Do mothers accurately identify their child's overweight/obesity status during early childhood? Evidence from a nationally representative cohort study

Parental Perceptions of Preschool Children's Weight Status in China: A Cross-Sectional Study

INTRODUCTION

Currently, overweight/obesity rates among children are increasing. Moreover, parents generally misunderstand their children's weight status. The correct perception of overweight/obesity in early childhood is very important for children's growth and development. The purpose of this study was to investigate parental perceptions of children's weight status.

METHODS

We analyzed data from a questionnaire study conducted among 1,971 preschool children in local kindergartens from December 1, 2021, to January 31, 2022, and classified the participants as having non-overweight and overweight/obesity according to the International Obesity Task Force (IOTF) criteria. Parents were asked whether they perceived their children to have non-overweight or overweight/obesity. We analyzed the related factors that parents underestimated or overestimated their children's weight status.

RESULTS

The rate of overweight/obesity in preschool children was 17.9%. Parental perceptions of children's weight status were inconsistent with children's real weight (kappa = 0.351, p < 0.001). The correctness of mother's perceptions of children's weight was higher than that of father's. Among children who were affected by overweight/obesity, 68.5% of parents underestimated their children's weights. Mothers with overweight/obesity had a 1.56 times greater risk of underestimating the children's weight than mothers who were affected by non-overweight (p = 0.010, odds ratio: 1.56, 95% confidence interval: 1.11-2.18). Children's sex and families with siblings were independent risk factors for parents to overestimate children's weight.

CONCLUSION

Parents were highly likely to misinterpret the weight status of their children who were affected by overweight/obesity. Mothers with overweight/obesity were more likely to underestimate their children's weight.

The MapMe Body Scales: Validity and Reliability of a Biometrically Accurate, Photorealistic Set of Child Body Size Scales

BACKGROUND/OBJECTIVES

It is vital to identify children whose weight status means that they may benefit from medical or behavioural support, but adult visual judgements of child weight status are inaccurate, and children are seldom routinely weighed and measured. Consequently, there is a need for validated visual tools for use in training, communication, and interventions relating to child weight.

METHODS

This paper presents validation data for a set of innovative photo-realistic colour body size scales depicting boys and girls aged 4-5 and 10-11. Each age- and gender-specific scale consists of 7 figures based on three-dimensional (3D) scans of 388 children to accurately represent the change in body size caused by changing adiposity. To assess scale validity, 238 adult participants (105 men, 132 women, 1 non-binary individual) undertook two tasks: rating figure adiposity using a visual analogue scale and ranking figures in ascending order of adiposity (OSF Reference: gdp9j).

RESULTS

Participants accurately estimated the relative adiposity of each figure, i.e., they were able to tell the difference between figures and correctly rank them by size. This demonstrates scale validity for use in body size tasks. One hundred and fifty-one participants also provided 3-day test-retest data, which demonstrates excellent short-term reliability.

CONCLUSIONS

Overall, the MapMe child body size scales provide an anthropometrically accurate, valid, reliable, and usable tool for size-related tasks and communication with adults regarding child weight.

Impact of the child's birth weight on maternal misperceptions of young children's weight: A retrospective study with nationally representative data

AIM

A young child's abnormal birth weight (BW) can affect a mother's misperceptions of her child's weight, potentially hindering the child's health management. Therefore, this study investigated the impact of children's BW on maternal misperceptions of children's weight during early childhood.

METHODS

A retrospective study was conducted for 485,095 children who were 54-60 months of age, born between 2011 and 2013, and participated in South Korea's Sixth National Health Screening Program for Infants and Children (NHSPIC). Data on BW, weight, sex, birth year, preterm birth, breastfeeding history, maternal age, mothers' perceptions of the child's weight, and socioeconomic status were collected and incorporated in the final analysis via data linkage between the NHSPIC and Korean healthcare claims information. Multiple logistic regression analysis was applied to identity the impact of BW on mothers' misperceptions of children's weight, after adjustment for all variables.

RESULTS

Low BW (LBW) children had the lowest proportion (57.1%) of mothers who accurately identified their child's weight compared to normal or high BW. LBW was an independent factor affected maternal misperception of the child's weight (underestimation: adjusted odds ratio [aOR]: 1.46, 95% confidence interval [CI]: 1.41-1.52; overestimation: aOR: 0.84, 95% CI: 0.73-0.97). Overweight or underweight status, male gender, preterm birth, a younger mother, and low socioeconomic status were also associated with both underestimation and overestimation.

