This study examined the relationship between three types of parent-reported child maltreatment (neglect, psychological aggression, and corporal punishment) and obesity in preschool children. The study found an association between neglect in the prior year and obesity at age 3, but no association between the other two types of maltreatment and obesity. The results add to evidence that neglect and obesity may share some developmental origins related to mental health conditions. However, the study had limitations such as using parent self-reports and not examining more severe forms of abuse.

1. The association between maltreatment and obesity among preschool children Robert C Whitaker, ShannonM Phillips, Sean M Orzol, Hillary L Burdette Revieweed by: Lindsey Mullinax, Heather Jones, & Hayfa Kheiry Nov 11, 2008Psyc 308

2. Objective To determine whether child maltreatment is associated with obesity in preschool children. Information for the study was obtained from a birth cohort study of 4,898 children born between 1998 - 2000 in 20 large US cities.

3. Introduction With an interest in the primary prevention of obesity, there are few modifiable behaviors that have been shown to increase the risk of obesity. Diet and activity behaviors that lead to energy imbalance have been studied. Energy is regulated by the hypothalamus, and the hypothalamus is influenced by inputs from regions in the brain.

4. Introduction In early childhood parents are a major environmental influence. Parent - child interaction may affect children’s obesity risk. Christoffel and Forsyth reported cases of what they called “severe childhood obesity of psychological origin.” Two epidemiologic studies have demonstrated a relationship between obesity in adulthood and childhood maltreatment.

5. Introduction Data from 20 US cities was assessed to show the relationship between three types of parent reported child maltreatment and obesity at 3 years. It was hypothesized that children who experienced greater levels of maltreatment would have an increased risk of obesity. It was hypothesized that children who experienced greater levels of maltreatment would have an increased risk of obesity

6. Methods Study Design and Sample Data were obtained for the Fragile Families and Child Wellbeing Study. The cohort consisted of children born between 1998 and 2000 in 20 large US cities. The mothers were surveyed in person at the hospital after the time of birth and then approximately 1 and 3 years after delivery. At 3 years after delivery, 2,452 mothers of the original 4,898 agreed to participate in an additional in-home survey. The racial/ethnic composition was 19.3% Caucasian, 52.2% African-American, 25.4% Hispanic, and 3.1% other.

7. Childhood Obesity Height and weight measurements were taken using a protocol modeled after one established by the Centers for Disease Control and Prevention (1994). Body mass index (BMI) and BMI percentiles for age and sex were computed according to the Centers for Disease Control and Prevention 2000 growth reference. Obesity was defined as a BMI ≥ 95 th percentile. Child Maltreatment Child maltreatment was assess by the Parent-Child Conflict Tactics Scales (CTSPC). The full CTSPC contains four scales (nonviolent discipline, psychological agression, neglect, and physical assault) For the purpose of this study child maltreatment was characterized using 15 items and three scales from the CTSPC: neglect (five items), psychological aggression (five items), and five items from the corporal punishment subscale of the physical assault scale. The frequency of each type of maltreatment behavior in the prior year was analyzed using categories-ever/never for neglect and quintiles for the other two types of maltreatment.

8. Covariates The mothers’ heights and weights were also taken, using the same equipment and methods used for the children. Data on the number of children in the household, mother’s education level, and relationship status were obtained from the survey after 3 years. Household income, mother’s race/ethnicity, age, smoking status during pregnancy, and the child’s sex and birth weight were obtained at the birth survey. Statistical Analysis Each of the three types of child maltreatment were examined separately. All covariates were analyzed as categorical variables. Chi-square tests were used to determine the significance of the association between the covariates and both maltreatment and obesity. Two-way interactions between the maltreatment variable and child sex, maternal race/ethnicity and household income were also examined.

9. Results

14. Discussion This study finds… no association between obesity and the two types of child maltreatment, corporal punishment and psychological aggression. that a true association could have been missed for several reasons. that the impact of the two forms of maltreatment on obesity may occur when the types of maltreatment are of a more severe or chronic nature than was assessed.

15. a possibility that could have had an impact on obesity may have not become apparent until an older age. that the common practice of corporal punishment and psychological aggression toward preschoolers may reflect the level of the child’s gross motor activity at an age when many parental disciplinary efforts are directed at trying to shape their children’s natural impulses to explore their environment and to establish autonomy.

16. Limitations The children in the study were living in large metropolitan areas and a high proportion of the children were born to unwed parents. Mothers who were younger than the age of 18 and/or who did not speak English or Spanish were excluded. The study involved only half the original birth cohort. Measurements were based on parental self-reports and did not include measures of severe physical maltreatment or sexual abuse. There may have been unmeasured factors that confound the relationship between neglect and obesity. Unmeasured factors would include diet or activity behaviors

17. This study DID account for the factors, which have shown the strongest relationship to obesity at this age, children’s birth weight and the mother’s body mass index (BMI), race/ethnicity, education, income, and smoking status.

18. Conclusions Findings for this study indicate that 3-year old children have an increased risk of obesity if they experienced neglect in the prior year and adds to the existing evidence that mental health conditions and obesity have some shared developmental origins.

19. Resources Whitaker, R., Phillips, S., Orzol, S., & Burdette, H. (2007). The association between maltreatment and obesity among preschool children. Child Abuse and Neglect (31), 1187-1199. Miller-Perrin, Cindy. & Perrin, R.D. (2006). Child Maltreatment . Second edition. Thousand Oaks, CA: Sage.