Self-regulation and household routines at age three and obesity at age eleven: longitudinal analysis of the UK Millennium Cohort Study.

OBJECTIVE: To examine, in a population-based cohort of 3-year-old children, the association between self-regulation and exposure to the household routines of regular bedtime, regular mealtime and limits on watching television/video, and to determine whether self-regulation and these routines predict the risk of obesity at age 11. METHODS: Analyses included 10 955 children in the nationally representative UK Millennium Cohort Study. When children were age 3, parents reported whether children had a regular bedtime and mealtime, and the amount of television/video watched. Emotional and cognitive self-regulation at age 3 were assessed by parent-report with the Child Social Behaviour Questionnaire. Children's height and weight were measured at age 11 and obesity was defined using the International Obesity Task Force (IOTF) criteria. RESULTS: At age 3, 41% of children always had a regular bedtime, 47% always had a regular mealtime and 23% were limited to ⩽1 h television/video daily. At age 11, 6.2% of children were obese. All three household routines were significantly associated with better emotional self-regulation, but not better cognitive self-regulation. In a multi-variable logistic regression model, including emotional and cognitive self-regulation, all routines and controlling for sociodemographic covariates, a 1-unit difference in emotional self-regulation at age 3 was associated with an OR (95% CI) for obesity of 1.38 (1.11, 1.71) at age 11, and inconsistent bedtimes with an OR (95% CI) for obesity of 1.87 (1.39, 2.51) at age 11. There was no evidence that emotional self-regulation mediated the relationship between regular bedtimes and later obesity. Cognitive self-regulation was not associated with later obesity. CONCLUSIONS: Three-year-old children who had regular bedtimes, mealtimes and limits on their television/video time had better emotional self-regulation. Lack of a regular bedtime and poorer emotional self-regulation at age 3 were independent predictors of obesity at age 11.

"Snacks are not food". Low-income, urban mothers' perceptions of feeding snacks to their preschool-aged children.

Snacking has become more frequent among US preschool-aged children in recent decades and represents a significant proportion of daily energy intake. Social influences on snacking among children, however, are not well understood. This qualitative research described low-income, urban mothers' perceptions of feeding snacks to their preschool-aged children using data from 7 focus groups with 32 participants. Focus group transcripts were analyzed using a constant comparative method to identify themes. Mothers described snacks as involving less preparation, balance, and sustenance than meals (Theme 1). Mothers also made reference to some snacks as not being "real food" (Theme 2). At the same time, snacks had significant hedonic value as reflected in mothers' enjoyment of those foods (Theme 3), the effectiveness of snacks to manage children's behavior (Theme 4), and the variety of restrictions that mothers placed on children's access to snacks, such as locking cabinets, offering small servings, and reducing the number of snacks in sight (Theme 5). Two overarching themes highlighted distinctions mothers made in feeding children snacks vs. meals as well as the powerful hedonic appeal of snacks for both mother and child. These observations suggest that low-income, urban mothers of preschool-aged children may perceive snacks as serving a more important role in managing children's behavior than in providing nutrition. Child feeding interventions should address non-food related ways of managing children's behavior as well as encouraging caregivers to see snacks as structured opportunities for nutrition and connecting with their children.

Teachers' perceptions about children's movement and learning in early childhood education programmes.

BACKGROUND: Efforts to improve the academic skills of preschool-aged children have resulted in approaches that tend to limit children's movement. However, movement experiences have long been considered important to children's learning and have received increased attention because of the obesity epidemic. Early childhood educators are important sources of information about if and how to promote learning and school readiness through movement, but little effort has been made to understand teachers' views on this topic. METHODS: We conducted six focus groups with 37 teachers from a Head Start programme with centres in three cities in eastern Pennsylvania. We inquired about: (1) how movement influences children's learning; (2) what types of movement experiences are most beneficial for children; (3) what settings best support children's movement; and (4) challenges related to children's movement. To identify key themes from the focus groups, transcripts were analysed using an inductive method of coding. RESULTS: Teachers' views were expressed in four major themes. First, young children have an innate need to move, and teachers respond to this need by using movement experiences to prepare children to learn and to teach academic concepts and spatial awareness. However, teachers wanted more training in these areas. Second, movement prepares children for school and for life by building children's confidence and social skills. Third, teachers and children benefit from moving together because it motivates children and promotes teacher-child relationships. Finally, moving outdoors promotes learning by engaging children's senses and promoting community interaction. CONCLUSIONS: More training may be required to help early childhood educators use movement experiences to teach academic concepts and improve children's spatial awareness. Future interventions could examine the impacts on children's movement and learning of having teachers move with children during outdoor free play and including more natural features in the design of outdoor play areas.

