The decline in BMI among Japanese women after World War II

The body mass index (BMI) of the Japanese is significantly lower than is found in other high-income countries. Moreover, the average BMI of Japanese women is lower than that of Japanese men, and the age-specific BMI of Japanese women has decreased over time. The average BMI of Japanese women at age 25 decreased from 21.8 in 1948 to 20.4 in 2010 whereas that of men increased from 21.4 to 22.3 over the same period. We examine the long-term BMI trend in Japan by combining several historical data sources spanning eleven decades, from 1901 to 2012, to determine not only when but also how the BMI decline among women began: whether its inception was period-specific or cohort-specific. Our nonparametric regression analysis generated five findings. First, the BMI of Japanese women peaked with the 1930s birth cohort. This means that the trend is cohort-specific. Second, the BMI of men outpaced that of women in the next cohort. Third, the BMI of Japanese children, boys and girls alike, increased steadily throughout the 20th century. Fourth, the gender difference in the BMI trend is due to a gender difference in the weight trend, not the height trend. Fifth, these BMI trends are observed in urban and rural populations alike. We conclude that the BMI decline among Japanese women began with those who were in their late teens shortly after World War II.     

Sex differences in height and sitting height in the Belgian population

Sex differences in growth were studied in a longitudinal study of 39 boys and 31 girls for sitting height. Individual growth patterns were determined by means of Preece Baines model 1. The results showed no significant bias in the fits of height and sitting height in boys and girls. Girls fits were significantly better than those of the boys for both height and sitting height. Univariate analysis by means of Mann-Whitney test showed significant sex differences for all function and biological parameters of height and sitting height excepted for s₁ parameter (the rate constant controlling pubertal velocity). Linear discriminant analysis revealed that the strongest sex differences for the timing and size parameters at adolescent. Peak velocity at adolescent was slightly less discriminating between the two sexes and velocity at take-off showed the least sex difference. These trends were similar for height and sitting height. Decomposition of sex differences in adult size showed that the major contributor to adult the sex differences is the effect of the later onset of the adolescent growth spurt in boys than in girls. Sex differences in adult phenotypes of height and sitting height are to a slightly lesser extent due to the greater adolescent gain in boys while prepubertal sex differences are almost negligible.     

Prevalence of Pre‐obesity and Obesity in Urban Adult Mexicans in Comparison with Other Large Surveys

Objective: 1. To estimate the prevalence of pre‐obesity and obesity in a 1992 to 1993 national survey of the Mexican urban adult population. 2. To compare our findings with other national surveys and with data for Mexican Americans. Research Methods and Procedures: The national representative sample of the Mexican urban adult population included 8462 women and 5929 men aged 20 to 69 years from 417 towns of >2500 people. Body mass index (BMI), calculated from measured weight and height, was classified using the World Health Organization categories of underweight (BMI < 18.5 kg/m²), normal weight (BMI 18.5 to 24.9 kg/m²), pre‐obesity (PreOB = BMI 25 to 29.9 kg/m²) and obesity (OB = BMI 30+ kg/m²). Estimates for Mexican Americans were calculated from U.S. survey data. Results: Overall, 38% of the Mexican urban adult population were classified as pre‐obese and 21% as obese. Men had a higher prevalence of pre‐obesity than women did at all ages, but women had higher values of obesity. Both pre‐obesity and obesity increased with age up to the age range brackets of 40 to 49 or 50 to 59 years for both men and women. Both pre‐obesity and obesity prevalence estimates were remarkably similar to data for Mexican Americans from 1982 through 1984. Comparison with other large surveys showed that countries differed more in the prevalence of obesity than of pre‐obesity, leading to differences in the PreOB/OB ratio, and that countries also differed in the gender ratio (female/male) for both pre‐obesity and obesity. Discussion: Pre‐obesity and obesity were high in our population and increased with age. Our approach of characterizing large surveys by PreOB/OB and gender ratios appeared promising.     

