The Parent Awareness Questionnaire (PAQ) was used to survey parents of fifth graders in 5 rural South Dakota schools on the perception of their own and their children's weight. The PAQ responses were compared with anthropometric assessments. Thirty-six percent of the children were overweight or obese. Correct weight status assessments were made by 19% of mothers and 23% of fathers of overweight children and 0% of mothers and 13% of fathers of obese children, whereas the remainder underassessed their children's weight. Parents of overweight and obese children were largely unconcerned and unaware of their children's true weight status.