CONCLUSION

LBW emerged as an important risk factor for maternal misperception of a child's weight. Therefore, pediatric nurses need to apply interventions to improve perceptions of children's weight among mothers of young LBW children.

Mothers' Awareness of Obesity and Its Complications Among Children in the Western Region of Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Awareness about obesity, its complications, and an age-appropriate, healthy, active lifestyle are essential to maintaining a healthy life. This study aimed to determine the level of awareness Saudi Arabian caregivers have regarding obesity and regular physical activity.

MATERIALS AND METHODS

In this cross-sectional study, a survey was conducted among parents in Saudi Arabia using a structured questionnaire. A convenience and snowball sampling method was employed to recruit participants from various regions of Saudi Arabia. The questionnaire assessed parents' knowledge about obesity, its complications, and healthy, active lifestyle practices. Data were analyzed using descriptive statistics, and associations between variables were examined using chi-squared tests.

RESULTS

In this study, responses from 256 moms in various Saudi Arabian locations were included in the analysis. Merely 35.5% of the participants demonstrated good knowledge about obesity and its complications. Regarding the promotion of a healthy, active lifestyle, only 11.3% of the participants were aware that kids should eat five types of vegetables and fruits daily, whereas 85% were aware that kids should have <2 hours a day of screen time, and 75.4% were aware that kids should be engaged in physical activity for at least one hour daily.

CONCLUSION

This study highlights a concerning gap in knowledge among caregivers in Saudi Arabia concerning obesity and its consequences, with merely 35.5% of participants demonstrating a good understanding of obesity and its complications. Alarmingly, only a fraction (11.3%) showed awareness of the importance of promoting a healthy, active lifestyle. These findings underscore the urgent need for enhanced awareness initiatives focused on obesity and its prevention to ensure optimal child health development, avert health issues, and strengthen positive dynamics between parents and children.

Accuracy of Syrain Refugee Mothers' Perceptions of Newborn's Birth Size: Insights from a National Survey in Turkey

This study aims to assess the accuracy of maternally perceived birth size and its associated factors among the Syrian refugees in Turkey, using the data from 2018 Turkey Demographic and Health Survey Syrian Migrant Sample (TDHS-SM-18). The study includes information on the last-born child, singleton pregnancies, births in healthcare facilities, children under 5 living with their mothers, with recorded birth weight (n = 969). The study categorizes the mother's perception of size into three groups : compatible, overestimated, and underestimated. Various factors, including sociodemographic characteristics, financial aspects, maternal characteristics, and child characteristics, are considered as explanatory variables. The analysis employs a complex sample multiple logistic regression model. The findings reveal that the majority of mothers accurately perceive the birth size, but 17.1% of them do not. Maternal factors such as region of residence, literacy, occupation, age at birth, and child factors such as birth order, birth interval, gender, and birth weight are identified as associated factors with maternal misperception. This study provides valuable insights into the accuracy of maternally perceived birth size and sheds light on the factors influencing this perception among Syrian refugee mothers in Turkey.

Every cockroach is beautiful to his mother's eyes"? A multicentric study on the perception of child's health status according to the parent

Introduction

Childhood obesity is a social health problem in the Western World and an important goal is to analyze and correct risk factors. However, part of the problem could be determined by a different perception of the weight.

Material and methods

In October 2019, we conducted a cross-sectional study in which a questionnaire was administered to the parents of primary and secondary school children in South-East Tuscany, Italy. The aim was to determine the association between children's Body Mass Index (BMI) and the parent's perception.

Results

Analysis was carried out on 1,405 complete questionnaires. We found that most parents wrongly perceive the weight of their children. 88.3% of parents with obese children believe that their children are of normal weight or only "a little overweight". 67.6% of parents who have overweight children think that their children are of normal weight (p < 0.001).

Conclusions

Our results show a misperception of the weight of the children in the parents eyes. The acquisition of healthy behaviour during childhood is extremely important for health in adulthood and for avoiding the onset of associated diseases. Therefore, food education becomes a crucial objective. Children and parents need to increase consciousness of the correct weight and diseases resulting from bad nutrition.

