Maternal perception of child weight and concern about child overweight mediates the relationship between child weight and feeding practices

OBJECTIVE: To examine the mediating effects of maternal perception of child weight (weight perception) and concern about overweight (weight concern) on the paths between child weight and maternal feeding practices. SETTING: Pudong District, Shanghai, China. PARTICIPANTS: A convenience sample of 1164 mothers who were primary caregivers of preschool children. RESULTS: Sixty per cent of the mothers perceived their overweight/obese children as normal weight or even underweight. The disagreement between actual child weight and maternal weight perception was statistically significant (Kappa = 0·212, P < 0·001). Structural equation modelling indicated that weight perception fully mediated the relationship between child BMI Z-scores and pressure to eat. Weight concern fully mediated the relationships between child BMI Z-scores and the other three feeding practices. The serial mediating effects of weight perception and concern were statistically significant for the paths between child BMI Z-score and monitoring (β = 0·035, P < 0·001), restriction (β = 0·022, P < 0·001), and food as a reward (β = –0·017, P < 0·05). CONCLUSION: Child weight may influence maternal feeding practices through weight perception and concern. Thus, interventions are needed to increase the accuracy of weight perception, which may influence several maternal feeding practices and thereby contribute to child health.