Longitudinal Impact of Parenting Practices On Child Overweight/Obesity Among Low-Income Ethnic Minorities

Introduction: Child obesity is highly correlated with adult obesity and chronic illnesses, including type 2 diabetes and cardiovascular disease, leading causes of preventable death in the US.  Identifying early social environmental and family risk factors of child obesity could provide a more comprehensive approach to prevention.  Child overweight/obesity is associated with parenting practices, which have been responsive to intervention and related to multiple child outcomes, making them an ideal target for prevention programs.  Few studies have examined changes in parenting practices over time and how these changes influence child obesity in pre-school and school-aged children, particularly among low-income racial/ethnic minorities who experience higher rates of child obesity.  This study addresses these research gaps by analyzing how parenting practices influence child overweight/obesity over time in a diverse, high-risk population.

Methods: Using three waves of data from the Welfare, Children, and Families: A Three-City Study, this study follows a random sample of low-income, ethnically diverse mothers and children ≤5 years old with parenting and growth measures (N=1070).  Parenting practices included maternal discipline (authoritative and harsh), cognitive stimulation, and family routines measured by self-report and interviewer observation.  Child overweight/obesity was defined as at or above the sex-specific 85^thpercentile on CDC 2000 BMI-for-age growth charts.  Unadjusted and adjusted logistic regression analyses were conducted to estimate the odds of child overweight/obesity by parenting practices controlling for sociodemographic characteristics.  Lagged regression models and longitudinal logistic models were used to examine the association of parenting and child overweight/obesity over time. 

Results:Approximately 36% of children were overweight/obese at baseline (mean age = 3.5 years), 32% were overweight/obese at the 1.5 year follow-up, and 45% were overweight/obese at the 6 year follow-up.  In lagged logistic regression models, higher levels of family routines at baseline were associated with lower odds of obesity at the 6 year follow-up (OR:0.45, 95% CI:0.26-0.78).  In longitudinal adjusted population average models, an increase in authoritative parenting was associated with 24% decrease in odds of child overweight/obesity over time (OR: 0.76, 95% CI: 0.62-0.94).

Conclusions: Parenting practices were associated with decreased odds of child overweight/obesity in middle childhood.  Establishing positive parenting practices early in childhood before parenting and obesity trajectories are set may help prevent or mitigate future growth problems and their negative health sequelae.  Incorporating parenting components into current interventions may provide a more comprehensive and effective approach to child obesity prevention and help address disparities in child overweight/obesity among racial/ethnic groups.