Family Meals and Adequate Sleep
Lower Risk of Childhood Obesity
A new national study suggests that preschool-aged children are likely
to have a lower risk for obesity if they regularly engage in one
or more of three specific household routines: eating dinner as a
family, getting adequate sleep and limiting their weekday television
In a large sample of the U.S. population, the study showed that
4-year-olds living in homes with all three routines had an almost
40 percent lower prevalence of obesity than did children living
in homes that practiced none of these routines.
Other studies have linked obesity to the individual behaviors
of excessive TV viewing, a lack of sleep and, to a lesser extent,
a low frequency of family meals. But this is the first study to
assess the combination of all three routines with obesity prevalence
in a national sample of preschoolers.
The researchers suggested that adopting these three household
routines could be an attractive obesity-prevention strategy for
all families with young children, especially because these routines
may benefit children's overall development. However, they also
cautioned that this study alone does not confirm whether the routines
themselves, or some other factor, protect children from obesity.
The study appears online and is scheduled for publication in
the March issue of the journal Pediatrics.
Each routine on its own was associated with lower obesity, and
more routines translated to lower obesity prevalence among 4-year-olds,
according to the analysis. The link between the routines and lower
obesity prevalence was also seen in children with and without
other risk factors for obesity.
"The routines were protective even among groups that typically
have a high risk for obesity. This is important because it suggests
that there's a potential for these routines to be useful targets
for obesity prevention in all children," said Sarah Anderson,
assistant professor of epidemiology at Ohio State University and
lead author of the study.
Anderson co-authored the paper with Robert Whitaker, professor
of public health and pediatrics at Temple University.
Anderson and Whitaker analyzed data collected in 2005 on 8,550
children who were born in the United States in 2001. The data
were collected as part of the Early Childhood Longitudinal Study,
Birth Cohort, a study conducted by the National Center for Education
Statistics to provide information about learning environments,
health and development of young U.S. children.
The researchers examined the association of childhood obesity
among preschool-aged children with three household routines: eating
the evening meal as a family more than five times per week; obtaining
at least 10½ hours of sleep per night; and watching less
than two hours per day of TV on weekdays referred to as
The researchers calculated the body mass index (BMI) of the children
using the measured heights and weights of the children. BMI measurements
were converted into percentiles for age and sex based on growth
charts developed by the Centers for Disease Control and Prevention
in 2000. For this study, children were considered obese if their
BMI scores were at or above the 95th percentile on those charts.
Eighteen percent of the children were determined to be obese
by this standard. Among 4-year-old children whose households practiced
all three routines, the prevalence of obesity was 14.3 percent.
In contrast, almost one in four of the children (24.5 percent)
living in households without any of the routines were obese.
The study also suggested that in households practicing none of
these routines, adopting just one could lower a child's risk of
becoming obese, and having two or three of the routines was more
protective than just one.
"I imagine people are going to want to know which of the
routines is most important: Is it limited TV, is it dinner, is
it adequate sleep? And what this suggests is that you can't point
to any one of these routines. Each one appears to be associated
with a lower risk of obesity, and having more of these routines
appears to lower the risk further," Anderson said.
That association could be seen even when children were already
at higher risk for obesity based on other aspects of their lives,
the researchers noted. For example, previous research has shown
that children are at higher risk for obesity if their mothers
are obese, if their household income is below the poverty level,
if their mothers did not finish high school, and if they are growing
up in a single-parent home.
All of those predictors of a higher prevalence of obesity in
4-year-olds were seen in this study. But even in these children,
the practice of all three household routines appeared to lower
the likelihood that they were obese.
She said the research suggests that an approach to obesity prevention
that emphasizes these routines might be acceptable to both parents
and pediatricians because adopting these practices could enhance
child well-being without a need to focus entirely on weight.
The researchers noted that the analysis revealed other important
details. Many families already practiced at least two of the routines:
56.6 percent of families had dinner together at least six evenings
per week, and 57.5 percent reported that their preschooler slept
at least 10½ hours per night. TV time was limited to two
hours or less among 40.4 percent of families.
On the other hand, some children were obese even when families
practiced all three routines a reminder that research based
on large populations does not necessarily apply to every individual
"Our research suggests these routines may have the opportunity
for impact. And they may help families move beyond the discussion
of eating and exercise to other aspects of behavior and biology
that have potential to be linked to obesity," Anderson said.
"Parents should talk to their child's doctor if they're worried
about their child's weight.
"It may be more difficult for some families than others
to have regular meals together, ensure their child gets enough
sleep, and limit TV time. However, given their specific circumstances
and constraints, families with young children may want to consider
what it would take for them to have these routines for their child.
We should support parents in their efforts to establish and maintain
these household routines."
February 8, 2010