The Relationship Between Parent and Child Self‐Reported Adherence and Weight Loss

Objective: Better adherence to treatment strategies in family‐based behavioral weight control programs may lead to greater weight reduction and improved weight maintenance in youth. This study assessed the influence of child and parent self‐reported adherence to behavioral strategies on changes in 2‐year child and parent percentage overweight. Research Methods and Procedures: Participants included 8‐ to 12‐year‐old children in ≥ 85th BMI percentile and their parents from 110 families taking part in two family‐based randomized controlled weight control studies. This study examined whether self‐reported adherence to behavioral strategies measured at 24 months increased prediction of child and parent percentage overweight change through 24‐month follow‐up after accounting for other factors that may influence weight change. Results: Child adherence to weighing and to preplanning for celebrations where high‐fat foods are served and parent adherence to praising the child and modeling healthy eating habits predicted 24‐month child percentage overweight change (p < 0.001). Child adherence to recording food and calories and parent adherence to modeling healthy eating habits predicted 24‐month parent percentage overweight change (p < 0.001). In hierarchical regression models, child weighing and preplanning and parent modeling were significant (p < 0.01) incremental predictors (r² of 24.8%) of 24‐month child percentage overweight. Child recording and parent modeling were significant (p < 0.01) incremental predictors (r² of 14%) of parent 24‐month percentage overweight change. Discussion: Child and parent adherence to specific components of family‐based behavioral weight control treatment are independent predictors of long‐term child and parent percentage overweight change.     

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 ≥ 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.     

Adherence to behavioral targets and treatment attendance during a pediatric weight control trial

Objective:

Better weight loss outcomes are achieved in adults and youth who adhere to obesity treatment regimens (i.e., session attendance and prescribed changes in weight control behaviors). However, more research is needed regarding children's adherence to a range of behaviors relevant for weight maintenance over long‐term follow‐up.

Design and Methods:

Overweight children (N = 101, aged 7‐12 years), along with an overweight parent, participated in a 20‐week family‐based behavioral weight loss treatment (FBT) and were then assigned to either a behaviorally focused or socially focused 16‐week weight maintenance treatment (MT). Treatment attendance and child and parent adherence (i.e., reported use of skills targeted within treatment) were examined in relation to child percent overweight change from baseline to post‐FBT, post‐MT, and 2‐year follow‐up.

Results:

Higher attendance predicted better child weight outcomes at post‐MT, but not at 2‐year follow‐up. Adherence to self‐regulatory skills/goal‐setting skills predicted child weight outcomes at 2‐year follow‐up among the behaviorally focused MT group.

Conclusions:

Future research is needed to examine mediators of change within family‐based weight control interventions, including behavioral and socially based targets. Incorporating self‐regulatory weight maintenance skills into a comprehensive MT may maximize children's sustained weight control.     

Is Parental Control over Children's Eating Associated with Childhood Obesity? Results from a Population‐Based Sample of Third Graders

Objective: Identifying parental behaviors that influence childhood obesity is critical for the development of effective prevention and treatment programs. Findings from a prior laboratory study suggest that parents who impose control over their children's eating may interfere with their children's ability to regulate intake, potentially resulting in overweight. These findings have been widely endorsed; however, the direct relationship between parental control of children's intake and their children's degree of overweight has not been shown in a generalized sample. Research Methods and Procedures: This study surveyed 792 third‐grade children with diverse ethnic and socioeconomic backgrounds from 13 public elementary schools. Parental control over children's intake was assessed through telephone interviews using a state‐of‐the‐art instrument, and children were measured for height, weight, and triceps skinfold thickness. Results: Counter to the hypothesis, parental control over children's intake was inversely associated with overweight in girls, as measured by body mass index, r = ?0.12, p < 0.05, and triceps skinfolds, r = ?0.11, p < 0.05. This weak relationship became only marginally significant when controlling for parents’ perceptions of their own weight, level of household education, and children's age. No relationship between parental control of children's intake and their children's degree of overweight was found in boys. Discussion: Previous observations of the influence of parental control over children's intake in middle‐class white families did not generalize to 8‐ to 9‐year‐olds in families with diverse socioeconomic and ethnic backgrounds. The present findings reveal a more complex relationship between parental behaviors and children's weight status.     