Evaluation of a pediatric hospitalist service: impact on length of stay and hospital charges.

OBJECTIVES: Inpatient medical services supervised by pediatric hospitalist physicians are a new development in academic medical centers in the United States. In a large pediatric teaching hospital, we compared length of stay, readmission rates, and hospital charges for children admitted to medical services with and without a hospitalist system of care. DESIGN: This retrospective observational study compared a baseline year of a traditional ward service (TS) with a subsequent year of a new hospitalist system of care called the Generalist Inpatient Service (GIS). Data were obtained from the hospital's clinical, demographic, and financial databases and from selected record review. All hospitalizations were at least 24 hours long and did not involve a stay in an intensive care unit. RESULTS: The average length of stay was longer for the 627 TS hospitalizations than for the 813 GIS hospitalizations (2.7 +/- 2.0 vs 2.4 +/- 1.7 days). Total hospital charges were significantly lower on the GIS ($3002 +/- $2160 vs $2720 +/- $1933) because of lower room and respiratory therapy charges. Three readmissions to the TS and 8 to the GIS occurred within 24 hours of hospital discharge and were, therefore, considered potentially preventable by a longer initial hospital stay. CONCLUSIONS: In a large pediatric teaching hospital, a system of inpatient care provided by hospitalists can reduce length of stay. This model has the potential to control hospital charges in a period of increasing health care costs.

An environmental intervention to reduce dietary fat in school lunches.

OBJECTIVE: To determine whether making a low-fat entree available as one of two choices in an elementary school lunch program would reduce the fat content of meals selected by children. DESIGN: In this before-after trial, students had a daily choice between two entrees, one of which was sometimes low-fat. For 93% of school days during 14 consecutive school months, daily entree choices were recorded for 619,976 student meals. The fat content of entrees was assessed with a computerized nutrient database supplemented by food manufacturer's data. SETTING: Sixteen elementary schools in the Bellevue (Washington) School District. PARTICIPANTS: The number of students eating school lunch averaged 2440 per day, of whom 25% were less than 185% of poverty. INTERVENTION: After a baseline period of 6 months, the intervention increased the number of days per month when one of the two entrees had 30% or fewer calories from fat. MAIN OUTCOME MEASURES: Data for the entire district were combined to estimate for each month the percent of students who selected low-fat entrees and the percent of calories from fat in the average meal selected by students. RESULTS: During the 6 months before the intervention, a low-fat entree was available on 23% of days; it was selected by 39% of students; and the average meal selected by students had 36% of calories from fat. By the end of the 8-month intervention, a low-fat option was available on 71% of days; it was selected by 29% of students; and the fat content of the average meal dropped from 36% to 30% of calories from fat (P = .02). CONCLUSIONS: In this school district, many students, given the choice, selected low-fat entrees. Recommendations for dietary fat were met simply by the environmental intervention of increasing the availability of low-fat foods.

A cost-effectiveness analysis of prevaccination testing for hepatitis B in adolescents and preadolescents.

