Hawkins SS, Law C. A review of risk factors for overweight in preschool children: a policy perspective. Int J Pediatr Obes 1, 195-209

Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK.
International Journal of Pediatric Obesity (Impact Factor: 3.03). 02/2006; 1(4):195-209. DOI: 10.1080/17477160600943351
Source: PubMed


An increasing number of preschool children are becoming overweight. Although many risk factors have been identified for school-age children, less is known about this young age group. Ecological models have been developed to illustrate how individual characteristics, family characteristics, community-level factors, and policies may influence weight gain. We used this model to review factors that influence overweight in children, aged six months to five years, which are amenable to policy intervention in resource-rich countries. We found strong evidence for a direct association between childhood overweight and maternal prepregnancy body size, maternal smoking during pregnancy, and children's television/media use; strong evidence for an inverse relationship between breastfeeding and overweight, and moderate evidence for children's physical activity. There was limited research on community-level factors, policies and interventions. Future policies and interventions should be subject to evaluation and aim to support parents and young children to develop health-related behaviours that may prevent early childhood overweight.

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Available from: Summer Hawkins, Jun 03, 2015
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    • "Several studies in different countries showed low intakes of non-sugared beverages, fruit, vegetables, water and milk and high intakes of unhealthy snacks, sugared drinks, juices, total and saturated fat and added sugar [10-15]. A growing number of studies on behaviours and determinants of PA and beverage consumption in preschool children have already been published [10-13,16-18]. On the other hand, studies on the perspectives of the caregivers (i.e. "
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    ABSTRACT: Background Qualitative research is a method in which new ideas and strategies can be discovered. This qualitative study aimed to investigate parents’ and teachers’ opinions on physical activity and beverage consumption of preschool children. Through separate, independent focus groups, they expressed their perceptions on children’s current physical activity and beverage consumption levels, factors that influence and enhance these behaviours, and anticipated barriers to making changes. Methods Multi-cultural and multi-geographical focus groups were carried out in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain). In total, twenty-four focus groups with 122 parents and eighteen focus groups with 87 teachers were conducted between October 2010 and January 2011. Based on a semi-structured interview guide, questions on preschoolers’ physical activity (opinions on preschoolers’ physical activity, how to increase physical activity, facilitators and barriers of physical activity) and beverage consumption (rules and policies, factors influencing promotion of healthy drinking, recommendations for future intervention development) were asked. The information was analyzed using qualitative data analysis software (NVivo8). Results The focus group results indicated misperceptions of caregivers on preschoolers’ physical activity and beverage consumption levels. Caregivers perceived preschoolers as sufficiently active; they argue that children need to learn to sit still in preparation for primary school. At most preschools, children can drink only water. In some preschools sugar-sweetened beverages like chocolate milk or fruit juices, are also allowed. It was mentioned that sugar-sweetened beverages can be healthy due to mineral and vitamin content, although according to parents their daily intake is limited. These opinions resulted in low perceived needs to change behaviours. Conclusions Although previous research shows need of change in obesity-related behaviours, the participants in the current study didn’t perceive such. The awareness of parents and teachers needs to be raised concerning their shared responsibility about healthy behaviours in preschoolers. Providing preschool teachers with ready-to-use classroom material will encourage them to change physical activity and beverage consumption, and to implement related activities in the classroom. Involvement in activities that their children perform at preschool will motivate parents to extend these behaviours to the home environment.
    Full-text · Article · Mar 2013 · BMC Public Health
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    • "Research among younger children (below 6 years old) is limited[8,15,16]. In studies that did include this young age-group, associations that were found were unclear due to conflicting results and differences in methodology between studies, for example differences in measurement of behavior and adjustment for confounders[8,16-27]. Furthermore, the analyses that were used were primarily simple or bivariate, while risk factors are likely to interact with each other[6,7]. "
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    ABSTRACT: The lifestyle-related behaviors having breakfast, drinking sweet beverages, playing outside and watching TV have been indicated to have an association with childhood overweight, but research among young children (below 6 years old) is limited. The aim of the present study was to assess the associations between these four behaviors and overweight among young children. This cross-sectional study used baseline data on 5-year-old children (n = 7505) collected for the study 'Be active, eat right'. Age and sex-specific cut-off points for body mass index of the International Obesity Task Force were used to assess overweight/obesity. Multivariable logistic regression analyses were applied. For children whom had breakfast <7 days/week and watched TV >2 hours/day, the odds ratio (OR) for having overweight (obesity included) was, respectively, 1.49 (95% confidence interval (CI): 1.13-1.95), and 1.25 (95% CI: 1.03-1.51). There was a positive association between the number of risk behaviors present and the risk for having overweight. For children with 3 or all of the risk behaviors having breakfast <7 days/week, drinking sweet beverages >2 glasses/day, playing outside <1 h/day, watching TV >2 hs/day, the OR for overweight was 1.73 (95% CI: 1.11-2.71) (all models adjusted for children's sex and sociodemographic characteristics). Given the positive association between the number of behavioral risk factors and overweight, further studies are needed to evaluate the effectiveness of behavioral counseling of parents of toddlers in preventing childhood overweight. In the meantime we recommend physicians to target all four behaviors for counseling during well-child visits.
    Full-text · Article · Jun 2012 · International Journal of Behavioral Nutrition and Physical Activity
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    • "A number of studies have shown that increased sedentary hours were associated with higher weight status, probably as a result of lower energy expenditure coupled with the consumption of unhealthy foods (Taveras et al., 2006; Miller et al., 2008). Sedentary behaviors in children, mainly TV viewing were associated with OWOB (Hawkins and Law, 2006; Jiang et al., 2006; Lasserre et al., 2007). For each additional hour per day of TV/video viewing, the odds ratio for BMI485th percentile was 1.06 (95% CI: 1.004–1.11) "
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    ABSTRACT: To identify modifiable risk factors for obesity among low socioeconomic status (LSES) children. Cross-sectional data were obtained from 238 4-7-year-old children and 224 mothers from LSES preschools. Anthropometric measurements were obtained; mothers were interviewed about sociodemographic characteristics, health behaviors, perceptions and beliefs. The combined prevalence of overweight and obesity (OWOB) among children was 29.8% based on the new World Health Organization (WHO) growth standard. Prevalence of OWOB (body mass index ≥25) among mothers was 51.8%. Mean age, sleeping hours, gender distribution and poverty level were similar between normal and OWOB children. Over 82% of mothers underestimated their child's weight status. Of the 62 OWOB children, 74.2% were perceived by their mothers as having 'normal weight' (NW) and 8% were perceived as 'thin'. Mothers perceived 67 out of 158 NW children (42.4%) as 'thin' (P<0.001). Mediation analysis indicated that 10% of the effect of maternal underestimation on child's OWOB may be mediated through child's daily sedentary hours (P=0.06). In a multivariable logistic-regression analysis controlling for maternal obesity, knowledge regarding breakfast's importance and child's daily sedentary hours, maternal underestimation of the child's weight status (odds ratio=7.33; 95% confidence interval (CI):2.41-22.37; P<0.0001) and parental smoking (odds ratio=3.25; 95% CI: 1.26-8.40; P=0.015) were the only significant factors associated with OWOB in LSES children. Maternal perception of child's weight status and parental smoking are associated with childhood OWOB among LSES children. These parameters can help identify children at risk for obesity. Maternal perception may be amenable to intervention.
    Full-text · Article · Aug 2011 · European journal of clinical nutrition
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