Increasing Fruit and Vegetable Intake and Decreasing Fat and Sugar Intake in Families at Risk for Childhood Obesity

Objective: The goal of this study was to evaluate the effect of a parent‐focused behavioral intervention on parent and child eating changes and on percentage of overweight changes in families that contain at least one obese parent and a non‐obese child. Research Methods and Procedures: Families with obese parents and non‐obese children were randomized to groups in which parents were provided a comprehensive behavioral weight‐control program and were encouraged to increase fruit and vegetable intake or decrease intake of high‐fat/high‐sugar foods. Child materials targeted the same dietary changes as their parents without caloric restriction. Results: Changes over 1 year showed that treatment influenced targeted parent and child fruit and vegetable intake and high‐fat/high‐sugar intake, with the Increase Fruit and Vegetable group also decreasing their consumption of high‐fat/high‐sugar foods. Parents in the increased fruit and vegetable group showed significantly greater decreases in percentage of overweight than parents in the decreased high‐fat/high‐sugar group. Discussion: These results suggest that focusing on increasing intake of healthy foods may be a useful approach for nutritional change in obese parents and their children.     

Childhood Obesity: Do Parents Recognize This Health Risk?

Objective: This study examined parents’ understanding of excess weight as a health risk, knowledge of healthy eating habits, and recognition of obesity in their children. Research Methods and Procedures: An anonymous questionnaire was distributed during well‐care visits involving children 4 to 8 years of age at a pediatric faculty practice. Parents indicated their level of concern about excess weight and other familiar health risks using a four‐point Likert scale, answered multiple‐choice questions concerning healthy eating patterns, and communicated their perceptions about their child's weight using a visual analog scale. A parent's perception was considered “accurate” if it deviated from the child's growth chart percentile by <30 points. Results: Of the 83 parents surveyed, 23% (19/83) had overweight children (≥95th percentile of age‐ and gender‐specific BMI growth charts). These parents did not differ from other parents in their level of concern about excess weight as a health risk or in their knowledge of healthy eating patterns, but the two groups of parents did differ in the accuracy of their perceptions about their children's weight. Only 10.5% of parents of overweight children (2/19) perceived their child's weight accurately compared with 59.4% of other parents (38/64; p < 0.001). Parents of overweight children invariably underestimated their children's weight. The median difference between their perception and the growth chart percentile was ?45 points. Discussion: Given that most parents of overweight children fail to recognize that their child has a weight problem, pediatricians should develop strategies to help these parents correct their misperceptions.     

Influence of parents' eating behaviors and child feeding practices on children's weight status

Objective : To investigate the effects of mothers’ and fathers’ eating behaviors, child feeding practices, and BMI on percentage body fat and BMI in their children. Research Methods and Procedures : Four hundred fifty‐eight parents (239 mothers, 219 fathers) were asked to complete two questionnaires: the Three‐Factor Eating Questionnaire and the Child Feeding Questionnaire, which measure dimensions of parent eating behavior and child feeding practices, respectively. Parent BMI was calculated from self‐reported height and weight; children's measures included BMI and percentage fat assessed by DXA. Regression analyses were used to analyze relationships between parents’ BMI and questionnaire scores and children's weight status. Results : One hundred forty‐three mothers and 68 fathers returned questionnaires, representing parents of 148 children 3 to 5 years old (78 boys). Children's weight was related to mothers’ BMI, but not fathers’. Girls had a greater BMI if either parent reported being overweight as a child, and both girls and boys were likely to be overweight if their mothers believed they had risky eating habits (fussiness, eating too much, etc.). Girls with fathers who were more controlling had a higher percentage fat; these fathers were also more concerned about their daughters’ future health. Discussion : Mothers exert a strong influence over their children's weight and seem to be more concerned about their children's eating behaviors; however, fathers play a role in imposing child feeding practices. Gender bias may be present in child feeding, as suggested by dissimilar effects of parent practices on the weight status of girls vs. boys. Fathers should be included in future studies analyzing parent feeding practices and children's weight outcome.     