OBJECTIVE: To study the clinical effectiveness and cost-effectiveness of prevaccination testing for hepatitis B virus in adolescents and preadolescents. DESIGN: Decision analysis model comparing (1) prevaccination testing for hepatitis B surface antibodies, (2) no testing, and (3) testing at the same time as the first vaccine dose. Sensitivity analyses of the first two strategies were performed varying the seroprevalence of hepatitis B surface antibodies, compliance with follow-up, and costs of testing. SETTING: Charges for testing and vaccination were obtained from Children's Hospital and Medical Center in Seattle, Wash. Vaccination compliance, hepatitis B surface antibodies seroprevalence, and vaccine response rates are from published literature. PATIENTS: A hypothetical cohort of 100,000 11-year-old children presenting for well-child care. MAIN OUTCOME MEASURES: Rate of complete vaccination, cost of testing and vaccination for each cohort, and cost per patient protected from hepatitis B virus. RESULTS: No testing was the most cost-effective strategy. Prevaccination testing elevated costs by $2.9 million for every 100,000 patients and lowered the rate of complete vaccination by 22% compared with vaccination without testing. For prevaccination testing to be cost-effective, the seroprevalence of hepatitis B surface antibodies needed to be greater than 40%. As the seroprevalence of hepatitis B surface antibodies decreased, the ratio of testing costs to vaccination costs had to decrease for prevaccination testing to remain cost-effective. Even with perfect compliance, prevaccination testing required high seroprevalence rates to be cost-effective. CONCLUSIONS: For most populations of preadolescents and adolescents, prevaccination testing for hepatitis B virus is not effective in terms of cost or rate of complete vaccination.

Characteristics of children selecting low-fat foods in an elementary school lunch program.

OBJECTIVE: To describe the demographic characteristics of children that were associated with the selection of low-fat entrees available in a school lunch program. DESIGN: For 5 consecutive months, we recorded student entree selections on the 46 days in which one of the two available lunch entrees was low fat (< or = 30% of calories from fat). Entree selections were tracked using a computerized meal-card system. The lunch menus did not indicate that one of the two entrees was low fat. Demographic and family characteristics were obtained from the school district's registration database and, in one school, from a household telephone survey. SETTING: A school lunch program in two public elementary schools in Bellevue, Wash. PARTICIPANTS: Students who regularly eat school lunches (N = 471). Sixty-five percent were from families with incomes less than 185% of the federal poverty level, and 49% were nonwhite. INTERVENTION: None. MAIN OUTCOME MEASURE: The proportion of days that each student selected the low-fat entree. RESULTS: Girls selected the low-fat entree more often than boys (33% of days vs 27% of days; P < .001), and the proportion of students selecting the low-fat entree increased with grade level (P = .003). Children were more likely to select low-fat entrees if a household member was known to have an elevated blood cholesterol level (P = .004). The proportion of students selecting the low-fat entree increased with maternal education level (P = .007), but children receiving free or reduced-price lunches (< 185% of the federal poverty level) chose the low-fat entree as often as those receiving full-price lunches (30% of days vs 29% of days; P = .14). There were no significant differences in entree selection among races. CONCLUSIONS: Given a choice of low-fat school lunch entrees, girls, older children, and those who had family members with elevated cholesterol levels were most likely to select these entrees. While parental education level was directly related to the selection of low-fat entrees, race and family income had little association with entree selection.

Maternal feeding practices and childhood obesity: a focus group study of low-income mothers.

OBJECTIVE: To identify maternal beliefs and practices about child feeding that are associated with the development of childhood obesity. DESIGN: Four focus groups. One group of dietitians from the Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the Northern Kentucky Health District and 3 groups of mothers with children enrolled in WIC. SETTING: The WIC program in the Northern Kentucky Health District. PARTICIPANTS: Fifteen WIC dietitians and 14 mothers (14 to 34 years of age) with young children (12 to 36 months of age) enrolled in WIC. RESULTS: The mothers in this study (1) believed that it was better to have a heavy infant because infant weight was the best marker of child health and successful parenting, (2) feared that their infants were not getting enough to eat, which led them to introduce rice cereal and other solid food to the diets before the recommended ages, and (3) used food to shape their children's behaviors (eg, to reward good behavior or to calm fussiness). The mothers acknowledged that some of their child-feeding practices went against the advice of their WIC nutritionists and physicians. Instead, the participants relied on their mothers as their main source of information about child feeding. CONCLUSIONS: Physicians and allied health professionals discussing childhood growth with mothers should avoid implying that infant weight is necessarily a measure of child health or parental competence. Parents who use food to satisfy their children's emotional needs or to promote good behavior in their children may promote obesity by interfering with their children's ability to regulate their own food intake. Interventions to alter child-feeding practices should include education of grandmothers.

