Actual Body Weight and the Parent's Perspective of Child's Body Weight Among Canadian First Nations Children.

BACKGROUND/OBJECTIVES: Indigenous children in Canada face higher rates of overweight and obesity compared to non-Indigenous children. Parents' perceptions of their child's body weight are shaped by broader systemic influences, including historical trauma and limited access to healthy food. This study aimed to evaluate the association between children's actual body weight (measured by BMI) and parental perceptions among First Nations children. METHODS: Participants were children from two Saskatchewan First Nations communities involved in the First Nations Lung Health Project (2013 and 2017). Self-administered questionnaires were distributed through schools to parents of children in Grades 1-12. The questionnaire collected data on health, environment, physical activity, and diet. Parents assessed their child's weight as underweight, about the right weight, or overweight. BMI was calculated using clinically measured height and weight. Logistic regression was used to identify predictors of BMI misclassification. RESULTS: Among 472 children with both survey and clinical data, 42.6% were boys. Clinically measured overweight prevalence was 52.3%, compared to 15.9% based on parental perception. Overall, 58% of parents accurately perceived their child's weight status. Misclassification was more likely among children who engaged in at least 60 min of daily physical activity on more days per week. CONCLUSIONS: Parents underestimated their children's overweight status compared to clinical measures. Questionnaire-based assessments significantly underestimated true weight status among school-aged First Nations children. These findings highlight the need to consider systemic and environmental factors when addressing childhood obesity in First Nations communities.