Hispanic Parental Perceptions of Child Weight in Preschool-Aged Children: An Integrated Review

Abstract

Background:

Obesity continues to disproportionately affect ethnic minorities. Parents play an integral role in early childhood, and parental perceptions regarding their child's weight are key to obesity prevention. Cultural differences contribute to parental perceptions, and increased understandings of these characteristics provide a basis to address obesity in high-risk populations at an earlier age. The aim of this integrative review was to analyze extant literature to identify Hispanic parental perceptions of their preschool-aged child's weight status.

Methods:

An integrative review of studies measuring Hispanic parental perception was conducted. Computerized searches were completed using MEDLINE, PubMed, CINHAL, Eric, and PsychINFO. Articles were included if they were English, included children 2–5 years of age, included a Hispanic population, and evaluated parental perception of their child's weight status. A total of 14 articles (n=8 qualitative; n=6 quantitative) met criteria and were included in the review. Cooper's integrative review methodology was used, and articles were evaluated for quality using Polit and Beck's evidence hierarchy leveling system.

Results:

The results revealed six themes of Hispanic parental perceptions relative to their preschool-aged child's weight: parental perception of body weight; relationship between child weight and health; causes and consequences of overweight; familial roles and influences on child weight; prevention of overweight; and cultural influences within the United States.

Conclusions:

This review highlights the importance of developing sociocultural approaches to addressing childhood obesity within the Hispanic population. Additional research is needed to incorporate what is known about Hispanic parental perceptions to positively influence behavior change during early childhood.

Introduction

Childhood obesity continues to be a significant health concern throughout the United States, particularly within minority populations. In the United States, the prevalence of overweight (BMI ≥85th to <95th percentile) and obesity (BMI ≥95th percentile) in preschool-aged children has dramatically increased over recent decades, with higher rates evident in ethnic minorities.^1,2 Although most recent data suggest a decrease in prevalence rates in preschool-aged children, significant disparities persist for ethnic minority groups.² It has been predicted that if the incidence of obesity persists, children will have shorter life expectancies then their parents.³ Parents play an integral role in early childhood, and parental perceptions regarding their child's weight are key to obesity prevention. This integrative review explores current literature to identify Hispanic parental perceptions of their preschool-aged child's weight status.

Background and Significance

Differences in ethnic prevalence of overweight and obesity are apparent in early childhood. Of ethnic minorities, Hispanic preschoolers have been found to have significantly higher rates of obesity than other ethnic groups.^2,4–6 Currently, 16.7% of Hispanic preschool-aged children are obese, compared to 3.5% of Caucasian preschool-aged children.² Weight-related health problems and cardiovascular risk factors often present during the preschool years, with increased risk factors in children of ethnic minorities.⁷ Adiposity rebound occurs during the preschool years, and an earlier adiposity rebound during preschool years may influence abnormal increases in BMI throughout life.¹ Overweight and obesity originating in preschool-aged children has been shown to persist into adolescence and adulthood.^1,8

Obesity-related health disparities, including diabetes, stroke, chronic liver disease, and certain cancers, are higher within adult Hispanic populations, and highlight the need for addressing obesity within these high-risk groups.⁹ In the United States, the economic burden of childhood obesity is estimated annually to be $14.1 billion in direct medical costs.¹⁰ These costs, coupled with the long-term health consequences mentioned above, highlight the need for early interventions. The rapid increase in the US Hispanic population coupled with the dramatic rise of overweight in minority populations is a major public health concern, one that highlights the need for early recognition and intervention.^1,11

Early childhood is an ideal time to target obesity prevention; habits related to diet and activity are shaped during the preschool years.^12,13 Parents are particularly influential during the preschool years with regard to modeling behaviors and adopting healthy behaviors.¹³ Accurate parental perceptions are key to addressing excess weight. Parents must recognize excess weight in their child as a precursor to developing concern about the consequences of obesity; accurate perceptions are instrumental to motivate behavior change. Moreover, childhood obesity experts recommend focusing preventative efforts on parents of preschool-aged children given that parental beliefs, perceptions, and attitudes may influence child weight gain.¹⁴ Several inherent cultural implications and preferences specific to parental perceptions within the Hispanic populations have been identified throughout the literature. A deeper understanding of perceptions and interventions to improve the accuracy of these perceptions in this unique population will inform clinicians and researchers regarding recognition, prevention, and treatment of excess weight in preschool-aged children.

