Abstract

Child obesity poses short- and long-term health risks and may have negative social and economic consequences in

adulthood. This study uses data on 8,000 children followed from kindergarten through third grade as part of the

Early Childhood Longitudinal Study-Kindergarten Class to examine predictors of persistent childhood overweight

and associated academic and socioemotional outcomes. Results show that socioeconomic status, gender, race, and

behavioral and environmental factors influence risk of persistent overweight. The odds of children being overweight

increased 3 percent for each additional hour of television that they watched per week and 9 percent for each family

meal per week that they did not experience. Overweight children progressed less than their nonoverweight peers

did in reading and math achievement, with overweight appearing to precede academic difficulties, and were rated

lower on academic and socioemotional factors by their teachers and themselves. Academic and social costs should

be considered in assessing costs of childhood overweight and potential benefits of overweight prevention.

Ecological Predictors and

Developmental Outcomes of

Persistent Childhood Overweight

Contractor and Cooperator Report No. 42

June 2008

By Sara Gable, Jo Britt-Rankin, and Jennifer L. Krull,

University of Missouri, Columbia

This study was conducted by the University of Missouri, Columbia, under a

cooperative research contract with USDA’s Economic Research Service (ERS)

Food and Nutrition Assistance Research Program (FANRP): contract number

43-3AEM-1-80077 (ERS project representative: Joanne Guthrie). The views

expressed are those of the authors and not necessarily those of ERS or

USDA.
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Contents 

Summary.......................................................................................................................................iii 

Introduction................................................................................................................................... 1 

Data and Methods......................................................................................................................... 2 

The Early Childhood Longitudinal Study – Kindergarten Class (ECLS-K) ............................ 2 

 Child Overweight...................................................................................................................... 4 

 Study 1 and Study 2: Predictors and Outcomes ...................................................................... 5 

 Analytic Approach.................................................................................................................... 6 

Summary of Findings ................................................................................................................... 7 

 Study 1: Predictors of Childhood Overweight ......................................................................... 7 

 Study 2: Academic and Social-Emotional Consequences of Childhood Overweight.............. 8 

Child Academic Achievement ............................................................................................ 8 

 Child Social-Emotional Outcomes................................................................................... 10 

Significance.................................................................................................................................. 12 

References.................................................................................................................................... 14 

Tables .......................................................................................................................................... 17 

Figures.......................................................................................................................................... 31 
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Summary 

What Is the Issue? 

 

The rise in childhood overweight has raised concerns because of short- and long-term health 

consequences. Overweight children are at greater risk for high blood pressure and cholesterol, 

diabetes, orthopedic problems, and sleep apnea. If overweight persists and results in obesity in 

adulthood, increased physical health risks continue. In addition, obesity has been noted to have 

negative social and economic consequences for adolescents and young adults. This study 

examines predictors of persistent childhood overweight using data on 8,000 children followed 

from kindergarten through third grade as part of the Early Childhood Longitudinal StudyKindergarten Cohort. Associated academic and socio-emotional outcomes were also assessed. 

What Are the Major Findings?

Socioeconomic status, gender, and race all influenced risk of persistent overweight from 

kindergarten entry through third grade. As family socioeconomic status decreased, the odds of 

membership in the persistently overweight group increased. Of the two genders, boys were more 

likely to be members of the overweight group and, in comparison to White/Non-Hispanic 

children, children of American Indian backgrounds were also more likely to be overweight. 

Several significant gender by child race interactions also emerged. Specifically, AfricanAmerican girls were more likely to be overweight than their White/Non-Hispanic female peers, 

and Hispanic and Asian boys were more likely to be overweight than their White/Non-Hispanic 

male peers. 

Above and beyond socioeconomic and demographic factors, family and environmental factors 

also were significant. For example, for each additional hour of television children watched per 
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week, their odds of being overweight increased 3 percent and for each family meal per week that 

children did not experience, their risk for overweight increased 9 percent. Children living in 

neighborhoods rated by parents as less safe for outdoor play were also at increased risk of being 

persistently overweight. 

Overweight children progressed less well than non-overweight peers on objective measures of 

reading and math achievement, with overweight appearing to precede academic difficulties. 

Overweight children also fared less well on teacher ratings of child academic abilities and socialemotional well-being, and gave poorer self-reports of interpersonal skills and internalizing 

symptoms. 

Although many studies address the etiology and consequences of childhood overweight, few 

have examined persistently overweight children’s developmental well-being and their 

experiences at home and at school over an extended period of time. This study furthers our 

understanding of the social and environmental correlates and multifaceted developmental costs 

of persistent overweight during childhood. These social and academic costs should be 

considered, along with physical health consequences, when assessing the overall costs of 

childhood overweight and the potential benefits of reducing overweight and obesity among the 

Nation’s children. 

How Was the Study Conducted?

The Early Childhood Longitudinal Study – Kindergarten Cohort (ECLS-K) followed a nationally 

representative sample of about 20,000 children who entered kindergarten in fall 1998 through 
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fifth grade. Data were gathered directly from children, parents/guardians, classroom teachers, 

and school administrators on a wide variety of child, parent, family, and school measures. For 

this project, children were selected for whom there were complete data on height and weight 

over 4 time points spanning the period from kindergarten entry to third grade spring. The 

comprehensive, longitudinal nature of the ECLS-K provides a unique opportunity to learn more 

about the etiology and developmental consequences of early appearing and persistent childhood 

overweight. 

 

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Introduction 

 The National Health and Nutrition Examination Survey reported that rates of overweight1

among children ages 6 to 19 have tripled over the past two decades (Ogden, Flegal, Carroll, and 

Johnson, 2002), and, from 1999 to 2004, the percent of overweight children ages 6 to 11 

increased significantly from 15% to 19% (Ogden, Carroll, Curtin, McDowell, Tabak, and Flegal, 

2006). 