Reference Growth Curves for Cypriot Children 6 to 17 Years of Age

Objective: The purpose of the study was to present smoothed percentiles for body weight and height, waist circumference, and body mass index (BMI) in Cypriot children and to compare their BMI 85th and 95th percentiles with those of children in other countries. Research Methods and Procedures: The study was a cross‐sectional study, including a representative sample of 2472 healthy children (49.1% boys) in Cyprus ages 6 to 17 years, who were evaluated during the 1999–2000 school year. Body weight and height and waist circumference were measured using standard procedures. BMI was calculated as weight in kilograms per height in square meters. Smoothed, sex‐specific percentiles for these variables were calculated using polynomial regression models. Crude weight, height, waist, and BMI percentile values are presented in sex‐specific tables and smoothed percentile curves are presented in charts. The 85th and 95th percentiles for BMI were compared with measurements from other countries, because of the concern of the upper limits of BMI in respect to the evaluation of obesity. Results: The 85th and 95th BMI percentile values are higher in Cypriot boys than in Swedish and Iranian boys through all ages and in girls ages 6 to 15 years, whereas after the age of 15 years, both Swedish and Iranian girls’ percentiles are equalized with their Cypriot peers. Discussion: Weight, height, waist circumference, and BMI values and charts are presented for the first time for Cypriot children and adolescents. Much concern should be addressed to the observation that for the majority of the Cypriot sample, the upper BMI limits are higher than the peers of developing and developed countries.     

Adult obesity does not predict 6-year weight gain in men: the Aerobics Center Longitudinal Study

Objective: To determine the longitudinal relation between history of adult obesity and the 6‐year trajectory of weight change in men. Research Methods and Procedures: Subjects were healthy, affluent men (n = 761) between the ages of 20 and 78 years who completed at least four comprehensive medical exams at the Cooper Clinic between 1987 and 2003. Maximum adult weight was reported, and current height was measured at baseline. Body weight and cardiorespiratory fitness were measured at all examinations. Adult obesity status was determined from self‐reported maximum weight and measured height at baseline as BMI ≥ 30 kg/m². Weight at all examinations was regressed on a history of adult obesity using linear mixed effects modeling. Results: At baseline, men reporting a history of adult obesity were significantly heavier than men reporting no such history (BMI 29.8 vs. 25.0 kg/m²; p < 0.05). However, the rate of weight gain among men with a history of obesity was slower than among men without a history of adult obesity (0.04 vs. 0.18 kg/yr; p = 0.09), although this difference was only marginally significant. Fitness modulated the relationship between history of obesity and weight change over time, and both higher levels of fitness and greater frequency of dieting were associated with attenuated weight gain. In contrast, chronic disease and depression were associated with accelerated weight gain. Discussion: Although a history of obesity was associated with higher weight, it did not seem to result in accelerated weight gain over time. Additionally, dieting and fitness were important for minimizing weight gain.     

Identification of overweight in children in the United States: a simplified approach

The objective of this study was to develop a screening instrument for easy identification of overweight in children and adolescents in the United States. Data derived from the 2000 Growth Charts published by the Centers for Disease Control and Prevention (CDC) were utilized to compute gender-specific screening values for identification of overweight in children and adolescents. Computations were based on age- and gender-specific 85th percentile BMI calculated for the various height percentiles at 6-month age intervals. The simplified approach for identification of overweight in children and adolescents consisted of two tables, one each for males and females. Each table described the screening values for overweight at 6-month age intervals for all the nine height percentiles described in the CDC Stature for Age Tables. Two screening tables for identification of obesity were also developed in a similar manner using age- and gender-specific 95th percentile BMI. The simplified approach described for identification of overweight uses only the child's height and weight measurements and obviates the need to compute BMI or assess BMI percentile scores.     

Influential Factors on the Relative Age Effect in Alpine Ski Racing

The relative age effect (RAE), which refers to an over-representation of selected athletes born early in the selection year, was proven to be present in alpine ski racing in all age categories at both national and international levels. However, the influential factors on, or the causal mechanisms of, the RAE are still unknown. Therefore, the aim of the present study was to examine three possible influential factors on the relative age effect in alpine skiing: physical performance, anthropometric characteristics and biological maturational status. The study included the investigation of 282 elite Austrian youth ski racers and 413 non-athletes (comparison group) of the same age (10–13 years) and region. Six physical performance tests were performed, body mass and height were assessed, and the age at peak height velocity (APHV) was calculated. A significant RAE was present in the ski racers. No differences were shown in the physical performance characteristics or in the calculated APHV between the relative age quarters. These results suggest that ski racers born in the last quarter can counteract the relative age disadvantages if they already present the same level of physical performance and maturational status as those born at the beginning of the year. The height and weight of ski racers born at the beginning of the year were significantly higher compared to the non-athletes, and ski racers born in relative age quarter 1 were taller and heavier compared to the ski racers of the other quarters. This indicates that the anthropometric characteristics influence the selection process in alpine ski racing, and that relatively older athletes are more likely to be selected if they exhibit advanced anthropometric characteristics.     

