FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Volume 337:869-873 September 25, 1997 Number 13 Next

Abstract PDF Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Childhood obesity increases the risk of obesity in adulthood, but how parental obesity affects the chances of a child's becoming an obese adult is unknown. We investigated the risk of obesity in young adulthood associated with both obesity in childhood and obesity in one or both parents.

Methods Height and weight measurements were abstracted from the records of 854 subjects born at a health maintenance organization in Washington State between 1965 and 1971. Their parents' medical records were also reviewed. Childhood obesity was defined as a body-mass index at or above the 85th percentile for age and sex, and obesity in adulthood as a mean body-mass index at or above 27.8 for men and 27.3 for women.

Results In young adulthood (defined as 21 to 29 years of age), 135 subjects (16 percent) were obese. Among those who were obese during childhood, the chance of obesity in adulthood ranged from 8 percent for 1- or 2-year-olds without obese parents to 79 percent for 10-to-14-year-olds with at least one obese parent. After adjustment for parental obesity, the odds ratios for obesity in adulthood associated with childhood obesity ranged from 1.3 (95 percent confidence interval, 0.6 to 3.0) for obesity at 1 or 2 years of age to 17.5 (7.7 to 39.5) for obesity at 15 to 17 years of age. After adjustment for the child's obesity status, the odds ratios for obesity in adulthood associated with having one obese parent ranged from 2.2 (95 percent confidence interval, 1.1 to 4.3) at 15 to 17 years of age to 3.2 (1.8 to 5.7) at 1 or 2 years of age.

Conclusions Obese children under three years of age without obese parents are at low risk for obesity in adulthood, but among older children, obesity is an increasingly important predictor of adult obesity, regardless of whether the parents are obese. Parental obesity more than doubles the risk of adult obesity among both obese and nonobese children under 10 years of age.

The purpose of this study was to determine the probability of obesity in young adulthood in relation to the presence or absence of obesity at various times throughout childhood and the presence or absence of obesity in the child's parents. We hypothesized that the probability that a child would become an obese adult depends on the presence of both childhood and parental obesity and that the effects of these two factors on the risk of obesity in adulthood differ according to the age of the child.

Methods

In this retrospective cohort study, we abstracted height and weight measurements from the outpatient medical records of a cohort of young adults and their parents who were long-term members of Group Health Cooperative of Puget Sound, a staff-model health maintenance organization established in 1947 in Washington State.

Selection of Subjects

Using computerized enrollment and outpatient-visit data bases, we identified all 1333 members who were born at the cooperative in 1965 through 1970 and who had at least one outpatient visit each after the age of 21 years. The majority of the subjects had received health care at the cooperative all their lives, and most outpatient visits were for routine health care and minor illnesses. The medical records of eight subjects could not be located or were partially missing. Among the remaining 1325 subjects, 854 (64 percent) met the following criteria for inclusion in the study cohort: at least one weight measurement at the age of 21 years or older, at least one height measurement at the age of 18 years or older for men and at the age of 16 years or older for women, no chronic condition that might affect stature or weight (e.g., cancer or inflammatory bowel disease), and birth at a gestational age of 36 weeks or more. The parents of all 854 subjects were Group Health Cooperative members. Two pairs of parents each had three adult children in the cohort, and 56 pairs of parents each had two. Thus, 118 subjects (14 percent) had at least one sibling each in the cohort. Among the 794 pairs of parents, we located records for 747 mothers (94 percent) and 699 fathers (88 percent).

Outcome Measures

All height and weight measurements recorded before January 1, 1994, were abstracted unless these measurements were from a visit to the emergency department or the subject was pregnant. For each subject, we calculated the average body-mass index (the weight in kilograms divided by the square of the height in meters) between 21 and 29 years of age. Adult obesity was defined as an average body-mass index >27.8 for men and >27.3 for women.¹²

Obesity in Childhood

We also defined childhood obesity in terms of the body-mass index, because it is the best and most widely used surrogate measure of adiposity among indexes derived from height and weight measurements.^13,14 The body-mass index in children is correlated with direct measures of adiposity,¹⁵ blood pressure,¹⁶ and serum concentrations of lipids¹⁷ and insulin.¹⁸ Although there is no established cutoff point for childhood obesity,¹⁹ we classified subjects with a body-mass index at or above the 85th percentile for age and sex as obese and those with a body-mass index at or above the 95th percentile as very obese. We used as reference standards the 85th and 95th percentiles for body-mass index in the combined data of the First and Second National Health and Nutrition Examination Surveys.²⁰

We defined five consecutive age intervals from 1 to 18 years of age (Table 1). The first interval, for example, included all measurements between the first and third birthdays. For each subject, all body-mass-index values (calculated from height and weight recorded on the same date) were standardized for age and sex by conversion to a z score. The z score was calculated as follows: (body-mass index - mean)/standard deviation; the mean and standard deviation for the body-mass index were from the chosen reference population of the same age and sex as the subject.²⁰ Means and standard deviations for the body-mass index at specific ages (e.g., 3.2 years) were found by linear interpolation between the discrete ages (e.g., 3 years and 4 years) given in the reference data. We calculated the average z score for the body-mass index for each subject during each interval by the method described below. We classified a subject as obese during an interval if the average z score for the body-mass index was >1.036 and as very obese if the average was >1.645. These z scores correspond to the 85th and 95th percentiles, respectively, of a normal distribution.

View this table: [in this window] [in a new window]   Table 1. Availability of Data on Body-Mass Index (BMI) and the Prevalence of Obesity in 854 Subjects at Various Ages, Their Mothers, and Their Fathers.

