Article Text

Download PDFPDF
An ecological systems approach to examining risk factors for early childhood overweight: findings from the UK Millennium Cohort Study
  1. S S Hawkins,
  2. T J Cole,
  3. C Law,
  4. and the Millennium Cohort Study Child Health Group
  1. Centre for Paediatric Epidemiology & Biostatistics, UCL Institute of Child Health, London, UK
  1. Dr S S Hawkins, Centre for Paediatric Epidemiology & Biostatistics, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; s.hawkins{at}


Objective: To use an ecological systems approach to examine individual-, family-, community- and area-level risk factors for overweight (including obesity) in 3-year-old children.

Methods: A prospective nationally representative cohort study conducted in England, Wales, Scotland, Northern Ireland. Participants included 13 188 singleton children aged 3 years in the Millennium Cohort Study, born between 2000 and 2002, who had complete height/weight data. The main outcome measure was childhood overweight (including obesity) defined by the International Obesity TaskForce cut-offs for body mass index.

Results: 23.0% of 3-year-old children were overweight or obese. In the fully adjusted model, primarily individual- and family-level factors were associated with early childhood overweight: birthweight z-score (adjusted odds ratio, 1.36, 95% CI 1.30 to 1.42), black ethnicity (1.41, 1.11 to 1.80) (compared with white), introduction to solid foods <4 months (1.12, 1.02 to 1.23), lone motherhood (1.32, 1.15 to 1.51), smoking during pregnancy (1–9 cigarettes daily: 1.34, 1.17 to 1.54; 10–19: 1.49, 1.26 to 1.75; 20+: 1.34, 1.05 to 1.70), parental overweight (both: 1.89, 1.63 to 2.19; father only: 1.45, 1.28 to 1.63; mother only: 1.37, 1.18 to 1.58), prepregnancy overweight (1.28, 1.14 to 1.45) and maternal employment ⩾21 hours/week (1.23, 1.10 to 1.37) (compared with never worked). Breastfeeding ⩾4 months (0.86, 0.76 to 0.97) (compared with none) and Indian ethnicity (0.63, 0.42 to 0.94) were associated with a decreased risk of early childhood overweight. Children from Wales were also more likely to be overweight than children from England.

Conclusions: Most risk factors for early childhood overweight are modifiable or would allow at-risk groups to be identified. Policies and interventions should focus on parents and providing them with an environment to support healthy behaviours for themselves and their children.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding: The Millennium Cohort Study is funded by grants to Professor Heather Joshi, director of the study, from the ESRC and a consortium of government funders. SSH is funded through a Department of Health Researcher Development Award. TJC is funded through an MRC programme grant (G9827821). This work was undertaken at GOSH/UCL Institute of Child Health, which received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centres funding scheme. The study design, collection, analysis and interpretation of data, writing of the report and the decision to submit the article for publication was conducted independent of the funding sources.

  • Competing interests: None.

  • Ethics approval: The MCS received ethics approval from the South West and London Multi-Centre Research Ethics Committees for the first and second contacts respectively.

  • Other members of the Millennium Cohort Study Child Health Group who contributed to this work: C Dezateux (Professor), C Peckham (Professor), H Bedford (Senior Lecturer), J Rahi (Reader), P Cumberland (Senior Research Fellow), L J Griffiths (Senior Research Fellow), A Pearce (Research Fellow), S Bartington (PhD student), C Rich (Research Assistant), all at the Centre for Paediatric Epidemiology & Biostatistics, UCL Institute of Child Health, London, UK.