 Overweight during childhood is costly to individuals and is linked with chronic health 

problems. Overweight children are at greater risk for Type 2 diabetes, high blood pressure and 

cholesterol, orthopedic problems, and sleep apnea (Must and Strauss, 1999; Committee on 

Prevention of Obesity in Children and Youth, 2005). If overweight persists and results in obesity 

in adulthood, increased physical health risks continue. Along with physical health risks, 

academic difficulties (e.g., Falkner et al., 2001), poor psychosocial health (Friedlander, Larkin, 

Rosen, Palermo, and Redline, 2003; Schwimmer, Burwinkle, and Varni, 2003), behavior 

problems (Lumeng, Gannon, Cabral, Frank, and Zuckerman, 2003), and social isolation among 

peer networks (Strauss and Pollack, 2003) have also been noted to be problems associated with 

child overweight. 

Traditionally viewed as a health problem, current research shows clear associations between 

weight problems and factors in the social and physical environment (Hill, Wyatt, Reed, and 

Peters, 2003). In its simplest portrayal, overweight is an imbalance between energy intake and 

 

1

 Throughout this report, unless otherwise noted, the terms childhood overweight or obesity are defined as a Body 

Mass Index (BMI; child weight in kilograms divided by height in meters squared) at or above the 95th percentile 

(Committee on Prevention of Obesity in Children and Youth, 2005). Many experts prefer the use of the term 

“overweight” to “obesity” when describing the condition in children. 
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energy output. As straightforward as this seems, overweight is an extremely complex problem. 

Consequently, experts contend that it is the most critical public health threat facing children 

today (Committee on Prevention of Obesity in Children and Youth, 2005; Committee on 

Progress in Preventing Childhood Obesity, 2007). Reducing the prevalence of children who are 

overweight and obese has been identified as a Healthy People 2010 priority health objective by 

the Federal government (U.S. Dept of Health and Human Services, 2000). Because of its role as 

the lead Federal department for nutrition and its involvement in providing food assistance and 

nutrition education to children and their families, the problem is of special importance to USDA 

(USDA Food and Nutrition Service, 2000). 

 Because families play such an important role in socializing children’s health beliefs and 

behaviors (Sallis and Nader, 1988), identifying the family-related factors that are associated with 

weight problems is crucial for effective prevention and treatment. Moreover, establishing the 

multifaceted costs associated with overweight during the school-age years is critical to garnering 

the attention and resources required for effective prevention and intervention programs. To 

further our understanding of the etiology and outcomes of childhood overweight, two separate 

studies were conducted; the first to identify the child and family eating and activity experiences 

that distinguish overweight from non-overweight children and the second to assess the 

relationship between persistent overweight and children's development, specifically their 

academic achievement and social-emotional well-being. 

Data and Methods 

The Early Childhood Longitudinal Study – Kindergarten Class (ECLS-K)
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 The Early Childhood Longitudinal Study – Kindergarten Class (ECLS-K; West) has 

followed a nationally representative sample of about 20,000 children from kindergarten entry in 

fall 1998 through fifth grade. Conceived as a descriptive study of children's status when they 

began kindergarten and their progression through fifth grade, the study also affords the 

opportunity to explore timely questions related to children's development and well-being. Aside 

from the unusually large, representative sample, what distinguishes the ECLS-K is the study’s 

ecologically and developmentally relevant design. The ECLS-K is guided by a multi-factor 

framework of children's development and addresses the multiple settings where children spend 

time and the key agents of socialization. Data are gathered directly from children, 

parents/guardians, classroom teachers, and school administrators on a wide variety of child, 

parent, family, and school measures. Subsequently, the comprehensive, longitudinal nature of 

the ECLS-K provides a unique opportunity to learn more about the consequences of early 

appearing and persistent childhood overweight. 

 For our project, we used data gathered at kindergarten fall and spring (T1 and T2), first-grade 

spring (T3), and third grade spring (T4). At each time point, the number of children who were 

directly assessed was T1 = 19,173, T2 = 19,967, T3 = 16,593, and T4 = 14,349. Children who 

weighed less than 2000 grams at birth (n = 473) or who received extensive therapeutic services 

prior to kindergarten entry (n = 780) were excluded from the study because these characteristics 

could by themselves explain the outcomes of interest. Additionally, children who were not in 

their first year of kindergarten (n = 801) and those children who repeated or skipped a grade (n = 

935 at first grade; n = 1,325 at third grade) were deemed ineligible. Lastly, because the study 

focused on persistent overweight, only children with complete height and weight data from all 4 

time points were included. Thus, both studies began with 8,459 participants (see Table 1 for a 
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complete description of the children and their families). 

Child Overweight 

 For both studies, the 2000 Center for Disease Control Growth Charts: United States 

(Kuczmarski, Ogden, Guo et al., 2002) were used to categorize children on the basis of their 

Body Mass Index (BMI; child weight in kilograms divided by height in meters squared) as not 

overweight (< 95th percentile) or overweight ( > 95th percentile). As shown in Table 2, the 

percent of children who were overweight at each timepoint was 12%, 11%, 13%, and 18%, 

respectively. 

 For Study 1, to investigate our research questions concerning the predictors and outcomes of 

early appearing and persistent childhood overweight, we identified two mutually-exclusive 

groups: never overweight and overweight (see Table 2). Thus, we excluded from analyses 

children who were intermittently overweight [n = 459 (5% of the original 8,459 participants); see 

Table 2 for details]. Children who were not overweight (i.e., at or above the 95th percentile of 

the Body Mass Index) at any of the 4 time points comprised the never overweight group (n = 

6,643; 47% boys). Children who were overweight at all 4 time points, who became overweight 

and remained overweight during the last 2 or 3 time points, and children who were overweight at 

third grade spring comprised the overweight group (n = 1,357; 51% boys). Thus, data analyses 

focused on 8,000 children. 

