Overweight Children's Barriers to and Support for Physical Activity

Objective: As the epidemic of overweight increases among youth, research needs to examine factors that may influence children's participation in weight‐related health behaviors. This study examined overweight children's perceived barriers to and support for physical activity compared with nonoverweight children. Research Methods and Procedures: Barriers to and support for physical activity were examined among 84 overweight children attending a summer fitness camp or a university‐based weight loss clinic. Barriers and support levels were then compared with those of 80 nonoverweight children of a similar age range. Results: Body‐related barriers were the most predominant barrier type among overweight youth, especially among overweight girls. Overweight children, particularly girls, reported significantly higher body‐related, resource, and social barriers to physical activity compared with nonoverweight children and lower levels of adult support for physical activity. Discussion: Overweight children may be particularly vulnerable to body‐related barriers to physical activity, and reducing such barriers may serve as physical activity intervention points most relevant for overweight youth. Future interventions may also benefit from enhancing support for physical activity from adults and peers.     

Childhood Obesity: Do Parents Recognize This Health Risk?

Objective: This study examined parents’ understanding of excess weight as a health risk, knowledge of healthy eating habits, and recognition of obesity in their children. Research Methods and Procedures: An anonymous questionnaire was distributed during well‐care visits involving children 4 to 8 years of age at a pediatric faculty practice. Parents indicated their level of concern about excess weight and other familiar health risks using a four‐point Likert scale, answered multiple‐choice questions concerning healthy eating patterns, and communicated their perceptions about their child's weight using a visual analog scale. A parent's perception was considered “accurate” if it deviated from the child's growth chart percentile by <30 points. Results: Of the 83 parents surveyed, 23% (19/83) had overweight children (≥95th percentile of age‐ and gender‐specific BMI growth charts). These parents did not differ from other parents in their level of concern about excess weight as a health risk or in their knowledge of healthy eating patterns, but the two groups of parents did differ in the accuracy of their perceptions about their children's weight. Only 10.5% of parents of overweight children (2/19) perceived their child's weight accurately compared with 59.4% of other parents (38/64; p < 0.001). Parents of overweight children invariably underestimated their children's weight. The median difference between their perception and the growth chart percentile was ?45 points. Discussion: Given that most parents of overweight children fail to recognize that their child has a weight problem, pediatricians should develop strategies to help these parents correct their misperceptions.     

Intergenerational Perceptions of Body Image in Hispanics: Role of BMI,Gender, and Acculturation

Objective: To assess role of BMI, gender, and acculturation on maternal and children's perception of body size, body ideal, and attractiveness. Research Methods and Procedures: Eighty mothers and their 6‐ to‐ 12‐year‐old children (41 boys, 39 girls) participated. Maternal and children's perceptions of body size (actual and ideal) and attractiveness were assessed through a pictorial instrument. Mother and child height and weight, demographic, and acculturation characteristics were also assessed. Results: Seventy‐nine percent of the mothers were overweight, and 32% of the boys and 34% of the girls were overweight or at‐risk for overweight. BMI influenced the children's selection of perceived ideal size. Overweight or at‐risk for overweight children were more likely to select thinner figures as the ideal size than non‐overweight children. Gender and acculturation differences concerning children's perceptions of body size and attractiveness were also found. Girls perceived the obese figure as being less attractive than did the boys. More acculturated children were likely to select thinner figures as more attractive than their less acculturated counterparts. Maternal acculturation was associated positively with the girls’ choice of thinner figures as an ideal body size, but not with the boys. Mothers viewed their daughters’ actual body size and BMI as ideal, although 34% of the girls were at‐risk for overweight. Mothers perceived average body size figures as more attractive for their sons. Discussion: Findings from this study provide empirical data about the role of BMI, gender, acculturation, and familial influences on children's perceptions of actual and ideal body sizes and attractiveness.     