Physical activity levels of normal-weight and overweight girls and boys during primary school recess

Objective: This study aimed to compare moderate‐to‐vigorous physical activity (MVPA) and vigorous physical activity (VPA) in normal‐weight and overweight boys and girls during school recess. Research Methods and Procedures: Four hundred twenty children, age 6 to 10 years, were randomly selected from 25 schools in England. Three hundred seventy‐seven children completed the study. BMI was calculated from height and weight measurements, and heart rate reserve thresholds of 50% and 75% reflected children's engagement in MVPA and VPA, respectively. Results: There was a significant main effect for sex and a significant interaction between BMI category and sex for the percent of recess time spent in MVPA and VPA. Normal‐weight girls were the least active group, compared with overweight boys and girls who were equally active. Fifty‐one boys and 24 girls of normal weight achieved the 40% threshold; of these, 30 boys and 10 girls exceeded 50% of recess time in MVPA. Eighteen overweight boys and 22 overweight girls exceeded the 40% threshold, whereas 8 boys and 8 girls exceeded the 50% threshold. Discussion: Overweight boys were significantly less active than their normal‐weight male counterparts; this difference did not hold true for girls. Even though nearly double the number of normal‐weight children achieved the 40% of MVPA during recess compared with overweight children, physical activity promotion in school playgrounds needs to be targeted not only at overweight but at other health parameters, as 40 overweight children met the 40% MVPA target proposed for recess.     

Parenting style and cultural influences on overweight children's attraction to physical activity

Objective: To investigate the associations among parenting style, gender, Chinese culture, and overweight children's attraction to physical activity. Research Methods and Procedures: A total of 104 parents with overweight children were recruited from six primary schools in Hong Kong, China. Only overweight children in grades 3 through 6 (8 to 12 years of age) were invited to participate. Overweight children were defined and identified using the international cut‐off points stratified by sex and age. Questionnaires were used to assess Children's Attraction to Physical Activity (CAPA), perceived competence, and parental socialization influences. Results: Parental influence, especially father's role modeling, was significantly related to attraction to physical activity in overweight Chinese children. Perceived physical competence was also an important correlate of an overweight child's attraction to physical activity. Gender differences in CAPA were not significant among the Chinese overweight children. However, gender differences were observed in the relationship between parent physical activity orientation and CAPA. Discussion: In addition to a child's perceived competence, father's role modeling can provide additional and significant influence with regard to overweight children's attraction to physical activity. Differences in cultural orientation toward body weight should be considered when explaining overweight children's physical activity.     

Influence of Body Composition on the Accuracy of Reported Energy Intake in Children

Objective: Mis‐reporting dietary intake is a substantial barrier to understanding the role of dietary behavior in disease. Work with adults indicates that heavier individuals under‐report dietary intake and that under‐reporting may be macronutrient‐specific. Whether weight status and macronutrient intake influence the accuracy of dietary reports among children, however, is less clear. This research evaluated children's dietary reporting accuracy as a function of their relative weight, body composition, and macronutrient intake. Research Methods and Procedures: Participants included 146 4‐ to 11‐year‐old children. Reported energy intake was determined by interviewing children in the presence of parents, using three multiple pass, 24‐hour recalls. Children were classified as having had an under‐reported, accurately reported, or over‐reported dietary intake relative to total energy expenditure, as measured by doubly labeled water. Reporting accuracy was examined as a function of children's body weight, body composition (using dual energy x‐ray absorptiometry), and macronutrient intake. Results: Average reported intake was, on average, 14% greater than children's estimated expenditure (p < 0.01). Reporting accuracy varied as a function of children's relative weight and body composition; under‐reporting tended to occur among heavier children, having the highest body fat content (p < 0.0001) and relative weight (p < 0.0001). Discussion: These findings suggest that weight status influences the accuracy of dietary reports made by children and their parents. More research is needed to address possible psychological and social factors that introduce bias in reporting children's dietary data.     

