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Predictors of Overweight Among a National Sample of Kindergartners

Disclosure Statement. SPEAKER: Heidi W. Smith, MDDr. Smith has documented that she has nothing to disclose. Background. Increasing prevalence of overweighteven among pre-school childrenPersistence of overweight within childhood into adulthoodAdiposity rebound as a period of risk. Why is chil

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Predictors of Overweight Among a National Sample of Kindergartners

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    1. Predictors of Overweight Among a National Sample of Kindergartners Heidi W. Smith, MD Elizabeth C. Hair, Ph.D. Stephen Cook, MD Tamara Halle, Ph.D. Michael Weitzman, MD

    2. Disclosure Statement SPEAKER: Heidi W. Smith, MD Dr. Smith has documented that she has nothing to disclose

    3. Background Increasing prevalence of overweight even among pre-school children Persistence of overweight within childhood into adulthood Adiposity rebound as a period of risk

    4. Why is childhood obesity important? Associated sequelae and co-morbidities psychosocial physiologic Increased health care expenditures Limited success at treating childhood obesity

    5. What to do� Prevention Risk factors among school-aged children Little is known about modifiable risk factors for overweight among American children at school entry

    6. Objective To identify modifiable risk factors for overweight among a national sample of kindergartners

    7. Methods Sample: Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999 (ECLS-K) Nationally representative sample Information obtained via: Computer assisted telephone interview with parent/guardian Written questionnaire by teacher Measurement of child�s height and weight Inclusion criteria: First-time kindergartner Recorded body mass index (BMI) Completed survey by parent/guardian N=14,991

    8. Study Design Cross-sectional data were collected during the kindergarten year Some variables required historical recall of information Child BMI was obtained in both the fall and spring of kindergarten

    9. Methods Main Outcome Measure: Weight status as defined by BMI Overweight (OW): BMI =85th %ile for age and sex Normal weight: BMI 5th-84.9th%ile for age and sex

    10. Potential Predictor Variables CHILD: age, gender, race/ethnicity, birthweight, amount of TV per day, # of days of exercise per week, weight status at kindergarten entry FAMILY: household income to poverty ratio, parent education, maternal depression, receipt of WIC services OUTSIDE HOME: receipt of school breakfast &/or lunch, method of travel to school, neighborhood safety, type of child care

    11. Statistical Analysis Chi square tests evaluated statistically significant associations between predictor variables and overweight status (p<0.05) Multivariate logistic regression model determined independent predictors of overweight status SAS and SUDAAN, to account for complex survey design, were used

    12. Results Of 14,991 kindergartners, more than one-quarter (26.5%) were overweight

    13. Child variables-bivariate results

    14. Family variables-bivariate results

    15. Outside home variables-bivariate results

    16. Independent Predictors for Overweight in Spring of Kindergarten

    17. Discussion Existing overweight is a tremendous risk factor for remaining overweight The risk of watching TV on the development of overweight was confirmed New identification of an independent association between child overweight and type of child care attendance prior to kindergarten

    18. Potential explanations for the risk of non-center based child care Amount and/or types of foods served to children Limited physical activity with greater use of TV, videos, or computers Day care may also be a marker for other risk factors contributing to overweight status

    19. Limitations Cross-sectional study design Significant information based on parent report No information regarding parental weight status dietary intake specifics of child care setting

    20. Strengths Nationally representative data Sample size = 14,991 Measured weight and height of each child Includes information about factors within AND outside the home

    21. Implications Nearly ALL children are seen by health care professionals before entering kindergarten, thus, creating an enormous opportunity to target those children who are already overweight Continue to support the American Academy of Pediatrics� recommendation to limit TV and other screen time to less than 2 hours daily

    22. Implications Need to further explore factors within child care settings that influence behaviors affecting weight status Interventions within child care settings could have significant influence given large number of pre-school children in child care Evaluate risk factors using longitudinal data

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