 
Parental Obesity

If a parent's record contained an adult height, then that height was used to calculate the body-mass index for all recorded parental weights. The parent's body-mass index was then estimated on the five dates when the subject reached the midpoint in each of the five age intervals. For the age interval one through two years, for example, we estimated each parent's body-mass index on the date of the subject's second birthday. To estimate the body-mass index, we used linear interpolation between values calculated for the parent before and after that date. Parental obesity was defined as a body-mass index >27.8 for fathers and >27.3 for mothers.

Statistical Analysis

We computed a weighted average of the body-mass-index values for each subject during each childhood age interval and in adulthood (at 21 through 29 years of age). The weighting was based on the time between the available values. Values closely spaced in time received less weight than widely spaced values, so that the average would not be unduly influenced by the values clustered close together in time. The formula used for the average was as follows:

_(i=1)^(K+1) 1/2 (BMIz(t_i) + (BMIz(t_i-1)) (t_i - t_i-1) / (t_K+1 - t₀),

when the ages at which body-mass indexes were measured were t_i, . . . t_K and where t₀ and t_K+1 denoted the end points of the time interval.

For each age interval, associations between obesity in young adulthood and both childhood and parental obesity were tabulated and analyzed by logistic-regression analysis. Regression parameters for these models were estimated with the generalized-estimating-equation method of Liang and Zeger,²¹ which incorporates adjustments for correlations between data from siblings.

Results

Ninety-four percent of the 854 subjects were non-Hispanic whites, 64 percent were female, and 93 percent were born to married mothers. More women than men met the inclusion criteria for the study, because in young adulthood women are more likely to use health care services.²² At the time of the subjects' births, the mean ages of their mothers and fathers were 29 and 32 years, respectively.

The 854 subjects had a median of nine body-mass-index values from 1 through 17 years of age; the last value was at a mean age of 24.5 years. The prevalence of adult obesity in the cohort (16 percent) (Table 1) was near the current value for the prevalence of obesity in 20-to-29-year-old non-Hispanic white subjects in the United States (18 percent).¹ The prevalence of obesity in the parents increased with age and reached 30 percent when their children were 15 to 17 years of age; this figure is near the current prevalence of obesity in older U.S. adults.¹

The probability of being obese as a young adult increased with the age of the obese child and was higher at all ages for the group of very obese children (Table 2). After six years of age, the probability of obesity in adulthood exceeded 50 percent for obese children, as compared with about 10 percent for nonobese children. Obesity at one or two years of age was not associated with an increased risk of adult obesity. Overall, there were no significant differences between the sexes in the risk of adult obesity associated with childhood obesity (data not shown). The risk of adult obesity was significantly greater if either the mother or the father was obese (Table 2). There were no significant differences in these risk estimates between boys and girls (data not shown). Although the odds ratios for obesity associated with maternal obesity were slightly higher than was the case for paternal obesity, the differences between these risk estimates were not statistically significant for any age interval.

View this table: [in this window] [in a new window]   Table 2. Odds Ratios for Obesity in Young Adulthood According to the Child's Age and the Obesity Status of the Child and the Parents.

 
Subjects were included in Table 3 and Table 4 only if data on obesity were also available for their parents. There was no significant difference in the rates of obesity in adulthood between subjects with and those without data on parental obesity. At every age interval, both obese and nonobese children were at greater risk for obesity as adults if at least one parent was obese. The effect of parental obesity on the risk of obesity in adulthood was most pronounced among obese and nonobese children under 10 years of age. For example, among nonobese one- and two-year-olds, those with at least one obese parent had a greater chance of being obese as adults than those without an obese parent (28 percent vs. 10 percent), and among obese three-to-five-year-olds, the chance of adult obesity increased from 24 percent if neither parent was obese to 62 percent if at least one parent was obese (Table 3). Very obese children with at least one obese parent had the highest risk of adult obesity.

View this table: [in this window] [in a new window]   Table 3. Prevalence of Obesity in Young Adulthood According to Subjects' Obesity Status in Childhood and Their Parents' Obesity Status.

 

View this table: [in this window] [in a new window]   Table 4. Odds Ratios for Obesity in Young Adulthood According to Subjects' Obesity Status in Childhood and Their Parents' Obesity Status, from Multivariate Logistic-Regression Models.

 
Before three years of age, the primary predictor of obesity in adulthood was the parents' obesity status; the child's obesity status was not an indicator of the risk of adult obesity (Table 4). For children three through nine years of age, the child's and the parents' obesity status were both important predictors, but as the child aged, the child's obesity status became the more important predictor. Especially before six years of age, obesity in both parents substantially increased the odds of the child's becoming an obese adult.

Among children who were obese in any age interval, neither the age of onset nor the duration of obesity increased the risk of adult obesity after adjustment for parental obesity and for whether or not the child was very obese (data not shown).

Discussion

Advancing knowledge about the molecular mechanisms and genetics of obesity²³ supports the results of observational studies that have revealed an inherited susceptibility to obesity.^24,25 Although the parents' body-mass indexes are a readily available marker for the susceptibility to obesity, the probability that a child will become an obese adult if at least one parent is obese has not previously been estimated. We found that parental obesity significantly alters the risk of obesity in adulthood for both obese and nonobese children, especially those under 10 years of age. Obesity in one or both parents probably influences the risk of obesity in their offspring because of shared genes or environmental factors within families.

