Obesity has become a disease of epidemic proportion having profound
negative health, psychological, and social consequences for both children
and adults in the United States. Obesity is a major risk factor for
four of the six leading causes of death in the country, including coronary
heart disease, certain types of cancer, stroke, and Type II diabetes. Psychological,
social, emotional, and health problems resulting from obesity in
children can continue into adulthood. Unfortunately, few studies have
been undertaken on childhood obesity, especially for children ages 6
The purpose of this study was to assess the prevalence of overweight
and obesity among Head Start children ages 3-4 in North Carolina and
to identify factors contributing to obesity among this group. The specific
objectives were to (1) assess the dietary habits and intake of the children,
(2) assess their exercise and lifestyle habits, (3) determine their parents’
perceptions and attitudes regarding obesity, (4) assess parental knowledge of
nutrition, and (5) determine predictors of child obesity, such as dietary
intake, exercise habits, and parents’ nutrition knowledge and attitude toward
nutrition and obesity.
The setting of the study in North Carolina is particularly important given
that children in this State have been found to be less flexible, have greater
body fat, and have poorer fitness than youth nationwide. In fact, youth in
North Carolina are more likely to be obese than other children in the
Nation as a whole.
One Head Start center in North Carolina, with 4 satellite locations,
selected for this study provided height and weight data for 244 children
ages 3-4. A survey questionnaire was administered to the parents who
agreed to participate in the study. The survey instrument contained questions
on the demographic profile of their children, their children’s dietary habits,
lifestyle/exercise habits, and food intake. In addition, parents were asked a
series of questions designed to capture their views on food intake issues,
their attitudes/perceptions/knowledge of nutrition, and their demographic
characteristics. Finally, parents were asked to maintain a 5-day log of their
children’s dietary intake, TV watching, and exercise regimen. Pre- and posttest
instruments were used to assess the effect of nutrition knowledge and
attitudes by parents before and after completion of a nutrition education
Of the 244 children whose weight and height were obtained and body
mass index (BMI) calculated, about 25 percent were overweight (at or
above the 95th percentile), 19 percent were at risk for being overweight
(85th-94th percentile), 48 percent were in the healthy range, and 8
percent were underweight. These figures tend to be higher than a 2003
national study that involved children ages 2-4.
Some 147 parents of the 244 children whose weights and heights were
obtained returned their questionnaires. However, only 109 of these surveys
were sufficiently complete for use in this study. Over one-half of their children
involved in the Head Start program were 4 years old, while the others
were 3 years old. Nearly 75 percent of the children were African-American,
while some 26 percent were of Hispanic background. Over 28 percent of the
109 children whose parents completed the surveys were classified as overweight.
Two-thirds of the overweight children were African-American.
Results of the survey showed that a majority of the children were
afraid to try new foods, regularly ate breakfast, and had good appetites.
Nearly 60 percent of the parents stated that their children often ate fruits and
vegetables (perhaps as a result of foods eaten while attending the Head Start
program). About 48 percent of the parents allowed their children to choose
their snacks when shopping for food, an item that had a strong correlation
with the BMI of these children.
As for the frequency of food intake, three of every five parents indicated
that their children often or always consumed whole milk, regular cheese,
and processed meats. Nearly one-half noted that their children always or
sometimes ate deep fried and breaded foods. Statistical analyses of the
dietary intake of children revealed that the type of food and frequency
consumed was significantly correlated with children’s BMI, especially
consumption of desserts, foods containing rich sauces and gravies, salted
nuts, chips, and doughnuts.
When the focus of the study shifted to parents’ attitudes toward nutrition,
about one-half of the parents indicated that they often made children finish
the food on their plates, offered them dessert as a way to make them finish
the food on their plates, or removed privileges from their children if they
felt they did not eat enough at mealtimes. These attitudes had a positive
correlation on the BMI of their children. Parents were then asked to
respond to 11 nutritional-knowledge multiple-choice questions. The
percentage of correct responses ranged from a low of 25 percent to a
high of 71 percent.
In order to assess the diversity of factors that might influence the BMI of
Head Start children in the study, a multiple regression model was developed
that contained eight key independent variables (children’s dietary habits,
food intake, exercise habits, and family weight status and parents’ BMI,
exercise habits, attitudes towards nutrition, and nutritional knowledge). The
results suggested that few of the variables proved significant and that the
explained variance was very low.
The results of the study offer some inkling of the factors that place
young children at risk with regard to their weight. The small sample of
Head Start children ages 3-4 revealed that many are already showing symptoms
of being overweight. Parents play a critical role in determining the
type of food their children eat and the frequency with which they eat it. But,
the study shows that parents had poor nutritional knowledge and contributed
to their children’s weight problems by allowing them to choose foods when
shopping (many which have limited nutritional value) and feeding them
foods that were high in fats and calories.