Weight transitions and psychosocial factors: A longitudinal cohort study of Finnish primary school children with overweight

Häkkänen, Paula; But, Anna; Ketola, Eeva; Laatikainen, Tiina

doi:10.1016/j.pmedr.2020.101239

Cited by 4 publications

(8 citation statements)

References 35 publications

(24 reference statements)

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“…Therefore, though unobserved, the child must have progressed to an overweight status first. This assumption is consistent with existing studies on childhood BMI transitions [ 9 , 10 ]. Consequently, our four-state model consisted of six possible transitions: underweight to healthy weight; healthy weight to underweight; healthy weight to overweight; overweight to healthy weight; overweight to obesity; and obesity to overweight.…”

Section: Methodssupporting

confidence: 92%

“…However, their analysis was not based on a nationally representative study population and did not validate results in the relevant population. Other continuous-time MSM studies relied on small sample sizes (507 [ 9 ], 928 [ 12 ], 1653 [ 8 ], and 2334 children [ 17 ]) that were not representative of the population from which they were drawn. These gaps constrain the robustness of comparisons with estimates from our analyses.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, transition probabilities have been assumed to be homogeneous throughout the course of childhood without justification or robust testing and validation [ 8 – 10 , 12 , 17 ]. Further, studies have been based on restricted sample sizes and age groups [ 8 – 10 , 12 ] and unrepresentative samples [ 8 , 9 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Childhood Transitions Between Weight Status Categories: Evidence from the UK Millennium Cohort Study

Onyimadu,

Astbury,

Achana

et al. 2024

PharmacoEconomics

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Background Assessing the cost-effectiveness of interventions targeting childhood excess weight requires estimates of the hazards of transitioning between weight status categories. Current estimates are based on studies characterized by insufficient sample sizes, a lack of national representativeness, and untested assumptions. Objectives We sought to (1) estimate transition probabilities and hazard ratios for transitioning between childhood weight status categories, (2) test the validity of the underlying assumption in the literature that transitions between childhood bodyweight categories are time-homogeneous, (3) account for complex sampling procedures when deriving nationally representative transition estimates, and (4) explore the impact of child, maternal, and sociodemographic characteristics. Methods We applied a multistate transition modeling approach accounting for complex survey design to UK Millennium Cohort Study (MCS) data to predict transition probabilities and hazard ratios for weight status movements for children aged 3–17. Surveys were conducted at ages 3 (wave 2 in 2004), 5 (wave 3 in 2006), 7 (wave 4 in 2008), 11 (wave 5 in 2012), 14 (wave 6 in 2015), and 17 (wave 7 in 2018) years. We derived datasets that included repeated body mass index measurements across waves after excluding multiple births and children with missing or implausible bodyweight records. To account for the stratified cluster sample design of the MCS, we incorporated survey weights and jackknife replicates of survey weights. Using a validation dataset from the MCS, we tested the validity of our models. Finally, we estimated the relationships between state transitions and child, maternal, and sociodemographic factors. Results The datasets for our primary analysis consisted of 10,399 children for waves 2–3, 10,729 for waves 3–4, 9685 for waves 4–5, 8593 for waves 5–6, and 7085 for waves 6–7. All datasets consisted of roughly equal splits of boys and girls. Under the assumption of time-heterogeneous transition rates (our base-case model), younger children (ages 3–5 and 5–7 years) had significantly higher annual transition probabilities of moving from healthy weight to overweight (0.033, 95% confidence interval [CI] 0.026–0.041, and 0.027, 95% CI 0.021–0.033, respectively) compared to older children (0.015, 95% CI 0.012–0.018, at ages 7–11; 0.018, 95% CI 0.013–0.023, at ages 11–14; and 0.018, 95% CI 0.013–0.025 at ages 14–17 years). However, the resolution of unhealthy weight was more strongly age-dependent than transitions from healthy weight to non-healthy weight states. Transition hazards differed by child, maternal, and sociodemographic factors. Conclusions Our models generated estimates of bodyweight status transitions in a representative UK childhood population. Compared to our scenario models (i.e., time-homogeneous transition rates), our base-case model fits the observed data best, indicating a non-time-homogeneous pattern in transitions between bodyweight categories during childhood. Transition hazards varied significantly by age and across subpopulations, suggesting that conducting subgroup-specific cost-effectiveness analyses of childhood weight management interventions will optimize decision-making.