Predicting Childhood Obesity Based on Single and Multiple Well-Child Visit Data Using Machine Learning Classifiers

Childhood obesity is a public health concern in the United States. Consequences of childhood obesity include metabolic disease and heart, lung, kidney, and other health-related comorbidities. Therefore, the early determination of obesity risk is needed and predicting the trend of a child's body mass index (BMI) at an early age is crucial. Early identification of obesity can lead to early prevention. Multiple methods have been tested and evaluated to assess obesity trends in children. Available growth charts help determine a child's current obesity level but do not predict future obesity risk. The present methods of predicting obesity include regression analysis and machine learning-based classifications and risk factor (threshold)-based categorizations based on specific criteria. All the present techniques, especially current machine learning-based methods, require longitudinal data and information on a large number of variables related to a child's growth (e.g., socioeconomic, family-related factors) in order to predict future obesity-risk. In this paper, we propose three different techniques for three different scenarios to predict childhood obesity based on machine learning approaches and apply them to real data. Our proposed methods predict obesity for children at five years of age using the following three data sets: (1) a single well-child visit, (2) multiple well-child visits under the age of two, and (3) multiple random well-child visits under the age of five. Our models are especially important for situations where only the current patient information is available rather than having multiple data points from regular spaced well-child visits. Our models predict obesity using basic information such as birth BMI, gestational age, BMI measures from well-child visits, and gender. Our models can predict a child's obesity category (normal, overweight, or obese) at five years of age with an accuracy of 89%, 77%, and 89%, for the three application scenarios, respectively. Therefore, our proposed models can assist healthcare professionals by acting as a decision support tool to aid in predicting childhood obesity early in order to reduce obesity-related complications, and in turn, improve healthcare.

Maternal perceptions and concerns about children's weight status and diet quality: a study among Black immigrant families

OBJECTIVE

To identify factors influencing Black immigrant mothers' perceptions and concerns about child weight and to compare children's diet quality according to these perceptions and concerns.

DESIGN

Mothers' perceptions and concerns about child weight were assessed with sex-specific figure rating scales and the Child Feeding Questionnaire, respectively. Participants' weights and heights were measured and characterised using WHO references. Children's dietary intakes were estimated using a 24-h dietary recall. Children's diet quality was evaluated using the relative proportion of their energy intake provided by ultra-processed products, which were identified with the NOVA classification. χ2 tests, multivariate logistic regressions and t tests were performed.

SETTING

Ottawa, Ontario, Canada.

PARTICIPANTS

Black immigrant mothers of Sub-Saharan African and Caribbean origin (n 186) and their 6-12-year-old children.

RESULTS

Among mothers, 32·4 % perceived their child as having overweight while 48·4 % expressed concerns about child weight. Girls and children with overweight or obesity were significantly more likely to be perceived as having overweight by their mothers than boys and normal-weight children, respectively. Mothers of children living with obesity, but not overweight, were significantly more likely to be concerned about their child's weight than mothers of normal-weight children. Children's diet quality did not differ according to mothers' perceptions and concerns.

CONCLUSIONS

Children's gender and weight status were major determinants of perceptions and concerns about child weight among Black immigrant mothers. Including knowledge about mothers' perceptions and concerns about child weight will help nutrition professionals develop interventions tailored to specific family needs within the context of their cultural backgrounds.

Impacts of an early childhood obesity prevention program in Mexico

The Healthy Change Program aimed to improve the accuracy of maternal perceptions of children's weight (MPCW), maternal feeding style (MFS) and feeding practices. Using a randomized control trial design, the intervention group received 4-weekly group sessions focusing on MPCW, MFS and healthy behaviors. The control group received the same dose of attention-control sessions on food hygiene. Data were collected at the baseline and at the end of the program via self-administered questionnaires and anthropometric measurements. Participants included 294 mother-child dyads with 149 in the intervention group and 145 in the control group. The accuracy of MPCW significantly increased at the study end point in the intervention group (57.0-67.1%, P < 0.05) but not in the control group (67.6-69.7%, P > 0.05), with no between-group difference in pre- and post-change (P > 0.05). At the study end point, more mothers of overweight and obese children in the intervention group had accurate MPCW than their control counterparts (31.4% versus 11.1%, P < 0.01). The intervention group had a shift toward an authoritative style at the study end point (17.4% versus 26.2%, P < 0.001) and favorable changes in feeding practices. The Healthy Change Program contributed to improving the accuracy of MPCW and shifts toward favorable MFS and feeding practices.

Development and validation of the Child Weight Risk Questionnaire

PURPOSE

The study objective was to develop and validate a measure of parent perception of child weight-related risk, the Child Weight Risk Questionnaire (CWRQ), among a sample of US parents.

