Academic journal article International Journal of Child and Adolescent Health

Early Childhood Obesity, Socioeconomic Status, and Executive Functioning in Atlanta Children

Academic journal article International Journal of Child and Adolescent Health

Early Childhood Obesity, Socioeconomic Status, and Executive Functioning in Atlanta Children

Article excerpt


In 2011-12, the prevalence of overweight among United States children was 14.4%, with an additional 8.4% obese, according to National Health and Nutrition Examination Survey (NHANES) data (1). Among low-income preschool children, obesity was even more common, with one child in seven obese (2). Further, a recent study by Cunningham et al (3) reported that the incidence of obesity among elementary school students was most likely to occur at younger ages. Because of the high prevalence of overweight and obesity among today's children, an association with childhood development, even if small in magnitude, could have a substantial impact on a population level. Moreover, because of the increased prevalence among lower-income children - a population already strained for academic resources and social services, the burden of an obesity/development relationship could be disproportionately borne by children with lower socioeconomic status (SES).

Executive functioning (EF) is an umbrella term for a series of distinct, but interrelated, cognitive processes responsible for thought and goal-directed behavior. While it had long been thought that EF capability developed primarily in adolescence and adulthood, recent evidence has shown that certain components - particularly those involving attentional control - begin to emerge in infancy and then develop rapidly during early childhood (4). Studies have consistently demonstrated negative associations of childhood obesity with several components of executive functioning, including inhibitory control (5, 6), reward sensitivity (7, 8), attention focus/shifting (9, 10), and working memory (11). However, the causal direction of the obesity/EF relationship remains unclear, with some suggesting that obesity is responsible for deficiencies in EF, while others believe that poor EF has led to an increase in obesity (12). Additionally, the negative impact of low socioeconomic status on the development of EF in children has been well established (13, 14).

Although research has suggested a potential negative association between obesity and EF, the majority of studies were conducted in school-aged children and adolescents when, in fact, an examination of the relationship among preschool-aged children may be important from both a developmental and an early-intervention perspective. Further, studies typically used only one obesity metric, BMI, rather than incorporating additional measures of childhood obesity. Using a population of African-American and white, 54 month-old Atlanta children, we sought to evaluate the potential association between three metrics of early childhood obesity and EF.


This analysis utilized data from the Follow-Up Development and Growth Experiences (FUDGE) Study and its precursor, the Fetal Growth and Development Study (FGDS). The FGDS was a case-control study conducted with the initial goal of developing enhanced surveillance for fetal alcohol syndrome among neonates. All African-American and white singleton infants born at one of two Atlanta-area hospitals between 2/1/93 - 12/31/94 with a gestational age of 32 - 42 weeks were eligible for the study. The first hospital, located in suburban Atlanta, was private and served primarily a white, middle-class population. The second was a public hospital located in downtown Atlanta with a largely African-American, lower SES population. Study staff collected data at hospitals in one week segments and the hospital was randomly selected without replacement from blocks of four weeks. Staff abstracted race, sex, gestational age, and birthweight from labor and delivery or nursery logs. All small for gestational age children (SGA, < 10th percentile for gender, race, and gestational age) were selected as case infants. A simple random 3% sample of all other singleton infants was included as appropriate for gestational age (AGA ≥ 10th percentile for gender, race, and gestational age) controls. The final sample size for the FGDS was 959 children. …

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