Long-term changes in body weight, BMI, and adiposity rebound among children and adolescents in the Czech republic

The Czech Republic has undergone rapid political, social, and economic transformation since the late 1980s. While obesity rates among children and adolescents in the Czech Republic have been previously relatively low, this has changed in recent years. Across the past 50 years, body weight, body mass index (BMI)-for-age, and adiposity rebound (AR) (the time when a child reaches the lowest BMI before their BMI gradually begins to increase until adulthood) occurs earlier. The most dramatic changes have been observed among school-aged children, where BMI values have increased at the 50th, 90th, and 97th percentiles. In contrast, adolescent girls appear to be thinner than in the past. The analyses of weight-for-height percentiles indicated that the 50th percentile of the body weight among boys and girls remained similar in nearly all age categories across the past 50 years. Although the growth pattern of children at the 50th percentile has not changed, the 10th and 90th percentiles have expanded. Our findings suggest that the secular trend of increased height, accelerated growth, and earlier maturation is responsible for Czech children experiencing adiposity rebound at earlier ages compared to the past.     

Obese children have higher arterial elasticity without a difference in endothelial function: the role of body composition

The childhood obesity epidemic is expected to increase cardiovascular disease risk, but the impact of obesity on vascular function in children is not fully understood. The purpose of this study was to determine the effect of obesity and maturation on vascular function in normal weight (BMI: 25-75 percentile) and obese (BMI: ≥95 percentile) children ages 8-18 years old. Large and small artery elasticity (LAEI and SAEI, respectively), measured by diastolic radial pulsewave contour analysis, and reactive hyperemia index (RHI), measured by peripheral arterial tonometry, were obtained, along with anthropometric and biochemical outcomes, in 61 normal weight and 62 obese children. SAEI and LAEI increased with age and were 30% and 18% higher, respectively, in obese children (P < 0.01). In contrast, reactive hyperemia increased with age in the normal weight group but did not differ between groups. Multivariate modeling was used to select variables that explained differences in vascular outcomes. The best model for LAEI in normal weight children was height alone (r(2) = 0.49), whereas for obese children the best model included height + fat mass (r(2) = 0.40). For SAEI, there were no significant models for normal weight children, but for obese children the best model included lean mass + fat mass (r(2) = 0.36). Obese children had greater lean and fat mass, and more advanced Tanner stages than their normal weight peers. The increased elasticity observed in obese children appears to reflect accelerated growth and maturation without affecting vascular reactivity measured by reactive hyperemia. Longitudinal follow up will be essential in determining effects on future vascular disease risk.     

Birth Weight,Adult Body Composition,and Subcutaneous Fat Distribution

Objectives: To investigate if birth weight is related to both body mass index (BMI) and distribution of subcutaneous fat at adult age. Research Methods and Procedures: A 9‐year longitudinal study was performed in 229 subjects (192 women) with ages ranging from 27 to 36 years. Birth weight was retrieved by a questionnaire, and adult weight, height, skinfold thicknesses, and waist‐to‐hip ratio (WHR) were repeatedly measured at mean ages 27, 29, 31, and 36 years. BMI, sum of four skinfolds (S4S), the ratio between two truncal skinfolds and S4S (SS/S4S), and the ratio between WHR and the cross‐sectional area of the left thigh were calculated with the available data. Results: The adjusted model showed that in women, birth weight was significantly negatively related to adult S4S [β = ?5.211; (?9.768 to ?0.654)], waist circumference [β = ?1.449; (?2.829 to ?0.069)], and SS/S4S ratio [β = ?3.579; (?5.296 to ?1.862)]. In men, a significant negative association was observed between birth weight and adult WHR [β = ?1.096; (?2.092 to ?0.100)] only. Other relationships showed, although not significantly, the same negative trend, namely that lower birth weight is related to higher adult body fat mass (S4S) and a more truncal subcutaneous fat distribution (SS/S4S). No associations were found between birth weight and either adult BMI or the cross‐sectional area of the thigh. Discussion: Lower birth weight is, in both adult men and women, related to a higher adult subcutaneous fat mass and a more truncal distribution of subcutaneous fat, indicating a higher risk for obesity.     