 

For Study 2, to investigate the outcomes of early appearing and persistent childhood 

overweight, we identified four mutually-exclusive overweight groups defined by onset of 
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overweight: kindergarten, first grade, third grade only, and never overweight (see Table 3). 

Children who were overweight at kindergarten fall or spring and whose overweight persisted 

through third grade were members of the kindergarten group (n = 757; 50% boys). Children 

who were not overweight during kindergarten but who were overweight at first grade spring and 

were overweight at third grade spring comprised the first grade group (n = 179; 48% boys). 

Children who were not overweight during kindergarten and first grade and who were overweight 

at third grade spring made up the third grade only group (n = 421; 54% boys). Children who 

were not overweight at any of the four time points comprised the never overweight group (n = 

6,643; 47% boys). Lastly, we excluded from analyses children who were intermittently 

overweight [n = 459 (5% of the original 8,459 participants)]; thus, all analyses focused on 8,000 

children. Mean Body Mass Index percentiles are presented for the four overweight groups at 

each time point in Table 3. 

Study 1 and Study 2: Predictors and Outcomes 

 Study 1 used parent reports of children's eating and activity experiences to estimate the odds 

of being a member of the persistently overweight group (for a published version of portions of 

this study, see Gable, Chang, and Krull, 2007). Specifically, we considered child and family 

participation in USDA food and nutrition assistance programs (i.e., WIC, the School Breakfast 

and National School Lunch Programs, and the Food Stamp Program), children's television habits, 

time spent engaged in vigorous activity, opportunities for physical activity, frequency of family 

meals, and neighborhood safety for outdoor play. 

 Study 2 examined the effect of overweight on direct assessments of children's reading and 

math. In addition, it assessed teacher reports of children's socio-emotional well-being, including 
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approaches to learning, self-control, interpersonal skills, externalizing behaviors, such as fighting 

and arguing, aggression toward people and objects, and general disobedience and internalizing 

behaviors such as the expression of anxiety, loneliness, and sadness. Finally, children's selfreports of their academic competence, social skills, and externalizing and internalizing symptoms 

were examined. Results concerning the direct measures of children's academic achievement 

appear in Gable, Krull, and Srikanta (2008) and a variation of the social-emotional findings are 

currently under review for publication (Gable, Krull, and Chang, under review). Additionally, 

some of the findings from Study 2 were presented at the annual Food Assistance Research: 

Recent Findings and Emerging Issues conference. Economic Research Service, U.S. Department 

of Agriculture, Washington, DC (Gable, 2006). 

Analytic Approach 

 Because the ECLS-K data were collected using a multistage sample of kindergarten students 

nested within schools, we used multilevel random coefficient models (MLM), a class of models 

specifically designed for the analysis of clustered data structures, to explicitly acknowledge and 

accommodate the clustered data structure and produce more accurate tests of effects 

(Raudenbush and Bryk, 2002). For Study 1, an MLM analog of logistic regression (Goldstein, 

1991; Goldstein and Rasbash, 1996) was performed using the SAS macro GLIMMIX to predict 

our dichotomous outcome variable (persistent overweight versus non-overweight). 

For Study 2, we used SAS PROC MIXED (Version 8) to estimate 3-level random coefficient 

models, with error terms estimated at the school (or teacher) and child level, as well as the 

residual variation across time (Raudenbush and Bryk, 2002; Singer, 1998). When models 

revealed significant results involving child overweight, effect sizes were calculated in terms of 

Cohen's d, as per Raudenbush and Xiao-Feng (2001), to reflect the magnitude of the group 
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differences. 

For both studies, sample weights were used to produce estimates that are representative of 

the population of children attending kindergarten in 1998 – 1999. Additionally, both Study 1 

and Study 2 controlled for the anticipated effects of child race and family socio-economic status. 

 

Summary of Findings 

 

 Together, these studies yielded results that further our understanding of the etiology and 

outcomes of persistent childhood overweight. 

Study 1: Predictors of Childhood Overweight 

Study 1 identified several demographic correlates of childhood overweight. Specifically, 

boys are more likely to be members of the overweight group and, in comparison to White/NonHispanic children, children of American Indian backgrounds are also more likely to be 

overweight. Several significant gender by child race interactions also emerged. Specifically, 

African-American girls were more likely to be overweight than their White/Non-Hispanic female 

peers; and, Hispanic and Asian boys were more likely to be overweight than their White/NonHispanic male peers. And finally, family socioeconomic status was associated with child weight 

status; as SES decreased, the odds of membership in the persistently overweight group increased. 

As presented in Table 4, our univariate analyses, each of which considered a single focal 

predictor and controlled for child and family demographics, showed that children who 

participated in WIC earlier in life (WIC eligibility ends at age 5) and who participated in the 

school lunch program, who watched more hours of television, ate fewer meals with their family, 

and lived in neighborhoods that parents reported were less safe for outdoor play were more likely 
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to be members of the persistently overweight group. In the univariate analyses, child 

participation in the school breakfast program, household participation in the food stamp program, 

and child aerobic exercise and exercise experiences were not associated with an increased 

likelihood of belonging to the persistent overweight group. 

