Adult socioeconomic, educational, social, and psychological outcomes o
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《英国医生杂志》
1 Department of Paediatrics, Royal Free and University College Medical School, University College London, London NW3 2PF, 2 Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London WC1N 1EH
Correspondence to: R M Viner R.Viner@ich.ucl.ac.uk
Objectives To assess adult socioeconomic, educational, social, and psychological outcomes of childhood obesity by using nationally representative data.
Design 1970 British birth cohort.
Participants 16 567 babies born in Great Britain 5-11 April 1970 and followed up at 5, 10, and 29-30 years.
Main outcome measures Obesity at age 10 and 30 years. Self reported socioeconomic, educational, psychological, and social outcomes at 30 years. Odds ratios were calculated for the risk of each adult outcome associated with obesity in childhood only, obesity in adulthood only, and persistent child and adult obesity, compared with those obese at neither period.
Results Of the 8490 participants with data on body mass index at 10 and 30 years, 4.3% were obese at 10 years and 16.3% at 30 years. Obesity in childhood only was not associated with adult social class, income, years of schooling, educational attainment, relationships, or psychological morbidity in either sex after adjustment for confounding factors. Persistent obesity was not associated with any adverse adult outcomes in men, though it was associated among women with a higher risk of never having been gainfully employed (odds ratio 1.9, 95% confidence interval 1.1 to 3.3) and not having a current partner (2.0, 1.3 to 3.3).
Conclusions Obesity limited to childhood has little impact on adult outcomes. Persistent obesity in women is associated with poorer employment and relationship outcomes. Efforts to reduce the socioeconomic and psychosocial burden of obesity in adult life should focus on prevention of the persistence of obesity from childhood into adulthood.
Concerns about the rising prevalence of obesity in children and adolescents have focused on the well documented associations between childhood obesity and increased cardiovascular risk1 and mortality in adulthood.2 Childhood obesity has considerable social and psychological consequences within childhood and adolescence,3 yet little is known about social, socioeconomic, and psychological consequences in adult life.
A recent systematic review found no longitudinal studies on the outcomes of childhood obesity other than physical health outcomes3 and only two longitudinal studies of the socioeconomic effects of obesity in adolescence. Gortmaker et al found that US women who had been obese in late adolescence in 1981 were less likely to be married and had lower incomes seven years later than women who had not been overweight, while men who had been overweight were less likely to be married.4 Sargent et al found that UK women, but not men, who had been obese at 16 years in 1974 earned 7.4% less than their non-obese peers at age 23.5
The study of adult outcomes of childhood obesity is difficult because obesity often continues into adult life and therefore poorer socioeconomic and educational outcomes may actually reflect confounding by adult obesity. Yet identifying outcomes related to obesity confined to childhood is important in determining whether people who are obese in childhood and who later lose weight remain at risk for adult adversity and inequalities.
We used longitudinal data from the 1970 British birth cohort to examine the adult socioeconomic, educational, social, and psychological outcomes of childhood obesity. We hypothesised that obesity limited to childhood has fewer adverse adult outcomes than obesity that persists into adult life.
