Attachment security and obesity in US preschool-aged children.

OBJECTIVE To estimate the association between attachment security in children aged 24 months and their risk for obesity at 4½ years of age. Insecure attachment is associated with unhealthy physiologic and behavioral responses to stress, which could lead to development of obesity. DESIGN Cohort study. SETTING National sample of US children born in 2001. PARTICIPANTS Children and mothers participating in the 2003 and 2005-2006 waves of the Early Childhood Longitudinal Study, Birth Cohort, conducted by the National Center for Education Statistics. Our analytic sample included 6650 children (76.0% of children assessed in both waves). MAIN EXPOSURE Attachment security at 24 months was assessed by trained interviewers during observation in the child's home. Insecure attachment was defined as lowest quartile of attachment security, based on the security score from the Toddler Attachment Sort-45 Item. OUTCOME MEASURE Obesity at 4½ years of age (sex-specific body mass index ≥95th percentile for age). RESULTS The prevalence of obesity was 23.1% in children with insecure attachment and 16.6% in those with secure attachment. For children with insecure attachment, the odds of obesity were 1.30 (95% confidence interval, 1.05-1.62) times higher than for children with secure attachment after controlling for the quality of mother-child interaction during play, parenting practices related to obesity, maternal body mass index, and sociodemographic characteristics. CONCLUSIONS Insecure attachment in early childhood may be a risk factor for obesity. Interventions to increase children's attachment security should examine the effects on children's weight.