Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Pediatrics

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

International Journal of Obesity volume 43, pages 1325–1333 (2019)Cite this article

Subjects

Abstract

Objective

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

Subjects

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

References

  1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. J Am Med Assoc. 2014;311:806–14.

    Article  CAS  Google Scholar 

  2. Rodd C, Sharma AK. Recent trends in the prevalence of overweight and obesity among Canadian children. CMAJ. 2016;188:313–320.

    Article  Google Scholar 

  3. Singh AS, Mulder C, Twisk JW, van Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9:474–88.

    Article  CAS  Google Scholar 

  4. Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997;337:869–73.

    Article  CAS  Google Scholar 

  5. Skinner AC, Perrin EM, Moss LA, Skelton JA. Cardiometabolic risks and severity of obesity in children and young adults. N Engl J Med. 2015;373:1307–17.

    Article  Google Scholar 

  6. Gilliland FD, Berhane K, Islam T, McConnell R, Gauderman WJ, Gilliland SS, et al. Obesity and the risk of newly diagnosed asthma in school-age children. Am J Epidemiol. 2003;158:406–15.

    Article  Google Scholar 

  7. Puder JJ, Munsch S. Psychological correlates of childhood obesity. Int J Obes. 2010;34:S37–43. Suppl 2

    Article  Google Scholar 

  8. Hering E, Pritsker I, Gonchar L, Pillar G. Obesity in children is associated with increased health care use. Clin Pediatr. 2009;48:812–8.

    Article  Google Scholar 

  9. Lynch BA, Finney Rutten LJ, Jacobson RM, Kumar S, Elrashidi MY, Wilson PM. et al. Health Care Utilization by Body Mass Index in a Pediatric Population. Acad Pediatr. 2015;15:644–650.

    Article  Google Scholar 

  10. Turer CB, Lin H, Flores G. Health status, emotional/behavioral problems, health care use, and expenditures in overweight/obese US children/adolescents. Acad Pediatr. 2013;13:251–8.

    Article  Google Scholar 

  11. Au N. The health care cost implications of overweight and obesity during childhood. Health Serv Res. 2012;47:655–76.

    Article  Google Scholar 

  12. Kirk SF, Kuhle S, Ohinmaa A, Colman I, Veugelers PJ. Health care utilization from prevalent medical conditions in normal-weight, overweight, and obese children. J Pediatr. 2012;160:216–21 e1.

    Article  Google Scholar 

  13. MASEF Team. The mental health of children and youth in Ontario: 2017 scorecard. Toronto, ON: Institute for Clinical Evaluative Sciences; 2017.

  14. Government of Ontario. Open minds, healthy minds: Ontario’s Comprehensive Mental Health and Addictions Strategy. Accessed on 12 January 2015. http://www.health.gov.on.ca/en/common/ministry/publications/reports/mental_health2011/mentalhealth.aspx2011

  15. Erhart M, Herpertz-Dahlmann B, Wille N, Sawitzky-Rose B, Holling H, Ravens-Sieberer U. Examining the relationship between attention-deficit/hyperactivity disorder and overweight in children and adolescents. Eur Child Adolesc Psychiatry. 2012;21:39–49.

    Article  Google Scholar 

  16. Anderson SE, Cohen P, Naumova EN, Jacques PF, Must A. Adolescent obesity and risk for subsequent major depressive disorder and anxiety disorder: prospective evidence. Psychosom Med. 2007;69:740–7.

    Article  Google Scholar 

  17. Farrant B, Utter J, Ameratunga S, Clark T, Fleming T, Denny S. Prevalence of severe obesity among New Zealand adolescents and associations with health risk behaviors and emotional well-being. J Pediatr. 2013;163:143–9.

    Article  Google Scholar 

  18. Halfon N, Larson K, Slusser W. Associations between obesity and comorbid mental health, developmental, and physical health conditions in a nationally representative sample of US children aged 10 to 17. Acad Pediatr. 2013;13:6–13.

    Article  Google Scholar 

  19. Mustillo S, Worthman C, Erkanli A, Keeler G, Angold A, Costello EJ. Obesity and psychiatric disorder: developmental trajectories. Pediatrics. 2003;111(4 Pt 1):851–9.

    Article  Google Scholar 

  20. Morrison KM, Shin S, Tarnopolsky M, Taylor VH. Association of depression & health related quality of life with body composition in children and youth with obesity. J Affect Disord. 2014;172C:18–23.

    Google Scholar 

  21. Janicke DM, Harman JS, Kelleher KJ, Zhang J. The association of psychiatric diagnoses, health service use, and expenditures in children with obesity-related health conditions. J Pediatr Psychol. 2009;34:79–88.

    Article  Google Scholar 

  22. Tu K, Mitiku TF, Ivers NM, Guo H, Lu H, Jaakkimainen L, et al. Evaluation of Electronic Medical Record Administrative data Linked Database (EMRALD). Am J Manag Care. 2014;20:e15–21.

    PubMed  Google Scholar 

  23. Schwartz KL, Tu K, Wing L, Campitelli MA, Crowcroft NS, Deeks SL, et al. Validation of infant immunization billing codes in administrative data. Hum Vaccin Immunother. 2015;11:1840–7.

    Article  Google Scholar 

  24. WHO Multicentre Growth Reference Study Group WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl. 2006;450:76–85.

  25. Smith N, Coleman KJ, Lawrence JM, Quinn VP, Getahun D, Reynolds K, et al. Body weight and height data in electronic medical records of children. Int J Pediatr Obes. 2010;5:237–42.

    Article  Google Scholar 

  26. WHO Expert Committee. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995;854:1–452.

    Google Scholar 

  27. Steele LS, Glazier RH, Lin E, Evans M. Using administrative data to measure ambulatory mental health service provision in primary care. Med Care. 2004;42:960–5.