Parental perceptions of overweight counseling in primary care: the roles of race/ethnicity and parent overweight

Objective: To examine parental perceptions of primary care efforts aimed at childhood obesity prevention Methods and Procedures: We interviewed 446 parents of children, aged 2–12 years, with an age‐ and sex‐specific BMI ≥85th percentile; interviews occurred within 2 weeks of their child's primary care visit. We assessed parental ratings of the nutrition and physical activity advice received. Using children's clinical heights and weights and parents' self‐reported heights and weights, we classified children into three categories: BMI 85th–94th percentile without an overweight parent, BMI 85th–94th percentile with an overweight parent (adult BMI ≥25 kg/m²), and BMI ≥95th percentile. Results: In multivariate analyses, compared to parents of children with BMI ≥95th percentile, overweight parents with children whose BMI was 85th–94th percentile were more likely to report receiving too little advice on nutrition and physical activity (odds ratio (OR) 3.05; 95% confidence interval (CI) 1.49, 6.25) and to rate as poor or fair the quality of advice they received (OR 2.23; 95% CI 1.18, 4.24). Independently, African‐American (OR 2.55; 95% CI 1.18, 5.51) and Hispanic/Latino (OR 2.78; 95% CI 1.27, 6.10) parents were more likely than white parents to rate as poor or fair the quality of advice they received. Discussion: Parental overweight is associated with low subjective ratings of overweight counseling in pediatric primary care. Our findings of poorer perceived quality among racial/ethnic minority parents need further investigation.     

Childhood Overweight and Academic Performance: National Study of Kindergartners and First‐Graders

Objective: To examine the association between children's overweight status in kindergarten and their academic achievement in kindergarten and first grade. Research Methods and Procedures: The data analyzed consisted of 11, 192 first time kindergartners from the Early Childhood Longitudinal Study, a nationally representative sample of kindergartners in the U.S. in 1998. Multivariate regression techniques were used to estimate the independent association of overweight status with children's math and reading standardized test scores in kindergarten and grade 1. We controlled for socioeconomic status, parent‐child interaction, birth weight, physical activity, and television watching. Results: Overweight children had significantly lower math and reading test scores compared with nonoverweight children in kindergarten. Both groups were gaining similarly on math and reading test scores, resulting in significantly lower test scores among overweight children at the end of grade 1. However, these differences, except for boys’ math scores at baseline (difference = 1.22 points, p = 0.001), became insignificant after including socioeconomic and behavioral variables, indicating that overweight is a marker but not a causal factor. Race/ethnicity and mother's education were stronger predictors of test score gains or levels than overweight status. Discussion: Significant differences in test scores by overweight status at the beginning of kindergarten and the end of grade 1 can be explained by other individual characteristics, including parental education and the home environment. However, overweight is more easily observable by other students compared with socioeconomic characteristics, and its significant (unadjusted) association with worse academic performance can contribute to the stigma of overweight as early as the first years of elementary school.     

Is Parental Control over Children's Eating Associated with Childhood Obesity? Results from a Population‐Based Sample of Third Graders

Objective: Identifying parental behaviors that influence childhood obesity is critical for the development of effective prevention and treatment programs. Findings from a prior laboratory study suggest that parents who impose control over their children's eating may interfere with their children's ability to regulate intake, potentially resulting in overweight. These findings have been widely endorsed; however, the direct relationship between parental control of children's intake and their children's degree of overweight has not been shown in a generalized sample. Research Methods and Procedures: This study surveyed 792 third‐grade children with diverse ethnic and socioeconomic backgrounds from 13 public elementary schools. Parental control over children's intake was assessed through telephone interviews using a state‐of‐the‐art instrument, and children were measured for height, weight, and triceps skinfold thickness. Results: Counter to the hypothesis, parental control over children's intake was inversely associated with overweight in girls, as measured by body mass index, r = ?0.12, p < 0.05, and triceps skinfolds, r = ?0.11, p < 0.05. This weak relationship became only marginally significant when controlling for parents’ perceptions of their own weight, level of household education, and children's age. No relationship between parental control of children's intake and their children's degree of overweight was found in boys. Discussion: Previous observations of the influence of parental control over children's intake in middle‐class white families did not generalize to 8‐ to 9‐year‐olds in families with diverse socioeconomic and ethnic backgrounds. The present findings reveal a more complex relationship between parental behaviors and children's weight status.     

Predictors of accurate maternal perception of their preschool child's weight status among Hispanic WIC participants

Childhood obesity is a growing problem in the United States. Parental perception of their children's weight status is a key factor that needs to be considered when developing prevention programs for preschool children. Using a randomly selected sample of participants of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Los Angeles County, we assessed accuracy of maternal perceptions of their children's weight status by comparing children's weight classification to the mothers' response to the question “Do you consider your child to be overweight, underweight or about right weight for (his) (her) height?” Additionally, we identified possible predictors of accurate maternal perception of their children's weight status by conducting a logistic regression model with child's gender, child's birth weight, maternal age, maternal BMI, maternal education, maternal acculturation level, and maternal language preference as potential predictors. Almost all mothers in the study classified their overweight or obese child as being about the right weight (93.6% and 77.5% of mothers, respectively). Maternal BMI and child's birth weight were the only predictors of maternal perception of their child's weight. Both were negatively associated with accuracy, with higher maternal BMI and higher infant birthweight associated with less accurate maternal perception of child weight. Parents need to be educated on the importance of childhood obesity and how to identify if their children are overweight or obese. If parents fail to recognize that their overweight child is overweight, then it is unlikely that they will recognize that interventions targeting obesity are relevant to their families.     