Methods

An integrative review was the chosen method; this approach allows for the combination of diverse methodologies (e.g., experimental and nonexperimental) used throughout the literature to synthesize and capture the realm of the topic under investigation.¹⁵ This integrated review was conducted using Cooper's¹⁶ five-stage framework of research synthesis: (1) problem formation; (2) data collection; (3) evaluation; (4) analysis and interpretation; and (5) presentations of findings. The focus of this review is to provide a comprehensive review of existing literature examining Hispanic parents' perceptions of preschool-aged children's weight status. Using a modification of Mareno's¹⁷ definition, parental perception was defined as a parent's judgment of their preschool-aged child's body weight formulated by a parent's recognition of body size, physical appearance, functional abilities, and health effects related to current body weight undergirded by cultural characteristics within the Hispanic population.¹⁷

Sampling Method

Five databases (MEDLINE, PubMed, CINHAL, Eric, and PsychINFO) were searched to identify relevant articles. Varying combinations of the following search terms were: obesity, obese, overweight, weight, body mass index, preschool, pre-k, perception, awareness, attitude, health, knowledge, diet, physical activity, parent(s), mother, father, Hispanic, Latino, Latina, Mexican American, Spanish American, Hispanic American, and Cuban American.

Peer-reviewed articles identified through the database search published in English between 2002 and 2013 were considered. One author and a research librarian conducted the literature search. Working independently, two authors screened all titles and abstracts to assess article inclusion. Consensus was reached through discussion. Where insufficient information was available in the title or abstract, the full text was reviewed. Inclusion criteria were: (1) inclusion of children 2–5 years of age in the sample; (2) Hispanic population; (3) studies using mixed ethnicity samples to report and evaluate Hispanic data separately (results not based solely on mixed report of study population); and (4) evaluated parental perception of their child's weight, health, or weight-related behaviors. Reference lists of articles retrieved were reviewed for additional articles not identified during the database searches. Journal articles that did not include original research were excluded from the review. Additional reasons for exclusion included: (1) not addressing the population of interest; (2) children outside the preschool age group were contained in the sample; (3) no evaluation of parental perception or perception measured by another individual (e.g., healthcare provider); and (4) research was conducted outside the United States. Several studies used samples with mixed ethnicities; studies that did not specifically report Hispanic parental perception findings were excluded. A total of 49 titles were identified; after removing duplicates, 34 titles appeared to meet inclusion criteria and were further reviewed. After exhaustive review, 14 studies met criteria and were included in the review.

Data Evaluation

Following the criteria outlined by Polit and Beck,¹⁸ an evidence hierarchy was used to rank the strength of the findings of the included studies. Polit and Beck's¹⁸ seven levels of evidence ranked from strongest to weakest include: (1) level Ia, systematic review of randomized, clinical trials (RCTs); level Ib, systematic review of nonrandomized trials; (2) level IIa, single RCT; level IIb, single nonrandomized trial; (3) level III, systematic review of correlational/observational studies; (4) level IV, single correlational/observational study; (5) level V, systematic review of descriptive/qualitative/physiological studies; (6) level VI, single descriptive/qualitative/physiological study; and (7) level VII, expert and committee opinions. Studies incorporated into this review were from similar methodologies and were empirical by design. To facilitate analysis and interpretation, the two authors independently assessed articles for level of evidence, study design, analysis, findings, and discussion. A data matrix was created that reflected the categories and emergent themes throughout the articles.

Results

This integrative review presents a succinct summary of Hispanic parental perceptions of their preschool-aged child's weight and health behaviors based on current research and findings by categorizing, summarizing, and identifying emergent themes. Of the 14 studies selected for the integrated review, three studies qualified as level IV research, and 11 studies qualified as level VI research. Table 1 lists studies included in this review and includes sample descriptions, study purposes, summaries of findings, and levels of evidence hierarchies. Major themes of parental perceptions and key findings are summarized in Table 2.

