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Overweight and obesity in preschool aged children and risk of mental health service utilization



To determine if overweight or obesity in preschool-age children is associated with mental health service utilization in later childhood.


Overall, 10,522 children 2 to <5 years, with no previous history of mental health service utilization, were identified from primary care electronic medical records (EMRs) across Ontario, Canada.


This was a retrospective longitudinal cohort study. Height and weight data were extracted and body mass index z-scores (zBMI) were calculated using the World Health Organization Growth Standards. Mental health service utilization, between ages 5 and <19, was defined using administrative billing codes for mental health outpatient visits, emergency department visits, and hospitalizations. A multivariable Cox proportional hazards model was performed.


In total, 74.9% of children were healthy weight (zBMI between −2 and ≤1), 18.8% of children were at risk of overweight (zBMI between 1 and ≤2), 4.9% were overweight (zBMI > 2 and ≤3), and 1.5% had obesity (zBMI > 3). The median follow-up time was 2.2 years (IQR 1.0–4.2). The overall incidence rate of mental health service use was 44.5 events per 1000 person-years. The hazard ratio for girls with obesity was 2.73 (95% CI 1.62–4.60; p < 0.001) compared to girls with healthy weight. Compared to boys with healthy weight, boys ‘at risk of overweight’ and overweight were 1.22 (95% CI 1.03–1.44; p = 0.02) and 1.43 (95% CI 1.09–1.87; p = 0.01) times at higher risk of an incident mental health visit.


Our study shows an association between weight status in preschool school aged children and higher incidence of mental health service use in later childhood. This relationship was strongest in girls. Future research is needed to understand this relationship by mental health diagnosis, sex, and age.

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This research was supported by a Team Grant in Bariatric Care (Team to Address Bariatric Care in Canadian Children – Team ABC3) from the Canadian Institutes of Health Research (Institute of Nutrition, Metabolism and Diabetes). Partnership funding was also provided generously by Alberta Health Services, Alberta Innovates - Health Solutions, Canadian Obesity Network, and The Ontario Ministry of Health and Long-Term Care.

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Correspondence to Catherine S. Birken.

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Carsley, S., Tu, K., Parkin, P.C. et al. Overweight and obesity in preschool aged children and risk of mental health service utilization. Int J Obes 43, 1325–1333 (2019).

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