Low Recognition of Childhood Overweight and Disease Risk among Native‐American Caregivers**

Objectives: Pediatric obesity is a significant and increasing problem in Native‐American communities. The aim of this study was to determine whether parents and other caregivers from three Wisconsin tribes recognized overweight children. We also assessed caregiver attributes associated with levels of concern for risk of future overweight and chronic disease. Research Methods and Procedures: Data were obtained from child health screenings and caregiver surveys. Participants included 366 kindergarten‐through‐second grade child–caregiver dyads. Children's BMI percentiles were calculated and compared with caregiver responses. We assessed the relationships between predictors of caregiver concern for health risk factors and recognition of overweight. Results: Twenty‐six percent of children were overweight (≥95th percentile), and 19% were at risk for being overweight (≥85th to <95th percentile) using Centers for Disease Control standards. Caregivers recognized only 15.1% of overweight children. Factors predictive of child overweight recognition included a child BMI >99th percentile and grandmother as caregiver. Overall, caregivers were more concerned about diabetes and cardiovascular disease than obesity. Parents with diabetes and heart disease were more concerned than others about risk for these diseases; however, only diabetic parents made a connection between child weight status and future risk of obesity‐related disease. Child sex, child age, and parental education level were not significant predictors for caregiver recognition of an overweight child. Discussion: Most caregivers did not recognize overweight children or associate excess weight with increased risk of disease. When designing community interventions, it is crucial to incorporate caregivers’ attitudes and beliefs regarding childhood overweight and risk of future disease.     

The Relationship of Rapid Weight Gain in Infancy to Obesity and Skeletal Maturity in Childhood

Objective: Children with birth weight appropriate for gestational age (AGA) who also demonstrate rapid weight gain in infancy have a greater risk of being overweight or obese during childhood. A concurrent advancement in skeletal maturity would account for their greater size and would, therefore, not necessarily pose a threat of greater risk during adolescence and early adulthood. This study aims to determine whether children with rapid weight gain during infancy have advanced skeletal maturity during childhood. Research Methods and Procedures: One hundred and ninety‐three African children (boys = 108; girls = 85) of normal birth weight and gestational age were assessed from birth to 9 years. Body composition was assessed at 9 years of age by whole‐body DXA, and skeletal maturity was assessed using the Tanner‐Whitehouse II technique. Rapid weight gain in infancy was defined as a +0.67 change in weight‐for‐age Z‐score between birth and 2 years. Results: Rapid weight gain was experienced by over 20% of the sample. Children with rapid weight gain were significantly lighter at birth and significantly taller, heavier, and fatter throughout childhood. Chronological age and Tanner‐Whitehouse II technique skeletal ages at 9 years were not significantly different between groups or between sexes within groups. Discussion: Because AGA children with rapid weight gain have a greater risk of overweight and obesity but are not advanced in skeletal maturity, later adolescent adjustments toward average weight and fatness values are unlikely. The identification and monitoring of such children is of importance in reducing their risk of morbidity.     

Rapid infant weight gain predicts childhood overweight

Objective : To determine among a contemporary cohort whether rapid weight gain between birth and 6 months is associated with risk of childhood overweight and if this risk differs by ethnicity and/or breast‐feeding history. Research Methods and Procedures : This was a cross‐sectional survey in 1999 to 2000 of parents/guardians of children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children in New York State. Measurements were abstracted by chart review, including weight at birth and 6 months, and height and weight at time of survey and every 6 months subsequently. Overweight at 4 years of age was defined as a BMI ≥ 95th age‐ and sex‐specific percentiles. Results : The study sample was 32% Hispanic, 19% black, and 49% white; 17% of children were overweight. Rate of infant weight gain (expressed in terms of 100 g/mo) was significantly associated with being overweight at 4 years (odds ratio, 1.4; 95% confidence interval, 1.3 to 1.6 after adjusting for history of breast‐feeding, birth weight, and ethnicity). The odds of being overweight at 4 years of age for Hispanic children were twice those of non‐Hispanic children (odds ratio, 2.2; 95% confidence interval, 1.5 to 3.3). The population‐attributable risk of overweight at 4 years of age was 19% for children in the highest quintile of infant weight gain. Discussion : Among this contemporary, multi‐ethnic cohort, rapid infant weight gain was associated with increased risk of being overweight at 4 years of age, independently of potential confounders. Identification of the risk factors contributing to rapid weight gain during infancy might improve early recognition and guide strategies for optimal nutrition to prevent the development of childhood overweight.     