Table 1.

Hispanic Parental Perceptions of Preschooler Weight Status Study Summaries

Study	Sample (no., interviewee, child age, location, sample ethnicity)	Purpose	Summary of findings	Evidence hierarchy level
Chaparro and colleagues¹⁶	n=1702 • Mothers (92.1% Hispanic) • Age: 36–60 months • California • Mothers self-identified as Hispanic	Assess accuracy of maternal perceptions of their children's weight status Identify predictors of accurate maternal perceptions of their children's weight status Explore the effects of acculturation in the accuracy of maternal perceptions of children's weight status	15% of sample overweight 17% of sample obese Mothers of obese (93.6%)/overweight (77.5%) children misclassified children as “about right weight” 92% correctly classified normal weight children Higher maternal BMI and child birth weight decreased likelihood of accurate prediction Acculturation not significant predictor	IV Cross-sectional, exploratory
May and colleagues¹⁸	n=967 • Mother-child dyads (144 Hispanic) • Age: 24–59 months • Minnesota • Self-reported on demographic sheet as Hispanic	Examine associations between maternal perceptions of child weight, feeding, and child overweight in ethnically diverse population	21% of overweight preschoolers were perceived as such. Feeding strategies were not associated with maternal perception of overweight. Mothers reported concern over their child becoming overweight. Mothers concerned about overweight restricted intake. No association between feeding and child overweight.	IV Cross-sectional, exploratory
Rosas and colleagues²³	• n=374 • Mothers • Age: 5 years • Mexico (314); California (60) • Mothers Mexican born	Examine and compare maternal perception of child weight	Mothers in California were more likely to underestimate their child's weight than mothers in Mexico. Mothers in California desired their children to be smaller whereass mothers in Mexico desired children be larger.	IV Cross-sectional, exploratory
Gallagher²⁸	• n=9 • Mexican-descent mothers • Age: 2–5 years • Texas • Self-identified as Mexican descent	Examine views of mothers of Mexican descent regarding lifestyle habits putting children at risk for obesity	Lifestyle habits, including food/nutrition, physical activity, and TV viewing, related to health and weight gain TV viewing viewed positively with respect to education Food intake and nutrition was related to health (positive and negative health outcomes). Physical activity was associated with health and could influence weight gain. TV was viewed positively as an educational tool. Views consistent with most recommendations for age group by AAP	VI Qualitative, naturalistic design using ethnographic interviews
Crawford and colleagues²⁵	n=43 • Latina mothers, grandmothers • Age: 2–5 years • California • Ethnicity defined by birthplace: - Mexico (21) - El Salvador (2) - California (7)	Assess Latina mothers' health beliefs/attitudes regarding preschooler weight issues Results used to update nutrition education methods	Greater weight associated with health Perception of good health not always associated with actual weight status Perceived causes/effects of overweight included genetics, associated illness, and social implications. Latina populations may have ethnic specific needs with respect to education.	VI Qualitative, descriptive, focus groups
Gomel and Zamora²⁹	n=37 • Latina mothers • Age: 2–5 years • California • Self-identified as Latina: - Mexican (23) - Latina (13) - Chicana (1)	Explore Latina mother's beliefs and feelings regarding children's health, food/eating, and parenting	Themes identified were related to food and health, how parents influence children's eating behaviors: beliefs about food, beliefs about food and health, parental modeling, perceptions of child eating preferences, food preparation, feeding strategies, and eating out.	VI Qualitative, descriptive, focus groups
Glassman and colleagues²¹	n=26 • Latino parents, grandmothers • Age: 3–5 years • New York • Self-identified Latino • Country of origin: - Mexico (8) - Dominican Republic (7) - El Salvador (4) - Ecuador (3) - Columbia (3) - Peru (1)	Explore Latino parental perceptions regarding their ability to prevent obesity in their children	Themes surrounding parental perception of ability to prevent obesity and barriers to prevention emerged.	VI Qualitative, descriptive, focus groups
Guerrero and colleagues¹⁷	n=24 • Mexican mothers • Age: 2–5 years • California • Mexican	Understand definitions and perceptions of health and obesity in their children, and physician weight assessments	80% of mothers correctly perceived their weight. 58% accurately perceived their child's weight with 42% of mothers correctly perceiving their overweight child's status. Themes identified included: health/overweight definitions, health professional's roles in assessing child health, etiology of child obesity, parent roles in preventing obesity.	VI Qualitative, grounded theory
Kersey and colleagues¹⁹	n=369 • Latino parents • Age: 2–5 years • Illinois • Ethnicity defined by birthplace - Mexico (72%) - United States (24%) - South America (2%) - Central America (1%) - Puerto Rico (0.5%)	Characterize Latino parental beliefs, knowledge, and attitudes about childhood obesity	Minimal difference between parental health knowledge, attitudes, and beliefs between overweight/nonoverweight children Parents recognized overweight health consequences and had accurate perception of ideal body size for a preschool child. Inaccuracies predicting their own child's weight status	VI Cross-sectional, descriptive
Lindsay and colleagues²⁶	n=51 • Latina mothers • Age: 2–4 years • Massachusetts • Defined by “foreign-born”: - Centra; America (47%) - Dominican Republic (33%)	Examine Latino mothers' perceptions of weight, feeding, and physical activity	Themes identified: maternal perceptions of self and child weight, understanding of obesity-associated health and social consequences, feeding beliefs and practices within a cultural context	VI Qualitative, descriptive, focus groups, in-depth interviews
McGarvey And colleagues²⁷	n=25 • Multiethnic mothers (6 Hispanic) • Age: preschool • Virginia • Ethnicity not further defined	Elicit multiethnic parental perspectives of feeding, overweight, diet, and physical activity Findings used to develop childhood obesity prevention pilot program	Mothers expressed both common and unique ethnic specific beliefs about child feeding and obesity. Several themes common among all participants: low awareness of the relationship of physical activity, use of food to influence behavior, and perceived loss of parental control when children attend school.	VI Qualitative, descriptive, focus groups
Reifsnider and colleagues²⁰	n=25 • Hispanic mother-child dyads • Age: 3 years • Texas • Mothers self-identified as Hispanic	Examine maternal perceptions of their child's size. Explore mother's beliefs regarding child size, growth, and health	36% correctly identified their child's weight. Mothers did not have an accurate perception of their child's size in relation to photos of children.	VI Cross-sectional, descriptive
Sherry and colleagues²²	n=101 • Mothers (27 Hispanic) • Age: 2–5 years • Georgia • Self-identified as Hispanic American	Explore maternal weight perceptions and attitudes, practices, and concerns about child feeding in varied economic and racial groups	Maternal perceptions varied among groups with Hispanic and low-income white mothers viewing overweight at a lower cutpoint than did other mothers.	VI Qualitative, descriptive, focus groups
Small and colleagues²⁴	n=11 • Mexican immigrants • Age: preschool • Arizona • Mexican immigrant parents	Explore Mexican immigrant parents' beliefs of weight and health in their preschoolers	Themes emerged included: meaning of excess weight in children, overweight/obesity causes, knowing about child weight, cultural changes from Mexico to the United States, societal effects, parental needs.	VI Qualitative, ethnography, focus groups

