What contributes to child weight issues?
A healthy child will gain weight proportionately as they grow in height. When this weight gain exceeds the corresponding height gain over a sustained period of time however, a child will become overweight (and vice-versa for underweight). For more information about how weight issues are diagnosed and managed in young children see the diagnosing weight module.
On the surface, weight appears to be a simple issue i.e. if a child takes on more energy than they are burning they will gain excess weight, conversely if a child is burning more energy than they are taking on they will lose weight.
Research indicates that child weight is influenced by many interacting factors, and is far more complex than a simple “energy in-energy out” equation. The Socio-Ecological Model5 (SEM) is a good way of understanding this. According to the SEM (see figure 4) a child’s weight is influenced by a wide range of factors, from individual characteristics, to family, peer and teaching influences, to the broader social and environmental context where they live. These influences interact on an ongoing basis to influence a child’s weight status. It is unlikely that a child’s weight can be explained by one single factor and it is important practitioners recognise the many influences in a pre-school child’s life that might affect their weight.
The pre-school years have been identified as a critical period for the development of childhood obesity as it is thought that a child’s eating and physical activity habits are established during this time6
It is important to note that regardless of a child’s weight, all children should be encouraged to eat a healthy diet and be physically active. Guidance on diet and physical activity for pre-school children is provided in modules physical activity and sedentary behaviour and nutrition.
A child’s weight is influenced by the food and drinks they consume. In our current environment children are often eating food that is high in calories but with little nutritional values (‘empty calories’). Excess caloric intake in relation to energy expenditure can result in children gaining weight too quickly as this excess energy intake can result in the storage of energy as fat. For more information on pre-school nutritional requirements see see nutrition module.
A child’s physical activity, as well as having a range of benefits on a child’s physical and psychological health, can also influence their weight. If a child is sufficiently active relative to what they eat, their weight remains stable. If a child is very active they may need to eat more to maintain their weight than a child who is less active. For more information on physical activity for pre-school children see physical activity and sedentary behaviour module.
Sedentary behaviours are activities that require children to be in a sitting or lying position (excluding sleep) (see module on physical activity and sedentary behaviour) The amount of time a child spends sedentary (e.g. watching television) may place a child at risk of overweight. Research has found that sedentary time is associated with increased risk of overweight/obesity in children independently of children’s physical activity levels7.
One of the main social influences on a pre-school child’s weight is their family. Particularly in young children parents are the ones who tend to control and set the rules for the amount of screen time allowed, cook meals, decide how regularly the family eat together and how often a child engages in physical activity. Research has outlined a number of parental factors that can have an influence over a child and family’s behaviours that can subsequently influence a child’s weight status.
As parents are responsible for what a child eats and how much physical activity their child participates in, parenting practices play a key part in the development of obesity-inducing behaviours in young children, and subsequently a child’s weight status. Research has found a number of associations between parenting style and a child’s weight status. Children raised in authoritative homes tend to be more physically active and have lower BMI, compared to children raised by parents who are more permissive or, uninvolved8. Below is a brief explanation of these different parenting styles:
Authoritative parenting: a style that is child-centred. This is where parents are loving and closely interact with their children, whilst also maintaining high expectations for behaviour. The practices of authoritative parents are usually supportive of the child’s needs for autonomy (e.g. through involving the child in decision-making), competence (e.g. through providing clear rules and guidelines, and praising children for positive behaviours) and relatedness (e.g. through being loving and caring towards their child) (see communication module for further explanations of these psychological needs).
Permissive (or indulgent) parenting: Permissive parents tend to be very loving towards their children, but provide few rules and guidelines. Parents can often appear more of a friend to their child rather than parental figures.
Uninvolved parenting: uninvolved or neglectful parents can be unresponsive to their child’s needs. Parents often make few demands on their children, and can appear indifferent.
Research has consistently linked lower parental education with risk of overweight in young children9. Parents with high levels of education are more likely to:
- have healthier diets
- model better eating behaviours
- plan family meals
- restrict television viewing
Parental obesity has been found to be a significant predictor of obesity in children (particularly maternal weight status). Parents’ physical activity and sedentary behaviours can also influence their child’s behaviours and weight status 10,11. Research has found that it is important for parents to encourage their child to be physically active; children whose parents encourage physical activity are less likely to be overweight12. Additionally parents engaging in physical activities with their children, and being concerned about their own physical activity levels are more likely to have physically active children, regardless of weight status12.
The environment children and their families live in can influence children’s access to heathy eating and physical activity options. The Marmot Review (2010) into health inequalities in England indicates that the conditions in which people are born, grow, live, work and age can lead to health inequalities. This is particularly important in childhood obesity, as a number of environmental factors have been found to influence a child’s health and weight.