Maternal feeding practices and beliefs and their relationships to overweight in early childhood.

To better explore possible factors that may lead to childhood obesity, we developed and analyzed two new instruments that assess maternal feeding practices and beliefs. The Infant Feeding Questionnaire (IFQ) assesses feeding during the entire first year of life and was administered to 453 mothers of children 11 to 23 months old. The Preschooler Feeding Questionnaire (PFQ) assesses feeding of young children between the ages of 2 to 5 years and was administered to 634 mothers of children this age. Each questionnaire was factor analyzed and mean factor scores were calculated and linked with the children's measured and mothers' self-reported weight and height. Mean factor scores from the IFQ and PFQ were compared between mothers who were obese (body mass index > or = 30 kg/m2) and those who were nonobese, between those who did and those who did not have an overweight child (weight-for-height > or = 90th percentile), and between those who had a low income (< or = 185% of the poverty level) and those who had a high income. To control for confounding variables and to detect interaction among variables, hierarchical linear regression was used. Results from this study did not suggest that there is a particular "feeding style" that is associated with overweight in young children; however, there were differences found in feeding behaviors between high and low income mothers.

Role of the prenatal environment in the development of obesity.

Establishing that prenatal life is a critical or sensitive period for the development of obesity may focus basic research and clinical prevention efforts on this period. This review summarizes evidence that the intrauterine environment influences the risk of later obesity and considers the mechanisms by which this may occur. The association between birth weight and adult weight suggests that there are enduring effects of the intrauterine environment on later obesity risk. We examine whether the maternal factors of diabetes, obesity, and pregnancy weight gain alter the intrauterine environment and thereby increase the risk of later obesity in the offspring. Of these maternal factors, evidence is strongest for the role of maternal diabetes. No single mechanism explains how these maternal factors could change the intrauterine environment to increase obesity risk. However, all potential mechanisms involve an altered transfer of metabolic substrates between mother and fetus, which may influence the developing structure or function of the organs involved in energy metabolism.

Estimating and comparing univariate associations with application to the prediction of adult obesity.

Studies examining the association between an outcome variable and multiple predictors are common in medical research. Examples include epidemiologic studies of risk factors for disease and clinical studies of prognostic indicators for diseased subjects. This paper is concerned with the assessment of the associations between the outcome and each predictor separately, the so-called univariate associations. Comparisons between predictors in regards to the strengths of their association with the outcome are considered. We show that though such comparisons cannot be made with standard techniques, they can be made using an algorithm which performs all of the univariate analyses simultaneously. This is accomplished with a non-standard application of generalized estimating equation methods. Comparisons of univariate associations are shown to be the key analyses of interest in a retrospective longitudinal study of childhood predictors of adult obesity. We illustrate the methodology on data from this study.

Comparison of methods to categorize undernutrition in children.

We compared the results of three methods of categorizing undernutrition in a group of 258 children referred for evaluation of "failure to thrive." There was broad variation between the number of children classified as malnourished (75% to 98%) and the degree of undernutrition, depending on the method used. We recommend that categorization systems be used only to define a child as having a risk of possible adverse effects of undernutrition, not as being malnourished.

The relationship of childhood adiposity to parent body mass index and eating behavior.

OBJECTIVE: To better understand risk factors for the development of obesity in early childhood, we examined the association between children's adiposity and their parents' eating behavior and body mass index (BMI). RESEARCH METHODS AND PROCEDURES: Parents of 85 white children 36 months of age (49 boys and 36 girls) completed the Three-Factor Eating Questionnaire measuring three dimensions of parent eating behavior: disinhibited eating, cognitive restraint of eating, and susceptibility to hunger. Parent BMI (kg/m2) was calculated using self-reported height and weight. The children's percentage body fat was assessed by dual energy X-ray absorptiometry analysis. RESULTS: Twenty-six percent of parents were obese (BMI > or = 30 kg/m2). Both maternal and paternal BMI were associated with higher scores for disinhibition (r = 0.69 and r = 0.68, p < 0.001), and maternal BMI was also associated with higher scores for hunger (r = 0.51, p < 0.001). There were no significant relationships between children's percentage body fat and parent eating scores, and the correlation between children's percentage body fat and parent BMI was significant only between mothers and daughters (r = 0.35, p = 0.04). Obese parents were no more likely to have a child who was fatter (upper quintile of percentage body fat for gender). DISCUSSION: Among 36 month-old white children, parent eating behavior was related to parent BMI, but not to children's adiposity. There was only a weak relationship between parent BMI and child adiposity. Despite the aggregation of adiposity within families due to shared genes and environments, children may not express differences in susceptibility to obesity by 3 years of age.

