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Acad Pediatr. 2014 Nov-Dec;14(6):639-45. doi: 10.1016/j.acap.2014.06.009. Epub 2014 Aug 13.

What can providers learn from childhood body mass index trajectories: a study of a large, safety-net clinical population.

Author information

1
Denver Public Health, Denver Health, Denver, Colo. Electronic address: Emily.mccormick@dhha.org.
2
Department of Biostatistics and Informatics and Family Medicine, University of Colorado, Aurora, Colo.
3
Department of Pediatrics, University of Colorado, Aurora, Colo.
4
Division of General Pediatrics, Community Health Services, Denver Health, Denver, Colo.
5
Department of Pediatrics, University of Colorado, Aurora, Colo; Department of Epidemiology, University of Colorado, Aurora, Colo; Division of General Pediatrics, Community Health Services, Denver Health, Denver, Colo.
6
Denver Public Health, Denver Health, Denver, Colo; Department of Biostatistics and Informatics and Family Medicine, University of Colorado, Aurora, Colo; Department of Pediatrics, University of Colorado, Aurora, Colo.

Abstract

OBJECTIVE:

To describe childhood weight gain using body mass index (BMI) z-score trajectories in a low-income urban safety-net population and identify among gender- and race/ethnicity-specific groups any trends for increased risk.

METHODS:

A retrospective cohort study was conducted among 2- to 12-year-old patients (2006-2013) visiting a safety-net provider. BMI z-score trajectories were calculated overall, for gender- and race/ethnicity-specific groups, and for peak BMI percentile subgroups to describe weight gain longitudinally.

RESULTS:

From 2006 to 2013, a total of 26,234 eligible children were followed for an average of 3.7 years. At baseline (mean age, 4.2 years), 74% of patients were at a normal weight compared to 65% at most recent observation (mean age, 7.8 years). All gender and race/ethnicity subgroups showed increasing average BMI z-scores during childhood. Children consistently under the 50th percentile and those of white race had the most stable BMI z-score trajectories. BMI z-score increased with increasing age in all subgroups. Hispanic boys and black girls had the most significant increase in BMI z-score during this observation period. Children observed in early childhood and whose BMI exceeded the 95th percentile at any time were often already overweight (20%) or obese (36%) by 3 years of age.

CONCLUSIONS:

The entire population demonstrated an upward trend in BMI z-score trajectory. This trend was most notable among black girls and Hispanic boys. Many obese children were already overweight by age 3, and persistence of obesity after 3 years of age was high, suggesting that intervention before age 3 may be essential to curbing unhealthy weight trajectories.

KEYWORDS:

BMI; obesity; prevention; trajectory

PMID:
25129568
DOI:
10.1016/j.acap.2014.06.009
[Indexed for MEDLINE]

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