Prevalence of Overweight among Inner City Hispanic‐American Children and Adolescents

Objective: National surveys have pointed to a particularly high risk of pediatric overweight among U.S. Hispanics. However, the data have been primarily from the Mexican‐American community. We studied the prevalence of overweight and clinical comorbidities in children and youth of predominantly El Salvadoran ancestry. Research Methods and Procedures: A sample of 309 Hispanic youth, 6–18 years was surveyed from two inner city Washington, DC, clinics. BMI; triceps skinfold (TSF) and subscapular skinfold thickness (SSSF); bioelectrical impedance analysis (BIA); and blood pressure measures were obtained, along with information regarding physical activity, sedentary behavior, dietary history, family, and personal medical history. Results: Thirty‐eight percent were overweight (BMI ≥ 95th percentile) and 22% at risk for overweight (BMI 85–94th percentile). Thirty‐four percent had TSF ≥ 90th percentile and 29% had SSSF ≥ 90th percentile. Fifty‐one percent of males and 70% of females had body fat > 30%. Compared to their nonoverweight counterparts, overweight youth had significantly higher systolic blood pressure (111.4 ± 1.3 vs. 104.5 ± 0.9 mm Hg, p < 0.0001). Among children younger than 11 years, overweight was associated with onset of adrenarche (23% vs. 10%, p = 0.01). Participation in one or more sports teams was negatively correlated with overweight) p = 0.04). Discussion: The prevalence of overweight and at risk for overweight in this sample was twice the national average for U.S. children and 1.7 times greater than that of Mexican‐American children in national surveys. Overweight was associated with advanced pubertal development, high body fat, elevated blood pressure, and decreased sports participation.     

Impact of Objective and Subjective Social Status on Obesity in a Biracial Cohort of Adolescents

Objective: To characterize the associations between socioeconomic status (SES), two levels of subjective social status (SSS), and adolescent obesity. Research Methods and Procedures: Cross‐sectional study of 1491 black and white adolescents attending public school in a suburban school district in Greater Cincinnati, Ohio. BMI ≥95th percentile derived from measured height and weight defined overweight. Students rated SSS on separate 10‐point scales for society and school. A parent provided information on parent education and household income for SES. Results: Although there were no sex differences in SES, black students were more likely to come from families with less well‐educated parents and lower incomes (p < 0.001). Black girls had the lowest societal SSS (p = 0.003), lowest school SSS (p = 0.046), and highest BMI (p < 0.001). Prevalence of overweight was highest among black girls (26.0%) and boys (26.2%), intermediate for white boys (17.2%), and least for white girls (11.6%). Logistic regression modeling revealed that parent education, household income, and school SSS were each associated with overweight. In a fully adjusted model, school SSS retained its association to overweight (odds ratio, 1.16; 95% CI, 1.06, 1.26) independent of SES. The association of school SSS was strongest among white girls, intermediate for white and black boys, and absent for black girls. Discussion: Perceptions of social stratification are independently associated with overweight. There were important racial and sex differences in the social status‐overweight association. SSS in the more immediate, local reference group, the school, had the strongest association to overweight.     

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.     

Impact of psychosocial factors on quality of life in overweight youth

Objective: The psychosocial functioning of overweight youth is a growing concern. Research has shown that overweight children report lower quality of life (QOL) than their non‐overweight peers. This study sought to extend the literature by examining the association between peer victimization, child depressive symptoms, parent distress, and health‐related QOL in overweight youth. Mediator models are used to assess the effect of child depressive symptoms on the relationship between psychosocial variables and QOL. Research Methods and Procedures: The sample consisted of 96 overweight and at‐risk‐for‐overweight children (mean age = 12.8 years) and their parents who were recruited from a Pediatric Endocrinology Obesity Clinic. Parents completed a demographic questionnaire, the Pediatric Quality of Life Inventory–parent‐proxy version, and the Brief Symptom Inventory. Children completed the Children's Depression Inventory–Short Form, the Schwartz Peer Victimization Scale, and the Pediatric Quality of Life Inventory. Results: Increased parent distress, child depressive symptoms, and peer victimization were associated with lower QOL by both parent‐proxy and self‐report. Child depressive symptoms mediated the relationship between psychosocial variables (parent distress and peer victimization) for self‐reported QOL but not for parent‐proxy‐reported QOL. Discussion: This study documented the important impact of peer victimization and parental distress on the QOL of overweight children. Expanding our understanding of how overweight children experience and interact with their environment is critical. Further research is needed to examine the mechanisms by which parent distress and peer victimization impact the development of depressive symptoms in overweight children, including coping and support strategies that may buffer these children against the development of depressive symptoms and ultimately lower QOL.     