TV, television; AAP, American Academy of Pediatrics.

Table 2.

Synthesis of Results

Major themes of parental perceptions	Key points
Preschool-aged child body weight	• Own children ○ Parents of normal weight children frequently categorize weight in their child correctly. ○ Parents of overweight/obese children frequently incorrectly categorize weight as “normal.”
	• Other children ○ Some parents able to correctly choose figures depicting healthy weight ○ Numerous parents chose overweight/obese figures depicting “ideal” weight.
Relationship between child weight and health	• Excess weight associated with “healthy” child
	• Health associated with appearance/abilities rather than weight status
	• Excess weight associated with negative social stigma and decreased physical abilities
Causes and consequences of overweight	• Parent identified causes of excess weight: genetics, food choices, inactivity, personal choices.
	• Parents able to associate excess weight with adverse health and psychological outcomes
Familial roles and influence on child weight	• Parents recognize role modeling±impact child weight
	• Role of extended family members negatively impact child food choices/consumption.
	• Role of food varies from reward to punishment.
	• Parents change feeding if concerned about child's weight.
Prevention of overweight (practices)	• Parents acknowledge role in prevention.
	• Parent prevention/control reduces as child ages, enters school/child care settings.
Cultural influences within United States	• Parenting practices changed (job/time).
	• Employment had negative effects on food prep/shopping/family time.
	• Food choices (– impact), transportation (– impact), role of television in United States (±impact)