METHODS

A cross-sectional survey was conducted in a sample of 216 parents of 6- to 12-year-old children who were overweight. The CWRQ was used to assess parent beliefs about their child's susceptibility to physical, social-emotional, and behavioral health problems due to weight.

RESULTS

Confirmatory factor analysis supported the three-factor structure of the CWRQ and acceptable fit was achieved. The internal consistency of the measure was excellent. Convergent, discriminant, and incremental validity analyses provided initial evidence for CWRQ validity.

CONCLUSION

The CWRQ is a reliable and valid instrument for assessing parent perception of child weight-related risk. This measure could be utilized in research and applied settings to capture the multifaceted nature of parent risk perception and support efforts to tailor family weight interventions in ways that align with parent beliefs.

LEVEL OF EVIDENCE

Level V, cross-sectional, descriptive study.

Infant and preschooler feeding behaviors in Chinese families: A systematic review

A systematic review was conducted on the literature on feeding behaviors in Chinese families of children under 6 years old. Forty relevant publications were identified, of which 33 were published in Chinese, 7 in English. All studies were questionnaire-based and used a cross-sectional research design. Approximately half of the studies reported a score for each feeding practice/style, based on a Likert scale; the other half dichotomized these scores into a percentage of the population that reported frequent use of the behaviors. The most commonly reported feeding style of Chinese caregivers was a locally defined "active response" style that somewhat resembled authoritative parenting. The most commonly reported feeding practices were praise, encouraging trying new foods, encouragement of balanced diet and encouragement of healthy eating. Some behaviors showed a great deal of variance in prevalence between studies, which may be at least partially due to differences in methodology and how behaviors were defined. Some feeding behaviors varied in frequency depending on the child's age, although longitudinal studies are needed to better understand how these evolve over time. Child body composition was also associated with feeding behaviors use, although the direction of the association cannot be determined due to the cross-sectional nature of the research. There is still an important gap in the literature regarding the feeding behaviors of non-maternal caregivers, as grandparents often play an important role in childcare in China.

Maternal Perception of the Child’s Weight, Lifestyle Problems and Self-Efficacy to Deal with Them

Objectives: To associate the maternal perception of the child’s weight (MPCW) and the child’s nutritional status. To describe child’s lifestyle behavior problems (CLBPs) and maternal self-efficacy (SE) to deal with them, as well as to verify differences according to children with and without overweight-obesity (OW-OB) and MPCW. Material and methods: There was participation of 274 dyads (mother-preschool child). MPCW was assessed through words and images. The mothers answered the Lifestyle Behaviour Checklist. The child’s weight and height were measured. Results: 18.8 % (n = 13) of the mothers of children with OW-OB and 78.8 % (n = 160) of the mothers of children without OW-OB obtained adequate MPCW values through words (X2 = 77.759; DoF = 1; p < .001). It was identified that the mothers of children with OW-OB reported more CLBPs and less SE. When the child’s OW-OB is perceived through words, there are more CLBPs (F = 17.041; p = .001) and less SE (U = 1,118; p = .015). Conclusions: Inadequate MPCW was predominant in mothers of children with OW-OB. When OW-OB is perceived, there are more CLBPs and fewer SE. It is recommended to promote adequate MPCW, particularly in mothers of children with OW-OB. Images assist in the identification of the child’s OW-OB more than to classify it into a category.

Parents' perceptions and dissatisfaction with child silhouette: associated factors among 7-year-old children of the Generation XXI birth cohort

PURPOSE

We compared parent's perceived child's silhouette, and investigated predictors of their dissatisfaction.

METHODS

Participants were 4930 mother-child dyads enrolled at a Portuguese birth cohort. Parents' perceptions of child's current and desired silhouette was assessed and dissatisfaction with child's silhouette was defined as the discrepancy between these ratings (current-desired body). Multinomial logistic regressions, adjusted for potential confounders, were performed.

RESULTS

Mothers were more dissatisfied with child's silhouette, compared to fathers, in all weight categories. Mothers and fathers of girls were more dissatisfied, preferring thinner silhouettes (OR = 2.77, 95% CI 2.19; 3.51 and OR = 2.08, 95% CI 1.18; 3.66, respectively), compared to parents of boys. Lower birth weight increased maternal desire for a heavier child silhouette. Younger (< 20 years) and less educated (≤ 9 years of schooling) mothers were more dissatisfied with their child's silhouette, preferring heavier children (OR = 1.65, 95% CI 1.10; 2.48 and OR = 1.73, 95% CI 1.42; 2.09, respectively). Parents' own dissatisfaction was also associated with child's silhouette dissatisfaction.