Identification of an Obese Eating Style in 4‐year‐old Children Born at High and Low Risk for Obesity

This study tested whether children's eating behavior and parental feeding prompts during a laboratory test meal differ among children born at high risk (HR) or low risk (LR) for obesity and are associated with excess child weight gain. At 4 years of age, 32 HR children (mean maternal prepregnancy BMI = 30.4 kg/m²) and 29 LR children (maternal BMI = 19.6 kg/m²) consumed a test meal in which their eating behavior was assessed, including rate of caloric consumption, mouthfuls/min, and requests for food. Parental prompts for the child to eat also were measured at year 4, and child body composition was measured at ages 4 and 6 years. T‐tests, and logistic and multiple regression analyses tested study aims. Results indicated that HR and LR children did not differ in eating rate or parental feeding prompts. Greater maternal BMI, child mouthfuls of food/min, and total caloric intake/min during the test meal predicted an increased risk of being overweight or obese at age 6, whereas greater active mealtime was associated with a reduced risk of being overweight or obese. Regression analyses indicated that only mouthfuls of food/min predicted changes in BMI from 4 to 6 years, and mouthfuls of food/min and gender predicted 2‐year changes in sum of skinfolds and total body fat. Thus, a rapid eating style, characterized by increased mouthfuls of food/min, may be a behavioral marker for the development of childhood obesity.     

Stability of the Association between Birth Weight and Childhood Overweight during the Development of the Obesity Epidemic

Objective: To assess whether changes in the birth weight distribution or changes in the association of birth weight with the later risk of childhood overweight have contributed to the development of the obesity epidemic. Research Methods and Procedures: A Danish population‐based cohort study of 124,615 girls and 128,346 boys (ages 6 to 13 years), born between 1936 and 1983, were studied. Birth weight and annual measurements of height and weight were obtained from school health records. Overweight was defined by BMI in relation to internationally accepted criteria. The relative risk of being overweight by birth weight was calculated separately for each age, sex, and time period. Results: The birth weight distribution remained relatively stable over time. Compared with children with a birth weight of 3.0 to 3.5 kg, the risk of overweight increased consistently with each increase in birth weight category among girls and boys and at all ages between 6 and 13 years. Furthermore, the association between birth weight and increased risk of overweight in childhood remained stable across a 48‐year period. Discussion: The increase in the prevalence of overweight could not be explained by time trends in the distribution of birth weight or by changes in the association between birth weight and the later risk of overweight over time. This implies that, unless the prenatal environment influences the later risk of overweight without increasing birth weight, the environmental influences contributing to the obesity epidemic in children of school age operate in the early postnatal period.     

Parental recognition of overweight in school-age children

Objective: Examine the accuracy of parental weight perceptions of overweight children before and after the implementation of childhood obesity legislation that included BMI screening and feedback. Methods and Procedures: Statewide telephone surveys of parents of overweight (BMI ≥ 85th percentile) Arkansas public school children before (n = 1,551; 15% African American) and after (n = 2,508; 15% African American) policy implementation were examined for correspondence between parental perception of child's weight and objective classification. Results: Most (60%) parents of overweight children underestimated weight at baseline. Parents of younger children were significantly more likely to underestimate (65%) than parents of adolescents (51%). Overweight parents were not more likely to underestimate, nor was inaccuracy associated with parental education or socioeconomic status. African‐American parents were twice as likely to underestimate as whites. One year after BMI screening and feedback was implemented, the accuracy of classification of overweight children improved (53% underestimation). African‐American parents had significantly greater improvements than white parents (P < 0.0001). Discussion: Parental recognition of childhood overweight may be improved with BMI screening and feedback, and African‐American parents may specifically benefit. Nonetheless, underestimation of overweight is common and may have implications for public health interventions.     

