Prevalence and Predictors of Child Obesity in North Carolina: Implications for Head Start Programs

Year: 2005

Research Center: Southern Rural Development Center, Mississippi State University

Investigator: Okeiyi, Esther C.

Institution: North Carolina Central University

Project Contact:
Esther C. Okeiyi
Program Director
Didactic in Dietetics & Dietetic Internship Program
Department of Human Sciences
North Carolina Central University
Durham, NC 27707
Phone: 919-530-7439


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 and younger.

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 intervention program.

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.