CONCLUSION

Sociodemographic characteristics and parents' dissatisfaction with their own silhouette influenced their dissatisfaction with child's silhouette and should be considered when developing obesity interventions.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Maternal perception, concern and dissatisfaction with child weight and their association with feeding practices in the Generation XXI birth cohort

What a mother thinks about her child's weight status might influence what and how she feeds her child. We examined the association between maternal perception, concern and dissatisfaction with child weight alongside feeding practices. Participants were from the Generation XXI birth cohort (n = 3233). A validated version of the Child Feeding Questionnaire and the Overt/Covert Control scale were used. Associations were evaluated by linear regression models (β coefficients and 95 % confidence intervals (95 % CI) with Bonferroni correction). Perceived underweight was associated with practices promoting food intake, such as higher pressure to eat at ages 4 and 7 years (β = 0·229; 95 % CI: 0·059, 0·398 and β = 0·190; 95 % CI:0·005, 0·376, respectively) and lower restriction at age 4 (β = -0·175; 95 % CI: -0·0310, -0·039). At age 7, perceived overweight was associated with higher covert control (β = 0·203; 95 % CI: 0·029, 0·376). Mothers who were concerned about child weight reported higher restriction (β = 0·226; 95 % CI: 0·142, 0·310 at 4 years and β = 0·261; 95 % CI: 0·169, 0·353 at 7 years) and covert control (β = 0·183; 95 % CI: 0·083, 0·282 at 4 years and β = 0·171; 95 % CI: 0·073, 0·269 at 7 years). Maternal desire for a heavier child was associated with higher pressure to eat at both ages (β = 0·285; 95 % CI: 0·163, 0·406 and β = 0·393; 95 % CI: 0·266, 0·520), while the desire for a thinner child was related to higher covert control at 7 years of age (β = 0·158; 95 % CI: 0·001, 0·316). Maternal perceptions and concern for child weight status are associated with feeding practices independently of actual weight status.

Parental neglect of feeding in obese individuals. A review of scientific evidence and its application among Saudi population

Human beings encountered malnutrition during the twentieth century and obesity in the very next century. This is how the future will look when the present becomes a slice of history. Obesity is threatening the healthy being of many youngsters throughout the world. Environmental influences have indicated to effect even genetically safe subjects among which parental neglect seems to be most alarming. Two extensively and globally investigated variables, the feeding style and the physical activity, provide some hope in its prevention. Despite the high rise of obesity prevalence in Saudi Arabia, there is scant research on these topics. The purpose of this review is to present a comprehensive assessment of these 2-obesity associated parental variables. The composed literature could provide an insight to the dominant surge of obesity in the Arab nations and stimulate research on current parenting practices in the Kingdom.

Describing the Process and Tools Adopted to Cocreate a Smartphone App for Obesity Prevention in Childhood: Mixed Method Study

Background

Childhood obesity prevention is a public health priority in industrialized countries. The Reggio Emilia Local Health Authority has implemented a program involving primary and secondary prevention as well as the care of obese children. There are many health-promoting mobile apps, but few are targeted to children and very few are sponsored by public health agencies.

Objective

The goal of the research was to describe the process and tools adopted to cocreate a mobile app sponsored by the Reggio Emilia Local Health Authority to be installed in parents’ phones aimed at promoting child health and preventing obesity.

Methods

After stakeholder mapping, a consulting committee including relevant actors, stakeholders, and users was formed. Key persons for childhood obesity prevention were interviewed, focus groups with parents and pediatricians were conducted, and community reporting storytelling was collected. The results of these activities were presented to the consulting committee in order to define the functionalities and contents of the mobile app.

Results

Three key trends emerged from community reporting: being active, playing, and being outdoors; time for oneself, family, and friends; and the pressures of life and work and not having time to be active and socialize. In focus groups, interviews, and labs, mothers showed a positive attitude toward using an app to manage their children's weight, while pediatricians expressed concerns that the app could increase their workload. When these findings were explored by the consulting committee, four key themes were extracted: strong relationships with peers, family members, and the community; access to safe outdoor spaces; children’s need for age-appropriate independence; and professional support should be nonjudgmental and stigma-free. It should be a dialogue that promotes family autonomy. The app functions related to these needs include the following: (1) newsletter with anticipatory guidance, recipes, and vaccination and well-child visit reminders; (2) regional map indicating where physical activity can be done; (3) information on how to manage emergencies (eg, falls, burns, fever); (4) module for reinforcing the counseling intervention conducted by pediatricians for overweight children; and (5) a function to build a balanced daily diet.

