Abstract
Purpose:
There remains a significant gap in our knowledge of the synergistic nature of family dynamics, child characteristics, and child-rearing features in the etiology of obesity from childhood through adolescence. We assessed the impact of family dynamics (poverty, family structure), child characteristics (child temperament), and child-rearing features (maternal depression, maternal sensitivity, and type of child care) on the development of childhood obesity.
Methods:
Children (n=1,240) whose weights and heights were measured at least once for ten time points (from 2 years through 15 years) from the NICHD Study of Early Child Care and Youth Development were included. Childhood obesity was based on standardized height and weight measures taken during the interviews and was defined according to appropriate 2000 CDC age and sex-specific body mass index percentiles. Maternal sensitivity was based on behavioral observations when children were 6 months of age, and all other measures were parental self-report. Generalized estimating equation (GEE) was used to examine the impact of family and individual factors on the childhood obesity after adjusting for covariates (child sex, race, birth weight).
Results:
Prevalence of obesity increased from 2 years (5.6%) to school ages (e.g., 19.5% at Grade 5 and 15.5% at age 15 years). Adjusted GEE models showed that living below poverty level was associated with an increased risk of obesity (odds ratio (OR)=1.62, 95% Confidence Interval (CI)=1.05, 2.53). Additionally, being nonwhite and higher birthweight were positively associated with an increased risk of obesity across time.
Conclusion:
Among these key family and individual factors, poverty status was observed to be the strongest predictor of obesity risk of offspring across time. Findings highlight the importance of systemic-level public health changes in obesity reduction efforts and suggest that poverty-reduction based prevention and intervention are likely more effective targets than more individual/family specific targets.