These factors include:13,3:
- Availability of shops selling fresh food: the presence of farmers markets and supermarkets is associated with lower levels of overweight in children
- Affordability of healthy foods
- Locality of fast food outlets: access to convenience stores and takeaways increases the risk of overweight and obesity
- Quality of housing (e.g. containing sufficient kitchen equipment)
- Access to safe outdoor space: which can affect opportunities for physical activity (e.g. areas to play, walkability)
Below is a short quiz containing questions on what you have learnt throughout this module. If it takes a number of goes to get all of the questions correct, please note down each score in your logbook in the space provided. The main purpose of this quiz is to embed learning, and provide you with the opportunity to evaluate your learning. Please remember that we are focusing on the effectiveness of this website and not auditing your practice.
Once you have all the questions correct you will be provided with a certificate of module completion.
Unhealthy weight at pre-school age
Start the quiz
1. In 2015 what were the rates of underweight, overweight and obesity in reception-ages children in Blackburn with Darwin?
a) Underweight: 1%, Overweight: 12.8%, Obesity: 9.3%
b) Underweight: 1.7%, Overweight: 11.3%, Obesity: 9.4%
c) Underweight: 3%, Overweight: 14.5%, Obesity: 11.6%
d) Underweight: 0.5%, Overweight: 10.8%, Obesity: 6.3%
2. Which of these factors does not put a child at risk of weight problems?
3. Unhealthy weight in children is linked with which health concerns?
a) Low self-esteem
b) Movement difficulties
c) Continence issues
d) All of the above
4. Which of these factors contribute to unhealthy weight in pre-school children?
a) Sedentary behaviour
b) Physical activity
c) Family factors
d) All of the above
5. Which of the following best describes the ideas of the Socio-Ecological Model?
a) A person’s behaviour is influenced by an interaction between individual, social and environmental factors
b) A person’s behaviour is most influenced by their thoughts, attitudes and motivations
c) A person who is autonomously motivated is more likely to adhere to behaviour change
d) None of the above
6. Imagine two parents. Parent A sets clear boundaries for their child, and is also very loving. Parent B is very loving, but pays very little attention to rules and boundaries. According to research, which of the following is true?
a) Parent A is displaying authoritative parenting and their child is more likely to become overweight (than parent B)
b) Parent A is displaying authoritative parenting and their child is less likely to become overweight (than parent B)
c) Parent B is displaying permissive parenting and their child is more likely to become overweight (than parent A)
d) b) and c)
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5. Bronfenbrenner, U. (1992). Ecological systems theory, Jessica Kingsley Publishers.
6. Skouteris, H., McCabe, M., Swinburn, B., Newgreen, V., Sacher, P., & Chadwick, P. (2011). Parental influence and obesity prevention in pre‐schoolers: a systematic review of interventions.Obesity reviews, 12(5), 315-328.
7. Keane, E., Li, X., Harrington, J. M., Fitzgerald, A. P., Perry, I. J., & Kearney, P. M. (2017). Physical Activity, Sedentary Behaviour and the Risk of Overweight and Obesity in School Aged Children. Pediatric Exercise Science, 1-27.
8. Sha, D. (2017). Parental education background, social support, and preschool-aged children with obesity.
9. Eck, K., Quick, V., Martin-Biggers, J., Delaney, C., & Byrd-Bredbenner, C. (2017). Education Level Influences Weight-Related Cognitions and Behaviors of Parents with Preschoolers.The FASEB Journal, 31(1 Supplement), 642-3.
10. Sleddens, E. F. C., Gerards, S. M. P. L., Thijs, C., de Vries, N. K., & Kremers, S. P. J. (2011). General parenting, childhood overweight and obesity-inducing behaviors: a review. International Journal of Pediatric Obesity, 2011(6), e12-e27.
11. Keane, E., Layte, R., Harrington, J., Kearney, P. M., & Perry, I. J. (2012). Measured parental weight status and familial socio-economic status correlates with childhood overweight and obesity at age 9. PloS one, 7(8), e43503.
12. Moens E, Braet C, Bosmans G, Rosseel Y. Unfavourable family characteristics and their associations with childhood obesity: A cross-sectional study. Eur Eat Disord Rev. 2009;17:315–23.
3. Sahoo, K., Sahoo, B., Choudhury, A. K., Sofi, N. Y., Kumar, R., & Bhadoria, A. S. (2015). Childhood obesity: causes and consequences. Journal of family medicine and primary care, 4(2), 187.
13. Rahman, T., Cushing, R. A., & Jackson, R. J. (2011). Contributions of built environment to childhood obesity. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, 78(1), 49-57.