Parental Perception: Preschool-Aged Child Body Weight

Parental perception of child weight was expressed by a rating based on photos/drawings or word descriptors. Parents were asked to judge child's weight-status by selecting a category that was based on an objective medical weight standard (e.g., CDC guidelines). Six studies examined the accuracy of parental perceptions of their own child's weight status. Across these studies, the majority of parents did not have an accurate perception of their child's actual weight status, and most frequently underestimated their child's actual weight category.^19–24 Parents of normal weight preschool-aged children (BMI 5th to <85th percentile) were more likely to accurately categorize their child's weight status than parents of overweight children.^19–22 Parents of overweight or obese children were more likely to underestimate their child's actual weight status, most frequently selecting a lighter picture/drawing or word descriptor to describe their child's weight.^19–22 In one study, a comparison of Hispanic mothers in Mexico and California found that Mexican mothers were more accurate in identifying their child's weight status, whereas immigrant mothers in the United States were more likely to underestimate their overweight or obese child's weight status.²⁴

Five studies examined Hispanic parental perceptions of “healthy” or “ideal” weight in preschool-aged children.^22–26 In three studies, the majority of parents were asked to identify a preschool-aged child with a normal BMI.^22,24,25 Across these studies, the majority of parents were able to correctly select photos or drawings representative of a preschool-aged child with a normal BMI.^23,26 In one study, when asked which children looked the healthiest, the majority of parents selected photos of overweight or obese children.²² In another study, when parents were asked to identify cut-off points for healthy weight in preschool-aged children, they selected drawings of overweight or obese children rather than those of normal weight children.²⁶ These findings suggest that whereas some parents are able to accurately identify normal weight in preschool-aged children, it is concerning that other parents perceive excess weight as an ideal or healthy weight in preschool-aged children. Maternal weight status in relation to perception of child weight was assessed in three studies. Guerrero and colleagues²⁰ found that Hispanic mothers perceived their own weight status more accurately than that of their child. Another study found that maternal perception of child weight was correlated with maternal BMI; decreased maternal perception was associated with increased maternal BMI.¹⁹ Conversely, Reifsneider and colleagues²³ found no relationship between maternal and child BMI based on silhouette selection.

Parental Perceptions: Relationship between Child Weight and Health

Hispanic parents of preschool-aged children had varied perceptions of health as it related to child weight status. The idea of health was often associated with a child's appearance and abilities rather than actual weight status. Parents perceived healthy children with characteristics such as feeling good, increased physical activity, intelligence, good behavior, success in school, and happiness, rather than based on weight status.^20,23,27,28 In three studies, parents equated excess weight with health, indicative of successful parenting, a desirable trait in preschool-aged children and one that children will “outgrow.”^27–29 Thin children were viewed as unhealthy.²⁷ In three studies, parents associated excess weight with negative connotations; however, excess weight was not discussed in terms of physical appearance, but by decreased physical activity and ability.^20,23,30 Excess weight was also viewed as harmful based on associated negative social stigma.²⁹

Parental Perceptions: Causes and Consequences of Overweight

Although Hispanic parents often equated health with excess weight in preschool-aged children, parents were able to correctly identify contributing factors to excess weight in childhood in seven studies. In two studies, parents identified a genetic role in causing excess weight.^25,27 Food (high fat, large portions) and lack of exercise were viewed by parents in four studies as additional causes of overweight.^20,23,31,32 Parents also correctly perceived personal choices and individual attributes, such as reduced self-care, self-esteem, and mental health, as additional causes of child overweight as described in two studies.^28,30

