Over a third of U.S. children are overweight or obese, a drastic increase from 16% in 1974 [1
]. Overweight or obese children (those with a body mass index for age at or above the 85th percentile based on Centers for Disease Control and Prevention norms) are at an increased risk for cardiovascular, metabolic, pulmonary, gastrointestinal, and skeletal complications [2
]. Overweight and obese children are also more likely to experience psychosocial difficulties such as depressive symptoms and impairments in health-related quality of life than their nonoverweight peers [3
Between the ages of three and five, adiposity rebound occurs, and children develop the eating and physical activity behaviors that will influence their lifetime habits [6
]. As a result, the preschool years (ages 3–5 years) have been identified as a critical period in growth and obesity development. The development of childhood obesity is commonly conceptualized within an ecological framework in which family, community and social factors, social policies, and national legislation may impact a child's weight status [9
]. Within this model, child and family characteristics such as minority race and low socioeconomic status may serve as high-risk factors for obesity [9
Community-level factors that further contribute to weight status include neighborhood factors such as child-care attendance [9
]. It is estimated that 63% of children in the US under the age of five receive care outside of the home [10
]. Given the large percentage of children attending preschool and the fact that the preschool environment can influence food intake and physical activity levels [9
], it is important to examine the relationship between the preschool environment and weight status during this period.
Currently, research is limited and studies examining this link remain inconclusive. Results of a study of 1,244 grade school children indicated that limited child care attendance (0–15 hours of child care a week during ages 3–5 years) was related to a decreased risk of being overweight in grade school (ages 6–12 years) [11
]. Contrary to their hypothesis, researchers found no significant association between extensive child care attendance (>15 hours per week) and weight status in grade school [11
To our knowledge, the only other study to examine this relationship and the only study to specifically examine preschool attendance was conducted by Maher et al. [12
]. Using data obtained from participants in the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K), researchers tested the relationship between child care participation in the year prior to kindergarten entry and BMI z
-scores at kindergarten entry. Results indicated that non-Latino children attending Head Start were more likely to be obese at kindergarten entry than non-Latino children receiving home-based parent care, regardless of family income [12
Given the inconclusive state of the literature, the purpose of the current study was to examine the relationship between preschool attendance (at ages 3–5 years) and obesity at kindergarten entry in a sample of urban children (ages 5-6 years). Results of this study will further our understanding of the relationship between preschool attendance and future weight. Particularly, this study will provide additional information regarding this relationship in an exclusively urban population, which has not yet been examined. This increased understanding will facilitate the development of a more accurate empirically based model of obesity development and could provide support for improvements to public policy.
The primary aim of this study was to examine the relationships between income, race/ethnicity, and preschool attendance and weight status at kindergarten entry in a sample of urban children. Based on an ecological framework model, it was hypothesized that lower family income, minority status, and preschool attendance would be linked to overweight or obesity at kindergarten entry.