Cover: Changes in Obesity Between Fifth and Tenth Grades

Changes in Obesity Between Fifth and Tenth Grades

A Longitudinal Study in Three Metropolitan Areas

Published in: Pediatrics, v. 134, no. 6, Dec. 2014, p. 1051-1058

Posted on 2014

by Mark A. Schuster, Marc N. Elliott, Laura M. Bogart, David J. Klein, Jeremy Y. Feng, Jan Wallander, Paula Cuccaro, Susan R. Tortolero

Research Questions

  1. How closely is childhood obesity associated with adolescent obesity?
  2. How do factors such as a child's body image or a parent's weight or education influence whether children will become or remain obese in high school?

BACKGROUND: Despite epidemic childhood obesity levels, we know little about how BMI changes from preadolescence to adolescence and what factors influence changes. METHODS: We studied 3961 randomly selected public school students and 1 parent per student in 3 US metropolitan areas in fifth and again in tenth grades. In each grade, we measured child and parent height/weight and calculated BMI category. We examined whether baseline sociodemographic characteristics, child health-related factors, and parental obesity were significantly associated with exit from and entry into obesity from fifth to tenth grade. RESULTS: Fifth- and tenth-graders were 1%/2% underweight, 53%/60% normal weight, 19%/18% overweight, and 26%/20% obese, respectively. Among obese tenth-graders, 83% had been obese as fifth-graders and 13% had been overweight. Sixty-five percent of obese fifth-graders remained obese as tenth-graders, and 23% transitioned to overweight. Multivariately, obese fifth-graders who perceived themselves to be much heavier than ideal (P = .01) and those who had lower household education (P = .006) were less likely to exit obesity; by contrast, overweight fifth-graders were more likely to become obese if they had an obese parent (P < .001) or watched more television (P = .02). CONCLUSIONS: Obese fifth-graders face challenges in reducing obesity, especially when they lack advantages associated with higher socioeconomic status or when they have a negative body image. Clinicians and others should educate parents on the importance of preventing obesity very early in development. Children who are not yet obese by fifth grade but who have an obese parent or who watch considerable television might benefit from monitoring, as might children who have negative body images.

Key Findings

  • Among fifth-grade students, 1% were underweight, 53% were normal weight, 19% were overweight, and 26% were obese.
  • Two-thirds of the children who were obese in fifth grade remained obese in tenth grade; of those who were no longer obese, most were still overweight.
  • Over 80% of obese tenth-grade students were obese in fifth grade.
  • Children were more likely to remain obese through high school if they had no college graduate in their household or if they thought of themselves as overweight.
  • Overweight fifth-graders with an obese parent or who watched a lot of television were the most likely to become obese by tenth grade.


Addressing childhood obesity, which is closely associated with adult obesity, should begin at a young age. Healthy eating, physical activity, and limited screen time should be goals throughout childhood.

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