 The final step was to conduct a multivariate, multilevel logistic regression model that 

included all variables that were significant at the univariate level. The final model, presented in 

Table 5, includes those predictors that remained significant when entered as a block. Child 

participation in WIC and the school lunch program became non-significant when entered with 

the other significant predictors and were thus trimmed from the final model. Children who 

watched more television (overweight group mean = 15.94 hours, SD = 6.74; never-overweight 

group mean = 14.12 hours, SD 6.40), ate fewer meals with their families (overweight group 

mean = 9.56 meals, SD = 2.61; never-overweight group mean = 10.26 meals, SD 2.56), and who 

lived in neighborhoods that are reported by parents as less safe for outdoor play (overweight 

group mean = 2.67, SD = 0.45; never-overweight group mean = 2.74, SD 0.40), were more likely 

to be members of the persistently overweight group. For example, for each additional hour of 

television children watched per week, their odds of being overweight increased 3 percent and for 

each family meal per week that children do not experience, their risk for overweight increased 9 

percent. 

Study 2: Academic and Social-Emotional Consequences of Childhood Overweight 

Child Academic Achievement 

 Results for the multilevel individual growth models predicting direct assessments of 

children's academic achievement from kindergarten entry through third grade are shown in Table 
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6. In general, findings from the full models support our original hypothesis that overweight 

children's academic achievement differs from their never-overweight peers. Trajectories of 

children’s academic abilities revealed effects of overweight that varied with time but were 

similar for overweight boys and girls. The significant overweight by time effect indicates that 

overweight children's academic abilities were increasingly diverging, in a downward fashion, 

from those of never overweight children at each subsequent timepoint (Appendix A contains 

unadjusted means and standard deviations for children's scores on the direct assessments of 

reading and math). When compared with their never-overweight peers, children who were 

overweight for the duration of the study performed more poorly on assessments of reading and 

math skills at first grade and third grade spring. For children who became overweight at first 

grade, their reading scores were lower than their never-overweight peers' scores at third grade 

and their math scores were lower at both first and third grade spring. Interestingly, the children 

who were overweight only at third grade exhibited academic skills that resembled their neveroverweight peers. Together, the current findings suggest that overweight may precede academic 

difficulties for children between age 5.5 and 9.5 years. That is, after young, school-age children 

cross the threshold to clinical overweight (i.e., a body mass index at or above the 95th percentile), 

they are at risk for academic challenges, in this case, problems with reading and math. 

Interestingly, as shown in Table 8, children's self perceptions of their school achievement did 

not necessarily correspond with the standardized reading and math assessments; only one effect 

of overweight emerged and it was moderated by child gender. Specifically, at the end of third 

grade, boys who were overweight only at third grade and girls who had been overweight since 

kindergarten both viewed their reading abilities more poorly than their never-overweight 

classmates. No other overweight effects emerged for children's views on their academic 
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abilities. 

Child Social-Emotional Outcomes

Teacher ratings. Results from the multilevel individual growth models of teacher reports of 

child social-emotional well-being are presented in Table 7. Our findings concur with other 

studies of childhood overweight and psychosocial well-being: children with weight problems are 

not faring as well as their non-overweight peers (Falkner et al., 2001; Friedlander et al., 2003; 

Lumeng et al., 2003; Schwimmer et al., 2003; Strauss and Pollack, 2003). For instance, as 

shown in Figure 1, at all grade levels teachers rated children who were persistently overweight 

(i.e., the kindergarten group) and children who were to become overweight (i.e., the third grade 

only group) as showing less skill in taking advantage of the learning environment than their 

never-overweight peers. 

 Also shown in Table 7, several of the overweight effects were moderated by child gender. 

For teacher reports of child self-control, overweight effects were not significant for boys. 

However, as depicted in Figure 2, when compared to never-overweight females, those girls who 

were overweight from kindergarten until third grade and those girls who were overweight only at 

third grade spring were rated by teachers as showing less self-control. Overweight effects were 

also not significant for teacher ratings of boys' social skills. However, as shown in Figure 3, 

there were effects for girls. Whereas the time effects varied for the different groups of 

overweight girls, the main message is that overweight effects seemed to disappear for the 

persistently overweight girls and to worsen for girls in the third grade group over the course of 

the study. Indeed, for girls who were first overweight in the third grade, the overweight effects 

appeared prior to the onset of clinical overweight and worsened with time. 
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Teacher ratings of children's externalizing behaviors revealed an interaction among weight, 

gender, and time. As shown in Figure 4, the boys who had been overweight since kindergarten 

were rated as showing decreasing levels of externalizing behaviors. For girls, teachers rated the 

expression of externalizing behaviors similarly for the girls in the overweight and neveroverweight groups at kindergarten entry. However, by first grade, differences between 

overweight and never-overweight girls emerged, particularly for girls who had been overweight 

since kindergarten and for girls who were to be overweight at third grade spring. By third grade 

spring, the differences disappeared for the girls who had been overweight since kindergarten and 

grew more pronounced for girls who were overweight only at third grade. 

 Teacher ratings of child internalizing behaviors revealed a significant overweight group by 

gender interaction. Whereas there was no effect of overweight for boys, as shown in Figure 5, 

girls who were overweight during kindergarten and remained so until third grade spring were 

rated by teachers as exhibiting more internalizing behaviors than their non-overweight female 

peers. 

Child self-reports. Table 8 shows the findings from the multilevel models predicting 

children’s third grade self-reports of their social-emotional well-being. For two subscales, 

overweight contributed significantly and in the expected direction to children’s perceptions of 

themselves. Specifically, for children's self-reports of their interpersonal skills, the effect of 

overweight was significant for all three overweight groups. Regardless of when children's 

clinical overweight appeared, children rated themselves at third grade spring as having more 

trouble with social relationships than their never-overweight peers. Children's third-grade self-
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reports of internalizing behaviors also showed overweight effects. Children in the kindergarten 

and first grade overweight groups reported more experiences of sadness, loneliness, and anxiety 

than their never-overweight peers at third grade. Overweight group did not play a role in 

children’s self-reports of externalizing behaviors. 

