Factors predicting severe childhood obesity in kindergarteners

Int J Obes (Lond). 2013 Jan;37(1):31-9. doi: 10.1038/ijo.2012.168. Epub 2012 Nov 13.


Background: Severe obesity has increased >300% in US children since 1976, and is associated with multiple cardiovascular risk factors and high adult obesity rates.

Objective: The objective of this study was to identify predictors of severe obesity in kindergarteners.

Methods: Multivariable logistic regression and recursive partitioning analysis (RPA) were used to identify prenatal/pregnancy, infant, and early childhood predictors of severe kindergarten obesity (body mass index (BMI) 99th percentile) in the Early Childhood Longitudinal Study Birth Cohort, a nationally representative longitudinal study that followed children from birth through kindergarten.

Results: For the 6800 children, the severe kindergarten obesity prevalence was 5.7%, with higher adjusted odds for crossing the 85th percentile of BMI at 2 years old (odds ratio (OR), 8.0; 95% confidence interval (CI), 4.1-15.7), preschool age (OR, 7.9; 95% CI, 4.9-12.8) and 9 months old (OR, 1.8; 95% CI, 1.2-2.6); maternal severe obesity (OR, 3.4; 95% CI, 1.9-5.8) and gestational diabetes (OR, 2.9; 95% CI, 1.5-5.5); drinking tea or coffee between meals/before bedtime at 2 years old (OR, 3.3; 95% CI, 1.3-8.5); Latino (OR, 2.3; 95% CI, 1.4-3.7) and multiracial (OR, 2.3; 95% CI, 1.1-4.8) race/ethnicity; and drinking sugary beverages at kindergarten age at least weekly (OR, 2.3; 95% CI, 1.4-3.7). Ever-attending center-based daycare (OR, 0.3; 95% CI, 0.1-0.9), eating fruit at least weekly at kindergarten age (OR, 0.3; 95% CI, 0.1-0.7), and maternal history of a prior newborn birth weight 4000 g (OR, 0.1; 95% CI, 0.02-0.6) were associated with reduced odds of severe obesity. RPA identified low severe obesity prevalence (1.9%) for non-85th BMI-percentile preschool crossers and high severe obesity (56-80%) for predictor clusters which included crossing the 85th BMI percentile at earlier ages, low parental education, specific maternal age cutoffs, preschooler bedtime rules, and outside walking/play frequency for 9-month-olds.

Conclusions: Certain parental, prenatal/pregnancy, infant, and early childhood factors, both alone and in combination, are potent predictors of severe obesity in kindergarteners.

MeSH terms

  • Birth Weight
  • Body Mass Index
  • Child, Preschool
  • Diet*
  • Female
  • Humans
  • Infant
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Mothers
  • Multivariate Analysis
  • Obesity, Morbid / epidemiology*
  • Obesity, Morbid / ethnology
  • Obesity, Morbid / prevention & control*
  • Odds Ratio
  • Predictive Value of Tests
  • Prevalence
  • Risk Factors
  • Sleep*
  • United States / epidemiology