Direct comparison of our results with those of other studies^{5,6,7,8,9,10,11} is difficult because of differences in the birth years of the cohorts, the ages at which examinations were performed, the methods used for the measurement of adiposity, the definitions of obesity, and the reference populations used to adjust measurements for age and sex.²⁶ Because our height and weight measurements were obtained from clinical records, they lack the precision that could be obtained in a prospective study. However, any errors in these measurements are likely to have been random.

We caution against interventions to treat overweight children under three years of age who do not have obese parents. Physicians should avoid labeling these children as being at risk for later obesity, because few of them will become obese adults. In contrast, any one- or two-year-old who has an obese parent, especially any who has two obese parents, appears to be susceptible to obesity in young adulthood. One- and two-year-olds with an obese parent may benefit most from efforts to prevent obesity, but it remains unclear what factors in the environments of these children contribute to the expression of obesity. These factors, once identified, may present reasonable targets for prevention trials.

Obese three-through-nine-year-olds with obese parents may be ideal candidates for treatment because the parents still have the opportunity to influence their children's activity and diet positively.²⁷ However, because many obese children, if left untreated, will not become obese adults, treatment trials should be designed to consider the benefits and risks, both physical and psychological, of any interventions. Between 10 and 17 years of age, parental obesity has a much more limited effect on a child's risk of future obesity. Decisions to treat overweight children after they reach 10 years of age can be made primarily on the basis of the child's obesity status.

This study demonstrates the importance of parental obesity in predicting children's risk of obesity in adulthood. Several studies now indicate that obesity in young adult life is associated with increased morbidity^28,29 and mortality.^30,31 Furthermore, excessive weight during adolescence predicts a number of adverse effects on health later in life, including increased mortality among men.³²

Supported by a Generalist Physician Faculty Scholars Award from the Robert Wood Johnson Foundation (to Dr. Whitaker) and by a grant (P30-DK46200) from the National Institutes of Health (to Dr. Dietz).

We are indebted to Thomas N. Robinson, M.D., M.P.H., for inspiring this project and for his ongoing advice; to Evan Charney, M.D., Marian O. Hodges, M.D., M.P.H., and Heidi J. Kalkwarf, Ph.D., for their careful review of the manuscript; to Edward H. Wagner, M.D., M.P.H., for facilitating our research at the Center for Health Studies at Group Health Cooperative of Puget Sound in Seattle; to Mr. Richard L. Furman for detailed abstraction of all the medical records for this study; and to Ms. Vicki Livengood for her assistance in the preparation of the manuscript.

Source Information

From the Department of Pediatrics, Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati (R.C.W.); the Department of Pediatrics, University of Washington School of Medicine, Seattle (J.A.W.); the Biostatistics Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle (M.S.P., K.D.S.); and the New England Medical Center, Boston (W.H.D.). Presented in part at the 5th National Program Meeting of the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program, San Antonio, Texas, December 11, 1996, and at the 37th Annual Meeting of the Ambulatory Pediatric Association, Washington, D.C., May 3, 1997.

Address reprint requests to Dr. Whitaker at the Division of General and Community Pediatrics, Children's Hospital Medical Center, CH-1 South, 3333 Burnet Ave., Cincinnati, OH 45229-3039.

