An ecological systems approach to examining risk factors for early childhood overweight: findings from the UK Millennium Cohort Study

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Abstract
Objective: To use an ecological systems approach to examine individual-, family-, community- and area-level risk factors for overweight (including obesity) in 3-year-old children. Methods: A prospective nationally representative cohort study conducted in England, Wales, Scotland, Northern Ireland. Participants included 13 188 singleton children aged 3 years in the Millennium Cohort Study, born between 2000 and 2002, who had complete height/weight data. The main outcome measure was childhood overweight (including obesity) defined by the International Obesity TaskForce cut-offs for body mass index. Results: 23.0% of 3-year-old children were overweight or obese. In the fully adjusted model, primarily individual- and family-level factors were associated with early childhood overweight: birthweight z-score (adjusted odds ratio, 1.36, 95% CI 1.30 to 1.42), black ethnicity (1.41, 1.11 to 1.80) (compared with white), introduction to solid foods Conclusions: Most risk factors for early childhood overweight are modifiable or would allow at-risk groups to be identified. Policies and interventions should focus on parents and providing them with an environment to support healthy behaviours for themselves and their children.