Parental Perspectives on Their Child’s Body Image

Abstract

Poor body image is a prominent issue affecting youth. In this nationally representative online survey, we explored parents’ concerns about their child’s appearance, as well as their perceptions of their child’s body image concerns and related behaviors and interactions with others. Among the 1653 respondents, weight was parents’ most cited body image concern, while more parents perceived that their child was self-conscious about their weight than there were parents concerned about their child’s weight. Parental perceptions related to their child’s body image can inform providers’ efforts to address poor body image, such as around weight, and improve the health and self-esteem of their pediatric patients.

Introduction

Parents are well positioned to identify when body image concerns develop in children and adolescents and to help intervene to avoid the negative consequences of youth being self-conscious about their appearance.¹ Among factors that may prompt body image concerns, weight has been a main focus of research, and the role of weight stigma in mental health and patient self-esteem has been well documented.^2–4

One area of research relates to the dynamics and potential impacts of conversations within families around weight. A doctor’s recommendation has been shown to motivate parents to talk about weight with their child,⁵ and the recent release by the American Academy of Pediatrics (AAP) of a clinical practice guideline for addressing obesity in children and adolescents⁶ may encourage weight-related discussions during healthcare visits.

We surveyed a nationally representative sample of parents to explore their perceptions of their child’s body image and related behaviors, as well as their own concerns about their child’s appearance.

Methods

We fielded a cross-sectional, web-based survey of US parents using the KnowledgePanel® from Ipsos Public Affairs, LLC (Ipsos), a probability-based, nationally representative panel with over 50,000 households.⁷ The survey was fielded in April 2022 to a sample of 3471 adult KnowledgePanel® members who were parents (or legal guardians) of a child aged 3–18 years living at least part-time in the same household, with 2059 completed surveys (participation rate 59.3%). Eligible respondents for questions related to body image were parents with at least one child aged 8–18. For households with multiple children in that age range, parents answered for a randomly selected referent child.

Survey questions were developed by the study team drawing on clinical experience, published literature, and input from a convenience sample of parents. The survey was pretested in March 2022 with a sample of 113 KnowledgePanel® members; revisions were made to question wording and survey functionality based on pretest results. Survey items asked parents to indicate from a list of factors (weight, height, acne/skin conditions, facial features, hair, teeth, and figure) those that concern them about their child’s appearance and separately to indicate which factors they believe are of concern to their child. Parents reported behaviors their child exhibits that they view as resulting from their child being self-conscious, such as making negative comments about their appearance, restricting what they eat, or hiding their appearance (e.g., baggy clothes). Questions had closed-ended responses with dichotomous (Yes/No) or Likert scale-type (e.g., Strongly Agree to Strongly Disagree) options. The full list of survey items and descriptive statistics are available online.⁸

Ipsos provided de-identified survey response data, demographic characteristics from panel enrollment files, and Census-based post-stratification weights used to match the US population distribution on sex, age, race/ethnicity, census region, metropolitan status, education, and household income. We generated weighted percentages and bivariate associations between survey responses and respondent characteristics using Stata/SE 17.0. The results reported here represent unweighted respondent counts and the weighted percentages. The University of Michigan Medical School Institutional Review Board deemed this study exempt from human subjects review.

Results

The 1653 eligible respondents included 933 (56.3%) mothers; were categorized as 1087 (56.4%) White, non-Hispanic respondents, 161 (11.7%) Black, non-Hispanic respondents, 254 (22.2%) Hispanic respondents; and were grouped by annual household income as 347 (22.2%) <$50,000, 462 (28.2%) $50,000-$99,999, and 844 (49.6%) ≥$100,000. Sex and age distribution of the referent child was 301 (18.8%) girls 8–12 years, 315 (20.4%) boys 8–12 years, 501 (29.2%) girls 13–18 years, and 533 (31.6%) boys 13–18 years.

Among the factors assessed, weight was most often stated as a concern for parents (17.5%), compared with height (3.8%), acne/skin conditions (13.3%), facial features (1%), hair (4.5%), teeth (9.8%), and figure (2.3%). Parent concern about weight did not vary significantly by child sex and age group (19.5% girls 8–12 years, 15.2% boys 8–12 years, 17.7% girls 13–18 years, and 17.7% boys 13–18 years; p = 0.63), but perceived child self-consciousness about weight did vary (27.7% girls 8–12 years, 24.3% boys 8–12 years, 36.5% girls 13–18 years, and 30.8% boys 13–18 years; p ≤ 0.01). Three in ten parents (30.5%) perceived their child as self-conscious about their weight, second only to acne/skin conditions (32.3%); other factors were 16.5% height, 11.8% facial features, 26.6% hair, 18.2% teeth, and 19.8% figure. Parents’ body image concerns and perceived child body image concerns did not differ between mothers and fathers or by parent race/ethnicity.