Parents consistently recognized consequences of overweight and related overweight to adverse health outcomes and specific disease processes. Parents frequently cited diabetes, high cholesterol, heart problems, asthma, joint problems, and cardiovascular disease as overweight-specific health outcomes.^20,23,31,32 Aside from specific diseases, parents also identified social and psychological affects associated with child overweight. Specifically, three parents identified teasing and social and emotional issues as consequences of overweight in preschool-aged children.^{22,23,25–27,32} Parents recognized that excess weight in preschool-aged children might carry through to adolescence.^23,28

Parental Perceptions: Familial Roles and Influences on Child Weight

Hispanic parents consistently discussed child weight and health in relation to familial roles and practices. Previous research has suggested that parent role modeling is particularly influential during the preschool years, and this period is when children develop eating and activity-related behaviors. Hispanic parents overwhelmingly identified the importance of role modeling for their children and recognized both positive and negative impacts. Parents acknowledged that their behaviors influenced those of their preschool-aged children. Gomel and Zamora³² discussed the maternal perception that children developed eating habits based on parental habits, and these habits often continue into adulthood. Parental modeling of healthy behaviors and food choices were seen as important positive impacts relative to child weight.^18,20,25,30 Poor parental food choices, stress-related eating, and maternal overeating were found to negatively impact child weight in two studies.^20,28

The roles and actions of extended family members within the context of child overweight were discussed in four studies. Hispanic parents frequently referenced family members' actions (often grandmothers) as counterintuitive to preventing overweight in their preschool-aged children.²⁸ Specifically, parents perceived they had little control over what extended family members did relative to obesity prevention, specifically mentioning members of older generations giving children candy and facilitating interparental conflict.²⁵ Another study found that extended family members often undermined medical professional's overweight-related recommendations.²⁰ Two studies discussed the role of family as educators; parents learned how to feed their children from other family members.^28,29

The familial roles and perceptions surrounding food were discussed in six studies. Among Spanish- and English-speaking mothers, Spanish-speaking mothers associated food preparation with “love” rather than nutrition.³² Parents had varying perceptions of child eating self-regulation and satiety in their preschool-aged children. Some Hispanic mothers felt confident that their children could self-regulate intake of food and took satiety cues from their children; other mothers did not take cues from their children.^28,29 Parents discussed using food as both reward (e.g., fast foods and fruit) and punishment (e.g., restricting certain foods).^22,32 Mothers who perceived their preschool-aged child as overweight were more likely to regulate food intake and restrict certain foods and less likely to pressure children to eat.^21,28

Parental Perceptions: Prevention of Overweight

Hispanic parents had varied views on their role in the prevention of excess weight in their preschool-aged children, as described in seven studies. Kersey and colleagues²² found that 52% of parents perceived they had “a lot” of control over their child's weight. In two studies, parents discussed the role of setting and the child's age in weight prevention.^25,29 Parents perceived less control regarding weight, diet, and activity as children got older, especially as they approached adolescence; parents also perceived less control once children entered child care or school.^23,31 Although parents acknowledged their role in obesity prevention in some studies, they also minimize their ability to assume control.^20,30 Specifically, parents were unsure of whether or not they would know their child was overweight and relied on healthcare provider assessments of weight.³⁰

Parental Perceptions: Cultural Influences Within the United States

In four studies, Hispanic parents identified several influences on child weight relative to living in the United States.^26,27,30,31 Influences included changes in parenting practices related to increased working hours, lack of time with family, and less time to cook^25,30; transportation issues and time to shop were also seen as barriers.²⁶ Parents acknowledged increased accessibility of “junk food,” change in choices of food available (e.g., high-fat foods), and increased food costs as being significant factors.^26,27,30 Parents discussed changes in transportation and the effects on exercise in two studies, where exercise (walking) significantly decreased in the United States given that other methods of transportation are preferred.^27,30 Screen time and the influence of television were discussed in three studies. The majority of parents in two studies viewed screen time as a negative influence.^27,30 Conversely, some parents viewed television as a valuable tool to learn English and not related to weight gain.³¹

