Childhood factors related to diverging body mass index trajectories from childhood into mid-adulthood: A mixed methods study. (February 2021)

• Record Type: Journal Article
• Authors: Sharman, Melanie J.; Jose, Kim A.; Tian, Jing; Venn, Alison J.; Canary, Jana; Banks, Susan; Ayton, Jennifer; Cleland, Verity J.
• Is Part Of: Social science & medicine. Volume 270(2021)
• Publication Date: 2021-02
• Subjects: Lifecourse -- Anthropometry -- Weight -- Social ecological theory -- Interviews -- Family; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2020.113460
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Body mass index (BMI) trajectories that improve over the lifecourse result in better cardiometabolic profiles, but only a small proportion of children of an unhealthy weight show improving BMI trajectories. This study aimed to examine the childhood factors related to diverging BMI trajectories from childhood into adulthood using data from the Childhood Determinants of Adult Health study. A convergent parallel mixed methods design was used. Quantitative data (n = 2206) came from the first (2004–06) and second (2009–11) adult follow-ups of 8498 Australian children (7–15 years) assessed in 1985. Using BMI z-scores, group-based trajectory modelling identified five trajectory groups: Persistently Low, Persistently Average, High Decreasing, Average Increasing and High Increasing. Qualitative data (n = 50) were collected from a sub-group (2016; 38–46 years). Semi-structured interviews with 6–12 participants from each BMI trajectory group focused on individual, social and environmental influences on weight, diet and physical activity across the lifecourse. Log multinomial regression modelling estimated relative risks of trajectory group membership across childhood demographic, behavioural, health, parental and school factors. Qualitative data were thematically analysed using a constant comparative approach. Childhood factors influenced BMI trajectories. Paternal education, main language spoken, alcohol and self-rated health were significant quantitative childhood predictors of BMI trajectory. A distinct 'legacy effect' of parental lifestyle influences during childhood was apparent among interview participants in the Stable and High Decreasing groups, a strong and mostly positive concept discussed by both men and women in these groups and persisting despite phases of unhealthy behaviours. In contrast, the 'legacy effect' was much weaker in the two Increasing BMI groups. This study is the first to simultaneously identify important quantitative and qualitative childhood factors related to divergent BMI trajectories, and to observe a legacy effect of parents' lifestyle behaviours on divergent BMI trajectories. This work provides direction for further exploration of the factors driving divergent BMI trajectories. Highlights: This study integrated quantitative prospective data with nested qualitative data. It enabled unique insights into childhood factors related to lifecourse BMI trajectories. Childhood paternal education, language, alcohol and self-rated health predicted BMI trajectory. Parental lifestyles and attitudes had lasting impacts for stable or high/decreasing BMI groups. Parents play a key role in shaping children's physical activity and diet across the lifecourse.