Physical activity levels of normal-weight and overweight girls and boys during primary school recess

Objective: This study aimed to compare moderate‐to‐vigorous physical activity (MVPA) and vigorous physical activity (VPA) in normal‐weight and overweight boys and girls during school recess. Research Methods and Procedures: Four hundred twenty children, age 6 to 10 years, were randomly selected from 25 schools in England. Three hundred seventy‐seven children completed the study. BMI was calculated from height and weight measurements, and heart rate reserve thresholds of 50% and 75% reflected children's engagement in MVPA and VPA, respectively. Results: There was a significant main effect for sex and a significant interaction between BMI category and sex for the percent of recess time spent in MVPA and VPA. Normal‐weight girls were the least active group, compared with overweight boys and girls who were equally active. Fifty‐one boys and 24 girls of normal weight achieved the 40% threshold; of these, 30 boys and 10 girls exceeded 50% of recess time in MVPA. Eighteen overweight boys and 22 overweight girls exceeded the 40% threshold, whereas 8 boys and 8 girls exceeded the 50% threshold. Discussion: Overweight boys were significantly less active than their normal‐weight male counterparts; this difference did not hold true for girls. Even though nearly double the number of normal‐weight children achieved the 40% of MVPA during recess compared with overweight children, physical activity promotion in school playgrounds needs to be targeted not only at overweight but at other health parameters, as 40 overweight children met the 40% MVPA target proposed for recess.     

Care Giver Perception of Children's Obesity‐Related Health Risk: A Study of African American Families

Objective: To examine care giver perception of children's weight‐related health risk in African American families. Research Methods and Procedures: One‐hundred and eleven families (representing 48 boys and 63 girls) screened for participation in a diabetes prevention study participated. Care givers completed a health awareness questionnaire that assessed their perception of the child's weight, eating habits, appearance, exercise habits, and health risk. The care givers also reported each subject's family history of obesity, diabetes, and other chronic diseases. After a physical examination, height and weight were used to compute an age‐ and sex‐adjusted body mass index for each child. Results: Despite the fact that a substantial number of children were obese (57%) and super‐obese (12%), only 44% of the care givers perceived the child's weight to be a potential health problem. Regression analysis showed that 21% of the variance in parental perception of obesity‐related health risk could be predicted by child age, body mass index, perception of frame size, and perception of exercise habits. Discussion: A number of reasons for the apparent minimization of child health risk are discussed, including cultural differences in the acceptance of a large body habitus, lack of knowledge about the connection between childhood obesity and future health risk, and an optimistic bias in the perception of personal health risk.     

Ability to taste 6-n-propylthiouracil and BMI in low-income preschool-aged children

Background: Sensitivity to the bitter compound 6‐n‐propylthiouracil (PROP) is genetically mediated. Sensitivity to PROP has been associated with weight status in both adults and children. Objective: To determine whether there is an association between PROP sensitivity and BMI in low‐income children of diverse race/ethnicity, among whom there is a high prevalence of obesity. Methods and Procedures: Eighty‐one preschool‐aged children attending Head Start tasted a solution of 560 μmol/l PROP and reported whether it tasted “like water” or “like something else”. Mothers reported child's race, age, maternal education, maternal weight and height, child's reluctance to sample new foods via the Food Neophobia Scale (FNS), and child's dietary intake using a food frequency questionnaire. Child weight and height were measured. BMI was calculated and for children, expressed in z‐scores. Regression analyses were used to evaluate the relationship between child's PROP taster status and BMI z‐score, testing covariates child's age, gender, race, maternal education and BMI, and child's FNS score. Children's dietary intake was compared by PROP taster status. Results: PROP tasters, compared with nontasters, had significantly higher BMI z‐scores (0.99 (s.d. 1.24) vs. 0.03 (1.12), P = 0.004) and had a significantly higher prevalence of overweight (31.8% vs. 5.6%, P = 0.025), but demonstrated no differences in reported dietary intake. The most parsimonious model predicting the child's BMI z‐score included only maternal BMI and the child's PROP taster status (R ² = 22.3%). Discussion: A genetically mediated ability to taste bitter may contribute to obesity risk in low‐income, preschool‐aged children.     