References

1. Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL. Increasing prevalence of overweight among US adults: the National Health and Nutrition Examination Surveys, 1960 to 1991. JAMA 1994;272:205-211. [Free Full Text]
2. Troiano RP, Flegal KM, Kuczmarski RJ, Campbell SM, Johnson CL. Overweight prevalence and trends for children and adolescents: the National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med 1995;149:1085-1091. [Free Full Text]
3. Pi-Sunyer FX. Medical hazards of obesity. Ann Intern Med 1993;119:655-660. [Free Full Text]
4. NIH Technology Assessment Conference Panel. Methods for voluntary weight loss and control. Ann Intern Med 1993;119:764-770. [Free Full Text]
5. Abraham S, Nordsieck M. Relationship of excess weight in children and adults. Public Health Rep 1960;75:263-273. [Medline]
6. Abraham S, Collins G, Nordsieck M. Relationship of childhood weight status to morbidity in adults. HSMHA Health Rep 1971;86:273-284. [Medline]
7. Stark O, Atkins E, Wolff OH, Douglas JWB. Longitudinal study of obesity in the National Survey of Health and Development. BMJ 1981;283:13-17.
8. Garn SM, LaVelle M. Two-decade follow-up of fatness in early childhood. Am J Dis Child 1985;139:181-185. [Free Full Text]
9. Rolland-Cachera MF, Deheeger M, Guilloud-Bataille M, Avons P, Patois E, Sempe M. Tracking the development of adiposity from one month of age to adulthood. Ann Hum Biol 1987;14:219-229. [CrossRef][Medline]
10. Clarke WR, Lauer RM. Does childhood obesity track into adulthood? Crit Rev Food Sci Nutr 1993;33:423-430. [Medline]
11. Guo SS, Roche AF, Chumlea WC, Gardner JD, Siervogel RM. The predictive value of childhood body mass index values for overweight at age 35 y. Am J Clin Nutr 1994;59:810-819. [Free Full Text]
12. National Institutes of Health Consensus Development Panel on the Health Implications of Obesity. Health implications of obesity: National Institutes of Health Consensus Development Conference statement. Ann Intern Med 1985;103:147-151.
13. Kraemer HC, Berkowitz RI, Hammer LD. Methodological difficulties in studies of obesity. I. Measurement issues. Ann Behav Med 1990;12:112-118. [CrossRef]
14. Rolland-Cachera MF, Sempe M, Guilloud-Bataille M, Patois E, Pequignot-Guggenbuhl F, Fautrad V. Adiposity indices in children. Am J Clin Nutr 1982;36:178-184. [Free Full Text]
15. Roche AF, Siervogel RM, Chumlea WC, Webb P. Grading body fatness from limited anthropometric data. Am J Clin Nutr 1981;34:2831-2838. [Free Full Text]
16. Gutin B, Basch C, Shea S, et al. Blood pressure, fitness, and fatness in 5- and 6-year-old children. JAMA 1990;264:1123-1127. [Free Full Text]
17. Laskarzewski P, Morrison JA, Mellies MJ, et al. Relationships of measurements of body mass to plasma lipoproteins in schoolchildren and adults. Am J Epidemiol 1980;111:395-406. [Free Full Text]
18. Ronnemaa T, Knip M, Lautala P, et al. Serum insulin and other cardiovascular risk indicators in children, adolescents and young adults. Ann Med 1991;23:67-72. [Medline]
19. Robinson TN. Defining obesity in children and adolescents: clinical approaches. Crit Rev Food Sci Nutr 1993;33:313-320. [Medline]
20. Frisancho AR. Anthropometric standards for the assessment of growth and nutritional status. Ann Arbor: University of Michigan Press, 1990.
21. Liang K-Y, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika 1986;73:13-22. [Free Full Text]
22. Schappert SM. National Ambulatory Medical Care Survey: 1994 summary. Advance data from vital and health statistics. No. 273. Hyattsville, Md.: National Center for Health Statistics, 1996. (DHHS publication no. (PHS) 96-1250.)
23. Perusse L, Chagnon YC, Dionne FT, Bouchard C. The human obesity gene map: the 1996 update. Obes Res 1997;5:49-61. [Medline]
24. Moll PP, Burns TL, Lauer RM. The genetic and environmental sources of body mass index variability: the Muscatine Ponderosity Family Study. Am J Hum Genet 1991;49:1243-1255. [Medline]
25. Stunkard AJ, Harris JR, Pedersen NL, McClearn GE. The body-mass index of twins who have been reared apart. N Engl J Med 1990;322:1483-1487. [Abstract]
26. Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, Byers T. Do obese children become obese adults? A review of the literature. Prev Med 1993;22:167-177. [CrossRef][Medline]
27. Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year follow-up of behavioral, family-based treatment for obese children. JAMA 1990;264:2519-2523. [Free Full Text]
28. Folsom AR, Jacobs DR Jr, Wagenknecht LE, et al. Increase in fasting insulin and glucose over seven years with increasing weight and inactivity of young adults: the CARDIA Study. Am J Epidemiol 1996;144:235-246. [Free Full Text]
29. Liu K, Ruth KJ, Flack JM, et al. Blood pressure in young blacks and whites: relevance of obesity and lifestyle factors in determining differences: the CARDIA Study. Circulation 1996;93:60-66. [Free Full Text]
30. Manson JE, Willett WC, Stampfer MJ, et al. Body weight and mortality among women. N Engl J Med 1995;333:677-685. [Free Full Text]
31. Hoffmans M, Kromhout D, de Lezenne Coulander C. The impact of body mass index of 78,612 18-year-old Dutch men on 32-year mortality from all causes. J Clin Epidemiol 1988;41:749-756. [CrossRef][Medline]
32. Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH. Long-term morbidity and mortality of overweight adolescents: a follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med 1992;327:1350-1355. [Abstract]

Abstract PDF Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

This article has been cited by other articles:

