Peer-reviewed article
Caregiver Feeding Practices and Late-Preschool BMI-for-Age z-Score Trajectories Among WIC-Enrolled Children: A National Longitudinal Study.
Oudat Q, Messiah SE, Pitts S, Ghoneum A ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study followed over 2,200 children enrolled in the WIC nutrition programme from ages 2 to 5 years to understand how their weight changed and what factors influenced it. Children in the programme had high rates of excess weight, and the study found that caregiver feeding practices like restricting food or pressuring children to eat, combined with maternal weight and smoking during pregnancy, were linked to children's weight trajectories. The findings suggest that interventions targeting feeding practices and caregiver behaviours between ages 4 and 5 could help prevent obesity in this vulnerable population.
Key points
- Nearly one in five WIC-enrolled children had obesity by age 5, with prevalence rising from 15.4% to 18.5% over the study period
- Children whose caregivers restricted their eating had higher subsequent weight-for-age measurements, while pressure to eat was associated with modestly lower weight
- Maternal overweight or obesity, prenatal smoking, and adolescent maternal age were independently associated with children's higher weight trajectories
- Male children had lower weight-for-age z-scores compared to females
- The 48-60-month age period may be an optimal window for WIC-based obesity prevention interventions
Limitations
This is an observational study using complete-case analysis, so it cannot establish causation and may be subject to selection bias. The findings are specific to WIC-enrolled children in the United States and may not generalise to other populations or countries.
Abstract
Background/objectives Early childhood is an important period when growth and adiposity patterns emerge and may persist into later childhood. Children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) face elevated obesity risk. We characterized BMI-for-age z-score (BMIz) trajectories from 24 to 60 months and their child-, caregiver-, and household-level correlates. Methods This was a secondary analysis of the WIC Infant and Toddler Feeding Practices Study-2 (ITFPS-2) public-use dataset. We analyzed 5,583 BMIz observations from 2,247 dyads; adjusted models used 4,314 observations from 1,738 children. Linear mixed-effects models tested individual, interpersonal, and household predictors. Restriction and pressure-to-eat were lagged, time-varying exposures. Results Mean BMIz was elevated at all waves (0.46 to 0.56). Obesity prevalence rose from 15.4% to 18.5%. Unconditionally, BMIz was stable from 24 to 48 months and rose by 60 months. Adjusted models linked higher BMIz to higher birth weight, Hispanic or Latino ethnicity, birth complications, maternal overweight or obesity, paternal overweight, prenatal smoking, adolescent maternal age, and lower maternal education. Male sex was associated with lower BMIz. Prior-wave restriction was associated with higher, and pressure to eat with modestly lower, subsequent BMIz. Household indicators showed no independent association. Conclusions Caregiver and perinatal characteristics and feeding practices were the most consistent modifiable correlates of late-preschool BMIz. These observational, complete-case findings warrant caution. The 48-60-month window may be a promising period to target for WIC-based obesity prevention.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
Problem
Elevated obesity risk and excess weight gain among WIC-enrolled children during late preschool years
- Intervention
- Examination of caregiver feeding practices (restriction and pressure-to-eat) and their association with children's weight trajectories; analysis to identify periods and characteristics suitable for obesity prevention targeting
- Population
- 2,247 caregiver-child dyads (1,738 children in adjusted analysis) enrolled in WIC, followed from 24 to 60 months of age
Key finding
Obesity prevalence rose from 15.4% to 18.5% between ages 2 and 5 years