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 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 therefore 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 (i.e. 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 what a pre-school child would be eating 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 what a pre-school child would be eating, 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 in other styles e.g. (permissive, uninvolved)8. See below for further explanations of these different parenting styles:
Authoritative parenting: a style that is child-centred. This is where parents closely interact with their children, at the same time as maintaining high expectations for behaviour. Authoritative parents often adhere to regular schedules and discipline.
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; and
- 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 has been found to be independently associated with increased physical activity in 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:
- The 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 – for example, does it contain sufficient kitchen equipment; and
- access to safe outdoor space - this can affect opportunities for physical activity (e.g. areas to play, walkability).
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.
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.
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.