Influence of the home environment on the development of obesity in children.

CONTEXT Obesity is the most common health problem facing children. The most recent data from the National Health and Nutrition Examination Survey III suggest that 22% of children and adolescents are overweight and that 11% are obese. OBJECTIVE To investigate prospectively the association between the home environment and socioeconomic factors and the development of obesity in children. DESIGN Prospective cohort study. SETTING The National Longitudinal Survey of Youth. Population. A total of 2913 normal weight children between the ages of 0 and 8 years were followed over a 6-year period. We examined the roles of race, marital status, maternal education, family income, and parental occupation, as well as standardized measures of the home environment (The Home Observation for Measurement of the Environment [HOME]-Short Form) on the development of childhood obesity. PRIMARY OUTCOME MEASURE Incidence of obesity. Obesity was defined as a body mass index >95th percentile for age and gender at the 6-year follow-up. RESULTS Maternal obesity was the most significant predictor of childhood obesity (OR: 3.62 [2. 65-4.96]). The HOME-Short Form cognitive scores and household income were also significant predictors of childhood obesity (OR, low HOME-cognitive: 2.64 [1.48-4.70], medium HOME-cognitive: 2.32 [1. 39-3.88]; low income: 2.91 [1.66-5.08], medium income: 2.04 [1.21-3. 44]). Children who lived with single mothers were also significantly more likely to become obese by the 6-year follow-up, as were black children, children with nonworking parents, children with nonprofessional parents, and children whose mothers did not complete high school. Neither the child's gender nor the HOME-emotional scores contributed to the development of obesity. After controlling for the child's initial weight-for-height z-score, maternal body mass index, race, marital status, occupation, education, and HOME emotional scores, only the HOME cognitive score and family income remained significant predictors of childhood obesity. CONCLUSION Children with obese mothers, low family incomes, and lower cognitive stimulation have significantly elevated risks of developing obesity, independent of other demographic and socioeconomic factors. In contrast, increased rates of obesity in black children, children with lower family education, and nonprofessional parents may be mediated through the confounding effects of low income and lower levels of cognitive stimulation.