Waist-to-height ratio is an accurate and easier index for evaluating obesity in children and adolescents

Objectives: The present study aims to evaluate the accuracy of the index of waist‐to‐height ratio (WHTR), and proposed the optimal thresholds of WHTR in the definition of childhood overweight and obesity in a bi‐ethnic Chinese school‐aged population. Research Methods and Procedures: Overweight and obese were identified by BMI for age and gender in a random sample including 2055 Han and 2132 Uygur ethnic school‐aged children (8 to 18 years old). WHTR was calculated by waist circumference divided by height on the basis of standard anthropometric measurements. Receiver operating characteristic (ROC) curve analyses were performed to assess the accuracy of WHTR as a diagnostic test for childhood overweight and obesity, compared with waist circumference. The optimal thresholds of WHTR for defining overweight and obesity were recommended respectively by gender. The correlation between WHTR and age was analyzed and compared with BMI. Results: A‐values (area under curve) of WHTR for diagnosing overweight and obesity were both over 0.90 in both genders and better than those of waist circumference. A threshold of 0.445 was identified for overweight in both genders, with the sensitivity and specificity >0.80. The thresholds for defining obesity was 0.485 in boys and 0.475 in girls, both having the sensitivity and specificity >0.90. WHTR showed less association with age than BMI. Conclusions: WHTR is a simple, easy, accurate, and non‐age‐dependent index with high applicability to screening overweight and obesity in children and adolescents. The use of WHTR in the general childhood population has been justified by this study.     

Parent overweight predicts daughters' increase in BMI and disinhibited overeating from 5 to 13 years

Objective: To assess whether parental overweight status and disinhibited overeating are predictive of daughters’ accelerated weight gain and disinhibited overeating. Research Methods and Procedures: Participants were part of a longitudinal study of girls (N = 197) and their parents. Measured height and weight were used to calculate BMI [weight (kilograms)/height (meters)²]. Parents’ disinhibited eating behavior was assessed using the Eating Inventory. Girls’ disinhibited eating was assessed using a behavioral protocol to measure eating in the absence of hunger. Girls were classified based on parental overweight at study entry into four groups: neither, mother only, father only, or both parents overweight. Results: Girls with both parents overweight had the most rapid increases in BMI from 5 to 13 years of age; BMI increased most slowly among the neither parent overweight group, with intermediate increases in BMI among mother only and father only overweight groups. Daughters with both parents overweight at study entry were eight times more likely to be overweight at age 13, controlling for daughters’ weight at age 5. Girls with both parents overweight had higher levels of disinhibited eating across all ages than all other groups. Although girls in all parental weight status groups showed increases in disinhibited eating over time, girls with both parents overweight had larger increases in disinhibited eating over time compared with all other groups. Discussion: Girls growing up in families differing in parental overweight had divergent developmental trajectories for BMI and disinhibited overeating. Findings reveal the need to focus prevention efforts on overweight parents of young children.     