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Section: Methodssupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Childhood Transitions Between Weight Status Categories: Evidence from the UK Millennium Cohort Study

Onyimadu,

Astbury,

Achana

et al. 2024

PharmacoEconomics

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“…The same pattern has also been noted in adults 27 . Other factors relating to childhood insecurity and a lack of basic needs include having a missing or disinterested parent, and having divorced or single parents 87,88 . Insecure attachment has been linked with both eating pathology and excessive weight gain in preadolescents 89,90 .…”

Section: The Integrating Modelmentioning

confidence: 64%

“… 27 Other factors relating to childhood insecurity and a lack of basic needs include having a missing or disinterested parent, and having divorced or single parents. 87 , 88 Insecure attachment has been linked with both eating pathology and excessive weight gain in preadolescents. 89 , 90 Particularly harmful social exposures are childhood abuse, maltreatment, neglect and trauma, 9 which strongly promote insecurity and chronic stress, and which are consistently linked with obesity and a plethora of health‐damaging issues.…”

Section: The Integrating Modelmentioning

confidence: 99%

The social origins of obesity within and across generations

et al. 2022

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We propose a model for obesity development that traces a considerable part of its origins to the social domain (mainly different forms of prolonged social adversity), both within and across generations, working in tandem with a genetic predisposition.To facilitate overview of social pathways, we place particular focus on three areas that form a cascading sequence: (A) social adversity within the family (parents having a low education, a low social position, poverty and financial insecurity; offspring being exposed to gestational stress, unmet social and emotional needs, abuse, maltreatment and other negative life events, social deprivation and relationship discord);(B) increasing levels of insecurity, negative emotions, chronic stress, and a disruption of energy homeostasis; and (C) weight gain and obesity, eliciting further social stress and weight stigma in both generations. Social adversity, when combined with genetic predisposition, thereby substantially contributes to highly effective transmission of obesity from parents to offspring, as well as to obesity development within current generations. Prevention efforts may benefit from mitigating multiple types of social adversity in individuals, families, and communities, notably poverty and financial strain, and by improving education levels.

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Transition patterns of weight status: A cohort study of Chinese school-age children

Tan²,

Wang³

et al. 2022

Front. Public Health

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BackgroundChildhood overweight and obesity are increasing public concerns. However, little is known about the transition patterns of childhood weight status, especially in developing countries. In this study, we aimed to evaluate patterns of change in weight status and the risk factors among Chinese school-age children.MethodsThis retrospective cohort study included 2,334 children aged 6 years with complete 5-year (2012–2017) physical examination data in Minhang District, Shanghai. A time-homogeneous three-state Markov model was fit to the longitudinal data with dynamic outcomes (normal weight, overweight, and obesity).ResultsAccording to the Markov model, 42.3% of school-age children who were initially overweight transitioned to another weight status within 1 year, with 24.8% (95% confidence interval [CI]: 23.1, 27.0) transitioning to normal weight and 17.5% (95% CI: 15.9, 19.3) becoming obese. In contrast, children who were initially normal weight (92.9% [95% CI: 92.3, 93.5]) or obese (83.1% [95% CI: 81.1, 84.8]) tended to maintain their initial weight status. Male sex, semi-urban area, absence of late adiposity rebound, lower annual height increments, higher annual weight increments, and higher initial body mass index were significantly associated with a higher risk of developing or maintaining overweight and obesity (p < 0.05).ConclusionsThe weight status of Chinese school-age children is more likely to change among those who are initially overweight than in those who are initially obese. Interventions to promote healthy weight status may be more effective if key groups are targeted, such as overweight and pre-school-age children.

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Weight transitions and psychosocial factors: A longitudinal cohort study of Finnish primary school children with overweight

Cited by 4 publications

References 35 publications

Childhood Transitions Between Weight Status Categories: Evidence from the UK Millennium Cohort Study

Childhood Transitions Between Weight Status Categories: Evidence from the UK Millennium Cohort Study

The social origins of obesity within and across generations

Transition patterns of weight status: A cohort study of Chinese school-age children

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