    Article  Google Scholar 

  28. Kisely S, Lin E, Lesage A, Gilbert C, Smith M, Campbell LA, et al. Use of administrative data for the surveillance of mental disorders in 5 provinces. Can J Psychiatry. 2009;54:571–5.

    Article  Google Scholar 

  29. Aris IM, Chen LW, Tint MT, Pang WW, Soh SE, Saw SM, et al. Body mass index trajectories in the first two years and subsequent childhood cardio-metabolic outcomes: a prospective multi-ethnic Asian cohort study. Sci Rep. 2017;7:8424.

    Article  CAS  Google Scholar 

  30. Chiu M, Amartey A, Wang X, Kurdyak P. Ethnic differences in mental health status and service utilization: a population-based study in Ontario, Canada. Can J Psychiatry. 2018;63:481–491.

    Article  Google Scholar 

  31. Tu AW, Masse LC, Lear SA, Gotay CC, Richardson CG. Body mass index trajectories from ages 1 to 20: results from two nationally representative canadian longitudinal cohorts. Obesity (Silver Spring). 2015;23:1703–11.

    Article  Google Scholar 

  32. Shah BR, Chiu M, Amin S, Ramani M, Sadry S, Tu JV. Surname lists to identify South Asian and Chinese ethnicity from secondary data in Ontario, Canada: a validation study. BMC Med Res Methodol. 2010;10:42.

    Article  Google Scholar 

  33. Vézina M, Maheux, H. Ethnic and cultural origins of Canadians: portrait of a rich heritage. Ottawa: Statistics Canada; 2017. Contract No.: Catalogue no. 98-200-X2016016

  34. The Johns Hopkins University Bloomberg School of Public Health. The Johns Hopkins ACG Case-Mix System Documentation & Application Manual Version 5. 0. In: Jonathan P. Weiner. Baltimore, MD: Johns Hopkins University; 2001.

  35. Estabrooks PA, Shetterly S. The prevalence and health care use of overweight children in an integrated health care system. Arch Pediatr Adolesc Med. 2007;161:222–7.

    Article  Google Scholar 

  36. Sanderson K, Patton GC, McKercher C, Dwyer T, Venn AJ. Overweight and obesity in childhood and risk of mental disorder: a 20-year cohort study. Aust N Z J Psychiatry. 2011;45:384–92.

    Article  Google Scholar 

  37. Viner RM, Cole TJ. Adult socioeconomic, educational, social, and psychological outcomes of childhood obesity: a national birth cohort study. BMJ. 2005;330:1354.

    Article  Google Scholar 

  38. Herva A, Laitinen J, Miettunen J, Veijola J, Karvonen JT, Laksy K, et al. Obesity and depression: results from the longitudinal Northern Finland 1966 Birth Cohort Study. Int J Obes. 2006;30:520–7.

    Article  CAS  Google Scholar 

  39. Lumeng JC, Miller AL, Horodynski MA, Brophy-Herb HE, Contreras D, Lee H, et al. Improving self-regulation for obesity prevention in head start: a randomized controlled trial. Pediatrics. 2017;139 https://doi.org/10.1542/peds.2016-2047.

    Article  Google Scholar 

  40. Wen LM, Baur LA, Simpson JM, Rissel C, Wardle K, Flood VM. Effectiveness of home based early intervention on children’s BMI at age 2: randomised controlled trial. BMJ. 2012;344:e3732.

    Article  Google Scholar 

  41. Griffiths LJ, Dezateux C, Hill A. Is obesity associated with emotional and behavioural problems in children? Findings from the Millennium Cohort Study. Int J Pediatr Obes. 2011;6:e423–32. (2-2)

    Article  Google Scholar 

  42. Sawyer MG, Miller-Lewis L, Guy S, Wake M, Canterford L, Carlin JB. Is there a relationship between overweight and obesity and mental health problems in 4- to 5-year-old Australian children? Ambul Pediatr. 2006;6:306–11.

    Article  Google Scholar 

  43. Hebebrand J, Herpertz-Dahlmann B. Psychological and psychiatric aspects of pediatric obesity. Child Adolesc Psychiatr Clin N Am. 2009;18:49–65.

    Article  Google Scholar 

  44. Gill PJ, Saunders N, Gandhi S, Gonzalez A, Kurdyak P, Vigod S, et al. Emergency department as a first contact for mental health problems in children and youth. J Am Acad Child Adolesc Psychiatry. 2017;56:475–82 e4.

    Article  Google Scholar 

Download references

Acknowledgements

Funding

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.

Author information

Authors and Affiliations

  1. Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    Sarah Carsley, Karen Tu, Patricia C. Parkin & Catherine S. Birken

  2. Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, the Hospital for Sick Children, Toronto, Canada

    Sarah Carsley, Patricia C. Parkin, Eleanor Pullenayegum & Catherine S. Birken

  3. Institute for Clinical Evaluative Sciences, Toronto, Canada

    Sarah Carsley

  4. Department of Family and Community Medicine, University of Toronto, Toronto, Canada

    Karen Tu

  5. Toronto Western Hospital Family Health Team, University Health Network, Toronto, Canada

    Karen Tu

  6. Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Department of Pediatrics, University of Toronto Faculty of Medicine, Toronto, Canada

    Patricia C. Parkin & Catherine S. Birken

Authors
  1. Sarah Carsley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karen Tu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patricia C. Parkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eleanor Pullenayegum
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Catherine S. Birken
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Catherine S. Birken.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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). https://doi.org/10.1038/s41366-018-0280-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41366-018-0280-1

Search

Advanced search

Quick links