The relationship between relative weight and school attendance among elementary schoolchildren

Objective: To determine the relationship between relative weight and school attendance among elementary schoolchildren. Research Methods and Procedures: A total of 1069 fourth to sixth graders from nine elementary schools in the inner city of Philadelphia, PA, were part of an ongoing randomized control trial to assess prevention strategies for obesity. The mean rate of students eligible for free/reduced meals was 82.9 ± 11.5%. Weight was measured in the second semester of the academic year. Absentee data for the entire academic year were recorded by homeroom teachers. Participants were classified into relative weight categories described by the Institute of Medicine: underweight, normal‐weight, overweight, and obese. Results: ANOVA showed that overweight children were absent significantly more than normal‐weight children (12.2 ± 11.7 days vs.10.1 ± 10.5 days) (p < 0.05). Linear regression showed that the obese category remained a significant contributor to the number of days absent even after adjusting for age, race/ethnicity, and gender. Discussion: These data suggest that in addition to the medical and psychosocial consequences of being overweight, heavier children have greater risk for school absenteeism than their normal‐weight peers. As the rate of childhood obesity increases, parallel increases in school absenteeism should be expected.     

Trends of overweight and obesity among white and american indian school children in south dakota, 1998–2010

Objective:

To investigate the prevalence of overweight and obesity among white and American Indian children in a predominantly rural state.

Design and Methods:

Using a repeated, cross‐sectional design of school children's height and weight, the study sample included 361,352 measures of children who were 5.0–19.9 years, attending school across 13 academic calendar years. Trained staff measured height, weight, and recorded gender, age, and race. Data were voluntarily reported to the State Department of Health.

Results:

American Indian children consistently had higher rates of overweight and obesity compared to white children. Across the years, 16.3% of white students were overweight, whereas 19.3% of American Indian students were overweight. In addition, 14.5% of white children were obese and 25.9% of American Indian children were obese. Examining by rural versus urban schools, prevalence of overweight had been increasing among white male and female students and American Indian female students living in rural areas. Obesity is also increasing among rural white females and male and female American Indian children.

Conclusions:

The findings here suggest that although American Indian children are at higher risk, in general, compared to white children, rural populations in general are experiencing increases in childhood overweight and obesity. Targeted rural interventions beginning at an early age are necessary to improve the health of rural children, especially in American Indian communities.     

Obesity and Overweight Prevalence in Polish 7‐ to 9‐Year‐Old Children

Objective: Secular trend in childhood obesity is a well‐known phenomenon, and it is important to monitor it in cross‐sectional studies. The study aim was to estimate prevalence of obesity and overweight in Polish 7‐ to 9‐year‐old children and to compare the results with a French study based on the same protocol. Research Methods and Procedures: The study was conducted in 2001 according to the protocol of the European Childhood Obesity Group. Height and weight were measured, and BMI was calculated to define nutritional status in a randomly selected group of 2916 (1445 girls and 1471 boys) primary school children. Obesity and overweight were estimated according to International Obesity Task Force references with curve for obesity and overweight passing through 30 and 25 kg/m² at age 18, respectively. Results: Overweight (including obesity) was found in 15.4% of Polish children (in 15.8% of girls and 15.0% of boys) and obesity in 3.6% (3.7% of girls and 3.6% of boys) compared with 18.1% of overweight and 3.8% of obese children in French study. There was no significant difference in nutrition status between Polish and French children except for higher frequency of overweight in French 9‐year‐old boys. The same trend of decreasing overweight through age classes was observed in both populations. Discussion: The prevalence of obesity and overweight (including obesity) in prepubertal children estimated in two European countries according to the same protocol and using the same references showed little differences between the two populations despite higher prevalence of obesity in Polish than French adults.     

A family-based approach to preventing excessive weight gain

Objective: Preventing weight gain in adults and excessive weight gain in children is a high priority. We evaluated the ability of a family‐based program aimed at increasing steps and cereal consumption (for breakfast and snacks) to reduce weight gain in children and adults. Research Methods and Procedures: Families (n = 105) with at least one 8‐ to 12‐year‐old child who was at‐risk‐for‐overweight or overweight (designated as the target child) were recruited for the study. Eighty‐two families were randomly assigned to receive the family‐based intervention and 23 families to the control condition. The 13‐week intervention consisted of specific increases in daily steps (an additional 2000 steps/d) and consumption of 2 servings/d of ready‐to‐eat cereal. Results: The intervention was successful in increasing walking (steps) and cereal consumption. The intervention had positive, significant effects on percentage BMI‐for‐age and percentage body fat for target children and weight, BMI, and percentage body fat for parents. On further analysis, the positive effects of the intervention were seen largely in target girls and moms, rather than in target boys and dads. Discussion: This family‐based weight gain prevention program based on small changes holds promise for reducing excessive weight gain in families and especially in growing overweight children.     