School lunch: a comparison of the fat and cholesterol content with dietary guidelines.

OBJECTIVE: To compare the fat and cholesterol content of the foods offered and selected in an elementary school lunch program with current dietary guidelines. DESIGN: For 105 school days we recorded the food items selected by elementary school students in an entire school district (262,851 meals) who were given a choice between two entrees. The nutrient content of foods was assessed with a computerized nutrient data base supplemented by the food manufacturers' data. SETTING: Sixteen elementary schools in the Bellevue (Washington) School District. PARTICIPANTS: The number of students eating school lunch averaged 2500 per day, of whom 25% were from households with incomes less than 185% of poverty. INTERVENTION: None. MAIN OUTCOME MEASURES: We determined the nutritional content of the average meal selected; the proportion of days when one of the two offered entrees met fat and cholesterol guidelines; and the proportion of children selecting the entrees that met the guidelines. RESULTS: The average lunch selected had 35.9% of calories from total fat and 12.6% from saturated fat, exceeding the guidelines of 30% and 10%, respectively. Lunch contained an average of 57 mg cholesterol (106 mg/1000 kcal) and met guidelines. One of the two daily entree choices met guidelines for both total fat and saturated fat on 20% of days, and met both fat and cholesterol guidelines on 14% of days. When available, entrees meeting the fat guidelines were chosen by 37% of students, and entrees meeting both fat and cholesterol guidelines were chosen by 34% of students. CONCLUSIONS: In this school district the average lunch selected did not meet the current guidelines for dietary fat; when given the choice, more than one third of students selected the entrees that met these guidelines.

Maternal perceptions of overweight preschool children.

CONTEXT: Childhood obesity is a major public health problem, and prevention efforts should begin early in life and involve parents. OBJECTIVE: To determine what factors are associated with mothers' failure to perceive when their preschool children are overweight. DESIGN: Cross-sectional survey. SETTINGS: Offices of private pediatricians and clinics of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). PARTICIPANTS: Six hundred twenty-two mothers with children 23 to 60 months of age. MAIN OUTCOME MEASURES: Maternal demographic variables, maternal self-reported height and weight, and children's measured height and weight. Mothers were asked whether they considered themselves or their children overweight. RESULTS: Forty-five percent of mothers had low education (high school degree or less) and 55% had high education (some college or more). Obesity (body mass index: >/=30 kg/m(2)) was more common in the low education group of mothers (30% vs 17%), and their children tended to be more overweight (weight-for-height percentile: >/=90th; 19% vs 14%). Ninety-five percent of obese mothers believed that they were overweight, with no difference between education groups. However, 79% of mothers failed to perceive their overweight child as overweight. Among the 99 mothers with overweight children, low maternal education was associated with a failure to perceive their children as overweight after adjusting for low family income (

Randomized intervention to increase children's selection of low-fat foods in school lunches.