Do American born Japanese children still grow faster than native Japanese?

Growth patterns of Japanese schoolchildren in Hawaii, composed of 2,954 boys and 3,213 girls aged between 11 and 17, were compared with those comparable groups of Japanese schoolchildren in Japan based on the data published by the Japanese Ministry of Education. Growth characteristics studied were height, weight, and relative weight index, weight/(height). The Hawaii-Japanese boys were taller at early ages but the difference disappeared by age 16. Native Japanese girls were shorter than Hawaii-Japanese until age 13, but they overtook the latter by age 14, exceeding them in height after age 15. A similar pattern was found in weights of girls but the Hawaii-Japanese boys remained consistently heavier by 5.0 to 9.0 kg than native Japanese. The relative weight measure indicated that the Hawaii boys were more "obese" than native Japanese boys for the growth period studied; whereas the same tendency was maintained until age 15 in girls. These observations indicate a marked degree of convergence of the patterns of physical growth of the two populations, whose differences were unmistakably in favor of American born children in earlier studies. It is concluded that the convergence is due largely to the improved environmental conditions in Japan in recent years.     

Growth reference centiles and secular changes in Turkish children and adolescents

The purpose of the study is to develop current reference growth centiles for Turkish children and adolescents. A cross-sectional growth survey was conducted on 1.427 (709 boys and 718 girls) healthy schoolchildren aged 6-17 years in Ankara, the capital city of Turkey. As an indicator of socio-economic status, the occupation of the parents was recorded. Growth references of height, weight, body mass index (BMI), sitting height, iliospinal height, relative iliospinal height and relative sitting height were constructed by the LMS method. Sex differences, association of parental occupation with height and BMI standard deviation scores were assessed by analyses of variance. Results showed significant sexual dimorphism for height, weight, sitting height and iliospinal height (p<0.001). Significant effect of socio-economic background was found on height and BMI. The prevalence of overweight and obesity was found using the International Obesity Task Force (IOTF) reference criteria 22.4% and 5.6% in boys and 21.2% and 3% in girls. Present results demonstrated an increment during the last three decades in height, leg length and weight curves which is more prominent in boys, but not in the sitting height. This positive secular change appears to be a logical outcome of the gradual changes in nutrition, health care and education, and environmental and economic conditions.     

Underreporting of BMI in adults and its effect on obesity prevalence estimations in the period 1998 to 2001

Objective: To identify the determinants of underreporting BMI and to evaluate the possibilities of using self‐reported data for valid obesity prevalence rate estimations. Research Methods and Procedures: A cross‐sectional monitoring health survey was carried out between 1998 and 2002, and a review of published studies was performed. A total of 1809 men and 1882 women ages 20 to 59 years from The Netherlands were included. Body weight and height were reported and measured. Equations were calculated to estimate individuals’ BMI from reported data. These equations and equations from published studies were applied to the present data to evaluate whether using these equations led to valid estimations of the obesity prevalence rate. Also, size of underestimation of obesity prevalence rate was compared between studies. Results: The prevalence of obesity was underestimated by 26.1% and 30.0% among men and women, respectively, when based on reported data. The most important determinant of underreporting BMI was a high BMI. When equations to calculate individuals’ BMI from reported data were used, the obesity prevalence rate was still underestimated by 12.9% and 8.1% of the “true” obesity prevalence rate among men and women, respectively. The degree of underestimating the obesity prevalence was inconsistent across studies. Applying equations from published studies to the present data led to estimations of the obesity prevalence varying from a 7% overestimation to a 74% underestimation. Discussion: Valuable efforts for monitoring and evaluating prevention and treatment studies require direct measurements of body weight and height.     