Risk Factors for Adult Overweight and Obesity in the Quebec Family Study: Have We Been Barking Up the Wrong Tree?

The aim of this study was to determine the independent contribution of previously reported risk factors for adult overweight and obesity. A cross‐sectional (n = 537) and a longitudinal (n = 283; 6‐year follow‐up period) analysis was performed for nine risk factors for overweight and obesity assessed in adult participants (aged 18–64 years) of the Quebec Family Study (QFS). The main outcome measure was overweight/obesity, defined as a BMI ≥25 kg/m². Using logistic regression analysis adjusted for age, sex, and socioeconomic status, short sleep duration, high disinhibition eating behavior, low dietary calcium intake, high susceptibility to hunger behavior, nonparticipation in high‐intensity physical exercise, high dietary restraint behavior, nonconsumption of multivitamin and dietary supplements, high dietary lipid intake, and high alcohol intake were all significantly associated with overweight and obesity in the cross‐sectional sample. The analysis of covariance adjusted for age, socioeconomic status, and all other risk factors revealed that only individuals characterized by short sleep duration, high disinhibition eating behavior, and low dietary calcium intake had significantly higher BMI compared to the reference category in both sexes. Over the 6‐year follow‐up period, short‐duration sleepers, low calcium consumers, and those with a high disinhibition and restraint eating behavior score were significantly more likely to gain weight and develop obesity. These results show that excess body weight or weight gain results from a number of obesogenic behaviors that have received considerable attention over the past decade. They also indicate that the four factors, which have the best predictive potential of variations in BMI, be it in a cross‐sectional or a longitudinal analytical design, do not have a “caloric value” per se.     

Maternal BMI and country of birth as indicators of childhood obesity in children of Mexican origin

Objective: The goal of this study was to evaluate the relationship between maternal and childhood BMI at baseline in a group of 5‐ to 18‐year‐old children and their mothers, all of whom were of Mexican origin, low socioeconomic status, and enrolled in a cohort study in Houston, TX. Research Methods and Procedures: Using data from 438 mother‐child dyads residing in the same household, we completed logistic regression analyses to determine maternal factors associated with the child being overweight or at‐risk‐for‐overweight, after adjusting for the child's gender, age, and level of physical activity and other maternal confounders. Results: Almost one‐half of the boys and girls (47% and 44%, respectively) were either overweight or at‐risk‐for‐overweight. Obese mothers were twice as likely to have an overweight and/or at‐risk‐for‐overweight child compared with normal‐weight mothers. Women born in the U.S. were twice as likely to have an overweight and/or at‐risk‐for‐overweight child compared with women born in Mexico. In addition, women with less than a high school education were twice as likely to have an overweight child compared with their more educated peers. Discussion: The high prevalence of overweight or at‐risk‐for‐overweight among Mexican‐origin children of low socioeconomic status suggests a continued need to develop and implement culturally sensitive preventive interventions for this minority population. Our data also suggest a need to tailor such interventions particularly for children of obese mothers and those born in the U.S.     