OBJECTIVE: The purpose of this study was to determine whether children would increase their selection of low-fat foods in school lunches if these foods were labeled on the menu and parents were notified of their availability. METHODS: The 16 elementary schools in the Bellevue (Washington) School District were randomly assigned to intervention and control groups. Participants were the students eating the school lunch--an average of 2445 students per day, of whom one third received free or reduced-price lunches. In all schools, one of the two daily lunch entrees was low in fat (< or = 30% of calories from fat). After a 5-month baseline period, eight schools received a 4-month intervention. The monthly menus carried home by students began to indicate the low-fat entree and to compare the fat content of both entrees. In the first month, parents in the intervention schools (2329 households) received a mailing with a copy of the menu, an informational pamphlet on dietary fat, and a letter that described the menu changes and asked the parents to encourage their children to select low-fat entrees. A follow-up telephone survey was performed in one school 1 month after the intervention mailing to assess the recall and impact of the intervention. The main outcome, based on 249,861 student meal selections, was the proportion of students who selected the low-fat entree, and the unit of analysis was the school. RESULTS: At baseline, there was little difference between intervention and control schools in the percentage of children choosing the low-fat entree (31.5% vs 30.8%). During the intervention, there was an increase in low-fat entree selection in the intervention schools compared with the control schools (35.5% vs 32.2%; p = 0.03). Of 221 parents surveyed, 71% recalled the mailing, 53% remembered that there were now low-fat entrees on the menu, and 10% reported that, after the mailing, they asked their child to choose a low-fat entree.

Predicting obesity in young adulthood from childhood and parental obesity.

BACKGROUND: Childhood obesity increases the risk of obesity in adulthood, but how parental obesity affects the chances of a child's becoming an obese adult is unknown. We investigated the risk of obesity in young adulthood associated with both obesity in childhood and obesity in one or both parents. METHODS: Height and weight measurements were abstracted from the records of 854 subjects born at a health maintenance organization in Washington State between 1965 and 1971. Their parents' medical records were also reviewed. Childhood obesity was defined as a body-mass index at or above the 85th percentile for age and sex, and obesity in adulthood as a mean body-mass index at or above 27.8 for men and 27.3 for women. RESULTS: In young adulthood (defined as 21 to 29 years of age), 135 subjects (16 percent) were obese. Among those who were obese during childhood, the chance of obesity in adulthood ranged from 8 percent for 1- or 2-year-olds without obese parents to 79 percent for 10-to-14-year-olds with at least one obese parent. After adjustment for parental obesity, the odds ratios for obesity in adulthood associated with childhood obesity ranged from 1.3 (95 percent confidence interval, 0.6 to 3.0) for obesity at 1 or 2 years of age to 17.5 (7.7 to 39.5) for obesity at 15 to 17 years of age. After adjustment for the child's obesity status, the odds ratios for obesity in adulthood associated with having one obese parent ranged from 2.2 (95 percent confidence interval, 1.1 to 4.3) at 15 to 17 years of age to 3.2 (1.8 to 5.7) at 1 or 2 years of age. CONCLUSIONS: Obese children under three years of age without obese parents are at low risk for obesity in adulthood, but among older children, obesity is an increasingly important predictor of adult obesity, regardless of whether the parents are obese. Parental obesity more than doubles the risk of adult obesity among both obese and nonobese children under 10 years of age.

Gestational diabetes and the risk of offspring obesity.

BACKGROUND: Intrauterine exposure to the metabolic alterations of maternal diabetes may increase the risk of later obesity. We determined whether offspring of mothers with diet-treated, gestational diabetes mellitus (GDM) have an increased risk of childhood obesity and examined the relationship between childhood obesity and metabolic markers of GDM. METHODS: At a health maintenance organization in Seattle, WA, we reviewed medical records to obtain the life-time height and weight measurements of 524, 8- to 10-year-old children whose mothers had been screened for GDM. Maternal plasma glucose and triglyceride levels were obtained in midgestation 1 hour after ingestion of 50 g of glucose. Those with glucose screening levels >/=7.77 mmol/L (140 mg/dL) underwent a 3-hour, 100-g, oral glucose tolerance test to determine GDM status. Cord serum insulin levels also were obtained at birth. Obesity was defined as an average body mass index between 5 and 10 years of age at or above the 85th percentile for age and sex. RESULTS: The prevalence of obesity was 19% in the 58 offspring of mothers with diet-treated GDM and 24% in the 257 offspring of mothers with negative glucose screen values. There also was no difference in mean body mass index (adjusted for age and sex) between these two groups of offspring. Among all 524 offspring, there was no significant increase in the rate of offspring obesity according to the quartile of maternal screening glucose, triglyceride, oral glucose tolerance test, or cord serum insulin level. CONCLUSION: Prenatal exposure to the metabolic effects of mild, diet-treated GDM does not increase the risk of childhood obesity.