The interaction of childhood height and childhood BMI in the prediction of young adult BMI

The purpose of this study was to examine the interaction of childhood height and childhood BMI in the prediction of young adult BMI. The 2,802 subjects in this study were from the Child and Adolescent Trial for Cardiovascular Health (CATCH). The subjects' heights and weights were measured in 3rd grade (mean age 8.7 years) and again in 12th grade (mean age 18.3 years). The associations and interactions between height (cm) and BMI (kg/m(2)) were assessed using mixed linear regression models with adult BMI as the dependent variable. We found a significant interaction between childhood height and childhood BMI in the prediction of adult BMI (P < 0.0001). Stratification by Centers for Disease Control and Prevention (CDC) reference quintiles revealed that a positive association between childhood height and adult BMI existed only for those subjects in the top quintile of childhood BMI, within whom predicted adult BMI ranged from 27.5 (95% confidence interval = 26.4-28.6) for those in the shortest height quintile to 30.2 (95% confidence interval = 29.7-30.6) for those in the highest height quintile. Among children with high BMI levels, those who were taller, as compared to those who were shorter, had significantly higher young adult BMI levels. This pattern seems primarily due to the positive association of childhood height and childhood BMI. Clinicians should recognize the risk of excess body weight in young adulthood for all children who have a high BMI, and pay special attention to those who are tall, because their childhood height will not protect them from subsequent weight gain and elevated BMI.     

Cognitive Change in Obese Adolescents Losing Weight

Objectives: To investigate how obese adolescents think about themselves in terms of exercise, eating, and appearance and whether these cognitions change over the course of a residential weight loss camp. Research Methods and Procedures: Obese adolescents [N = 61; age, 14.1 (±0.2) years; BMI, 33.9 (±0.7) kg/m²] completed assessments of body weight and height and self‐esteem and a sentence‐completion test eliciting thoughts and beliefs about exercise, eating, and appearance at the start and end of the camp (mean stay, 26 days). They were compared with a single assessment of 20 normal‐weight adolescents [age, 15.4 (±0.2) years; BMI, 21.8 (±0.5) kg/m²]. Results: The obese adolescents lost 5.7 kg and reduced their BMI SD score by 0.25. Camp residence was associated with a significant reduction in the number of negative automatic thoughts and an increase in positive thoughts, especially related to exercise and appearance. There was no change in conditional beliefs, either functional or dysfunctional. Including BMI SD score change as a covariate took away all the main and interaction effects of time, showing that cognitive change was largely accounted for by the reduction in weight. Despite this improvement, campers remained cognitively more negative and dysfunctional than the normal‐weight comparison adolescents. Discussion: Obese adolescents not only lost weight, but they improved their self‐representation, specifically in terms of automatic thoughts about exercise and appearance. Although these are short‐term cognitive changes, they reflect positively on the camp experience and show the value of psychological improvement in assessing obesity‐treatment outcomes.     

海拔对儿童和青少年生长发育的影响

为进一步探讨自然环境因素对生长发育的影响,本文收集了14个省会城市1996年以来7-18岁107986(男56300,女51686)儿童青少年的身高、体重、胸围资料及体质测量当年的海拔、年降水量、年均气温和年日照时数资料,做海拔等自然环境因素与发育指标的Z-分数和发育分相关与回归分析。结果表明,从低海拔组到中海拔组、高海拔组,儿童青少年的生长发育指标逐步下降,其中体重与BMI有统计学意义(P0.05),低海拔组发育指标明显好于高海拔组;生长发育水平与海拔的相关系数大于年均气温和日照时数,与年降水量不相关;回归分析表明海拔每增加1000m,身高、体重、胸围和BMI分别减少0.112,0.101,0.043和0.118个Z-分数。在四项自然环境因素中,海拔对生长发育的影响最大,对身高、体重、胸围和BMI的贡献率分别是28.0%,26.8%,12.0%,16.8%。     

A 30‐year Follow‐up of the Effects of Child Abuse and Neglect on Obesity in Adulthood

Childhood maltreatment has been implicated as a risk factor for adult obesity. We describe the first prospective assessment of adult obesity in individuals with documented histories of childhood physical and sexual abuse and neglect and a matched comparison group in a 30‐year follow‐up. Using a prospective cohort design, children with court substantiated cases of physical and sexual abuse and neglect (ages 0–11 years) from a Midwest county during 1967–1971 (n = 410) were matched with children without histories of abuse or neglect on age, sex, race/ethnicity and approximate family social class (n = 303) and followed up and assessed at mean age 41. Outcome measures include BMI and obesity assessed in 2003–2004 as part of a medical status examination and interview. Childhood physical abuse predicted significantly higher BMI scores in adulthood (β = 0.14, P < 0.05), even controlling for demographic characteristics, cigarette smoking, and alcohol consumption (β = 0.16, P < 0.01). Childhood sexual abuse (β = 0.07, not significant) and neglect (β = 0.02, not significant) were not significant predictors of adult BMI scores. These results demonstrate the long‐term impact of childhood physical abuse on weight into adulthood and suggest that physically abused children may be at risk for other adverse health outcomes associated with increased weight. Health professionals need to understand this risk for physically abused children and researchers should identify and evaluate strategies for effective interventions.     