Predictive value of weight-for-age to identify overweight children

Objective: The objective was to assess the predictive value of weight‐for‐age to identify overweight children and adolescents in the unusual research or public health situations where height is not available to calculate BMI. Research Methods and Procedures: Data from the National Health and Nutrition Examination Survey 1999 to 2004 were used to calculate the sensitivity, specificity, and positive and negative predictive values of selected weight‐for‐age cut‐off points to identify overweight children and adolescents (as defined by BMI ≥95th percentile). Positive and negative predictive values are dependent on prevalence and are reported here for this study population only. Results: The 50th and 75th weight‐for‐age percentiles had good sensitivity (100% and 99.6%, respectively), but poor positive predictive value (23.7% and 37.0%, respectively), while the 95th and 97th percentiles had reasonable positive predictive value (80.3% and 91.5%, respectively), but limited sensitivity (82.0% and 66.7%, respectively) to identify overweight subjects. The properties of weight‐for‐age percentiles to identify overweight subjects differed between sex, age, and race/ethnicity but remain within a relatively narrow range. Discussion: No single weight‐for‐age cut‐off point was found to identify overweight children and adolescents with acceptable values for all properties and, therefore, cannot be used in the clinical setting. Furthermore, the positive predictive values reported here may be lower in populations with a lower prevalence of obesity. However, in unusual research or public health situations where height is not available, such as existing databases, weight‐for‐age percentiles may be useful to target limited resources to groups more likely to include overweight children and adolescents than the general population.     

Psychological status and weight-related distress in overweight or at-risk-for-overweight children

Objective: To associate psychological status, weight‐related distress, and weight status during childhood in overweight or at‐risk‐for‐overweight children. Research Methods and Procedures: We associated self‐report of depression, trait anxiety, and weight‐related distress (body size dissatisfaction and weight‐related peer teasing after controlling for the effects of weight) in 164 children (black 35%; age 11.9 ± 2.5 years; girls 51%) who were overweight or at‐high‐risk‐for‐overweight and were not seeking weight loss. Results: Overall, heavier children reported more psychological and weight‐related distress. Black children reported more anxiety and body size dissatisfaction than white children, despite equivalent weights. However, psychological distress was not significantly associated with weight in white children. Girls reported more weight‐related distress than boys. Depression was associated with weight‐related teasing in all predictive models, except in the model using only black subjects. Trait anxiety was associated with report of peer teasing when using all subjects. Depression was also significantly associated with children's report of body size dissatisfaction in models using all subjects, only girls, or white subjects, but not in analyses using only boys or black subjects. For boys peer teasing was associated with body size dissatisfaction. In models including only black children, depression and trait anxiety were not significantly associated with either report of peer teasing or body size dissatisfaction. Discussion: Regardless of race or sex, increasing weight is associated with emotional and weight‐related distress in children. However, associations of psychological status, weight, and weight‐related distress differ for girls and boys, and for black and white children.     

Family mealtimes: A contextual approach to understanding childhood obesity

There has been a growing interest in the role that shared family mealtimes may play in promoting the health and well-being of children. Families that regularly eat their main meal together four or more times a week are more likely to have children who do better in school, are of average weight, less likely to use drugs and alcohol at an early age, and consume more fruits and vegetables. The mere fact that families eat together does not address the process by which shared family mealtimes may protect children from unhealthy weight gain. Just as there is no simple explanation for the rising rates of obesity, the link between shared family mealtimes and childhood obesity is a complex one including socioeconomic and cultural context. In this paper, we provide an overview of how shared family mealtimes are embedded in a socio-cultural context that may either support or derail healthy eating patterns for children and youth. Evidence from an observational study of 200 family mealtimes demonstrates the complex interplay between socio-economic factors, family mealtime behaviors, and child obesity status. Families who had a child of healthy weight spent more time engaged with each other during the meal, expressed more positive communication, and considered mealtimes more important and meaningful than families who had a child who was overweight or obese. Using a cumulative risk model, it was found that the combination of family level and neighborhood risk factors predicted child overweight status. Recommendations are made for future research directions and policies directed toward families living in diverse economic circumstances.     

Eating in the Absence of Hunger: A Genetic Marker for Childhood Obesity in Prepubertal Boys?