• Lightwood, J., Bibbins-Domingo, K., Coxson, P., Wang, Y. C., Williams, L., Goldman, L. (2009). Forecasting the Future Economic Burden of Current Adolescent Overweight: An Estimate of the Coronary Heart Disease Policy Model. AJPH 99: 2230-2237 [Abstract] [Full Text]  
• Harris, K. M., Perreira, K. M., Lee, D. (2009). Obesity in the Transition to Adulthood: Predictions Across Race/Ethnicity, Immigrant Generation, and Sex. Arch Pediatr Adolesc Med 163: 1022-1028 [Abstract] [Full Text]  
• Asante, P. A., Cox, J., Sonneville, K., Samuels, R. C., Taveras, E. M. (2009). Overweight Prevention in Pediatric Primary Care: A Needs Assessment of an Urban Racial/Ethnic Minority Population. CLIN PEDIATR 48: 837-843 [Abstract]  
• Daniels, S. R. (2009). The Use of BMI in the Clinical Setting. Pediatrics 124: S35-S41 [Abstract] [Full Text]  
• Fitzgibbon, M. L., Beech, B. M. (2009). The Role of Culture in the Context of School-Based BMI Screening. Pediatrics 124: S50-S62 [Abstract] [Full Text]  
• Kwok, M. K., Schooling, C M., Lam, T. H., Leung, G. M (2009). Does breastfeeding protect against childhood overweight? Hong Kong's 'Children of 1997' birth cohort. Int J Epidemiol 0: dyp274v1-dyp274 [Abstract] [Full Text]  
• Thunfors, P., Collins, B. N., Hanlon, A. L. (2009). Health behavior interests of adolescents with unhealthy diet and exercise: implications for weight management. Health Educ Res 24: 634-645 [Abstract] [Full Text]  
• Krul, M., van der Wouden, J. C., Schellevis, F. G., van Suijlekom-Smit, L. W. A., Koes, B. W. (2009). Musculoskeletal Problems in Overweight and Obese Children. Ann Fam Med 7: 352-356 [Abstract] [Full Text]  
• Kral, T. V. E., Faith, M. S. (2009). Influences on Child Eating and Weight Development from a Behavioral Genetics Perspective. J Pediatr Psychol 34: 596-605 [Abstract] [Full Text]  
• Taveras, E. M., Mitchell, K., Gortmaker, S. L. (2009). Parental Confidence in Making Overweight-Related Behavior Changes. Pediatrics 124: 151-158 [Abstract] [Full Text]  
• Trasande, L., Liu, Y., Fryer, G., Weitzman, M. (2009). Effects Of Childhood Obesity On Hospital Care And Costs, 1999-2005. Health Aff (Millwood) 28: w751-w760 [Abstract] [Full Text]  
• Lazarou, C., Soteriades, E. S. (2009). Children's physical activity, TV watching and obesity in Cyprus: the CYKIDS study. Eur J Public Health 0: ckp093v1-ckp093 [Abstract] [Full Text]  
• Ashe, M., Bennett, G., Economos, C., Goodman, E., Schilling, J., Quintiliani, L., Rosenbaum, S., Vincent, J., Must, A. (2009). Assessing Coordination of Legal-Based Efforts across Jurisdictions and Sectors for Obesity Prevention and Control. J Law Med Ethics 37: 45-54  
• Soderlund, L. L., Nordqvist, C., Angbratt, M., Nilsen, P. (2009). Applying motivational interviewing to counselling overweight and obese children. Health Educ Res 24: 442-449 [Abstract] [Full Text]  
• Judge, L. W., Petersen, J., Lydum, M. (2009). The Best Kept Secret in Sports: The 2010 Youth Olympic Games. International Review for the Sociology of Sport 44: 173-191 [Abstract]  
• Ay, L., Van Houten, V. A. A., Steegers, E. A. P., Hofman, A., Witteman, J. C. M., Jaddoe, V. W. V., Hokken-Koelega, A. C. S. (2009). Fetal and Postnatal Growth and Body Composition at 6 Months of Age. J. Clin. Endocrinol. Metab. 94: 2023-2030 [Abstract] [Full Text]  
• Angelopoulos, P. D., Milionis, H. J., Grammatikaki, E., Moschonis, G., Manios, Y. (2009). Changes in BMI and blood pressure after a school based intervention: The CHILDREN study. Eur J Public Health 19: 319-325 [Abstract] [Full Text]  
• Lurbe, E., Carvajal, E., Torro, I., Aguilar, F., Alvarez, J., Redon, J. (2009). Influence of Concurrent Obesity and Low Birth Weight on Blood Pressure Phenotype in Youth. Hypertension 53: 912-917 [Abstract] [Full Text]  
• Bouchard, C. (2009). Childhood obesity: are genetic differences involved?. Am. J. Clin. Nutr. 89: 1494S-1501S [Abstract] [Full Text]  
• Daniels, S. R., Jacobson, M. S., McCrindle, B. W., Eckel, R. H., Sanner, B. M. (2009). American Heart Association Childhood Obesity Research Summit: Executive Summary. Circulation 119: 2114-2123 [Full Text]  
• Daniels, S. R., Jacobson, M. S., McCrindle, B. W., Eckel, R. H., Sanner, B. M. (2009). American Heart Association Childhood Obesity Research Summit Report. Circulation 119: e489-e517 [Full Text]  
• Francis, L. A., Susman, E. J. (2009). Self-regulation and Rapid Weight Gain in Children From Age 3 to 12 Years. Arch Pediatr Adolesc Med 163: 297-302 [Abstract] [Full Text]  
• Seeyave, D. M., Coleman, S., Appugliese, D., Corwyn, R. F., Bradley, R. H., Davidson, N. S., Kaciroti, N., Lumeng, J. C. (2009). Ability to Delay Gratification at Age 4 Years and Risk of Overweight at Age 11 Years. Arch Pediatr Adolesc Med 163: 303-308 [Abstract] [Full Text]  
• Kindblom, J. M., Lorentzon, M., Hellqvist, A., Lonn, L., Brandberg, J., Nilsson, S., Norjavaara, E., Ohlsson, C. (2009). BMI Changes During Childhood and Adolescence as Predictors of Amount of Adult Subcutaneous and Visceral Adipose Tissue in Men: The GOOD Study. Diabetes 58: 867-874 [Abstract] [Full Text]  
