In this study we sought to detect and evaluate eventual differences in weight status and in body image perception in schoolchildren living in Emilia Romagna region (North Italy), and in their mothers perception of them, in relation to the immigrant or Italian status of the mother. In addition we sought to develop and explore a new scheme to validate the body image perception in underweight children.
Previous studies have reported a relationship between the nutritional status of children and the immigrant and nutritional status of their mothers
[5, 6, 9, 22–24]. In addition to genetic influences or events occurring during fetal life, great importance is given to the mother's behavior. Indeed the mother's behavior concerning food serves as a model for her children and strongly influences their feeding behavior. Moreover, the mother usually deals with the selection and preparation of food for meals eaten at home and thus is responsible for the accessibility or not to certain foods by her children, for eventual food restrictions or for any pressure to eat certain foods because they are considered healthy or to eat more or less in general
[8, 10, 23–25].
Differences in the choice and preparation of food, and in eating habit in general, are often linked to ethnic and cultural traditions: these differences will probably have an impact on the diet and nutritional status of children.
Our findings support a greater prevalence of overweight and obesity in children with Italian mothers and a higher prevalence of underweight in children with immigrant mothers than in their peers. This may be related to genetic factors, but also perhaps to a lower socio-economic status of families recently immigrated to Italy, with preservation of the culinary traditions of the country of origin and consequently with lower accessibility by children of immigrants to certain types of foods rich in fat.
The analysis of body image perception showed that the children’s choice of the actual silhouette tended to be consistent with their nutritional status, as assessed by the anthropometric survey (BMI). While these data do not prove a correct body image perception by the children, they provide a proxy measure of its general appropriateness, as it approaches their actual nutritional status.
On average the children, both with Italian and immigrant mothers and both males and females, chose an “ideal” silhouette that was slimmer than the one chosen as “actual”: this means that they would like to be slimmer than they perceive themselves, with a consequent positive FID. This was particularly evident for daughters of Italian mothers, who showed a significantly higher FID than daughters of immigrant mothers, in agreement with the findings of Thompson et al.
 and Caradas et al.
The daughters of Italian mothers were generally the most dissatisfied (their FID was almost twice that of all the other subsamples), especially the overweight and obese daughters who chose mean actual figure values of 4.09 and 4.82, respectively, but would have liked to be (ideal figure) 2.81 and 2.93 on average. These data confirm previous studies in which Italian girls were more dissatisfied than Italian boys
 and confirm general data according to which immigrant women (particularly black ones) are more satisfied with their body image than white ones
[2, 26]. Most of the males who would like to be slimmer were the obese sons of Italian mothers.
Analysis of the body image perception the mothers had of their children showed that they had a tendency to perceive them as thinner than the children perceived themselves. Moreover the mothers were more satisfied with their children’s body image than the children were, especially the immigrant mothers of girls and the Italian mothers of boys. Instead, the Italian mothers of girls were the only ones to have a positive FID, meaning they would like their daughters to be slimmer than they perceive them. However, the positive FID of Italian mothers was lower than the FID of their daughters, indicating that the mothers were more lenient about the nutritional status of their daughters than the daughters themselves.
In contrast, the immigrant mothers of boys had a negative FID, meaning they would like their sons to be heavier than they perceive them: immigrant mothers chose F.4 as the ideal figure for their sons, whereas Italian mothers preferred F.3. These data disagreed with the FID values of their children, which were positive to the same degree as those of the mothers were negative (sons’ FID= + 0,35; mothers’ FID= −0,35).
The fact that the Italian mothers significantly preferred that their daughters be slimmer whereas the immigrant mothers significantly preferred that their sons be heavier may be linked to socio-cultural and behavioral influences, perhaps related to different aesthetic ideals.
A particular analysis of body image discrepancy was carried out on malnourished children on the basis of two schemes applied to Collins’ silhouettes: the first was previously proposed for overweight and obese children
, the second is a new scheme proposed in this study for underweight children. An interesting result of this analysis is a much higher (triple) frequency of body image discrepancy in underweight sons of immigrant mothers than in sons of Italian mothers. The opposite was observed in girls, in whom only daughters of Italian mothers showed misperception (albeit with low frequency). A very different situation was found in overweight and obese children, with frequencies of body image discrepancy greater than 30% in the children of Italian mothers and around 25% in those of immigrant mothers.