Objective: Eating in the absence of hunger (EAH) may be a behavioral trait through which obesity‐promoting genes promote positive energy balance. The primary aim of this study was to compare children born at high vs. low risk for obesity with respect to EAH at 5 years of age. Research Methods and Procedures: This was an observational investigation of families enrolled in the University of Pennsylvania and The Children's Hospital of Philadelphia's Infant Growth Study. Five‐year‐old children born at high (N = 28) or low (N = 25) risk for obesity on the basis of maternal prepregnancy body weight were evaluated at a hospital‐based laboratory. Children consumed 11 snack foods ad libitum after consuming an ad libitum dinner and reporting fullness. Parents reported on snack foods at home and their own eating styles. Nutritive sucking at 3 months of age was evaluated by computerized apparatus. Results: EAH in high‐risk boys (mean ± standard error = 326 ± 66 kJ] was more than twice that of low‐risk boys (mean ± standard error = 151 ± 39 kJ), p = 0.03. Among girls, there was a trend for EAH to be associated with increased parental limitations on daughter snack food consumption at home (p = 0.06). EAH was unrelated to 3‐month sucking behavior. Discussion: Genes that promote childhood obesity may partially exert their influence through EAH, an effect that was limited to boys born at risk for obesity. The unique influences of genes and home environment on this trait should be disaggregated in subsequent studies.     

Associations of Maternal Diabetes During Pregnancy with Overweight in Offspring: Results from the Prospective TEDDY Study

Objective: This study aimed to determine the relationship between different forms of, and potential pathways between, maternal diabetes and childhood obesity at different ages. Methods: Prospective cohort data from The Environmental Determinants of Diabetes in the Young (TEDDY) study, which was composed of 5,324 children examined from 0.25 to 6 years of age, were analyzed. Cross‐sectional and longitudinal analyses taking into account potential confounders and effect modifiers such as maternal prepregnancy BMI and birth weight z scores were performed. Results: Offspring of mothers with gestational diabetes mellitus (GDM) or type 1 diabetes mellitus (T1DM) showed a higher BMI standard deviation score and increased risk for overweight and obesity at 5.5 years of age than offspring of mothers without diabetes. While these associations could be substantially explained by maternal prepregnancy BMI in offspring of mothers with GDM, significant associations disappeared after adjustment for birth weight z scores in offspring of T1DM mothers. Furthermore, overweight risk became stronger with increasing age in offspring of mothers with diabetes compared with offspring of mothers without diabetes. Conclusions: Maternal diabetes is associated with increased risk of offspring overweight, and the association appears to get stronger as children grow older. Indeed, intrauterine exposure to maternal T1DM may predispose children to later obesity through increased birth weight, while maternal BMI is more important in children exposed to GDM.     

Parental obesity moderates the relationship between childhood appetitive traits and weight

Objective:

In this study, the independent and combined associations between childhood appetitive traits and parental obesity on weight gain from 0 to 24 months and body mass index (BMI) z‐score at 24 months in a diverse community‐based sample of dual parent families (n = 213) were examined.

Design and Methods:

Participants were mothers who had recently completed a randomized trial of weight loss for overweight/obese postpartum women. As measures of childhood appetitive traits, mothers completed subscales of the Children's Eating Behavior Questionnaire, including Desire to Drink (DD), Enjoyment of Food (EF), and Satiety Responsiveness (SR), and a 24‐h dietary recall for their child. Heights and weights were measured for all children and mothers and self‐reported for mothers' partners. The relationship between children's appetitive traits and parental obesity on toddler weight gain and BMI z‐score were evaluated using multivariate linear regression models, controlling for a number of potential confounders.

Results:

Having two obese parents was related to greater weight gain from birth to 24 months independent of childhood appetitive traits, and although significant associations were found between appetitive traits (DD and SR) and child BMI z‐score at 24 months, these associations were observed only among children who had two obese parents. When both parents were obese, increasing DD and decreasing SR were associated with a higher BMI z‐score.

Conclusions:

The results highlight the importance of considering familial risk factors when examining the relationship between childhood appetitive traits on childhood obesity.