Targeting Parents Exclusively in the Treatment of Childhood Obesity: Long‐Term Results

Objective: To report the long‐term change in children's overweight following a family‐based health‐centered approach where only parents were targeted compared with a control intervention where only children were targeted. Research Methods and Procedures: Fifty of the 60 children who participated in the original study were located 7 years later, and their weight and height were measured. At the point of the 7‐year follow‐up, the children were 14 to 19 years of age. Repeated measure ANOVA was used to test differences between the groups in percent overweight at different time‐points. Results: Mean reduction in percent overweight was greater at all follow‐up points in children of the parent‐only group compared with those in the children‐only group (p < 0.05). Seven years after the program terminated, mean reduction in children's overweight was 29% in the parent‐only group vs. 20.2% in the children‐only group (p < 0.05). Discussion: Over the long term, treatment of childhood obesity with the parents as the exclusive agents of change was superior to the conventional approach.     

Maternal BMI and country of birth as indicators of childhood obesity in children of Mexican origin

Objective: The goal of this study was to evaluate the relationship between maternal and childhood BMI at baseline in a group of 5‐ to 18‐year‐old children and their mothers, all of whom were of Mexican origin, low socioeconomic status, and enrolled in a cohort study in Houston, TX. Research Methods and Procedures: Using data from 438 mother‐child dyads residing in the same household, we completed logistic regression analyses to determine maternal factors associated with the child being overweight or at‐risk‐for‐overweight, after adjusting for the child's gender, age, and level of physical activity and other maternal confounders. Results: Almost one‐half of the boys and girls (47% and 44%, respectively) were either overweight or at‐risk‐for‐overweight. Obese mothers were twice as likely to have an overweight and/or at‐risk‐for‐overweight child compared with normal‐weight mothers. Women born in the U.S. were twice as likely to have an overweight and/or at‐risk‐for‐overweight child compared with women born in Mexico. In addition, women with less than a high school education were twice as likely to have an overweight child compared with their more educated peers. Discussion: The high prevalence of overweight or at‐risk‐for‐overweight among Mexican‐origin children of low socioeconomic status suggests a continued need to develop and implement culturally sensitive preventive interventions for this minority population. Our data also suggest a need to tailor such interventions particularly for children of obese mothers and those born in the U.S.     

Stress exposure in specific growth periods associates with children's weight,height, and body mass index

Objectives

We investigate associations between children exposure to stressful events, considering: (1) the period in which the event took place, (2) the type of event, and (3) the cumulative effect of the events on children's weight, height and body mass index (BMI).

Methods

A total of 8429 Portuguese children (3349 exposed to at least one stressful event during their lifetime; 50.2% males; mean age = 7.21 ± 1.85 years) were included in the analysis. The occurrence of stressful (i.e., adverse) events was reported in a parental questionnaire; children's weight and height were objectively measured.

Results

When the stress event took place in the first 2 years of life, compared with during pregnancy or after the 2 years, children were shorter; but the association was weak and only significant for boys. After adjustment for child's birthweight, gestational age, breastfeeding duration, number of siblings, and father's education, the experience of 3+ stressful events (vs. 1 or 2) was associated with higher weight and height in boys. No interaction effect was found between stress and BMI.

Discussion

We found some evidence of associations between exposure to stressful events and physical growth of boys. We highlight the complex relationship between exposure to stressful experiences and children's physical growth, particularly the different effects of specific characteristics of the stress event and the sex differences.