Methods
Participants
The 1970 British cohort study (BCS70) is a continuing, multidisciplinary longitudinal study that takes as its subjects all people living in Great Britain who were born 5-11 April 1970. A total of 16 567 babies born in England, Scotland, and Wales were enrolled in the birth cohort, and they have been followed up at 5, 10, 16, 26, and 29-30 years. Additional people born in the same week who immigrated to the UK or were identified subsequently have been added to the cohort. Longitudinal follow-up was maintained through collection of multiple subject identifiers and mailing of annual birthday cards between follow-up surveys.6 We obtained electronic data from the various surveys of the BCS70 from the UK Data Archive, University of Essex, and supporting information and code for cleaning the databases and deriving summary variables from the Centre for Longitudinal Studies, London.6
At 10 years of age (in 1980), 15 995 cohort members were traced and invited to participate, and data were obtained on 14 875. Analysis showed a significant loss of children of single mothers (loss of 25% of estimated target) and children whose parents were born outside Great Britain (loss of 25% of estimated target). There were, however, no significant social class differences (gain of 1.7% in those with father in manual employment).7 In 2000, when participants were aged 29-30, 14 087 of an estimated 16 695 cohort members were traced and invited to participate, of whom 11 261 (68%) underwent interview.6 Marked efforts were made to recruit difficult to reach participants, and response bias compared with the birth survey was less than at 10 years: between the birth and 30 year surveys there was a loss of 17% for those with parents born outside Britain, 9% for children of teenage mothers, and 15% for children of single mothers. Loss of those from lower social classes was minimal at 4% loss from manual employment.6
Childhood data
Height was measured at 10 years of age by school medical staff with a standardised technique and recorded to the nearest 0.1 cm (or 0.25 inch). Weight was measured in underclothes with a beam balance and recorded to the nearest 0.1 kg (or 0.25 ounce). Body mass index z score at 10 years was calculated from height and weight with the revised UK 1990 growth reference.8 Obesity at 10 years was defined as body mass index 95th centile. Height and weight of parents were measured or self reported at parental interview in the 10 year survey. Body mass index z scores for parents were calculated from cohort mean and standard deviation. Birth weight was recorded in the original birth survey. Socioeconomic status in childhood was defined by social class (paternal occupation obtained from parental interview at 10 years) and maternal educational status at 10 years. Cognitive ability was assessed at 10 years by completion of the British ability scales (BAS); age appropriate T scores for each subscale and mean T score were calculated with reference norms appropriate for 1980.9
Adult data
Outcomes in adult life were obtained by completion of an interview on computer or self report as part of the 1999-2000 survey of the cohort when participants were aged 29-30. Height and weight were obtained by self report. Women who were pregnant at time of interview were asked to report their weight before pregnancy. Self reported data have been shown to be highly correlated with measured weight and height in adults in previous studies10 and are accepted as useful in epidemiological studies of risk factors for obesity and overweight.11 As under-reporting of weight in obese individuals and over-reporting of height may underestimate BMI, however, we chose to define self reported obesity as BMI 28.5 rather than the standard definition of 30, as recent data from a large UK epidemiological cohort showed that obese men and women underestimate their true BMI by a mean of 1.5.10 Adjustment by this amount is supported by internal data from the cohort: the relation between measured and self reported height and weight was examined at 16 years in a reduced sample of 2795 participants, with obese people more likely to underestimate their BMI. Cohort members who were obese at 10 years underestimated their BMI at 16 by a mean of 1.3 compared with 0.5 for non-obese people.12
Data on other adult outcomes included occupational status, annual net income, employment history, educational and vocational achievements, marital and relationship history, and the presence of a long standing illness ( 6 months' duration) significantly limiting home or work activities. Mental health was assessed by confidential completion of the Rutter malaise inventory, a 24 item self completed scale designed to assess psychiatric morbidity in epidemiological samples: scores 7 suggested psychiatric morbidity.13
Analysis
We divided participants into four categories of obesity: not obese in childhood or adulthood, obese in childhood only, obese in adulthood only, and obese in childhood and adulthood (persistent obesity). Frequency differences between groups were investigated with 2 tests. For each adult outcome we then constructed multivariable models using logistic regression to calculate odds ratios for the risk of that outcome conferred by childhood and adult obesity. We did this in two ways. Firstly, we examined the risk of each outcome posed by each of the four obesity categories, using never obese as the reference category. Secondly, to test for possible bias introduced by this double dichotomisation of child and adult obesity variables into four categories,14 we entered the childhood obesity and adult obesity variables as main effects and then tested for the significance of the interaction between child and adult obesity. In both sets of analyses we included childhood variables (height at 10 years, maternal and paternal body mass index z scores, maternal education, and social class) and adult variables (height and social class) as potential confounding factors. We also included height because body mass index is not completely independent of height, and stature has been associated with adult socioeconomic status.5 Data were analysed with Stata 8.