Long‐Term Weight Development in Women: A 15‐Year Follow‐up of the Effects of Pregnancy

Objective: The aim of this study was to evaluate how well prepregnancy BMI, gestational weight gain, and postpartum weight retention predict retention of weight 15 years later among parous women. Research Methods and Procedures: The Stockholm Pregnancy and Women's Nutrition (SPAWN) study is a long‐term follow‐up study of women who delivered children in 1984 to 1985 (n = 2342). The participants initially filled out questionnaires about their eating and exercise habits, social circumstances, etc. before, during, and at 1 year after pregnancy. Anthropometric data were also sampled. Fifteen years later, these women were invited to take part in the follow‐up study. Anthropometric measurements were collected, and similar questions were asked. Five hundred sixty‐three women participated in the SPAWN 15‐year follow‐up study. The sample was divided into groups to examine three presumably critical time periods: 1) overweight and normal weight before pregnancy; 2) low, intermediate, and high weight gainers during pregnancy; and 3) low, intermediate, and high weight retainers at 1 year after pregnancy. Results: The overweight women did not gain more weight during pregnancy or retain more weight at 1 year follow‐up. High weight gainers during pregnancy retained more weight at the 1‐year and the 15‐year follow‐ups. High weight retainers had gained more during pregnancy and retained it at the 15‐year follow‐up. Fifty‐six percent of the high weight gainers during pregnancy ended up in the high weight retainers group. Discussion: Women who are overweight before pregnancy do not have a higher risk of postpartum weight retention than normal weight women. Thus, it is not necessarily the initially overweight woman who should be the target or focus of weight control programs during or after pregnancy. Both high weight gainers and high weight retainers had higher BMI at the 15‐year follow‐up, although only 56% of the high weight gainers during pregnancy were also classified as high weight retainers at the 1‐year follow‐up. Weight retention at the end of the postpartum year predicts future overweight 15 years later.     

Low Resting and Sleeping Energy Expenditure and Fat Use Do Not Contribute to Obesity in Women

Objective: Determine whether sleeping and resting energy expenditure and sleeping, resting, and 24‐hour fuel use distinguish obesity‐prone from obesity‐resistant women and whether these metabolic factors explain long‐term weight gain. Research Methods and Procedures: Forty‐nine previously overweight but currently normal‐weight women were compared with 49 never‐overweight controls. To date, 87% of the 98 women have been re‐evaluated after 1 year of follow‐up, without intervention, and 38% after 2 years. Subjects were studied at a General Clinical Research Center after 4 weeks of tightly controlled conditions of energy balance and macronutrient intake. Forty‐nine obesity‐prone weight‐reduced women were group‐matched with 49 never‐overweight obesity‐resistant controls. All were premenopausal, sedentary, and normoglycemic. Energy expenditure and fuel use were assessed using chamber calorimetry. Body composition was assessed using DXA. Results: At baseline, percent body fat was not different between the obesity‐prone and control women (33 ± 4% vs. 32 ± 5%, respectively; p = 0.22). Analysis of covariance results show that after adjusting for lean and fat mass, sleeping and resting energy expenditure of obesity‐prone women was within 2% of controls. Neither sleeping nor resting energy expenditure nor sleeping, resting, or 24‐hour fuel use was significantly different between the groups (p > 0.25). None of the metabolic variables contributed significantly to patterns of weight gain at 1 or 2 years of follow‐up. Discussion: The results suggest that when resting and sleeping energy expenditure and fuel use are assessed under tightly controlled conditions, these metabolic factors do not distinguish obesity‐prone from obesity‐resistant women or explain long‐term weight changes.     