     

The extended relationship between child cardiovascular risks and academic performance measures

Objective: To examine the relationship between children's overweight status and other cardiovascular risk fitness factors and academic performance among fifth‐grade students. Research Methods and Procedures: Using a sample of 968 fifth‐grade students (50.7% boys; mean age = 10.6 years), children's cardiovascular risks (BMI, blood pressure, acanthosis nigricans) and fitness measures were compared with their mean group performance scores across four subscales (mathematics, reading/language arts, science, and social studies) of a statewide standardized academic performance test. Results: Of this sample, 39% were either at risk for being overweight or were already overweight; slightly over one half were of normal weight. Initial findings revealed a significant relationship between children's weight category and their reading/language arts, mathematics, and science test scores even after controlling for a proxy of socioeconomic status. When additional cardiovascular risk and fitness measures were included in the model, however, children's BMI status had no association. Instead, a composite fitness index, children's blood pressure, sex, and proxy of socioeconomic status were significantly associated with children's academic test scores. Discussion: This study expanded our understanding of the connection between children's overweight risks and academic performance by examining the impact of other cardiovascular risk factors such as high blood pressure and measures of fitness. These findings support the development and implementation of childhood cardiovascular risk surveillance programs that evaluate not only children's overweight risks but also their fitness, risk for type 2 diabetes, and/or high blood pressure by showing a relationship between some of these risks and children's academic test performance.     

Communication

Abstract

In studying the effect of father's education on child's cognitive ability, we find that some models of analysis yield a negative effect, which does not seem plausible according to our current understanding of the nature of the two variables. Two new models are proposed to take account of the biological relationships between parents and children. The analyses based on these new models show a positive effect of father's education on child's IQ scores. While the results of the proposed models become more plausible, it cannot be claimed as “correct,” because there is no conclusive and permanent “proof in empirical sciences.     

Influence of parents' eating behaviors and child feeding practices on children's weight status

Objective : To investigate the effects of mothers’ and fathers’ eating behaviors, child feeding practices, and BMI on percentage body fat and BMI in their children. Research Methods and Procedures : Four hundred fifty‐eight parents (239 mothers, 219 fathers) were asked to complete two questionnaires: the Three‐Factor Eating Questionnaire and the Child Feeding Questionnaire, which measure dimensions of parent eating behavior and child feeding practices, respectively. Parent BMI was calculated from self‐reported height and weight; children's measures included BMI and percentage fat assessed by DXA. Regression analyses were used to analyze relationships between parents’ BMI and questionnaire scores and children's weight status. Results : One hundred forty‐three mothers and 68 fathers returned questionnaires, representing parents of 148 children 3 to 5 years old (78 boys). Children's weight was related to mothers’ BMI, but not fathers’. Girls had a greater BMI if either parent reported being overweight as a child, and both girls and boys were likely to be overweight if their mothers believed they had risky eating habits (fussiness, eating too much, etc.). Girls with fathers who were more controlling had a higher percentage fat; these fathers were also more concerned about their daughters’ future health. Discussion : Mothers exert a strong influence over their children's weight and seem to be more concerned about their children's eating behaviors; however, fathers play a role in imposing child feeding practices. Gender bias may be present in child feeding, as suggested by dissimilar effects of parent practices on the weight status of girls vs. boys. Fathers should be included in future studies analyzing parent feeding practices and children's weight outcome.     

Bone Mineral Density of the Spine in 11,898 Chinese Infants and Young Children: A Cross-Sectional Study

Background

Bone mineral density (BMD) increases progressively during childhood and adolescence and is affected by various genetic and environmental factors. The aim of this study was to establish reference values for lumbar BMD in healthy Chinese infants and young children and investigate its influencing factors.

Methods and Findings

Healthy children aged 0 to 3 years who underwent regular physical examinations at the Child Health Care Clinic of Hubei Maternal and Child Health Hospital (N = 11,898) were recruited for this study. We also chose 379 preterm infants aged 0 to 1 years to preliminarily explore the development of BMD in this special population. BMD (g/cm²) measurements of the lumbar spine (L2–L4) were carried out with dual-energy X-ray absorptiometry and a questionnaire was administered to full-term children''s parents to gather information on various nutritional and lifestyle factors as well as mothers'' nutritional supplement use during pregnancy. Lumbar BMD significantly increased with age among both boys and girls (p<0.05), with fastest growth observed during the first postnatal year. There was no significant difference in lumbar BMD between boys and girls of similar age (p>0.05), either among healthy reference children or preterm infants. However, BMD values in preterm infants were significantly lower than those in term infants 3 to 8 months old (p<0.05) after adjustment for gestational age. Multivariable linear regression analysis indicated significant positive associations between lumbar BMD of healthy children and the child''s age and current weight, mother''s weight gain during pregnancy, birth weight, children''s outdoor activity duration and children''s physical activity duration.

Conclusion

Our study provides reference values of lumbar BMD for healthy Chinese children aged 0 to 3 years and identifies several influencing factors.     