Significance 

The current project contributes to our understanding of the potential causes and consequences 

of persistent childhood overweight. As prevalence rates climb, with no clear signs of abating, 

research must continue to identify windows of opportunity for intervention. Curbing the onset 

and maintenance of overweight is no easy task; overweight does not appear, or disappear, 

overnight. 

 The first study provides insights into strategies that may be employed by those seeking to 

reduce childhood obesity. Reducing television viewing and promoting family meals are 

education messages that have been employed by some nutrition education programs, such as the 

“Eat Better, Eat Together” campaign being conducted by the Washington State Nutrition 

Education Network, with funding support from USDA’s Food and Nutrition Service. These 

findings support the value of these types of messages. 

 Moreover, to garner the attention and resources necessary to confront the problem, research 

must continue investigating the implications of weight problems for children’s development and 

to document its costs. Although studies suggest that overweight interferes with quality of life in 

all domains, little is known about the developmental course of individuals who develop weight 

problems early in life. Some of the findings from Study 2 indicate that the distinction between 
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clinical overweight and larger-than-average body size is not germane to the prediction of poor 

outcomes, as negative effects precede the onset of clinical overweight, especially for girls of 

school age. Furthermore, for children who become and remain overweight early in the school 

years, the cumulative effects of small but significant decreases in school performance over time 

may have long term implications for a variety of outcomes associated with educational 

achievement. The 2006 release of the ECLS-K fifth grade data will permit follow-up 

investigation and evaluation of these trends. The studies conducted as part of this project thus 

strengthen the research base concerning the etiology and outcomes of childhood overweight. 
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1813-1819. 

Singer, J.D. (1998). Using SAS PROC MIXED to fit multilevel models, hierarchical models, 

and individual growth models. Journal of Educational and Behavioral Statistics, 24(4), 323-355. 

Strauss, R. S. and Pollack, H. A. (2003). Social marginalization of overweight children. 

Archives of Pediatric and Adolescent Medicine, 157, 746 – 752. 

United States Department of Agriculture. (September, 2000). Food and Nutrition Service 

(FNS) Strategic Plan 2000 to 2005. Washington, DC: Author. 
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U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. With 

Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, 

DC: U.S. Government Printing Office, November 2000. 

Washington State University. Eat Better, Eat Together. Accessed October 16, 2007 at: 

http://nutrition.wsu.edu/ebet/index.html. 
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Table 1. Characteristics of Children and Families at Kindergarten Fall (n = 8,459)a

Mean +SD Range

Child Age (months) 68.42 4.05 51.13 – 86.23 

 

Siblings 1.43 1.11 0 – 10 

Median Annual Income (dollars) $ 48,000 0 – $ 999,999 

 N (%) 

 

Child Gender

Boys ( = 0) 4080 (48) 

Girls ( = 1) 4379 (52) 

Child Race

White/Non-Hispanic 5296 (63) 

African-American 874 (10) 

Hispanic 1376 (16) 

Asian 440 (5) 

Native Hawaiian / Pacific Islander 129 (2) 

American Indian or Alaska Native 114 (1) 

Multi-Race (Non-Hispanic) 221 (3) 

Family Type

2 Parents + Siblings 6033 (71) 

2 Parents No Siblings 836 (10) 

1 Parent + Siblings 1030 (12) 

1 Parent No Siblings 486 (6) 

Other 74 (<1) 

Home Language (n=8,456) 

Non-English 1002 (12) 

English 7454 (88) 

 
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Table 1. (continued) 

 N (%)

Maternal Education (n=8,374) 

8th Grade or below 296 (4) 

9th to 12th Grade 526 (6) 

High School Diploma 2470 (30) 

Vocational Program 460 (5) 

Some College 2317 (28) 

Bachelor's Degree 1535 (18) 

Graduate or Professional (no degree) 187 (2) 

Master's Degree 431 (5) 

Doctorate or Professional Degree 152 (2) 

SES Categorical Measureb

 

1st Quintile (lowest) 1126 (13) 

2nd Quintile 1523 (18) 

3rd Quintile 1763 (21) 

4th Quintile 1907 (23) 

5th Quintile (highest) 2140 (25) 

Poverty Level

Below Poverty 1225 (14) 

Above Poverty 7234 (86) 

a

 Values are unweighted. 

b

 Family socioeconomic status is represented by a composite variable which uses kindergarten 

spring parent interview data, specifically maternal/female education and occupation, 

paternal/male education and occupation, and household income (see United States Department of 

Education, National Center for Education Statistics, 2001 for more details). 
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Table 2. Study 1: Prevalence of Child Overweighta: Within-Time and Longitudinally (n = 

8,459) 

K-Fall K-Spring 1st-Spring 3rd-Spring

Within-Time Overweight 999 (12) 943 (11) 1,118 (13) 1,527 (18) 

Longitudinal Overweight 

Never Overweight (n = 6643; 79%) No No No No 

Intermittently Overweight (n = 459; 5%) 

 n=83 Yes No No No 

 n=51 No Yes No No 

 n=56 No No Yes No 

 n=37 Yes Yes No No 

 n=16 Yes No Yes No 

 n=54 Yes No No Yes 

 n=11 No Yes Yes No 

 n=35 Yes Yes Yes No 

 n=52 Yes Yes No Yes 

 n=64 Yes No Yes Yes 

Early and Persistent Overweight (n= 1,357; 16%) 

n = 421 No No No Yes 

n = 179 No No Yes Yes 

n = 99 No Yes Yes Yes 

n = 658 Yes Yes Yes Yes 

 

a

 Children were categorized as overweight or not overweight on the basis of their Body Mass 

Index (BMI; child weight in kilograms divided by height in meters squared) as not overweight (< 