Results
Our sample comprised 8490 participants for whom we knew body mass index at 10 and 30 years (forming 75% of participants at 30 years). Table 1 shows details of the participants at 10 and 30 years. Overall, 362 (4.3%) people were obese at 10 years and 1380 (16.3%) were obese at 30, with about 52% of those obese in childhood also obese at 30 years. One hundred and seventy three (2.0%) were obese in childhood only, 1191 (14%) in adulthood only, and 189 (2.2%) had persistent obesity. Childhood obesity increased the risk of adult obesity in men (odds ratio 4.8, 95% confidence interval 3.3 to 6.8; P < 0.0001) and women (4.7, 3.2 to 6.9; P < 0.0001) after adjustment for social class and maternal education in childhood, parental BMI z scores, height, and adult social class. Follow-up at 30 years of those with valid BMI at 10 years showed similar loss to follow-up to that reported for the entire cohort, with a higher loss of men and those from lower social classes. Obesity at 10 years was not associated with loss to follow-up at 30 years.
Table 1 Characteristics of participants with valid measurement of body mass index during follow-up. Figures are percentage (number) unless stated otherwise
Table 2 shows the prevalence of adverse adult outcomes in the four categories of obesity for men and women. For men, there were significant differences between groups for educational and social outcomes, social class, and long standing illness. For women, there were significant differences in all outcomes apart from unemployment and longstanding illnesses.
Table 2 Prevalence of adverse outcomes associated with childhood, adulthood, and persistent obesity*
Mean annual net income was significantly lower in women who were obese in childhood and persistently obese compared with those not obese at either period (mean for not obese ￡12 954 ($24 581; 18 962) (SE ￡802); obese in childhood only ￡10 549 (SE ￡904); obese in adulthood only ￡11 409 (SE ￡2075); persistent obesity ￡9653 (SE ￡685); P < 0.0001). These differences, however, were not significant when they were adjusted for childhood socioeconomic status and parental BMI z scores. Mean annual net income was not associated with obesity category in men.
Table 3 shows adjusted odds ratios for the risk of each adult outcome posed by the four obesity categories. In these analyses, obesity limited to childhood was not significantly associated with any adult outcomes in either sex. Analysis of childhood obesity as a main effect adjusted for adult obesity similarly found that childhood obesity was not associated with any adult outcomes measured in either sex (data not shown). Persistent obesity in men was not significantly associated with any adverse adult outcomes measured, while in women, persistent obesity predicted higher risk of never having been gainfully employed and not having a current partner. In men, obesity limited to adulthood was associated with a higher risk of longstanding illness and leaving school with no qualifications but with a lower risk of never having married or not having a current partner. In women, obesity limited to adulthood was associated with higher risk of psychological disorder and longstanding illness. The same associations for adult obesity were found in each sex when adult obesity was entered as a main effect adjusted for childhood obesity (data not shown). Reanalysis of educational outcomes with adjustment for cognitive ability at 10 years did not materially change results (data not shown).
Table 3 Adjusted* odds ratios (95% confidence intervals) for the associations of childhood, adulthood, and persistent obesity with adverse adult outcomes
Discussion
Srinivasan SR, Myers L, Berenson GS. Predictability of childhood adiposity and insulin for developing insulin resistance syndrome (syndrome X) in young adulthood: the Bogalusa heart study. Diabetes 2002;51: 204-9.
Hoffmans MD, Kromhout D, de Lezenne CC. The impact of body mass index of 78,612 18-year old Dutch men on 32-year mortality from all causes. J Clin Epidemiol 1988;41: 749-56.
Reilly JJ, Methven E, McDowell ZC, Hacking B, Alexander D, Stewart L, et al. Health consequences of obesity. Arch Dis Child 2003;88: 748-52.
Gortmaker SL, Must A, Perrin JM, Sobol AM, Dietz WH. Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med 1993;329: 1008-12.
Sargent JD, Blanchflower DG. Obesity and stature in adolescence and earnings in young adulthood. Analysis of a British birth cohort. Arch Pediatr Adolesc Med 1994;148: 681-7.
Bynner J, Butler N, Ferri E, Shepherd P, Smith K. The design and conduct of the 1999-2000 surveys of the national child development study and the 1970 British birth cohort study. UK data archive. London: Centre for Longitudinal Studies, Institute of Education, 2002. (CLS Cohort Studies Working Paper 1.)
Butler NR, Despotidou S, Shepherd P. The 1970 British birth cohort study: ten year follow-up: a guide to the BCS70. Swindon: Economic and Social Research Council, 2000.