Behavioral and Self-report Measures Influencing Children's Reported Attachment to Their Dog

Despite the prevalence of dogs as family pets and increased scientific interest in canine behavior, few studies have investigated charac- teristics of the child or dog that influence the child–dog relationship. In the present study, we explored how behavioral and some self-report measures influence a child's reported attachment to their dog, as assessed by the Lexington Attachment to Pets Scale (LAPS). We tested specifically whether children (n = 99; mean age = 10.25 years, SD = 1.31) reported stronger attachment to dogs that were perceived as being more supportive (mea- sured by a modified version of the Network of Relationships Inventory), that were more successful in following the child's pointing gesture in a standard two-object choice test, or that solicited more petting in a sociability assess- ment. In addition, we assessed whether children's attachment security to their parent and being responsible for the care of their dog influenced re- ported attachment to the dog. Overall, perceived support provided by the dog was highly predictive of all subscales of the LAPS. The dog's success in following the child's pointing gestures and lower rates of petting during the sociability assessment were associated with higher ratings on the General Attachment subscale of the LAPS, but not on the other subscales. Caring for the dog did not predict the child's reported attachment to the dog, but did predict the dog's behavior on the point-following task and petting during the sociability task. If the child cared for the dog, the dog was more likely to be successful on the pointing task and more likely to be petted. These results indicate a dyadic relationship in which the child's care for the dog is associ- ated with the dog's behavior on the behavioral tasks, which in turn is related to the child's reported attachment to their dog. The direction of influence and nature of this dyad will be a fruitful area for future research.     

Parental recognition of overweight in school-age children

Objective: Examine the accuracy of parental weight perceptions of overweight children before and after the implementation of childhood obesity legislation that included BMI screening and feedback. Methods and Procedures: Statewide telephone surveys of parents of overweight (BMI ≥ 85th percentile) Arkansas public school children before (n = 1,551; 15% African American) and after (n = 2,508; 15% African American) policy implementation were examined for correspondence between parental perception of child's weight and objective classification. Results: Most (60%) parents of overweight children underestimated weight at baseline. Parents of younger children were significantly more likely to underestimate (65%) than parents of adolescents (51%). Overweight parents were not more likely to underestimate, nor was inaccuracy associated with parental education or socioeconomic status. African‐American parents were twice as likely to underestimate as whites. One year after BMI screening and feedback was implemented, the accuracy of classification of overweight children improved (53% underestimation). African‐American parents had significantly greater improvements than white parents (P < 0.0001). Discussion: Parental recognition of childhood overweight may be improved with BMI screening and feedback, and African‐American parents may specifically benefit. Nonetheless, underestimation of overweight is common and may have implications for public health interventions.     

Youths' perceptions of overweight-related prevention counseling at a primary care visit

Objective: We examined youths’ report of receiving specific overweight‐related preventive counseling and perceived readiness to adopt nutrition and physical activity behaviors recommended by their clinicians. Research Methods and Procedures: We surveyed 324 youth 10 to 18 years old who had a physical exam within the past year. The survey included questions on height, weight, race/ethnicity, mother's education, and topics they discussed with their clinician during their visit. We used multivariable analyses to examine whether weight status and sociodemographic characteristics were predictors of which youth received counseling from their clinicians and which youth were ready to change. Results: The mean (standard deviation) age of participants was 13.7 (1.8) years; 54% were black, and 22% were Hispanic. Less than one‐half of participants reported discussing sugar‐sweetened beverages [38%; 95% confidence interval (CI), 32% to 43%] or television viewing (41%; 95% CI, 36% to 47%) with their clinicians. In multivariable analyses adjusting for participant's age, sex, race/ethnicity, overweight status, and mother's educational attainment, youth whose mothers lacked education beyond high school were significantly less likely to report receiving counseling on any overweight‐specific topic including television viewing [odds ratio (OR), 0.46; 95% CI, 0.27, 0.79], sugar‐sweetened beverage (OR, 0.47; 95% CI, 0.28, 0.80), and fast food consumption (OR, 0.54; 95% CI, 0.32, 0.92). In addition, youth 10 to 14 years old were more likely than those 15 to 18 years old to report they would try to change their television viewing (OR, 4.10; 95% CI, 1.78, 9.44) if recommended by their clinician. Discussion: Youth report infrequently receiving counseling on specific overweight prevention topics during routine primary care visits. Our findings suggest that greater efforts may be needed to reduce social class disparities in overweight prevention counseling and that counseling to prevent overweight in youth may be more acceptable to younger children.