95th percentile) or overweight ( > 95th percentile) (Kuczmarski, Ogden, Guo et al., 2002). 
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Table 3. Study 2: Mean Body Mass Index Percentiles (and standard deviations) for Overweight 

Groups by Time (n = 8,000)a

K-Fall K-Spring 1st-Spring 3rd-Spring

Kindergarten Group 96.34 98.24 98.34 98.43 

(n = 757) (10.04) (1.34) (1.16) (1.03) 

First Grade Group 85.56 86.79 96.61 97.62 

(n = 179) (12.89) (11.62) (1.08) (1.03) 

Third Grade Group 78.29 79.26 85.15 96.60 

(n = 421) (18.30) (16.97) (13.73) (1.10) 

Never Overweight 54.55 54.08 53.27 56.44 

(n = 6,643) (26.24) (25.59) (25.76) (26.63) 

 

a

 Children who became overweight at kindergarten fall or spring and were overweight at first and 

third grade were members of the kindergarten group (n = 757); children who were not 

overweight during kindergarten but who became overweight by first grade spring and remained 

overweight at third grade spring comprised the first grade group (n = 179); and, children who 

were not overweight during kindergarten and first grade and who became overweight by third 

grade spring made up the third grade group (n = 421). Children who were not overweight at any 

of the 4 time points comprised the never overweight group (n = 6,643). 
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 Table 4. Multilevel Logistic Regression Results: Univariate Associations between Correlates 

and Childhood Overweighta

 

 γ SE OR 

Child Participation in WIC .26*** .07 1.30 

Child Participation in School Breakfast .10 .08 1.10 

Child Participation in Free/Reduced Lunch .20* .08 1.22 

Household Receipt of Food Stamps .05 .06 1.05 

Child TV Hours/Week (Mean of K, 1, 3) .03# .004 1.03 

Child Aerobic Exercise/Week (Mean of K, 3) -.03 .02 1.03 

Child Opps. for Exercise (Mean of K, 3) -.02 .03 1.02 

Family Meals/Week (Mean of K, 1, 3) -.08# .01 1.09 

Neighborhood Safety (Mean of K, 1, 3) -.23** .07 1.27 

 

a

 All univariate analyses accounted for child and family demographic covariates. 

* p < .05; ** p < .01; *** p < .001; # p < .0001 
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Table 5. Multilevel Logistic Regression Results: Multivariate Associations between Correlatesa

and Childhood Overweight (n = 7,921) 

 

 γ SE OR 

Intercept -.36 .26 

Child TV Hours/Week (Mean of K, 1, 3) .03# .004 1.03 

Family Meals/Week (Mean of K, 1, 3) -.08# .01 1.09 

Neighborhood Safety (Mean of K, 1, 3) -.19* .08 1.20 

Child Gender (0 = boy) -.14 .07 1.15 

Child Raceb

 African American -.22 .14 1.25 

 Hispanic .52# .11 1.68 

 Asian .56* .26 1.75 

 Pacific Islander .19 .36 1.21 

 American Indian .90*** .24 2.46 

 Multi-Race .04 .21 1.04 

Family SES -.13# .02 1.14 

Gender x African American . 62*** .17 1.86 

Gender x Hispanic -.37* .15 1.45 

Gender x Asian -1.35** .48 3.85 

Variance Components

School Level .42# .05 

Child .87# .01 

 

a

 Child participation in WIC and the Free/Reduced Lunch program became non-significant when 

included in the multivariate analyses. 

b

 Comparison group is White/Non-Hispanic. 

* p < .05; ** p < .01; *** p < .001; # p < .0001 
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Table 6. Multilevel Individual Growth Models of Child Academic Achievement: Direct 

Assessments (Standard Errors in Parentheses) 

 Direct Assessments 

 Reading Math 

Fixed Effects

Intercept 16.80 (0.34)*** 18.19 (0.24)*** 

Time 21.71 (0.16)*** 14.29 (0.11)*** 

Time * Time 0.94 (0.04)*** 1.34 (0.03)*** 

Overweight Groupa

 Overall F 0.40 1.46 (0.22) 

Kindergarten –0.32 (0.32) -0.38 (0.22) 

First Grade 0.20 (0.63) -0.49 (0.43) 

Third Grade 0.07 (0.42) -0.24 (0.29) 

Overweight Group * Time 

 Overall F 3.92** 4.93** 

 Kindergarten -0.36 (0.16)* -0.37 (0.13)** 

 First Grade -0.73 (0.32)* -0.65 (0.25)** 

Third Grade -0.36 (0.21) -0.12 (0.16) 

Gender 1.17 (0.18)*** -0.16 (0.13) 

Child Raceb

 African-American –1.51 (0.35)*** -1.87 (0.25)*** 

 Hispanic –2.58 (0.31)*** -2.77 (0.21)*** 

 Asian 2.75 (0.49)*** -0.15 (0.36) 

 Pacific Islander –2.07 (0.93)* -2.78 (0.67)*** 

 American Indian –3.07 (0.90)*** -1.23 (0.64) 

 

 Multi-Race –0.26 (0.58) –1.10 (0.42)** 

Family SES 2.09 (0.08)*** 1.19 (0.06)*** 
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Table 6. (continued) 

 Direct Assessments 

 Reading Math 

Variance Components

School 

 Initial Status 8.10 (0.81)*** 5.80 (0.56)*** 

 Linear Trend 10.72 (1.07)*** 4.00 (0.44)*** 

 Quadratic Trend 0.77 (0.08)*** 0.50 (0.05)*** 

 

Child (within school) 

 Initial Status 46.85 (1.13)*** 31.01 (0.71)*** 

 Linear Trend 38.09 (1.37)*** 12.28 (0.60)*** 

 Quadratic Trend 3.03 (0.10)*** 1.56 (0.06)*** 

Time (within child) 18.20 (0.25)*** 11.58 (0.15)*** 

a

 Comparison Group is Never Overweight.

b

 Comparison Group is White/Non-Hispanic. 

