Running head: AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD

OBESITY

An Integrative Review: Parental Obesity and the Association of Childhood Obesity

Lauren Cunningham
Bon Secours Memorial College of Nursing
Nursing Research: 4122

I have neither given nor received aid, other than acknowledged, on this assignment or test, nor
have I seen anyone else do so.

AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD OBESITY

Abstract
The goal of this integrative review is to evaluate the literature regarding the association of
parental obesity status and childhood obesity from ages 5-17. There has been an increase in
childhood obesity recently, and these children carry their obesity into adulthood leading to
further health complications. Current research is conducted to evaluate risk factors and
associations that influence childhood obesity, specifically parental obesity. The research design
is an integrative review. The search for literature was conducted using the computer-based
search engines PubMed and the Nursing Reference Center within the EBSCO database. The
search yielded 42 research articles, and 5 met inclusion criteria. The results and findings analysis
of the five articles demonstrated support of the association of parental obesity influencing
childhood obesity. Findings showed that although further research is indicated, integrating
healthy lifestyle and diet as a family intervention is more effective than individual interventions.
Limitations to the review included the student's lack of experience with research, amount of time
allotted, and knowledge related to research articles. Future research should include longitudinal
studies, where a family may be studied before and after an intervention of healthy lifestyles and
diet has been implicated; therefore noticing changes in a child's obesity status after the
intervention is applied.

AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD OBESITY

An Integrative Review: School-Based Interventions

The purpose of this integrative review is to study the literature pertaining to the
association of parental obesity and how it may influence childhood obesity. Childhood obesity
has increased significantly in recent years. According to the Center for Disease Control and
Prevention (2015) childhood obesity has doubled in children and quadrupled in adolescents in
the past 30 years. Childhood obesity predisposes children to complications later in life such as
diabetes, cardiovascular disease, cancer, and joint/bone problems. In addition, childhood obesity
is associated with psychological problems such as low self-esteem and stigmatization. Healthy
lifestyle habits such as exercise, getting adequate sleep, and diet may decrease a child's risk of
becoming obese and developing some of these other complications related to obesity. In
addition, dietary and physical activity may be influenced by other areas of society such as
families, communities, school, medical care providers, and the media (CDC, 2015). Regarding
these statistics, the proposed PICO question by the researcher discussed; Are kids who have
obese parents compared to those without obese parents at a increased risk for obesity over ages
5-17?
Research Design, Search Methods, & Search Outcomes
The research design is an integrative review, a class assignment for an undergraduate
nursing program. The search for research articles was conducted utilizing the computer-based
search engines such as PubMed, EBSCO, and the Nursing Reference Center. Additionally, other
journals included Pediatric Obesity; International Association for the Study of Obesity, PLoS,
and Asia Pac J Clin Nutr Journal. The search terms included, childhood obesity, 'parental
obesity', 'BMI', 'anthropometrics', and 'adolescent obesity'. The search yielded 26 articles from
the Nursing Reference Center and 13 articles from PubMed, that were all relevant to the topic of

AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD OBESITY

parental obesity influencing childhood obesity. The researcher then found additional articles
from the International Association for the Study of Obesity, PLoS, Asia Pac J Clin Nutr Journal.
In order to remain current on the approach to this issue, the search was limited to peer-reviewed
qualitative and quantitative nursing research journal articles, written between 2009-2015 in
English. It was imperative that these research journal articles were relevant to the researcher's
PICO question, Are kids who have obese parents compared to those without obese parents at an
increased risk for obesity over ages 5-17?". From these results the articles were then further
based on results such as maternal obesity, paternal obesity, BMI, and anthropometrics. From
these results the articles were further screened based on the inclusion criteria and relevance to the
PICO question. The researcher eliminated the articles that did not meet the inclusion criteria and
relevance. The end result of these screenings provided the researcher with 5 journal articles
relevant to the PICO question.
Findings/Results
The findings and results of the five reviewed studies all indicate a positive correlation
between parental obesity and childhood obesity (Bammann et al., 2014; Durmus et al., 2012;
Fuemmele et al., 2012 ; Jiang et al., 2013; Shafaghi et al., 2014). A summation of the compiled
research articles reviewed is presented in Table 1. The researcher framed the review with the
following categories: risk factors increasing prevalence of childhood obesity, variables for
analysis, and outcomes with statistical significance.
Risk Factors Increasing Prevalence of Childhood Obesity
There was an agreement between all five studies concluding that obesity has become an
epidemic and risk factors must be identified in order to decrease the prevalence (Bammann et
al., 2014; Durmus et al., 2012; Fuemmele et al., 2012 ; Jiang et al., 2013; Shafaghi et al., 2014).

AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD OBESITY

In the qualitative study conducted by Fuemmeler et al., 2012, it was discussed that children with
two obese parents are 10 to 12 times more likely to be obese. In addition to parental obesity, the
research of Fuemmeler indicates that other socioeconomic factors including gestational age, birth
weight, and length of breast feeding have an impact of childhood weight gain. This study
specifically explored the extent to which a child's appetitive traits and parental obesity status are
associated with food intake, weight gain from birth, and BMI score at 24 months (Fuemmeler et
al., 2013). The results found that there were significant associations between parental obesity,
appetitive traits, and BMI scores (Fuemmeler et al., 2013).
The four quantitative studies discussed risk factors that the researchers believed to be
related to childhood and adolescent obesity (Johnston et al., 2010, Johnston et al., 2013,
Sacchetti et al., 2013, Williamson et al., 2012). The experimental study by Bammann et al.
(2014) investigated risk factors including gestation weight gain, smoking during pregnancy,
Caesarian section, breast feeding 4 to 11 months, maternal, and paternal obesity. A case-control
study of 1,024 completed a baseline survey (from September 2007-May 2008) that gathered
information on the children's behavior, parental attitudes, and the social microenvironment of
children. Additionally, an extensive questionnaire on health related and medical information was
obtained during the physical exam of the child. In order to evaluate the risk factors, researchers
used a conditional logistic regression model to fit the data. Statistical analysis were done with
SAS 9.2 and multivariate models. Research concluded that statistically significant risk factors
on the risk of subsequent childhood obesity include Caesarian section, gestational weight gain in
kg, maternal smoking during pregnancy, breastfeeding 4 to 11 months, parental BMI, and
educational level (Bammann et al., 2014).
Durmus et al. (2012) evaluated risk factors related to childhood obesity, such as maternal

AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD OBESITY

anthropometrics (pre-pregnancy) paternal anthropometrics, gestational weight gain and BMI.

Research was conducted and analyzed for 5,674 mother, fathers, and children. The associations
between pre-pregnancy maternal and paternal anthropometrics was assessed using linear
regression models, logistic regression models, and the F-test. The models were adjusted based
on the child's age, sex, maternal ethnicity and education, parity, and maternal smoking and
breastfeeding (Durmus et al., 2012). Results concluded that having both parents with obesity is
correlated with an increased risk of childhood obesity at the age of 4. Further research is
necessary to identify genetic and environmental influences (Durmus et al., 2012).
The experimental study conducted by Shafaghi et al. (2014) assessed the prevalence of
overweight and obesity between ages 12-14 and the correlation with parental BMI. The
researchers used a stratified multistage random sampling method including 1,189 students
between the ages 12-14. The researchers specifically addressed parental BMI, 24-hour dietary
recall of each participant, and socio-demographic background including age, sex, and birth order
which were obtained through an interview. Statistical analyses were used with SPSS 18, chisquared test, and multiple regression model (Shafaghi et al., 2014). Results indicated that a
higher proportion of male students than female students were obese. The overall prevalence of
obesity in Mashhad city was 17.2% and 11.9%. The chi-squared test revealed that the
prevalence of obesity in adolescents was increased 43.3% when both parents were obese.
Researchers summarized that the study indicated a father's BMI was more predictive of
adolescent obesity than a mother's BMI (Shafaghi et al., 2014).
Jiang et al., 2013 investigated risk factors, such as BMI of each study participant and
added covariates of age, sex, parents' educational level, number of people in the house, and
ethnicity. The study was conducted as a large-scale epidemiological survey that evaluated 5,041

AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD OBESITY

(2,872 males; 2,3969 females) Chinese children and adolescents from 6-17 in rural China
between July 2010 and January 2011. The chi-squared test and logistic regression models were
performed using SPSS version 19 software to identify statistically significant research. The
results indicated that a total of 344 children or adolescents were found to be obese resulting in a
prevalence rate of 6.82%. Overweight and obese parental weight status were associated with a
significantly higher incidence of childhood and adolescent obesity (Jiang et al., 2013). The
research also suggested that obese fathers may have a greater impact on their female children,
where as obese mothers may have a greater impact on their male children. Additionally, the
researchers focused on the importance of encouraging families to join together and to fight
obesity as an entire family, practicing healthy lifestyle and diet habits (Jiang et al., 2013).
Variables Used For Analysis
Four of the 5 research studies utilized quantitative variables to measure the risk factors
indicated in the association of parental obesity related to childhood and adolescent obesity
(Bammann et al., 2014; Durmus et al., 2012; Fuemmele et al., 2012 ; Jiang et al., 2013; Shafaghi
et al., 2014). Body mass index (BMI) was consistently identified as a risk factor in the research
articles. BMI was calculated using the student, maternal, and paternal height and weight. BMI
were adjusted and calculated based on the participant's age and sex. Parental anthropometrics
were identified and studied in two quantitative articles (Durmus et al., 2012; Shafaghi et al.,
2014). Added covariates such as age, sex, parental educational level, number of people in the
house, and ethnicity were identified in Jiang et al., 2012. Bammann et al., 2014 further identified
gestational weight gain, smoking during pregnancy, Caesarian section, breastfeeding 4 to 11
months, parental obesity and educational status as variables to childhood and adolescent obesity.
The qualitative study conducted by Fummeler et al., 2012 used measures such as

AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD OBESITY

childhood appetitive traits, a Children's Eating Behavior questionnaire, and a 24-hour dietary
recall. In addition, child BMI z-scores were assessed at 24 months and observed for children that
had two obese parents. The Children's Eating Behavior questionnaire included a child's desire to
drink (DD), enjoyment of food (EF), and satiety responsiveness (SR) (Fuemmeler et al., 2013).
Outcomes with Statistical Significance
The four quantitative studies included outcomes based on various variables including
parental BMI, child BMI, gestational weight gain, smoking during pregnancy, Caesarian section,
breastfeeding 4 to 11 months, parental obesity, parental anthropometrics and educational status
(Bammann et al., 2014; Durmus et al., 2012; Fuemmele et al., 2012 ; Jiang et al., 2013; Shafaghi
et al., 2014). The outcomes of each investigation are located in Table 1 in the conclusion
column. As showed in Table 1, 5 of the 5 studies achieved statistically significant findings in
some or all of the quantitative and qualitative variables related to childhood obesity. Durmus et
al., 2012 indicated that having both parents with obesity is associated with an increased risk of
childhood obesity at age 4. Fuemmeler et al., 2012 had similar findings that indicated when both
parents were obese this was associated with a higher BMI z-score for children. Statistically
significant results indicated that the prevalence of children with BMI z-scores exceeding 85th
percentile was 25% (higher than the national average 21%) with parents that were classified as
obese (Fuemmeler et al., 2012). Jiang et al., 2012 results showed that the greatest risk of
adolescent obesity has a significant association with adulthood obesity. Specifically, the obesity
rate in children with 2 obese parents were 3.62% times more likely to be obese. Parental eating
and lifestyle habits such as eating unhealthy, fried food, lack of exercise, and prolonged
television viewing can be associated with childhood and parental obesity (Jiang et al., 2012).
Shafaghi et al., 2014 confirmed that childhood obesity is of growing concern and is becoming a

AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD OBESITY

major health challenge in Iran. The chi-squared test revealed that the prevalence of obesity in
adolescents was increased 43.3% when both parents were obese. The results of the researchers
indicated that the number of obese adolescent is more frequently associated with well educated
and affluent parents in Iran. This research may differ from previous research conducted
(Shafaghi et al., 2014). The experimental study conducted by Bammann et al. (2014) focused
more on family impact of obesity and indicated that by reducing the prevalence of parental
obesity it would benefit and improve health among these obese children as well as their parents.
Possible prevention strategies included interventions such as diet, and other social and behavioral
factors (Bammann et al., 2014).
Discussion/Implications
The findings of the integrative review address the effects parental obesity and how it may
impact childhood and adolescent obesity. Therefore, the review findings relate to and support
the researchers PICO question. The PICO question from the researcher questioned whether
children with obese parents are more at risk for obesity compared to those without obese parents.
The qualitative study conducted by Jiang et al., 2013 indicated that children with obese parents
were 10 to 12 times more likely to be obese. The four quantitative studies showed statistical
significance in factors such as parental obesity, BMI, and parental anthropometrics being
associated with risk factors of childhood obesity (Bammann et al., 2014; Durmus et al., 2012;
Fuemmele et al., 2012 ; Jiang et al., 2013; Shafaghi et al., 2014). The four quantitative studies
also focused on an approach that identified risk factors for childhood obesity in order to decrease
the prevalence in the future. By educating families about the risk factors and teaching healthy
lifestyle changes and diet/exercise researchers anticipate that childhood obesity will not be as
widespread.

AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD OBESITY

10

The implications of the findings suggest the association of parental obesity and how it
may influence and increase the risk childhood and adolescent obesity. The researchers discuss
the importance of incorporating healthy habits as a family and not just as an individual. These
habits may decrease the incidence of childhood obesity promoting a healthy lifestyle including
exercise, a well-balanced diet, and over all healthier living.
Limitations
There are numerous limitations acknowledged by the researcher that have influenced this
integrative review. The researcher is a full time nursing student with several other assignments
and exams. Additionally the researcher works at the hospital 1 or 2 shifts a week, which adds to
time commitments. The review is a final class assignment being conducted solely by the
researcher. The assignment criteria were limited to 5 nursing journal articles within the last 6
years ranging from 2009 to 2014. This is the researchers first attempt at writing an integrative
review which may explain the lack of knowledge and experience affecting the review.
Conclusion
The findings of this integrative review reiterate the importance of identifying risk factors
to decrease childhood and adolescent obesity, as it is becoming such an epidemic across the
world. Beneficial findings from the review conclude that parental obesity is associated with a
higher risk of obesity in children and adolescents. Identifying risk factors can help to decrease
the number of obese children and adolescents. Specific to this paper, the researcher concluded
that if both parents of a child are obese, they are at an increased risk of childhood obesity. If
parents are aware that their lifestyle habits influence their children's, they may be more likely to
incorporate healthy habits as a family. Understanding the complications that childhood obesity
carries into adulthood such as diabetes, cardiovascular disease, cancer, and osteoarthritis can

AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD OBESITY

11

motivate parents to become more active advocates of maintaining a healthy habits for their
children. By decreasing the prevalence of obesity among parents, researchers hope to decrease
the number of children and adolescents that are currently considered obese.

AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD OBESITY

12

References
Bammann, K., Peplies, J., Henauw, S., Hunsberger, M., Molnar, D., Moreno, L., Tornaritis, M.,
Veidebaum, T., Ahrens, W., & Siani, A. (2014). Early life course risk factors for
childhood obesity: The IDEFICS case-control study. PLos One, 9(2). doi:
10.1371/journal.pone.0086914
Centers for Disease Control and Prevention. (2015). Adolescent and school health: Childhood
obesity facts. Retrieved on 4/25/15 from
http://www.cdc.gov/HealthyYouth/obesity/facts.htm
Durmus, B., Arends, L., Ay, L., Hokken-Koelega, A., Raaat, H., Hofman, A., Steegers A., &
Jaddoe, V. (2012). Parental anthropometrics, early growth and risk of overweight in preschool children: T generation R study. International Association for the Study of
Pediatric Obesity, 8, 339-350.
Fuemmele, B.F., Lovelady, C.A., Zucker, N.L., & Ostbye T. (2012). Parental Obesity Moderates
the Relationship Between Childhood Appetitive Traits and Weight. Pediatric Obesity, 21,
815-823. doi: 10.1002/oby.20144
Jiang, M., Yang, Y., Guo, X., & Sun, Y. (2013). Association between child and adolescent obesity
and parental weight status: A cross sectional study from rural north China. Journal of
International Medical Research, 41(4), 1326-1332. doi: 10.1177/0300060513480081
Shafaghi, K., Shariff, Z., Taib, M., Rahman, H., Mobarhan, M., & Jabbari, H. (2014). Parental
body mass index is associated with adolescent overweight and obesity in Machhad, Iran.
Asia Pac J Clin Nutr, 23(2), 225-231. doi: 10.6133/apjcn.2014.23.2.11

AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD OBESITY

NUR 4122: Nursing Research
Table of Evidence
(Parental Obesity and the Association of Childhood Obesity)
Authors
(Year)

Title of
Article

Datab
ase

Keywor
ds used
in
search

Resear
ch
Design

Data
Colle
ction

Su
bj
ect
s

Jiang,
Yang,
Guo, Sun
(2013)

Associa
tion
between
child
and
adolesc
ent
obesity
and
parental
weight
status:
A crosssectiona
l study
from
rural
north
China

PubMe
d
EBSC
O

Childho
od
obesity,
parental
obesity,
relations
hip

Quantit Quest
ative
ionna
ire
comp
leted
by
paren
ts,
inclu
ding
age,
sex/ra
ce,
paren
ts'
educa
tional
status
and
numb
er of
peopl
e in
the
house
hold.
BMI
of
each
partic
ipant
and
paren
t

Sa
m
ple
ize
:
50
41
Ch
ine
se
chi
ldr
en
ag
ed
617
an
d
bo
th
pa
re
nts
of
chi
ld.

Sam
plin
g
Met
hods
A
cross
secti
onal
epid
emio
logic
al
surv
ey
was
cond
ucte
d.
Writt
en
infor
med
cons
ent
was
obtai
ned
from
pare
nts.
Stud
y
was
not
rand
omiz
ed
and
parti

Data
Anal
ysis
Statis
tical
analy
ses,
chisquar
ed
test

Conclusio
n

study
suggests
that
families
should be
encourage
d to
improve
eating
The
habits and
obesit lifestyle
y rate change of
in
the entire
childr family.
en
greatest
with
risk of
2
adolescent
obese obesity is
paren related to
ts
significant
were association
3.62
with adult
times obesity
more
likely
to be
obese
.
The
overa
ll
child
hood
obesit
y rate

AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD OBESITY

cipa
nts
were
recru
ited
from
rural
scho
ols
in
Chin
a.

Fuemmel
e,
Lovelady
, Zucker,
& Ostbye
(2012)

Parental
Obesity
Modera
tes the
Relatio
nship
Betwee
n
Childho
od
Appetiti
ve
Traits
and
Weight

PubMe
d
EBSC
O

Childho
od
obesity,
parental
obesity,
relations
hip

Qualita
tive

was
high,
6.82
%
and
show
n to
incre
ase
signif
icantl
y
with
paren
tal
weig
ht
status
.
Child Sa Sam Multi
ren's m ple
variat
eatin ple was e
g
siz recru linear
behav e: ited
regre
ior
21 from ssion
questi 3
3
mode
onnai of large ls
re;
du obste
heigh al trics The
ts and pa clini preva
weig re cs
lence
hts;
nt for a of
fa beha childr
mi viora en
lie l
with
s
rand BMI
omiz zed
score
contr s
olled excee
trial. ding
Ther 85th
e
perce
was ntile
not a was
contr 25%

Certain
factors
such as
parental
obesity can
interact
with
childhood
appetitive
traits to
increase
risk of
childhood
obesity.

AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD OBESITY

Shafaghi
et al.
(2014)

Parental
body
mass
index is
associat
ed with
adolesc
ent
overwei
ght and
obesity
in
Mashha
d, Iran

PubMe
d
EBSC
O

Childho
od
obesity,
parental
BMI,
associati
on

Quantit
ative;
cross
section
al
study

All
meas
ured
for
heigh
t and
weig
ht;
socio
demo
graph
ic
infor
matio
n and
paren
tal
weig
ht
and
heigh
t selfreport
ed.

ol
grou
p as
all of
the
parti
cipa
nts
took
the
quest
ionn
aire
and
answ
ered
quest
ions.
Sa Strat
m ified
ple multi
siz stage
e= rand
11 om
89 samp
of ling
12
14
ye
ar
ol
ds

(high
er
than
the
natio
nal
avera
ge
21%)
with
paren
ts that
were
classi
fied
as
obese
.
SPSS
(versi
on
18);
chisquar
ed
test;
multi
ple
regre
ssion
The
chisquar
ed
test
revea
led
that
preva
lence
for
obesit
y was
43.3
%
highe

Parental
BMI
associated
with
adolescent
overweight
/obesity,
fathers
BMI was a
more
powerful
predictor
as
compared
to mothers
BMI.
*Not much
research
has been
done on
this topic
and
therefore
there is a
need to
confirm
the
findings

AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD OBESITY

Bamman
n et. al
(2014)

Early
life
course
risk
factors
for
childho
od
obesity:
the
IDEFIC
S casecontrol
study

Google
scholar
s,
PLoS

Childho
od
obesity,
parental
BMI

r for
childr
en
when
both
paren
ts
were
obese
.
Quantit Basel Ba Used Statis
ative,
ine
sel unbi tical
Experi surve ine ased analy
mental y,
sur and
sis
selfve rand with
admi y
omiz SAS
nister inc ed
9.2;
ed
lu base multi
questi de d on variat
onnai d
strat e
re by 16 um.
mode
paren ,2 Ethic ls
ts
20 al
inclu chi appr Statis
ding
ldr oval ticall
child' en was y
s
ag obtai signif
behav es ned
icant
ior,
2- from risk
paren 9. parti factor
tal
cipa s
attitu
nts.
were
des,
Ever Caesa
and
y
rian
social
parti sectio
envir
cipa n
onme
nt
(adju
nt of
was sted
child
invol OR=
.
ved
1.38,
in
95%
surv CI,
ey
1.10and
1.74),
data gestat
meas ional

through up
to date
studies.

Parental
BMI is of
particular
importance
for
childhood
obesity. It
is a factor
but also
includes
other
causal
pathways
such as
genetics,
environme
nt, and
early
interventio
ns
Maternal
and
Paternal
BMI were
strongest
risk factors
for
childhood
obesity in
this study

AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD OBESITY

urem
ent
so
no
contr
ol
was
prese
nt.

Durmus
et. al,
2012

Parental
anthrop
ometric
s, early
growth
and the
risk of
overwei
ght in
preschool
children
: the
Generat
ion R
study

PubMe
d
EBSC
O

Childho
od
obesity;
parental
anthropo
metrics;
BMI

Quantit
ative
Experi
mental

Prepr
egnan
cy
mater
al and
pater
nal
heigh
t,
weig
ht
and
body
mass
index
, and
asses

5,
67
4
m
ot
he
rs,
fat
he
rs,
an
d
the
ir
chi
ldr
en

Ques
tionn
aire
as
enrol
lmen
t into
the
stud
y.
No
contr
ol
grou
p
beca
use

weig
ht
gain
(OR=
1.48,
95%
CI,
1.082.01),
breast
feedi
ng 411mo
s
(adju
sted
OR=
0.77,
95%
CI,
0.620.96),
BMI
(OR=
1.16,
95%
CI,
1.111.20).
SPSS
;
logist
ic and
linear
regre
ssion
mode
ls; Ftest
The
stron
gest
effect
was
seen

Having
both
parents
with
obesity is
associated
with an
increased
risk of
childhood
overweight
at the age
4 years.
Further
research is
needed to
determine

AN INTEGRATIVE REVIEW: PARENTAL AND CHILDHOOD OBESITY

sment
of
anthr
opom
etric
meas
ures

all
parti
cipa
nts
infor
mati
on
was
meas
ured.

at 4
years
old.
Child
ren
with
2
obese
paren
ts had
a
stron
gly
incre
ased
risk
of
over
weig
ht at
the
age
of 4
years
(odds
ratio
6.52
(95%
CI
3.44,
12.38
).

underlying
genetic
and
environme
ntal
association
s.