BMJ  2005;331:453 (20 August), doi:10.1136/bmj.331.7514.453-a

Letter

Early life risk factors for obesity in childhood

The hand that rocks the cradle rules the world

EDITOR—The survey by Reilly et al to identify the risk factors for obesity in children seems to have been well designed, meticulously conducted, and rigorously analysed.¹ But as someone who is neither especially numerate nor an expert in this research topic, I had to read the paper three times and consult a statistician colleague to confirm that the authors had systematically controlled for maternal education—a proxy for social class—in every item in their analysis.

In other words, in their conclusion "Eight factors in early life are associated with an increased risk of obesity in childhood," the authors might (for the benefit of the general practitioner on the Clapham omnibus) have inserted the qualifier "that is, AFTER controlling for maternal education, which was confirmed by this study to be highly significantly related to the development of obesity in children."

Having (rightly, I'm sure, from a statistical standpoint) controlled so carefully for maternal education, the authors then do not mention it in their discussion of potentially modifiable risk factors for childhood obesity. Their recommendations seem to focus on technical tweaks targeted at metabolic variables, but my own hypothesis as a general practitioner is that interventions aimed at increasing the health literacy of the primary caregiver have far greater potential for achieving a slimmer cohort of primary school children.

I would value comment on this suggestion from both the authors and practitioners who try to influence the rate of weight gain of their youngest patients.

University College London, London N19 5LW p.greenhalgh{at}pcps.ucl.ac.uk

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Thanks to Richard Morris for advice on the statistical aspects of the paper.

Competing interests: None declared.

References

1. Reilly JJ, Armstrong J, Dorosty AR, Emmett PM, Ness A, Rogers I, et al. Early life risk factors for obesity in childhood: cohort study. BMJ 2005;330: 1357. (11 June.)[Abstract/Free Full Text]

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Early life risk factors for obesity in childhood: cohort study

John J Reilly, Julie Armstrong, Ahmad R Dorosty, Pauline M Emmett, A Ness, I Rogers, Colin Steer, Andrea Sherriff for the Avon Longitudinal Study of Parents and Children Study Team
BMJ 2005 330: 1357. [Abstract] [Full Text] [PDF]

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