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PEDIATRICS Vol. 112 No. 5 November 2003, pp. 1138-1145

Association Between Clinically Meaningful Behavior Problems and Overweight in Children

Julie C. Lumeng, MD*, Kate Gannon, MPH{ddagger}, Howard J. Cabral, PhD{ddagger}, Deborah A. Frank, MD* and Barry Zuckerman, MD*

* Division of Behavioral and Developmental Pediatrics, Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
{ddagger} Boston University School of Public Health, Boston, Massachusetts

Objective. To determine whether there is a relationship between clinically meaningful behavior problems and concurrent and future overweight in 8- to 11-year-old children.

Methods. 1998 National Longitudinal Survey of Youth interview data for 8- to 11-year-old children and their mothers were analyzed. A Behavior Problems Index score >90th percentile was considered clinically meaningful. Child overweight was defined as a body mass index (BMI) ≥95th percentile for age and sex. Multiple logistic regression was used to control for potential confounders (selected a priori): child’s sex, race, use of behavior-modifying medication, history of academic retention, and hours of television per day; maternal obesity, smoking status, marital status, education, and depressive symptoms; family poverty status; and Home Observation for Measurement of the Environment-Short Form (HOME-SF) cognitive stimulation score. In an attempt to elucidate temporal sequence, a second analysis was conducted with a subsample of normal-weight children who became overweight between 1996 and 1998 while controlling for BMI z score in 1996.

Results. The sample included 755 mother-child pairs. Of the potential confounding variables, race, maternal obesity, academic grade retention, maternal education, poverty status, and HOME-SF cognitive stimulation score acted as joint confounders, altering the relationship between behavior problems and overweight in the multiple logistic regression model. With these covariates in the final model, behavior problems were independently associated with concurrent child overweight (adjusted odds ratio: 2.95; 95% confidence interval: 1.34–6.49). The relationship was strengthened in the subsample of previously normal-weight children, with race, maternal obesity, HOME-SF cognitive stimulation score, and 1996 BMI z score acting as confounders (adjusted odds ratio: 5.23; 95% confidence interval: 1.37–19.9).

Conclusions. Clinically meaningful behavior problems in 8- to 11-year-old children were independently associated with an increased risk of concurrent overweight and becoming overweight in previously normal-weight children.

Key Words: obesity • overweight • child behavior • child behavior disorders • National Longitudinal Survey of Youth

Abbreviations: BMI, body mass index • NLSY, National Longitudinal Survey of Youth • HOME-SF, Home Observation for Measurement of the Environment-Short Form • BPI, Behavior Problems Index • OR, odds ratio • CI, confidence interval

Received for publication Apr 1, 2002; Accepted Jul 7, 2003.




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