Parents play a central role in efforts to prevent obesity in early childhood. Despite what is known about how stress affects obesity and about how parenting shapes children's stress response, no studies have examined how the emotional quality of observed parent-child interaction and children's attachment security are related to obesity. The epidemiologic research proposed in this application utilizes data from two large national studies, the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B) and the NICHD Study of Early Child Care and Youth Development (SECCYD). The objective of the research is to determine how the emotional quality of early parent-child relationships affects risk for childhood obesity. The central hypothesis is that low levels of maternal sensitivity and responsiveness, children's observed negative behavior and lack of engagement with their mother, and insecure attachment, will increase children's risk for obesity before they enter elementary school, and be associated with higher weight gain into adolescence. The rationale for this research is that it will support development of new strategies to prevent obesity in early childhood. These strategies would move beyond the usual focus on diet and physical activity to target the quality of the early parent-child relationship, affecting energy balance by improving children's ability to respond to stress.
Three specific aims will be pursued corresponding to three key predictors of children's weight: 1) maternal sensitivity and responsiveness, 2) child engagement and behavior, and 3) attachment security. These aspects of parenting, child behavior, and attachment were assessed in both studies at 24 months of age using validated measures based on direct observations of parent-child interaction. Children's heights and weights were also measured repeatedly in both studies. Levels of these predictors will be examined in relation to two outcomes: 1) risk of obesity at kindergarten (in ECLS-B using logistic regression), and 2) BMI trajectory through adolescence (in SECCYD using hierarchical linear mixed effects models). A component of each aim is assessment of effect modification to investigate the extent to which associations differ by sociodemographic characteristics. The project is innovative because it applies concepts established in the field of developmental psychology to the public health challenge of childhood obesity and moves the research field beyond its current examination of obesity and parenting, which is largely focused on parenting practices that are directly related to children's food intake and activity, or parenting styles that are based on self-report. This project will identify and characterize new risk factors for early childhood obesity that focus on the emotional quality of the parent-child relationship. The proposed epidemiologic research is significant because the results can be used to improve existing obesity prevention strategies for preventing obesity before children enter elementary school. These new strategies can be expected to have an important positive impact on children's weight and energy balance while also benefiting their social and emotional development.

Public Health Relevance

The proposed research will identify new risk factors for early childhood obesity. It will provide evidence that childhood obesity is associated with the emotional quality of the relationship between the parent and the child and whether the child has secure emotional attachment to the parent. The work focuses on aspects of positive parenting that are already known from other research to produce desirable outcomes in children's social and emotional development, and adding healthy weight to these outcomes could reinforce the importance of interventions to improve parenting skills, aligning efforts in the fields of pediatrics, nutrition, child development, and public health.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
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Study Section
Kidney, Nutrition, Obesity and Diabetes (KNOD)
Program Officer
Hunter, Christine
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Ohio State University
Public Health & Prev Medicine
Schools of Public Health
United States
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Anderson, Sarah E; Andridge, Rebecca; Whitaker, Robert C (2016) Bedtime in Preschool-Aged Children and Risk for Adolescent Obesity. J Pediatr 176:17-22
Anderson, Sarah E; Lemeshow, Stanley; Whitaker, Robert C (2014) Maternal-infant relationship quality and risk of obesity at age 5.5 years in a national US cohort. BMC Pediatr 14:54
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Marino, Alexis J; Fletcher, Erica N; Whitaker, Robert C et al. (2012) Amount and environmental predictors of outdoor playtime at home and school: a cross-sectional analysis of a national sample of preschool-aged children attending Head Start. Health Place 18:1224-30
Whitaker, Robert C; Wright, Jeffrey A (2012) Why feed breast milk from a bottle? Arch Pediatr Adolesc Med 166:483-4
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Whitaker, Robert C (2010) The infancy of obesity prevention. Arch Pediatr Adolesc Med 164:1167-9