Discussion

Significant health disparities exist related to obesity in the Hispanic population. This integrative review summarized parental perceptions of weight in preschool-aged children in this population. The qualities of studies included in this review were from the mid (21%) and lower (78%) ranges of evidence. Although a large percentage (82%) of level VI articles were qualitative studies, findings from these studies provided a firsthand account from Hispanic parents and, as suggested by Towns and D'Auria,³³ add to the knowledge base by providing an understanding of how Hispanic parents define, value, and interpret overweight. Many Hispanic parents have inaccurate perceptions of their preschool-aged child's weight status and most often underestimated their child's weight. These findings are consistent with previous literature examining parental perceptions of preschooler overweight in samples including varied ethnicities, suggesting that this aspect of parental perceptions is not unique to the Hispanic population.^34–36

Hispanic parents often associate health with excess weight, with excess weight frequently being considered a desirable trait in preschool-aged children. This has been well described throughout the literature and is an important cultural consideration when attempting to address the issue.³⁷ Viewing excess weight as desirable during early childhood is a concerning trend among Hispanic parents. Although many parents indicated that excess weight was “healthy,” they also were able to associate overweight with specific adverse psychosocial and health outcomes. This suggests that Hispanic parents have some awareness of overweight and related health outcomes. Despite this apparent awareness, parents did not always express concern specific to the preschool age group. Given that research suggests that obesity in later childhood is difficult to reverse,⁸ these findings highlight the importance of focusing efforts on developing interventions that target children at younger ages.

This review highlighted preschool-aged children within the context of Hispanic families and discussed the impact of family on the management of child weight. Hispanic families typically include the extended family, with different family members often taking different roles and approaches to child rearing.³⁷ These roles and how they impact child weight require further exploration, especially within the familial and cultural contexts. A better understanding of familial and cultural roles has the potential to impact the entire family. Parents recognized that life in the United States impacted weight in preschool-aged children. Most parents viewed these cultural influences as negatively affecting weight during early childhood. Although cultural impacts have been addressed in the literature, a recent review did not find a conclusive relationship between acculturation and BMI in Latino children.³⁸ This integrated review had several limitations. Whereas extensive efforts were made to conduct a thorough review, literature retrieved by electronic database is subject to bias and may yield limited sources.¹⁵ Research on Hispanic parental perceptions of excess weight during the preschool years overweight is limited. A number of studies were based on convenience samples, were limited to small sample sizes, and had varied methodological approaches. There were no uniform measures used to ascertain parental perception across studies, and several studies used varying aspects of parental perception, including diet, activity, and health implications. These approaches limit the ability to generalize the findings to other Hispanic populations.

In addition to the above limitations, the application of race and ethnicity were not uniform across studies. Studies included varied populations, did not consistently report specific ethnicities, or relied on participant self-identification. It should be noted that Hispanics comprise a large heterogeneous group incorporating many national origins, religions, beliefs, and levels of acculturation; it should not be assumed that this review adequately captured all of these attributes and processes. Accurately defining and including specific ethnicities in research is imperative when addressing health disparities, to ascertain potential differences between ethnicities, and to apply findings to other populations of interest.³⁹ Despite these limitations, this review describes an evolving evidence base relative to parental perceptions of weight status in preschool-aged children from a cultural perspective.

Implications

Findings generated from this integrated review serve as a foundation from which a better understanding of Hispanic parental perceptions of overweight and obesity in early childhood can be developed. Future research should focus on enhancing our understanding of how cultural implications impact parental perceptions and how they may ultimately influence interventions. This review has illuminated several ethnic-specific findings and highlights the importance of developing culturally tailored approaches to addressing childhood obesity within the Hispanic population. A more in-depth understanding of dietary and activity practices, familial roles, parental perceptions, and role of cultural influences associated with living in the United States are imperative to enable clinicians to better address the growing obesity epidemic in hopes of reducing long-term health implications and associated health disparities within this ethnic minority.

Footnotes

Author Disclosure Statement

No competing financial interests exist.

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