• Taveras, E. M., Rifas-Shiman, S. L., Belfort, M. B., Kleinman, K. P., Oken, E., Gillman, M. W. (2009). Weight Status in the First 6 Months of Life and Obesity at 3 Years of Age. Pediatrics 123: 1177-1183 [Abstract] [Full Text]  
• Harris, K. C., Kuramoto, L. K., Schulzer, M., Retallack, J. E. (2009). Effect of school-based physical activity interventions on body mass index in children: a meta-analysis. CMAJ 180: 719-726 [Abstract] [Full Text]  
• Kestila, L., Rahkonen, O., Martelin, T., Lahti-Koski, M., Koskinen, S. (2009). Do childhood social circumstances affect overweight and obesity in early adulthood?. Scand J Public Health 37: 206-219 [Abstract]  
• Modi, A. C., Guilfoyle, S. M., Zeller, M. H. (2009). Impaired Health-related Quality of Life in Caregivers of Youth Seeking Obesity Treatment. J Pediatr Psychol 34: 147-155 [Abstract] [Full Text]  
• Steinberger, J., Daniels, S. R., Eckel, R. H., Hayman, L., Lustig, R. H., McCrindle, B., Mietus-Snyder, M. L. (2009). Progress and Challenges in Metabolic Syndrome in Children and Adolescents: A Scientific Statement From the American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular Nursing; and Council on Nutrition, Physical Activity, and Metabolism. Circulation 119: 628-647 [Full Text]  
• Huang, J. S., Donohue, M., Becerra, K., Ronghui Xu, (2009). Relationship Between Parents' and Children's Weight Perceptions Results of a Survey. ICAN: Infant, Child, & Adolescent Nutrition 1: 15-20 [Abstract]  
• Li, L., Law, C., Lo Conte, R., Power, C. (2009). Intergenerational influences on childhood body mass index: the effect of parental body mass index trajectories. Am. J. Clin. Nutr. 89: 551-557 [Abstract] [Full Text]  
• McNear, S., Harrison, S. A. (2009). Review: Current status of therapy in nonalcoholic fatty liver disease. Therapeutic Advances in Gastroenterology 2: 29-43 [Abstract]  
• Janicke, D. M., Harman, J. S., Kelleher, K. J., Zhang, J. (2009). The Association of Psychiatric Diagnoses, Health Service Use, and Expenditures in Children with Obesity-related Health Conditions. J Pediatr Psychol 34: 79-88 [Abstract] [Full Text]  
• Varness, T., Allen, D. B., Carrel, A. L., Fost, N. (2009). Childhood Obesity and Medical Neglect. Pediatrics 123: 399-406 [Abstract] [Full Text]  
• Lieb, W., Pencina, M. J., Lanier, K. J., Tofler, G. H., Levy, D., Fox, C. S., Wang, T. J., D'Agostino, R. B. Sr., Vasan, R. S. (2009). Association of Parental Obesity With Concentrations of Select Systemic Biomarkers in Nonobese Offspring: The Framingham Heart Study. Diabetes 58: 134-137 [Abstract] [Full Text]  
• August, G. P., Caprio, S., Fennoy, I., Freemark, M., Kaufman, F. R., Lustig, R. H., Silverstein, J. H., Speiser, P. W., Styne, D. M., Montori, V. M. (2008). Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion. J. Clin. Endocrinol. Metab. 93: 4576-4599 [Abstract] [Full Text]  
• Davis, M. M., McGonagle, K., Schoeni, R. F., Stafford, F. (2008). Grandparental and Parental Obesity Influences on Childhood Overweight: Implications for Primary Care Practice. J Am Board Fam Med 21: 549-554 [Abstract] [Full Text]  
• Sacheck, J. (2008). Pediatric Obesity: An Inflammatory Condition?. JPEN J Parenter Enteral Nutr 32: 633-637 [Abstract] [Full Text]  
• Suzanne Goodell, L., Pierce, M. B., Bravo, C. M., Ferris, A. M. (2008). Parental Perceptions of Overweight During Early Childhood. Qual Health Res 18: 1548-1555 [Abstract]  
• Kipping, R. R, Jago, R., Lawlor, D. A (2008). Obesity in children. Part 2: Prevention and management. BMJ 337: a1848-a1848 [Full Text]  
• Kipping, R. R, Jago, R., Lawlor, D. A (2008). Obesity in children. Part 1: Epidemiology, measurement, risk factors, and screening. BMJ 337: a1824-a1824 [Full Text]  
• Peterson, M., Chandlee, M., Abraham, A. (2008). Cost-Effectiveness Analysis of a Statewide Media Campaign to Promote Adolescent Physical Activity. Health Promot Pract 9: 426-433 [Abstract]  
• Lagstrom, H., Hakanen, M., Niinikoski, H., Viikari, J., Ronnemaa, T., Saarinen, M., Pahkala, K., Simell, O. (2008). Growth Patterns and Obesity Development in Overweight or Normal-Weight 13-Year-Old Adolescents: The STRIP Study. Pediatrics 122: e876-e883 [Abstract] [Full Text]  
• McCormick, D. P., Ramirez, M., Caldwell, S., Ripley, A. W., Wilkey, D. (2008). YMCA Program for Childhood Obesity: A Case Series. CLIN PEDIATR 47: 693-697 [Abstract]  
• Lobstein, T. (2008). Obesity in children. BMJ 337: a669-a669 [Full Text]  
• Miller, D. P., Han, W.-J. (2008). Maternal Nonstandard Work Schedules and Adolescent Overweight. AJPH 98: 1495-1502 [Abstract] [Full Text]  
• Shibli, R., Rubin, L., Akons, H., Shaoul, R. (2008). Morbidity of Overweight (>=85th Percentile) in the First 2 Years of Life. Pediatrics 122: 267-272 [Abstract] [Full Text]  
