1. Children in Ireland are becoming overweight and obese at an alarming rate. 1 Research has shown that the majority of children who are overweight before puberty will be overweight in adulthood. 2 Childhood obesity has been linked to lower perceived self worth and competence in sports, physical appearance and peer engagement 3 and strongly linked to risk factors for CVD, DM and both orthopaedic problems and mental disorders. 4,5 Parent’s perception of their children’s weight tends to underestimate or poorly recognise overweight or obesity. 6 There is a paucity of research on this problem in Irish primary care. General Practitioners are ideally placed to identify, monitor and intervene at a family level with children who are overweight or obese. A cross-sectional study design was applied. Data was collected prospectively on children aged 4-14, (mean age 7.9 years; 54.9% male) and their parents (parental mean age was 39.1), who attended consecutively (92% accompanied by mother) to a semi-rural group general practice (4 GPs) over a three month period. A total of 101 parents and their children participated. Only 23.5% of the participants held medical cards, which is in line with the demographics of our practice. A questionnaire was pilot- tested and developed which explored basic demographics and lifestyle factors regarding family diet and exercise. Parents were asked to estimate their child’s weight status. Height and weight were objectively measured, and weight status was determined for both parent and child. The United States Centres for Disease Control’s BMI-for-age references were used to define children’s weight status. 7 14.9% of the children were overweight or obese. 51.6 % of the parents were overweight or obese. Of note 11.9% of the children were underweight. (Figure 3) Parents were poor at recognising their children’s increased weight – 81.8% of overweight children were perceived as normal weight by their parents. None of obese children had their correct weight category identified. Parents were also inaccurate in recognising their children to be underweight with 50% of underweight children described as normal and 4.1% of normal children described incorrectly as underweight. (Figure 1,2) Male children had higher rates of both overweight/obesity (13.3% vs. 16.1%) and of underweight (14.3% vs. 8.9%) then female children. However parents showed less accuracy in identifying overweight in sons than daughters (85.7% vs. 75% misconception of weight in male vs. female overweight children). 81.3% of children travel to school by vehicle. 26.7% of parents reported their children watch television for 2-3 hours or more on an average school day. (Figure 4) 31.3% of parents cook separate meals for different family members more than once per week or daily. Significant rates of overweight and obese children were observed, with more than half of their parents being affected. Parents showed poor ability to recognise a weight problem in their children. Boys were more frequently overweight /obese and yet parents had lower accuracy in perception of overweight in their sons. These findings are in line with studies of prevalence of obesity previously undertaken in Ireland. 8 Paradoxically, previous research has demonstrated that parents are more likely to have concerns regarding increased weight in female children. 6 This study demonstrates that it is paramount for General Practitioners (GPs) to raise this issue or it is likely to be overlooked. This study demonstrates alarming rates of childhood and parental obesity. GP’s have a vital role in recognition, monitoring and intervention at a family level for the growing problem of childhood overweight / obesity. Parents in this study demonstrated inaccuracy and underestimation of their children’s actual weight and are therefore unlikely to raise concerns around obesity during consultations. Boys are at particular risk which is of importance considering the male gender’s shorter life expectancy and higher risk of cardiovascular events in adulthood. Despite anticipated parental sensitivities regarding the issue of children’s weight, it was clearly acceptable and possible for this to be constructively and systematically raised in consultation with the families surveyed As a result of this research we have changed our practice to include a routine documentation of BMI for age in all children attending the practice on an annual basis. This study was limited in terms of its power which prevented the ability to statistically analyse parental or social factors which influenced the misconception of children’s weight by their parents. This is the first study of its type undertaken in Irish general practice and it is hoped to expand its reach to include a greater sample size in a cross section of socioeconomic locations References 1. J PerryWhelton, J Harrington, B Cousins. The heights and weights of Irish children from the post-war era to the Celtic tiger. J Epidemiol Community Health.2009; 63: 262-264. 2.Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997;337:869-873 3.Franklin J, Denyer G, Steinbeck KS, Caterson ID, Hill AJ. Obesity and risk of low self-esteem: a statewide survey of Australian children. Pediatrics. 2006;118:2481-7. 4.Must A, Strauss RS. Risks and consequences of childhood and adolescent obesity. Int J Obes Relat Metab Disord 1999;23(suppl):S2–11. 5.Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of childhood obesity to coronary heart disease risk factors in adulthood: The Bogalusa heart study. Pediatrics. 2001;108 :712 –718 6.Meizi H, Evans A. Are parents aware that their children are overweight or obese? Do they care?. Can Fam Physician 2007; 53: 1493–9. 7. Centres for Disease Control and Prevention, Body Mass Index-for-age growth chart 8.Whelton H, Harrington J, Crowley E. Prevalence of overweight and obesity on the island of Ireland: Results from the North South Survey of Children’s Height, Weight and Body Mass Index, 2002. BMC Public Health. 2007;31;7:187. Figure 3. Percentage cases per weight category Acknowledgements I wish to thank Dr Brendan O'Brien and Dr Tom Houlihan and their practice staff for their encouragement and help with data collection Thank you also Dr Brendan O’Shea and Dr. Catherine Darker for their expert knowledge and support.