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Public Health. 2017 Aug 23;153:44-51. doi: 10.1016/j.puhe.2017.07.002. [Epub ahead of print]

Increased obesity risks for being an only child in China: findings from a nationally representative study of 19,487 children.

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Systems-oriented Global Childhood Obesity Intervention Program, Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY, USA; Department of Sociology, University of Notre Dame, Notre Dame, IN, USA.
Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, USA.
Department of Sociology, Renmin University of China, Haidian District, Beijing, China.
Department of Sociology, University of Utah, UT, USA.
Fisher Institute of Health and Well-being, College of Health, Ball State University, Muncie, IN, USA. Electronic address:



Given the rapid demographic transition and obesity growth in China, it is important to study how the large only-child population (≈100 million) might contribute to the obesity epidemic. This study evaluated associations of only-child status with weight and energy expenditure-related behaviors in China and examined how the associations may vary by sex and urbanicity.


Secondary analyses of nationally representative cross-sectional data from China Education Panel Survey: Junior Cohorts 2013-14, which included 19,487 students from 112 middle schools in 28 regions across China.


We used propensity-score-weighted multilevel models to test associations between only-child status and weight outcomes.


Compared with sibling-sons, only-sons had higher body mass index (BMI) (Beta = 0.32, P < 0.05) and higher risks of overweight (OR = 1.24, 95% CI = [1.07-1.45]) and obesity (OR = 1.29, 95% CI = [1.02-1.64]); and spent less time on TV watching (Incidence rate ratio (IRR) = 0.89, 95% CI = [0.81-0.98]), internet use (IRR = 0.87, 95% CI = [0.79-0.96]), after-school sports (IRR = 0.91, 95% CI = [0.83-0.99]), and household chores (IRR = 0.85, 95% CI = [0.80-0.92]). Overweight/obesity risks for only-sons were particularly pronounced in urban China, where only-sons were 36% more likely to be overweight and 43% more likely to be obese than sibling-sons. Only-daughters had a higher risk of obesity (OR = 1.43, 95% CI = [1.01-2.04]) than sibling-daughters. However, the association was not significant for either urban girls or rural girls examined separately. Only-daughters in rural areas spent less time helping with household chores (IRR = 0.88, 95% CI = [0.80-0.97]) than sibling-daughters.


Future childhood obesity interventions should pay special attention targeting the large young only-child population in China.


Child obesity; China; One child policy; Only child; Physical activity

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