• Kumanyika, S. K., Obarzanek, E., Stettler, N., Bell, R., Field, A. E., Fortmann, S. P., Franklin, B. A., Gillman, M. W., Lewis, C. E., Poston, W. C. II, Stevens, J., Hong, Y. (2008). Population-Based Prevention of Obesity: The Need for Comprehensive Promotion of Healthful Eating, Physical Activity, and Energy Balance: A Scientific Statement From American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (Formerly the Expert Panel on Population and Prevention Science). Circulation 118: 428-464 [Abstract] [Full Text]  
• O'Neil, C. E., Nicklas, T. A. (2008). A Review of the Relationship Between 100% Fruit Juice Consumption and Weight in Children and Adolescents. AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2: 315-354 [Abstract]  
• Woolford, S. J., Clark, S. J., Strecher, V. J., Gebremariam, A., Davis, M. M. (2008). Physicians' Perspectives on Increasing the Use of BMI Charts for Young Children. CLIN PEDIATR 47: 573-577 [Abstract]  
• Urrutia-Rojas, X., Ahmad, N., Bayona, M., Bae, S., Rivers, P. A., Singh, K. P. (2008). Risk factors associated with obesity in children of different racial backgrounds. Health Education Journal 67: 121-133 [Abstract]  
• Perry, C. M., De Ayala, R.J., Lebow, R., Hayden, E. (2008). A Validation and Reliability Study of the Physical Activity and Healthy Food Efficacy Scale for Children (PAHFE). Health Educ Behav 35: 346-360 [Abstract]  
• Mellor, J. M., Rapoport, R. B., Maliniak, D. (2008). The Impact of Child Obesity on Active Parental Consent in School-Based Survey Research on Healthy Eating and Physical Activity. Eval Rev 32: 298-312 [Abstract]  
• Tsiros, M. D, Sinn, N., Brennan, L., Coates, A. M, Walkley, J. W, Petkov, J., Howe, P. R., Buckley, J. D (2008). Cognitive behavioral therapy improves diet and body composition in overweight and obese adolescents. Am. J. Clin. Nutr. 87: 1134-1140 [Abstract] [Full Text]  
• Ippisch, H. M., Inge, T. H., Daniels, S. R., Wang, B., Khoury, P. R., Witt, S. A., Glascock, B. J., Garcia, V. F., Kimball, T. R. (2008). Reversibility of Cardiac Abnormalities in Morbidly Obese Adolescents. J Am Coll Cardiol 51: 1342-1348 [Abstract] [Full Text]  
• Holm, S. (2008). Parental Responsibility and Obesity in Children. Public Health Ethics 1: 21-29 [Abstract] [Full Text]  
• Yang, S., Lynch, J., Schulenberg, J., Roux, A. V. D., Raghunathan, T. (2008). Emergence of Socioeconomic Inequalities in Smoking and Overweight and Obesity in Early Adulthood: The National Longitudinal Study of Adolescent Health. AJPH 98: 468-477 [Abstract] [Full Text]  
• Epstein, L. H., Roemmich, J. N., Robinson, J. L., Paluch, R. A., Winiewicz, D. D., Fuerch, J. H., Robinson, T. N. (2008). A Randomized Trial of the Effects of Reducing Television Viewing and Computer Use on Body Mass Index in Young Children. Arch Pediatr Adolesc Med 162: 239-245 [Abstract] [Full Text]  
• Lurbe, E., Torro, I., Aguilar, F., Alvarez, J., Alcon, J., Pascual, J. M., Redon, J. (2008). Added Impact of Obesity and Insulin Resistance in Nocturnal Blood Pressure Elevation in Children and Adolescents. Hypertension 51: 635-641 [Abstract] [Full Text]  
• Meriwether, R. A., Lobelo, F., Pate, R. R. (2008). Themed Review: Clinical Interventions to Promote Physical Activity in Youth. AMERICAN JOURNAL OF LIFESTYLE MEDICINE 2: 7-25 [Abstract]  
• Stoddard, S. A., Kubik, M. Y., Skay, C. (2008). Is School-Based Height and Weight Screening of Elementary Students Private and Reliable?. The Journal of School Nursing 24: 43-48 [Abstract] [Full Text]  
• Weiss, R., Kaufman, F. R. (2008). Metabolic Complications of Childhood Obesity: Identifying and mitigating the risk. Diabetes Care 31: S310-S316 [Abstract] [Full Text]  
• Menschik, D., Ahmed, S., Alexander, M. H., Blum, R. Wm. (2008). Adolescent Physical Activities as Predictors of Young Adult Weight. Arch Pediatr Adolesc Med 162: 29-33 [Abstract] [Full Text]  
• Cao, D., Lu, H., Lewis, T. L., Li, L. (2007). Intake of Sucrose-sweetened Water Induces Insulin Resistance and Exacerbates Memory Deficits and Amyloidosis in a Transgenic Mouse Model of Alzheimer Disease. J. Biol. Chem. 282: 36275-36282 [Abstract] [Full Text]  
• Bibbins-Domingo, K., Coxson, P., Pletcher, M. J., Lightwood, J., Goldman, L. (2007). Adolescent Overweight and Future Adult Coronary Heart Disease. NEJM 357: 2371-2379 [Abstract] [Full Text]  
• Hirschler, V., Roque, M. I., Calcagno, M. L., Gonzalez, C., Aranda, C. (2007). Maternal Waist Circumference and the Prediction of Children's Metabolic Syndrome. Arch Pediatr Adolesc Med 161: 1205-1210 [Abstract] [Full Text]  
• Barlow, S. E., and the Expert Committee, (2007). Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Pediatrics 120: S164-S192 [Abstract] [Full Text]  
• Krebs, N. F., Himes, J. H., Jacobson, D., Nicklas, T. A., Guilday, P., Styne, D. (2007). Assessment of Child and Adolescent Overweight and Obesity. Pediatrics 120: S193-S228 [Abstract] [Full Text]  