Early adiposity rebound and the risk of adult obesity.

OBJECTIVE: At 5 to 6 years of age, body fatness normally declines to a minimum, a point called adiposity rebound (AR), before increasing again into adulthood. We determined whether a younger age at AR was associated with an increased risk of adult obesity and whether this risk was independent of fatness at AR and parent obesity. DESIGN: A retrospective cohort study using lifelong height and weight measurements recorded in outpatient medical records. SETTING: Group Health Cooperative of Puget Sound (GHC), a health maintenance organization based in Seattle, Washington. PARTICIPANTS: All 390 GHC members (and their parents) born at GHC between January 1, 1965, and January 1, 1971, who had at least one recorded adult height and weight measurement plus two visits with recorded height and weight measurements in each of three age intervals: 1.5 to 4, 4 to 8, and 8 to 16 years. MAIN OUTCOME MEASURES: We calculated the mean body mass index (BMI) of each subject during young adulthood (age 21 to 29 years) and the BMI of the parents when each subject was 1.5 years of age. Adult obesity was defined as a BMI >/=27.8 for males and >/=27. 3 for females. Curves were fit to each subject's BMI values between ages 1.5 and 16 years, and the age and BMI at AR were calculated from these curves. Subjects were divided into tertiles of age at AR (early, middle, and late), BMI at AR, and parent BMI (heavy, medium, and lean). RESULTS: The mean age at AR was 5.5 years, and 15% of the cohort was obese in young adulthood. Adult obesity rates were higher in those with early versus late AR (25% vs 5%), those who were heavy versus lean at AR (24% vs 4%), those with heavy versus lean mothers (25% vs 5%), and those with heavy versus lean fathers (21% vs 5%). After adjusting for parent BMI and BMI at AR, the odds ratio for adult obesity associated with early versus late AR was 6.0 (95% CI, 1.3-26.6). CONCLUSION: An early AR is associated with an increased risk of adult obesity independent of parent obesity and the BMI at AR. Future research should examine the biological and behavioral determinants of AR.

Why don't low-income mothers worry about their preschoolers being overweight?

CONTEXT: Mothers are in an important position to prevent obesity in their children by shaping early diet and activity patterns. However, many mothers of overweight preschool children are not worried about their child's weight. OBJECTIVE: To explore mothers' perceptions about how they determine when a child is overweight, why children become overweight, and what barriers exist to preventing or managing childhood obesity. DESIGN: Three focus groups with 6 participants in each. Participant comments were transcribed and analyzed. Themes were coded independently by the 6 authors who then agreed on common themes. SETTING: A clinic of the Special Supplemental Nutrition Program for Women, Infants, and Children in Cincinnati, Ohio. PARTICIPANTS: Eighteen low-income mothers (13 black, 5 white) of preschool children (mean age of 44 months) who were at-risk for later obesity. All but 1 mother had a body mass index (BMI) >/=25 kg/m(2), and 12 mothers had a BMI >/=30 kg/m(2). All but 1 child had a BMI >/=85th percentile for age and sex, and 7 had a BMI >/=95th percentile. Results. Mothers did not define overweight or obese in their children according to how height and weight measurements were plotted on the standard growth charts used by health professionals. Instead, mothers were more likely to consider being teased about weight or developing limitations in physical activity as indicators of their child being overweight. Children were not believed to be overweight if they were active and had a healthy diet and/or a good appetite. Mothers described overweight children as thick or solid. Mothers believed that an inherited tendency to be overweight was likely to be expressed in the child regardless of environmental factors. In trying to shape their children's eating, mothers believed that their control over the child's diet was challenged by other family members. If a child was hungry, despite having just eaten, it was emotionally difficult for mothers to deny additional food. CONCLUSIONS: Health professionals should not assume that defining overweight according to the growth charts has meaning for all mothers. Despite differing perceptions between mothers and health professionals about the definition of overweight, both groups agree that children should be physically active and have healthy diets. Health professionals may be more effective in preventing childhood obesity by focusing on these goals that they share with mothers, rather than on labeling children as overweight.