This study examined prevalence of childhood overweight and obesity (ov/ob) and central
obesity in five mega-cities across China (Beijing, Shanghai, Xian, Nanjing and Chengdu);
described parental perceptions of children’s ideal body image (IBI); and prospectively
examined associations between parental perception of child IBI and child weight changes
over 3 years. In this NIH-funded, open cohort study, data were collected from students
and their parents in 2015, 2016 and 2017 (n = 3298, in 3 waves). Cross-sectional analysis
included all 3,298 children; longitudinal data analysis used mixed effects models
and included 1691 children aged 6–17 years with ≥ two body mass index (BMI) measurements
during 2015–2017. Ov/ob prevalence based on Chinese age-sex-specific BMI cut-points
was 30.0%. Based on waist-to-height ratio (WHtR), the abdominal obesity rate was 19.8%.
Parents reported different preferred IBI for boys vs girls, being about 3 times more
likely to select ov/ob as ideal for boys than for girls (4.5% vs 1.5%, respectively,
P < 0.001). In longitudinal analysis, children whose parents selected ov/ob as ideal
had higher BMI Z-scores and WHtR increase over time than those whose parents selected
an average body image (β [SE] = 0.042 [0.011], and β [SE] = 0.010 [0.004], respectively,
all P < 0.05). Ov/ob rates were high among children in major cities in China. Chinese
parents preferred a heavier ideal body image for their boys. Health promotion programs
should help empower parents and their children to develop appropriate body images
and maintain healthy body weight.