WHAT'S KNOWN ON THIS SUBJECT:The quality of the relationship between mother and child affects the child' s neurodevelopment, emotion regulation, and stress response. Extreme or sustained stress responses are associated with dysregulation of physiologic systems involved in energy balance, which could lead to obesity. WHAT THIS STUDY ADDS:The prevalence of obesity in adolescence was more than twice as high among those youth who in early childhood had poor-quality relationships with their mothers compared with those with better relationships. abstract OBJECTIVE: The goal of this study was to determine whether obesity in adolescence is related to the quality of the early maternal-child relationship. METHODS:We analyzed data from 977 of 1364 participants in the Study of Early Child Care and Youth Development. Child attachment security and maternal sensitivity were assessed by observing mother-child interaction at 15, 24, and 36 months of age. A maternal-child relationship quality score was constructed as the number of times across the 3 ages that the child was either insecurely attached or experienced low maternal sensitivity. Adolescent obesity was defined as a measured BMI $95th percentile at age 15 years. RESULTS:Poor-quality maternal-child relationships (score: $3) were experienced by 24.7% of children compared with 22.0% who, at all 3 ages, were neither insecurely attached nor exposed to low maternal sensitivity (score: 0). The prevalence of adolescent obesity was 26.1%, 15.5%, 12.1%, and 13.0% for those with risk scores of $3, 2, 1, and 0, respectively. After adjustment for gender and birth weight, the odds (95% confidence interval) of adolescent obesity was 2.45 (1.49-4.04) times higher in those with the poorest quality early maternal-child relationships (score: $3) compared with those with the highest quality (score: 0). Low maternal sensitivity was more strongly associated with obesity than insecure attachment.CONCLUSIONS: Poor quality of the early maternal-child relationship was associated with a higher prevalence of adolescent obesity. Interventions aimed at improving the quality of maternal-child interactions should consider assessing effects on children' s weight and examining potential mechanisms involving stress response and emotion regulation.

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IntroductionDespite attention to the health of low-income children in Head Start, little is known about the health of adults working for the program. The objective of our study was to compare the physical and mental health of women working in Pennsylvania Head Start programs with the health of US women who have similar sociodemographic characteristics.MethodsWe used data from a web-based survey in 2012 in which 2,199 of 3,375 (65.2%) staff in 66 Pennsylvania Head Start programs participated. For the 2,122 female respondents, we determined the prevalence of fair or poor health status, frequent (≥14 d/mo) unhealthy days, frequent (≥10 d/y) work absences due to illness, diagnosed depression, and 3 or more of 6 physical health conditions. We compared these prevalences with those found in 2 national samples of employed women of similar age, education, race/ethnicity, and marital status.ResultsAmong Head Start staff, 85.7% were non-Hispanic white, 62.4% were married, and 60.3% had completed college. The prevalence (% [95% confidence interval]) of several health indicators was higher in Head Start staff than in the national samples: fair or poor health (14.6% [13.1%–16.1%] vs 5.1% [4.5%–5.6%]), frequent unhealthy days (28.3% [26.3%–30.2%] vs 14.5% [14.1%–14.9%]), diagnosed depression (23.5% [21.7%–25.3%] vs 17.6% [17.1%–18.0%]), and 3 or more physical health conditions (21.8% [20.0%–23.6%] vs 12.6% [11.7%–13.5%]).ConclusionWomen working with children in Head Start programs have poorer physical and mental health than do US women who have similar sociodemographic characteristics.

To describe obesity prevention practices and environments in Head Start, the largest federally funded early childhood education program in the United States. Design: Self-administered survey as part of the Study of Healthy Activity and Eating Practices and Environments in Head Start (SHAPES).

Head Start provides early childhood education to nearly one million low-income children, through federal grants to more than 2,000 local programs. About one-third of children who enter Head Start are overweight or obese. But program directors face difficulty in implementing policies and practices to address obesity-and in our national survey, they identified the key barriers as lack of time, money, and knowledge. Also, parents and staff sometimes shared cultural beliefs that were inconsistent with preventing obesity, such as the belief that heavier children are healthier. Minimizing those barriers will require federal resources to increase staff training and technical assistance, develop staff wellness programs, and provide healthy meals and snacks.

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