239
        • Coleman-Jenson A
        • Rabbitt M
        • Gregory C
        • et al.
        Household food security in the United States in 2014.
        Economic Research Service, US Department of Agriculture, Washington, DC2015
        • Cook JT
        • Frank DA
        • Berkowitz C
        • et al.
        Food insecurity is associated with adverse health outcomes among human infants and toddlers.
        J Nutr. 2004; 134: 1432-1438
        • Weinreb L
        • Wehler C
        • Perloff J
        • et al.
        Hunger: its impact on children's health and mental health.
        Pediatrics. 2002; 110: e41
        • Gundersen C
        • Kreider B
        Bounding the effects of food insecurity on children's health outcomes.
        J Health Econ. 2009; 28: 971-983
        • Gundersen C
        Food insecurity is an ongoing national concern.
        Adv Nutr. 2013; 4: 36-41
        • Gamba RJ
        • Schuchter J
        • Rutt C
        • et al.
        Measuring the food environment and its effects on obesity in the United States: a systematic review of methods and results.
        J Community Health. 2015; 40: 464-475
        • Timperio A
        • Ball K
        • Roberts R
        • et al.
        Children's fruit and vegetable intake: associations with the neighbourhood food environment.
        Prev Med. 2008; 46: 331-335
        • Asfour L
        • Natale R
        • Uhlhorn S
        • et al.
        Ethnicity, household food security, and nutrition and activity patterns in families with preschool children.
        J Nutr Educ Behav. 2015; 47: 498-505.e1
        • Orr CJ
        • Ben-Davies M
        • Ravanbakht SN
        • et al.
        Parental feeding beliefs and practices and household food insecurity in infancy.
        Acad Pediatr. 2019; 19: 80-89
        • Dinour LM
        • Bergen D
        • Yeh M-C
        The food insecurity-obesity paradox: a review of the literature and the role food stamps may play.
        J Am Diet Assoc. 2007; 107: 1952-1961
        • Larson NI
        • Story MT
        Food insecurity and weight status among U.S. children and families: a review of the literature.
        Am J Prev Med. 2011; 40: 166-173
        • Franklin B
        • Jones A
        • Love D
        • et al.
        Exploring mediators of food insecurity and obesity: a review of recent literature.
        J Community Health. 2012; 37: 253-264
        • Andreyeva T
        • Tripp AS
        • Schwartz MB
        Dietary quality of Americans by supplemental nutrition assistance program participation status.
        Am J Prev Med. 2015; 49: 594-604
        • Pauline M
        • Selvam S
        • Swaminathan S
        • et al.
        Body weight perception is associated with socio-economic status and current body weight in selected urban and rural South Indian school-going children.
        Public Health Nutr. 2012; 15: 2348-2356
        • Vliet J
        • Gustafsson P
        • Duchén K
        • et al.
        Social inequality and age-specific gender differences in overweight and perception of overweight among Swedish children and adolescents: a cross-sectional study.
        BMC Public Health. 2015; 15: 628
        • Hager ER
        • Quigg AM
        • Black MM
        • et al.
        Development and validity of a 2-item screen to identify families at risk for food insecurity.
        Pediatrics. 2010; 126: e26-e32
        • Kuczmarski RJ
        • Ogden CL
        • Grummer-Strawn LM
        • et al.
        CDC growth charts: United States.
        Adv Data. 2000; : 1-27
        • Oettinger MD
        • Finkle JP
        • Esserman D
        • et al.
        Color-coding improves parental understanding of body mass index charting.
        Acad Pediatr. 2009; 9: 330-338