Childhood Overweight and Academic Performance: National Study of Kindergartners and First‐Graders

Objective: To examine the association between children's overweight status in kindergarten and their academic achievement in kindergarten and first grade. Research Methods and Procedures: The data analyzed consisted of 11, 192 first time kindergartners from the Early Childhood Longitudinal Study, a nationally representative sample of kindergartners in the U.S. in 1998. Multivariate regression techniques were used to estimate the independent association of overweight status with children's math and reading standardized test scores in kindergarten and grade 1. We controlled for socioeconomic status, parent‐child interaction, birth weight, physical activity, and television watching. Results: Overweight children had significantly lower math and reading test scores compared with nonoverweight children in kindergarten. Both groups were gaining similarly on math and reading test scores, resulting in significantly lower test scores among overweight children at the end of grade 1. However, these differences, except for boys’ math scores at baseline (difference = 1.22 points, p = 0.001), became insignificant after including socioeconomic and behavioral variables, indicating that overweight is a marker but not a causal factor. Race/ethnicity and mother's education were stronger predictors of test score gains or levels than overweight status. Discussion: Significant differences in test scores by overweight status at the beginning of kindergarten and the end of grade 1 can be explained by other individual characteristics, including parental education and the home environment. However, overweight is more easily observable by other students compared with socioeconomic characteristics, and its significant (unadjusted) association with worse academic performance can contribute to the stigma of overweight as early as the first years of elementary school.     

Overweight in Swiss children and associations with children's and parents' characteristics

Objective: The objective was to assess the prevalence of overweight and obesity in children in a canton of Switzerland and the association with various characteristics of the parents and the children. Research Methods and Procedures: A cross‐sectional survey was conducted in all children of the sixth school grade of the canton of Vaud, Switzerland. Weight and height were measured, and selected lifestyle variables were assessed with a self‐administered semiquantitative questionnaire. Information on children's parents was gathered through a mailed structured questionnaire. Overweight and obesity were based on the International Obesity Task Force criteria. Results: Of 6873 eligible children, 5207 (76%) participated (2621 boys, 2586 girls; mean age, 12.3 years; standard deviation, 0.5 year). The prevalence of overweight (including obesity) was 15.0% (95% confidence interval, 13.7% to 16.4%) in boys and 12.4% (11.1% to 13.7%) in girls, and the prevalence of obesity was 1.8% (1.3% to 2.3%) and 1.7% (1.2% to 2.2%), respectively. In both univariate and multivariate analyses, overweight was strongly associated with high television viewing time and selected characteristics of the parents (overweight, low educational level, and foreign nationality). Discussion: The prevalence of pediatric overweight and obesity was lower in this region of Switzerland than in several European countries. The correlates of overweight found in this region suggest areas for potential interventions.     

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.     

Children at High Risk for Overweight: A Classification and Regression Trees Analysis Approach

Objective: Early identification of children at high risk for childhood overweight is a major challenge in fighting the obesity epidemic. We tried to identify the most powerful set of combined predictors for childhood overweight at school entry. Research Methods and Procedures: A classification and regression trees analysis on risk factors for childhood overweight in 4289 children 5 to 6 years of age participating in the obligatory school entry health examination 2001/2002 in Bavaria, Germany, was performed. Parental questionnaires asked for children's weight at birth and 2 years, breastfeeding history, maternal smoking in pregnancy, parental education, parental overweight/obesity, nationality, and number of older siblings. Overweight was defined according to sex‐ and age‐specific BMI cut‐points proposed by the International Obesity Task Force. Results: Prevalence of overweight was 11% among the entire study population. Although high early weight gain >10, 000 grams was found in about one‐half of the overweight children, its positive predictive value reached only 25%, indicating that one of four children with a high early weight gain is overweight at school entry. The best reliable set of predictors included high early weight gain and obese parents and accounted for a likelihood ratio of 3.6, with a corresponding positive predictive value of 40%, and was found in 4% of all children. Discussion: A combination of predictors available at 2 years of age could improve predictability of overweight at school entry. However, corresponding low positive predictive values indicate a precision of the prediction that might be insufficient for targeting intervention programs for identified high‐risk children.