Associations Between Parental Misperceptions of Preschoolers' Weight and Diet- and Physical Activity-Related Parenting Attitudes and Practices.

Objective: Diet- and physical activity-related parenting attitudes and practices play a central role in shaping young children's diet and physical activity behaviors. Accurate parental perception of children's weight is particularly important, as it may influence these parenting attitudes and practices. This study examined the prevalence of parental misperceptions of preschoolers' weight and their associations with diet- and physical activity-related parenting attitudes and practices in China.

Methods: This online cross-sectional study included 17,342 parents of preschoolers in Chongqing, China. Parents reported perception of their child's weight status and diet- and physical activity-related parenting attitudes and practices. Multivariable logistic regression was used to examine the associations between parental weight misperceptions and parenting attitudes and practices.

Results: Overall, 26.8% of parents underestimated and 19.2% overestimated their child's weight. Overestimation occurred in 64.3% of underweight children, and underestimation occurred in 87.2% of children with overweight or obesity. In the overall sample, overestimation was associated with lower odds of being in the high-score group for total attitudes (OR 0.92, 95% CI 0.85-0.99) and diet-related attitudes (OR 0.88, 95% CI 0.80-0.97); underestimation was associated with lower odds of being in the high-score group for diet-related attitudes (OR 0.92, 95% CI 0.85-0.99). For parenting practices, overestimation was associated with higher odds of being in the high-score group for total practices (OR 1.21, 95% CI 1.11-1.31) and physical activity-related practices (OR 1.12, 95% CI 1.03-1.22); underestimation was associated with higher odds of being in the high-score group for non-responsive feeding practices (OR 1.13, 95% CI 1.06-1.22). In stratified analyses, the associations varied by children's actual weight status.

Conclusion: Parental misperceptions of preschoolers' weight were associated with specific diet- and physical activity-related parenting attitudes and practices. These findings may help inform family-based approaches to childhood weight management.