Trends in Height and BMI of 6‐Year‐Old Children during the Nutrition Transition in Chile

Objective: We analyzed trends in height and BMI and their interaction in 6‐year‐old Chilean children over the last 15 years. Research Methods and Procedures: We calculated height for age z‐score (HAZ), BMI z‐score, prevalence of obesity, underweight, and stunting from cross‐sectional national school‐based annual population surveys in 1987, 1990, 1993, 1996, 2000, and 2002. Using mixed model analysis, we determined the risk of obesity according to height over time as odds ratios (ORs) and 95% confidence interval and the potential influence of height and year of study on BMI z‐score. Results: Over the study period, height increased by 2.8 cm in boys and 2.6 cm in girls, whereas stunting declined from 5% to 2% in both. Tallness increased by ～2%, BMI z‐score increased from +0.3 to +0.65 in boys and to +0.62 in girls, and HAZ increased from ?0.47 in boys and ?0.45 in girls to 0 in 2002. Underweight declined from 4% to 3%, whereas obesity rose from 5% to ～14%. The probability of obesity among tall children was significantly greater than that for normal height children (OR, 2.3 to 3.5). The lowest obesity risk was observed between ?2 and ?1 HAZ. The OR for obesity in the stunted relative to normal height children was variable, ranging from 1.23 to 0.65, whereas it was significant and consistently positive (1.1 to 1.7) for boys and girls when it was compared with the lowest obesity risk according to height. Discussion: Tallness is significantly associated with increased obesity risk in children, while stunting is also associated, but to a lesser degree.     

Human Growth and Body Weight Dynamics: An Integrative Systems Model

Quantifying human weight and height dynamics due to growth, aging, and energy balance can inform clinical practice and policy analysis. This paper presents the first mechanism-based model spanning full individual life and capturing changes in body weight, composition and height. Integrating previous empirical and modeling findings and validated against several additional empirical studies, the model replicates key trends in human growth including A) Changes in energy requirements from birth to old ages. B) Short and long-term dynamics of body weight and composition. C) Stunted growth with chronic malnutrition and potential for catch up growth. From obesity policy analysis to treating malnutrition and tracking growth trajectories, the model can address diverse policy questions. For example I find that even without further rise in obesity, the gap between healthy and actual Body Mass Indexes (BMIs) has embedded, for different population groups, a surplus of 14%–24% in energy intake which will be a source of significant inertia in obesity trends. In another analysis, energy deficit percentage needed to reduce BMI by one unit is found to be relatively constant across ages. Accompanying documented and freely available simulation model facilitates diverse applications customized to different sub-populations.     

Role of BMI-associated loci identified in GWAS meta-analyses in the context of common childhood obesity in European Americans

Obesity is a serious health concern for children and adolescents, particularly in Western societies, where its incidence is now considered to have reached epidemic proportions. A number of genetic determinants of adult BMI have already been established through genome wide association studies (GWAS), most recently from the GIANT meta-analysis of such datasets combined. In this current study of European Americans, we examined the 32 loci detected in that GIANT study in the context of common childhood obesity within a cohort of 1,097 cases (defined as BMI ≥95th percentile), together with 2,760 lean controls (defined as BMI <50th percentile), aged between 2 and 18 years old. Nine of these single-nucleotide polymorphims (SNPs) yielded at least nominal evidence for association with common childhood obesity, namely at the FTO, TMEM18, NRXN3, MC4R, SEC16B, GNPDA2, TNNI3K, QPCTL, and BDNF loci. However, overall 28 of the 32 loci showed directionally consistent effects to that of the adult BMI meta-analysis. We conclude that among the 32 loci that have been reported to associate with adult BMI in the largest meta-analysis of BMI to date, at least nine also contribute to the determination of common obesity in childhood in European Americans, as demonstrated by their associations in our pediatric cohort.