Conclusions

The pilot study we conducted showed that cocreation in health promotion is feasible, with the consulting committee being the key co-governance and cocreation tool. The involvement of stakeholders in this committee made it possible to expand the number of persons and institutions actively contributing to the project.

A 3-year longitudinal study of effects of parental perception of children's ideal body image on child weight change: The Childhood Obesity Study in China mega-cities

This study examined prevalence of childhood overweight and obesity (ov/ob) and central obesity in five mega-cities across China (Beijing, Shanghai, Xi'an, Nanjing and Chengdu); described parental perceptions of children's ideal body image (IBI); and prospectively examined associations between parental perception of child IBI and child weight changes over 3 years. In this NIH-funded, open cohort study, data were collected from students and their parents in 2015, 2016 and 2017 (n = 3298, in 3 waves). Cross-sectional analysis included all 3298 children; longitudinal data analysis used mixed effects models and included 1691 children aged 6-17 years with ≥two body mass index (BMI) measurements during 2015-2017. Ov/ob prevalence based on Chinese age-sex-specific BMI cut-points was 30.0%. Based on waist-to-height ratio (WHtR), the abdominal obesity rate was 19.8%. Parents reported different preferred IBI for boys vs girls, being about 3 times more likely to select ov/ob as ideal for boys than for girls (4.5% vs 1.5%, respectively, P < .001). In longitudinal analysis, children whose parents selected ov/ob as ideal had higher BMI Z-scores and WHtR increase over time than those whose parents selected an average body image (β [SE] = 0.042 [0.011], and β [SE] = 0.010 [0.004], respectively, all P < .05). Ov/ob rates were high among children in major cities in China. Chinese parents preferred a heavier ideal body image for their boys. Health promotion programs should help empower parents and their children to develop appropriate body images and maintain healthy body weight.

Factors Influencing Parents' and Children's Misperception of Children's Weight Status: a Systematic Review of Current Research

PURPOSE OF REVIEW

Misperception of children's weight status is prevalent among parents and children themselves and may impact parents' and children's health behaviors. This study was conducted in order to provide a descriptive systematic review of research on factors influencing parents' and children's misperceptions of children's weight status published in the past 5 years.

RECENT FINDINGS

Factors studied most often in relation to parents' and children's misperception included children's weight status, gender, and age, as well as parents' weight status, parental education levels and socioeconomic status, and ethnicity. Most determinants that were found to have a significant influence on misperception in parents also did in children. The literature on misperception of children's weight status is extensive. Most determinants assessed in included studies were known determinants of childhood obesity. Further research should be directed toward better understanding the impact of weight status perception (whether it is accurate or not) on health behaviors and weight gain over time.

Adverse childhood experiences are associated with an increased risk of obesity in early adolescence: a population-based prospective cohort study

OBJECTIVE

To determine whether adverse childhood experiences were associated with weight gain and obesity risk in adolescence.

METHODS

We analyzed data from 6942 adolescents followed between 9 and 13 years of age in the Growing Up in Ireland cohort study. The main exposures were 14 adverse childhood experiences, 4 of which were included in the Adverse Childhood Experience (ACE) study. The primary outcome was incident overweight and obesity at 13 years. Secondary outcomes included prevalent overweight/obesity and weight gain.

RESULTS

More than 75% of the youth experienced an adverse experience and 17% experienced an ACE-specific experience before 9 years. At 13 years, 48% were female and 31.4% were overweight or obese. After adjusting for confounding, exposure to any adverse experience was associated with prevalent overweight/obesity (aOR: 1.56; 1.19-2.05) and incident overweight/obesity (adjusted IRR: 2.15; 95% CI: 1.37-3.39), while exposure to an ACE-specific exposure was associated weight gain (BMI Z score change = 0.202; 95% CI: 0.100-0.303). A significant interaction between income and adverse childhood experiences was observed for both incident overweight/obesity and weight gain (BMI Z change: -0.046; 95% CI: -0.092 to 0.000).

CONCLUSIONS

Adverse childhood experiences and low income interact and independently predict obesity risk in early adolescence.