* p < .05; ** p < .01; *** p < .001
Cont

Univ

Table 7. Multilevel Individual Growth Models of Teacher Reports of Child Social-Emotional Well-Being (Stan

Parentheses) 

Learning Self-Control Interpersonal Externalizing 

 Skills Behaviors Fixed Effects

Intercept 2.79*** 2.96*** 2.82*** 1.77***  (0.02) (0.02) (0.02) (0.02) Time 0.06*** 0.08*** 0.13*** 0.04***  (0.01) (0.01) (0.01) (0.01) Time*Time -0.02*** -0.02*** -0.03*** -0.003  (0.003) (0.003) (0.003) (0.002) Overweight Groupa

Overall F 4.86** 0.16 0.95 1.59 

Kindergarten -0.05** -0.01 -0.03 0.06*  (0.02) (0.02) (0.03) (0.03) First Grade -0.06 -0.01 -0.04 -0.02  (0.04) (0.05) (0.05) (0.06) Third Grade -0.06** 0.02 0.03 -0.02 

 (0.02) (0.03) (0.03) (0.04) Gender 0.25*** 0.20*** 0.23*** -0.23***  (0.01) (0.01) (0.01) (0.01) Overweight Group * Time 

Overall F - - 3.87** 4.67** Kindergarten - - 0.02* -0.04***  (0.01) (0.01) First Grade - - -0.03* -0.01  (0.02) (0.02) Third Grade - - -0.01 -0.01  (0.01) (0.01) 
Cont

Univ

Table 7. (continued) 

Learning Self-Control Interpersonal Externalizing 

 Skills Behaviors Overweight Group * Gender 

Overall F - 5.02** 3.77* 0.86 

Kindergarten - -0.05* -0.06 -0.01  (0.03) (0.03) (0.04) First Grade - -0.06 0.02 0.05  (0.06) (0.07) (0.08) Third Grade - -0.15*** -0.12** 0.08 

 (0.04) (0.04) (0.05) Time * Gender - - - -0.01*  (0.00) Overweight Group * Time * Gender 

Overall F - - - 3.24* Kindergarten - - - 0.04*  (0.01) First Grade - - - 0.03  (0.03) Third Grade - - - 0.04 

 (0.02) Child Raceb African-American –0.14*** -0.20*** -0.14*** 0.20***  (0.02) (0.02) (0.02) (0.02)  Hispanic –0.03 –0.01 –0.01 –0.03  (0.02) (0.01) (0.02) (0.02)  Asian 0.16*** 0.10*** 0.05 –0.15***  (0.03) (0.03) (0.03) (0.03) 
Cont

Univ

Table 7. (continued) 

Learning Self-Control Interpersonal Externalizing 

 Skills Behaviors  Pacific Islander –0.16** -0.16*** -0.21*** 0.14**  (0.05) (0.05) (0.05) (0.05)  American Indian 0.01 –0.05 –0.05 0.06  (0.05) (0.04) (0.05) (0.05)  Multi-Race –0.02 0.003 –0.02 –0.01  (0.04) (0.03) (0.03) (0.03) Family SES 0.07*** 0.04*** 0.05*** -0.03***  (0.004) (0.004) (0.004) (0.004) Variance Components

Teacher  Initial Status 0.10*** 0.11*** 0.11*** 0.05***  (0.006) (0.006) (0.01) (0.004)  Linear Trend 0.12*** 0.12*** 0.14*** 0.06***  (0.008) (0.01) (0.01) (0.006)  Quadratic Trend 0.006*** 0.007*** 0.008*** 0.004***  (0.001) (0.001) (0.001) (0.000) Child (within teacher)  Initial Status 0.17*** 0.14*** 0.14*** 0.20***  (0.005) (0.005) (0.005) (0.005)  Linear Trend 0.15*** 0.14*** 0.15*** 0.12***  (0.008) (0.01) (0.009) (0.01)  Quadratic Trend 0.009*** 0.01*** 0.01*** 0.01***  (0.001) (0.001) (0.001) (0.000) 
Cont

Univ

Table 7. (continued) 

Learning Self-Control Interpersonal Externalizing 

 Skills Behaviors Time (within child) 0.11*** 0.11*** 0.13*** 0.09***  (0.001) (0.001) (0.002) (0.001) 

a Comparison Group is Never Overweight.

b Comparison Group is White/Non-Hispanic. 

* p < .05; ** p < .01; *** p < .001 
Cont

Univ

Table 8. Multilevel Random Coefficient Models of Child Self-Description Questionnaire (3rd Grade Spring) (St

Parentheses) 

Reading Math All Subjects Interpersonal Externalizing 

 Skills Behaviors Fixed Effects

Intercept 3.11*** 3.22*** 2.86*** 2.98*** 2.27***  (0.03) (0.03) (0.03) (0.02) (0.03) Overweight Groupa

Overall F 3.26* 1.37 0.71 6.91*** 0.97 

Kindergarten -0.03 0.03 -0.02 -0.07** 0.00  (0.03) (0.03) (0.02) (0.02) (0.02) First Grade -0.05 0.08 -0.01 -0.11* 0.08  (0.07) (0.06) (0.05) (0.05) (0.05) Third Grade -0.13** 0.04 -0.04 -0.09** 0.01 

 (0.04) 0.04 (0.03) (0.03) (0.03) Gender 0.17*** -0.20*** 0.06*** 0.08*** -0.19***  (0.01) (0.02) (0.01) (0.01) (0.01) Overweight Group * Gender 