[22, 24, 25, 27–29] and our findings support the tendency in overweight subjects to underestimate their nutritional status. This distortion of body image perception in overweight children may be exacerbated by the perception and beauty ideals of the parents (mothers in particular). Indeed the mothers of overweight/obese children showed a high percentage of misperception, particularly with regard to daughters.
This situation is serious and can have negative effects on health, as body image misperception in overweight and obese children and in their parents may prevent the assumption of correct dietary and exercise habits. On the other hand, misperceptions and distortions of body image can also lead to opposite behaviors, for example to excessive weight control and eating disorders such as anorexia and bulimia
[4, 30, 31]. On the other hand, the presence of overweight male individuals who see themselves as very slim, who are satisfied with their body image and choose as ideal a silhouette heavier than that corresponding to their nutritional status may be related to the erroneous belief that heavier figures correspond to greater muscularity
[4, 32]. These ideal body images, also seen in mothers (especially immigrant mothers) regarding their sons, are in agreement with findings by Jeffery et al.
, according to which parents were less likely to identify overweight in sons than in daughters.
Concerns about nutritional status, weight and body image also seem to show a close relationship with ethnicity, being largely influenced by cultural models and standards of beauty that can vary among different cultures. The importance of cultural and ethnic component is made explicit by the different ideals of beauty: larger women are considered healthy and more attractive in many traditional African and Latin American cultures
[2, 34–36], unlike what usually occurs in Western countries. Differences in how immigrant and Italian women perceive their bodies and those of their children, and cultural patterns of beauty underlying them, may have an impact on the way they feed and control their weight and that of their children. It must not be forgotten that the mothers’ feeding behavior acts as a direct model for the feeding behavior of the children
. These differences in ideals of beauty may be the source of the greater dissatisfaction with the nutritional status of their daughters shown by Italian mothers than by immigrant mothers, who instead would like their sons to be heavier. Moreover, the body image dissatisfaction in children (particularly in girls) can have serious psycho-social consequences, with low self-esteem, acquisition of risk behaviors and emergence of eating disorders during adolescence (with a tendency to anticipation of the age of onset of the disorders into childhood)
Some limitations of the present study should be noted: the lack of precise information on the country of origin of the immigrant mother and on the socio-economic status of the families. Furthermore, despite evidence of the close relationships between weight status of mother and child
[8, 10], we did not have the chance to collect anthropometric data for the mothers.
Despite these limitations, this study found differences in nutritional status and body image perception (and satisfaction) of two subsamples of children with Italian or immigrant mothers, and also in their mothers; these differences are probably due to socio-cultural and behavioral influences linked to ethnic origin.
It can be reasonably supposed that the ethnic heterogeneity of the sample, given its width, resembles that which can be found in literature for Emilia Romagna students
, having a higher frequency of Moroccans (20.7%), then Albanians (15.6%), followed by Romanians, Chinese and Tunisians.
From a socio-economic point of view
, immigrant families are generally concentrated in the lower social strata. According to Italian labor demand, primarily oriented toward unskilled workers, a large numbers of working immigrants are employed in unskilled jobs with low salaries, although some hold high educational qualifications (especially those coming from Eastern Europe and Asia)
[40, 41]. In addition, another element which have influenced their behaviors and habits (life style, diet etc.) may be the religious diversity, including a 49.1% of Christians, 33.2% of Muslims and different Eastern religions (about 5%)
In addition to differences in diet and exercise habits between ethnic groups, our results confirm the possibility of nutritional status disparities
 that could be related to differences in body image, leading to possible differences in responses to weight changes and weight control.
These results indicate the need to monitor and control nutrition, BMI, body image perception and body image satisfaction in children, especially those in BMI categories of underweight or overweight and obesity. Parental involvement in monitoring is crucial in order to establish strategies of weight control and to supervise the nutritional status of children, with the aim of bringing it within recommended ranges.
Use of Collins’ body silhouette chart according to the proposed methodology for assessing body perception and misperception in underweight and overweight children may be a rapid tool for the assessment and prevention of health risk behaviors, including eating disorders.