Caregiver Weight Misperception and Feeding Practices in U.S. Preschool-Aged Children: A Theory-Based Cross-Sectional Study

Background/Objectives: Caregiver perception of child weight may be a cognitive antecedent of feeding practices, yet evidence linking misperception to feeding practices remains inconsistent. Guided by Social Cognitive Theory, this study examined whether caregiver weight perception (underestimation, overestimation, or accurate) is independently associated with feeding practices among caregivers of U.S. preschool-aged children. Methods: Primary caregivers of children aged 3–5 years (analytic n = 139) were recruited across the Midwestern United States from April 2022 to March 2023. Weight perception was classified as accurate, underestimation, or overestimation by comparing perceived with CDC BMI-for-age category. Four Comprehensive Feeding Practices Questionnaire (CFPQ) subscales were assessed: pressure to eat, restriction for health, restriction for weight control, and monitoring. Multivariable linear regression estimated associations, adjusting for child and caregiver characteristics and child BMI-for-age z-score. Results: Overall, 45.3% of caregivers accurately perceived their child’s weight, 44.6% underestimated it, and 10.1% overestimated it. In adjusted models, underestimation was independently associated with lower restriction for health (B = −0.62, 95% CI: −1.10, −0.13, p = 0.013) and lower restriction for weight control (B = −0.30, 95% CI: −0.58, −0.02, p = 0.033) relative to accurate perception. Overestimation was marginally associated with higher restriction for weight control (B = 0.53, 95% CI: 0.00, 1.07, p = 0.050). No associations were observed with pressure to eat or monitoring. Conclusions: Weight misperception was selectively associated with restrictive feeding. This identifies it as a candidate cognitive target in early obesity prevention research. Longitudinal research is needed to establish causality.