For a comparable Body mass index (BMI), Indian children have
higher body fat (2-8%) and greater risk of disease (e.g.
higher insulin resistance) than Caucasian children .
Mothers play a role in shaping the early (0-5 years) eating
and activity behaviors related to childhood obesity .
Poor maternal recognition of their child’s true weight
status could therefore be a potential risk factor for
obesity. In a systematic review, 6-73% of predominantly
Caucasian parents under-estimated the weight status of
children aged 2-12 years . The accuracy of maternal
perceived child weight has been examined in populations
(e.g. Caucasians and Hispanics in US) where obesity is a
public health concern , but not in populations of urban
affluent Indian children, for whom obesity is an increasing
concern . The present study examined the accuracy of
mothers’ perception of their preschool (2-5 years)
children’s weight, in Mumbai.
In total, 111 mothers with children aged
2-5 years (mean±SD, 44.1±9.7 mo) attending private medical
clinics (n=5) in the affluent areas of Mumbai were
recruited after receiving approval from the QUT Human
Research Ethics Committee, Australia. Child’s height and
weight were measured by the researcher using standard
equipments/protocols. Maternal perception of the child’s
weight status was measured using a single item from the
NOURISH questionnaire : Do you think your child is...(i)
underweight, (ii) healthyweight, (iii)
somewhat overweight, (iv) very overweight, or (v) don’t
According to the BMI z-score categories
, 51.4% of children were healthyweight. The prevalence of
underweight (26.6% vs 43.0%) was lower than the
national data on children aged 1-5 years , whereas
overweight (11% vs 6%) and obesity (11% vs 8%)
were higher in the present study compared to a multi-centric
study with urban-affluent Indian children aged 2-5 years
Nearly a quarter of mothers overestimated
their underweight child as healthyweight (Table I).
This is of concern as 17% of child-deaths in 1-5 year olds
are attributable to underweight in developing countries .
In contrast, all mothers underestimated their
overweight/obese child’s weight status (Table I).
Similarly, a systematic review found that 86% of
predominantly Caucasian parents did not recognise the
overweight status of their young child aged 2-6 years .
Mothers may underestimate their child’s weight status
because they may be skeptical towards objective measurements
(e.g. growth charts)  and may rely on visual assessments
- such as comparison with other children . Indian
mothers’ perception of a chubby baby as healthy – an
indicator of good child rearing and of social opulence 
– may also prevent mothers from accurately perceiving their
child’s weight status.
TABLE I Accuracy of Maternal Perception of Child’s Weight Status Against Measured BMI Z-scores
In conclusion, the study highlights the
prevalence of the double burden of malnutrition and the
mothers’ poor recognition of their child’s true weight
status. However, the small sample size limits the findings
to the urban-affluent sampled population with preschool
children (2-5 years) in Mumbai. The implications of the
study are that health professionals need to assist mothers
to correctly perceive their child’s weight status.
Strategies such as the use of growth charts and sensitively
addressing cultural beliefs around children’s weight should
Acknowledgement: Prof. Lynne Daniels,
QUT, Australia for study conception. KM Mallan occupied the
Heinz Postdoctoral Research Fellowship.
Contributors: All authors have
contributed, designed and approved the study.
Funding: QUT, Australia. Competing
interests: None stated.
1. Whincup PH, Nightingale CM, Owen CG,
Rudnicka AR, Gibb I, McKay CM, et al. Early emergence
of ethnic differences in type 2 diabetes precursors in the
UK: the Child Heart and Health Study in England (CHASE
Study). PLoS Med. 2010;7:1-10.
2. Satter E. Child of Mine: Feeding with
Love and Good Sense. Boulder, Colorado: Bull Publishing
3. Rietmeijer Mentink M, Paulis WD,
Middelkoop M, Bindels PJE, Wouden JC. Difference between
parental perception and actual weight status of children: a
systematic review. Matern Child Nutr. 2013;9:3-22.
4. Khadilkar V, Khadilkar A, Cole T,
Chiplonkar S, Pandit D. Overweight and obesity prevalence
and body mass index trends in Indian children. Int J Pediatr
5. Daniels L, Magarey A, Battistutta D,
Nicholson J, Farrell A, Davidson G, et al. The
NOURISH randomised control trial: Positive feeding practices
and food preferences in early childhood- a primary
prevention program for childhood obesity. BMC Public Health.
6. World Health Organization. Child
growth standards: training course on child growth
assessment. WHO, Geneva; 2008.
7. National Family Health Survey. Mumbai,
India: International Institute for Population Sciences and
Macro International; 2005-06.
8. Black RE, Victora CG, Walker SP,
Bhutta ZA, Christian P, de Onis M, et al. Maternal
and child undernutrition and overweight in low-income and
middle-income countries. Lancet. 2013;382:427-51.
9. Towns N, D’Auria J. Parental
perceptions of their child’s overweight: an integrative
review of the literature. J Pediatr Nurs. 2009;24:115-9.
10. Bhave S, Bavdekar A, Otiv M. IAP National task force
for childhood prevention of adult diseases: childhood
obesity. Indian Pediatr. 2004;4:559-76.