Effects of Parent and Child Behaviours on Overweight and Obesity in Infants and Young Children From Disadvantaged Backgrounds

Systematic Review With Narrative Synthesis

Catherine Georgina Russell; Sarah Taki; Rachel Laws; Leva Azadi; Karen J. Campbell; Rosalind Elliott; John Lynch; Kylie Ball; Rachael Taylor; Elizabeth Denney-Wilson


BMC Public Health. 2016;16(151) 

In This Article


The rapid global increases in the prevalence of childhood overweight and obesity herald an urgent need to understand how to improve infant and early childhood risk for adiposity.[1,2] Overweight in infancy is important given it is likely to track into childhood[3–5]and later life.[6,7] Similarly, eating and activity habits and preferences appear to be learned in infancy and childhood,[8–10] and may also track into adolescence and adulthood.[11–13] Given this persistence and the consequent effects of adiposity across the lifespan, focusing attention on infants and young children may have benefits in the longer term.

Children from socioeconomically disadvantaged backgrounds and Indigenous families carry the burden of overweight and obesity disproportionately.[1,14] In Australia over one quarter (27 %) of children from disadvantaged backgrounds are overweight or obese compared to less than one fifth (19 %) of socioeconomically advantaged children.[15] Similar patterns are observed in the USA,[16] France,[17] the UK[18]and Canada.[19] Indigenous children are also at greater risk of overweight and obesity than their non-Indigenous peers. A recent study of urban Indigenous infants in Australia, for instance, reported that more than a third (36.9 %) of the children in that cohort were overweight or obese at two years of age, while nationally the figure is close to 20 %.[20] Understanding the most appropriate ways in which to prevent overweight and obesity in our disadvantaged groups is therefore of particular importance. Despite this, the evidence base upon which to design interventions remains poor, and there is some evidence that current obesity prevention programs may widen the disparity in obesity prevalence.[21] Further exploration of the determinants of socioeconomically patterned overweight and obesity in infancy and early childhood is required.

The reasons why children from disadvantaged backgrounds are at greater risk of becoming overweight are likely to be multifaceted, although the family environment must play a major role.[22,23] Those aspects of the family environment that are both prevalent and amenable to intervention are of greatest interest, namely parenting and dietary and physical activity behaviours. Although a range of parental feeding behaviours, such as breastfeeding, formula feeding, timing and type of solid foods introduced, parental control in feeding, parental pressure to eat or restriction in feeding[24–26] have been linked with excessive weight gain in children,[27–30] most existing research has focused on mixed populations or those of higher advantage.[24] Evaluating these behaviours in less advantaged populations appears to have been rarely examined. Similarly, although children's eating and activity habits and preferences vary by socioeconomic factors,[31–34] exactly how these behaviours explain the increased risk of obesity amongst those experiencing disadvantage is not well understood. The available literature from a range of OECD countries does point to similar predictors for these groups, with many of the behaviours associated with excess weight gain being more prevalent in these groups,[35–40] suggesting common pathways.

In summary, although there are a number of plausible pathways through which disadvantaged children may experience greater weight gain, it is presently unclear as to how parental feeding, child or infant activity and sedentary behaviours each contribute. By conducting this review we aimed to synthesize research on potential pathways through which disadvantaged infants and children aged up to 5 years and from OECD countries may experience greater weight gain. In particular, we focused on the roles of (a) parenting behaviours, (b) children's eating and (c) children's physical activity or sedentary behaviour as mechanisms for linking socioeconomic disadvantage and Indigenous status to greater weight gain in these groups. This emphasis on mechanistic pathways is intended to illuminate the most promising avenues for future interventions.