The proportion of parents with discordant parent versus perceived child concern regarding weight varied by child sex and age group (Table 1). Parents who reported their own concerns or perceived their child was self-conscious about their weight were more likely to indicate their child exhibited behaviors consistent with self-consciousness about body image (Table 2).

Table 1.

Concordance between Parent Concern and Perceived Child Self-Consciousness about Weight, by Child Sex/Age Group

	Girl 8–12 years	Boy 8–12 years	Girl 13–18 years	Boy 13–18 years
Both parent concern and perceived child self-consciousness	11.7%	10.1%	13.3%	12.9%
Neither parent concern nor perceived child self-consciousness	64.5%	70.6%	59.1%	64.4%
Parent concern only	7.8%	5.1%	4.4%	4.8%
Perceived child self-consciousness only	16.0%	14.2%	23.2%	17.9%
Total proportion with discordance between parent concern and perceived child self-consciousness	23.8%	19.3%	27.6%	22.7%

Table 2.

Parent Report of Body-Conscious Behaviors, by Parent Concern and Perceived Child Self-Consciousness about Weight

Among parents who said “yes” to:	Parent is concerned about child’s weight			Parent perceives that child is self-conscious about weight
Among parents who said “yes” to:	Yes (n = 279)	No (n = 1374)	p-value	Yes (n = 493)	No (n = 1160)	p-value
Child makes negative comments about appearance	46.1%	28.3%	p < 0.0001	60.6%	18.6%	p < 0.0001
Child avoids being in photos	26.3%	15.9%	p < 0.0001	30.0%	12.3%	p < 0.0001
Child hides appearance	29.0%	14.3%	p < 0.0001	33.4%	9.6%	p < 0.0001
Child restricts eating in unhealthy way	13.7%	7.1%	p = 0.0012	16.6%	4.6%	p < 0.0001

Note: p-values calculated via Pearson chi-squared test.

Discussion

These findings are consistent with research indicating that parent concerns and their perception of child self-consciousness about weight, including body-conscious behaviors, begin as young as elementary school and become more prevalent with age.^2–4 While we found that parent concerns and their perception of child concerns about weight were generally more prevalent for girls, there was a similar level of concern for boys, consistent with prior research and underscoring the need to address body image at a young age without regard to a child’s sex.⁹ Though research has shown possible differences between mother and fathers in their motivations for talking to children about weight,⁵ we found no difference between mother and fathers in the perceptions captured in this survey.

The overall level of concordance between parent and child level of concern about weight is consistent with prior research¹⁰ but differed in that more parents in this study perceived that their children are self-conscious about weight than were concerned themselves. This may present a challenge for providers if there is a mismatch between parent and child concern about weight, as they may also have different levels of motivation to implement behavior change. Future research should further explore the extent to which concordance of concern impacts how interventions can be best targeted.

The new AAP guidelines⁶ regarding obesity encourage providers to engage in intensive weight management efforts, which may lead to more conversations in healthcare settings centered around weight. It is vital that providers’ and parents’ efforts to address weight management support the development of a healthy body image and avoid contributing to stigmas, including weight stigma. Provider-specific guidance for talking about weight^6,11 and research on youth and young adult preferences for discussing weight^12,13 can inform communication strategies for addressing weight concerns. For example, these conversations should focus on health and specific lifestyle habits while de-emphasizing the number on the scale.

A key limitation is that our results represent parent perceptions, which may not be consistent with child report. However, these perceptions likely influence whether and how parents interact with their child around weight and body image. In addition, we did not have data on body weight for parent respondents or their children to compare perceptions by actual weight values.

Impact Statement

Parents’ concerns regarding their child’s appearance, as well as their perceptions of their child’s body image concerns, can provide helpful information to providers as they work with families to improve the health and self-esteem of their pediatric patients.

Footnotes

Authors’ Contributions

S.W. and S.C. conceptualized the study, designed the data collection instrument, drafted the initial article, and critically reviewed and revised the article. J.V. critically reviewed and revised the article. A.G. analyzed the data. All authors approved the final article as submitted and agree to be accountable for all aspects of the work.

Funding Information

This work was supported by Michigan Medicine internal funds.

Author Disclosure Statement

The authors have no conflicts of interest to disclose.

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