Overall F 3.42* - - - - Kindergarten -0.07 - - - -  (0.05) First Grade 0.16 - - - -  (0.09) Third Grade 0.13* - - - - 

(0.06) 
Cont

Univ

Table 8. (continued) 

Reading Math All Subjects Interpersonal Externalizing 

 Skills Behaviors Child Raceb

 African-American 0.04 0.05 0.04* 0.07* 0.24***  (0.03) (0.03) (0.03) (0.03) (0.03)  Hispanic 0.04 0.04 0.04 -0.01 0.02  (0.02) (0.03) (0.02) (0.02) (0.02)  Asian 0.03 0.15* 0.08 -0.18*** -0.12*  (0.05) (0.06) (0.05) (0.05) (0.05)  Pacific Islander 0.08 -0.02 0.04 –0.09 0.31**  (0.09) (0.12) (0.09) (0.09) (0.09)  American Indian 0.04 -0.02 -0.06 –0.02 0.00  (0.07) (0.09) (0.07) (0.07) (0.07)  Multi-Race 0.02 0.06 0.08 -0.02 0.05  (0.05) (0.06) (0.05) (0.05) (0.05) Family SES 0.02*** -0.00 0.01 0.01 -0.08***  (0.01) (0.01) (0.01) (0.01) (0.01) Variance ComponentsTeacher 0.11*** 0.14*** 0.11*** 0.09*** 0.10***  (0.007) (0.01) (0.008) (0.006) (0.007) Child 0.33*** 0.49*** 0.33*** 0.32*** 0.33***  (0.006) (0.009) (0.006) (0.005) (0.006) a Comparison Group is Never Overweight.

b Comparison Group is White/Non-Hispanic. 

* p < .05; ** p < .01; *** p < .001 
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Figure 1. Teacher ratings of children's approaches to learning at each time point for all 

overweight groups. 

Child Approaches to Learning

Overweight (F = 4.86**)

2.9

3

3.1

3.2

3.3

3.4

3.5

K-Fall KSpring1stSpring3rdSpring

Time

Approaches to Learning

Kindergarten 1st Grade 3rd Grade Never Over

BOYS and GIRLS

K: γ = -0.05**

3rd

: γ = -0.06**

Cohen’s d: 0.09 – 0.11 
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Figure 2. Teacher ratings of girls' self-control at each time point for all overweight groups. 

Child Self-Control

Overweight * Gender (F = 5.02**)

2.9

3

3.1

3.2

3.3

3.4

3.5

K-Fall KSpring1stSpring3rdSpring

Time

Self Control: Girls

Kindergarten 1st Grade 3rd Grade Never Over

GIRLS

K: γ = -0.05*

3rd

: γ = -0.14***

Cohen’s d: 0.09 – 0.27 
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Figure 3. Teacher ratings of girls' interpersonal skills at each time point for all overweight 

groups. 

Child Interpersonal Skills

Overweight * Time (F = 3.87*) 

Overweight * Gender (F = 5.02**)

2.9

3

3.1

3.2

3.3

3.4

3.5

K-Fall KSpring1stSpring3rdSpring

Time

Interpersonal Skills: Girls

Kindergarten 1st Grade 3rd Grade Never Over

GIRLS

K: Effects at

kindergarten and 1st

grade; disappear by

3rd grade

3rd

: Effects persist

from kindergarten

entry until 3rd grade

Cohen’s d: 0.12 – 0.25 
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Figure 4. Teacher ratings of child externalizing behaviors at each time point for all overweight 

groups. 

Child Externalizing Behaviors

Overweight * Time * Gender (F = 3.24*)

GIRLS

K: Effects only at 1st

grade

3rd

: Effects emerge

at 1st grade and

persist at 3rd 1.4 grade

1.45

1.5

1.55

1.6

1.65

1.7

1.75

1.8

1.85

K-Fall KSpring1stSpring3rdSpring

Time

Externalizing Behaviors: Girls

Kindergarten 1st Grade 3rd Grade Never Over

Cohen’s d: 0.09 – 0.29 

BOYS

K: Effects only at

3rd grade (decrease)
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Figure 5. Teacher ratings of girls' internalizing behaviors at each time point for all overweight 

groups 

Child Internalizing Behaviors

Overweight * Gender (F = 2.98*)

GIRLS

K: γ = 0.10***

1.4

1.45

1.5

1.55

1.6

1.65

1.7

1.75

1.8

1.85

K-Fall K-Spring 1stSpring3rdSpring

Time

Internalizing Behaviors: Girls

Kindergarten 1st Grade 3rd Grade Never Over

Cohen’s d: 0.24 
Cont

Univ

Appendix A. Child Academic Achievement: Unadjusted Means and Standard Deviations by Time and Child W

 Kindergarten 1st Grade 3rd Grade 

 Overweight Overweight Overweight 

 (n = 757) (n = 179) (n = 421) 

 Mean (SD) Mean (SD) Mean (SD) Direct Assessments of Child: ReadingKindergarten Fall 22.05 (7.58) 23.17 (7.82) 22.24 (7.86) Kindergarten Spring 32.54 (9.31) 32.65 (9.57) 32.90 (9.46) 1st Grade Spring 56.56 (12.30) 56.03 (12.15) 56.56 (12.30) 3rd Grade Spring 108.12 (18.87) 108.94 (17.91) 108.70 (18.58) MathKindergarten Fall 19.52 (6.58) 20.17 (6.74) 19.64 (7.03) Kindergarten Spring 27.85 (8.03) 27.78 (7.84) 28.26 (8.35) 1st Grade Spring 43.52 (8.08) 43.21 (7.68) 44.10 (8.16) 3rd Grade Spring 85.13 (16.42) 84.65 (16.58) 85.64 (17.04) a Values are unweighted.