• Kivimaki, M., Lawlor, D. A, Smith, G. D., Elovainio, M., Jokela, M., Keltikangas-Jarvinen, L., Viikari, J. S., Raitakari, O. T (2007). Substantial intergenerational increases in body mass index are not explained by the fetal overnutrition hypothesis: the Cardiovascular Risk in Young Finns Study. Am. J. Clin. Nutr. 86: 1509-1514 [Abstract] [Full Text]  
• Velasquez-Mieyer, P., Neira, C. P., Nieto, R., Cowan, P. A. (2007). Review: Obesity and cardiometabolic syndrome in children. Ther Adv Cardiovasc Dis 1: 61-81 [Abstract]  
• Gale, C. R., Javaid, M. K., Robinson, S. M., Law, C. M., Godfrey, K. M., Cooper, C. (2007). Maternal Size in Pregnancy and Body Composition in Children. J. Clin. Endocrinol. Metab. 92: 3904-3911 [Abstract] [Full Text]  
• Rodearmel, S. J., Wyatt, H. R., Stroebele, N., Smith, S. M., Ogden, L. G., Hill, J. O. (2007). Small Changes in Dietary Sugar and Physical Activity as an Approach to Preventing Excessive Weight Gain: The America on the Move Family Study. Pediatrics 120: e869-e879 [Abstract] [Full Text]  
• Singhal, V., Schwenk, W. F., Kumar, S. (2007). Evaluation and Management of Childhood and Adolescent Obesity. Mayo Clin Proc. 82: 1258-1264 [Abstract] [Full Text]  
• Blair, N. J, Thompson, J. M D, Black, P. N, Becroft, D. M O, Clark, P. M, Han, D. Y., Robinson, E., Waldie, K. E, Wild, C. J, Mitchell, E. A (2007). Risk factors for obesity in 7-year-old European children: the Auckland Birthweight Collaborative Study. Arch. Dis. Child. 92: 866-871 [Abstract] [Full Text]  
• Peeters, M. W, Beunen, G. P, Maes, H. H, Loos, R. J., Claessens, A. L, Vlietinck, R., Thomis, M. A (2007). Genetic and environmental determination of tracking in subcutaneous fat distribution during adolescence. Am. J. Clin. Nutr. 86: 652-660 [Abstract] [Full Text]  
• Scully, M., Dixon, H., White, V., Beckmann, K. (2007). Dietary, physical activity and sedentary behaviour among Australian secondary students in 2005. HEALTH PROMOT INT 22: 236-245 [Abstract] [Full Text]  
• Dunican, K. C, Desilets, A. R, Montalbano, J. K (2007). Pharmacotherapeutic Options for Overweight Adolescents. The Annals of Pharmacotherapy 41: 1445-1455 [Abstract] [Full Text]  
• Lavizzo-Mourey, R. (2007). Childhood Obesity: What It Means for Physicians. JAMA 298: 920-922 [Full Text]  
• Kubik, M. Y., Story, M., Rieland, G. (2007). Developing School-Based BMI Screening and Parent Notification Programs: Findings From Focus Groups With Parents of Elementary School Students. Health Educ Behav 34: 622-633 [Abstract]  
• Zhang, Q., Wang, Y. (2007). Using concentration index to study changes in socio-economic inequality of overweight among US adolescents between 1971 and 2002. Int J Epidemiol 36: 916-925 [Abstract] [Full Text]  
• Gunderson, E. P. (2007). Breastfeeding After Gestational Diabetes Pregnancy: Subsequent obesity and type 2 diabetes in women and their offspring. Diabetes Care 30: S161-S168 [Full Text]  
• Perrin, J. M., Bloom, S. R., Gortmaker, S. L. (2007). The Increase of Childhood Chronic Conditions in the United States. JAMA 297: 2755-2759 [Full Text]  
• Evers, S., Arnold, R., Hamilton, T., Midgett, C. (2007). Persistence of Overweight among Young Children Living in Low Income Communities in Ontario. J. Am. Coll. Nutr. 26: 219-224 [Abstract] [Full Text]  
• Powell, L. M., Szczypka, G., Chaloupka, F. J. (2007). Exposure to Food Advertising on Television Among US Children. Arch Pediatr Adolesc Med 161: 553-560 [Abstract] [Full Text]  
• Papas, M. A., Alberg, A. J., Ewing, R., Helzlsouer, K. J., Gary, T. L., Klassen, A. C. (2007). The Built Environment and Obesity. Epidemiol Rev 0: mxm009v1- [Abstract] [Full Text]  
• Wang, Y., Beydoun, M. A. (2007). The Obesity Epidemic in the United States--Gender, Age, Socioeconomic, Racial/Ethnic, and Geographic Characteristics: A Systematic Review and Meta-Regression Analysis. Epidemiol Rev 0: mxm007v1- [Abstract] [Full Text]  
• Lindsay, J. (2007). Higher Treatment Costs Associated With Obese Kids. DOC News 4: 21-21 [Full Text]  
• Boardley, D., Sherman, C., Ambrosetti, L., Lewis, J. (2007). Obesity Evaluation and Intervention During Family Medicine Well Visits. J Am Board Fam Med 20: 252-257 [Abstract] [Full Text]  
• Knutson, K. L., Lauderdale, D. S. (2007). Sleep Duration and Overweight in Adolescents: Self-reported Sleep Hours Versus Time Diaries. Pediatrics 119: e1056-e1062 [Abstract] [Full Text]  
• Niinimaki, R. A., Harila-Saari, A. H., Jartti, A. E., Seuri, R. M., Riikonen, P. V., Paakko, E. L., Mottonen, M. I., Lanning, M. (2007). High Body Mass Index Increases the Risk for Osteonecrosis in Children With Acute Lymphoblastic Leukemia. JCO 25: 1498-1504 [Abstract] [Full Text]  
• de Bruijn, G.-J., Kremers, S. P. J., de Vries, H., van Mechelen, W., Brug, J. (2007). Associations of social-environmental and individual-level factors with adolescent soft drink consumption: results from the SMILE study. Health Educ Res 22: 227-237 [Abstract] [Full Text]