Risk factors for overweight/obesity in preschool children: An ecological approach

Background: Identification of risk factors is critical to preventing the childhood obesity epidemic. Risk factors that contribute to obesity are multifactorial. However, limited research has focused on identifying obesity risk factors using an ecological approach. Methods: Baseline self-report survey data from the STRONG Kids program were used. The sample consisted of 329 parent-child dyads recruited from childcare programs in east-central Illinois. Child height and weight were measured and converted to age- and sex-specific z-scores using standard growth charts. An ecological model provided the theoretical framework for the selection of 22 previously reported childhood obesity risk factors. Multiple logistic regression analyses were used to identify risk factors. Results: Of 22 potential risk factors, three were found to be significantly associated with child overweight/obesity. These included child nighttime sleep duration (χ²=8.56; p=0.003), parent BMI (χ²=5.62; p=0.01), and parental restrictive feeding for weight control (χ²=4.77; p=0.02). Children who slept for 8 hours and less were 2.2 times more likely to be overweight/obese [95% confidence interval (CI): 1.3-3.7), whereas children with an overweight/obese parent were 1.9 times more likely to be overweight/obese (95% CI: 1.12-3.2). Finally, children whose parents used restrictive feeding practices were 1.75 times more likely to be overweight/obese (95% CI: 1.06-2.9). Conclusions: Using an ecological approach, we conclude that childhood obesity prevention efforts may benefit from targeting the key risk factors of child sleep duration, parent BMI, and parental restrictive feeding practices as focus areas for obesity prevention.