Cole TJ, Freeman JV, Preece MA. Body mass index reference curves for the UK, 1990. Arch Dis Child 1995;73: 25-9.
Elliot CD. British ability scales technical handbook. Windsor: NFER-Nelson, 1983.
Spencer EA, Appleby PN, Davey GK, Key TJ. Validity of self-reported height and weight in 4808 EPIC-Oxford participants. Public Health Nutr 2002;5: 561-5.
Goodman E, Strauss RS. Self-reported height and weight and the definition of obesity in epidemiological studies. J Adolesc Health 2003;33: 140-1.
Crawley HF, Portides G. Self-reported versus measured height, weight and body mass index amongst 16-17 year old British teenagers. Int J Obes Relat Metab Disord 1995;19: 579-84.
Rodgers B, Pickles A, Power C, Collishaw S, Maughan B. Validity of the malaise inventory in general population samples. Soc Psychiatry Psychiatr Epidemiol 1999;34: 333-41.
Maxwell SE, Delaney HD. Bivariate median splits and spurious statistical significance. Psychol Bull 1993;113: 181-90.
Lake JK, Power C, Cole TJ. Child to adult body mass index in the 1958 British birth cohort: associations with parental obesity. Arch Dis Child 1997;77: 376-81.
Power C, Manor O, Matthews S. Child to adult socioeconomic conditions and obesity in a national cohort. Int J Obes Relat Metab Disord 2003;27: 1081-6.
Chinn S, Rona RJ. Prevalence and trends in overweight and obesity in three cross sectional studies of British children, 1974-94. BMJ 2001;322: 24-6.
Laitinen J, Power C, Ek E, Sovio U, Jarvelin MR. Unemployment and obesity among young adults in a northern Finland 1966 birth cohort. Int J Obes Relat Metab Disord 2002;26: 1329-38.
Mustillo S, Worthman C, Erkanli A, Keeler G, Angold A, Costello EJ. Obesity and psychiatric disorder: developmental trajectories. Pediatrics 2003;111: 851-9.
Goodman E, Whitaker RC. A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics 2002;109: 497-504.
Onyike CU, Crum RM, Lee HB, Lyketsos CG, Eaton WW. Is obesity associated with major depression? Results from the third national health and nutrition examination survey. Am J Epidemiol 2003;158: 1139-47.
Ferraro KF, Thorpe RJ Jr, Wilkinson JA. The life course of severe obesity: does childhood overweight matter? J Gerontol B Psychol Sci Soc Sci 2003;58: S110-9.
Wright CM, Parker L, Lamont D, Craft AW. Implications of childhood obesity for adult health: findings from thousand families cohort study. BMJ 2001;323: 1280-4.(Russell M Viner, honorary senior lecture)
Correspondence to: R M Viner R.Viner@ich.ucl.ac.uk
Objectives To assess adult socioeconomic, educational, social, and psychological outcomes of childhood obesity by using nationally representative data.
Design 1970 British birth cohort.
Participants 16 567 babies born in Great Britain 5-11 April 1970 and followed up at 5, 10, and 29-30 years.
Main outcome measures Obesity at age 10 and 30 years. Self reported socioeconomic, educational, psychological, and social outcomes at 30 years. Odds ratios were calculated for the risk of each adult outcome associated with obesity in childhood only, obesity in adulthood only, and persistent child and adult obesity, compared with those obese at neither period.
Results Of the 8490 participants with data on body mass index at 10 and 30 years, 4.3% were obese at 10 years and 16.3% at 30 years. Obesity in childhood only was not associated with adult social class, income, years of schooling, educational attainment, relationships, or psychological morbidity in either sex after adjustment for confounding factors. Persistent obesity was not associated with any adverse adult outcomes in men, though it was associated among women with a higher risk of never having been gainfully employed (odds ratio 1.9, 95% confidence interval 1.1 to 3.3) and not having a current partner (2.0, 1.3 to 3.3).
Conclusions Obesity limited to childhood has little impact on adult outcomes. Persistent obesity in women is associated with poorer employment and relationship outcomes. Efforts to reduce the socioeconomic and psychosocial burden of obesity in adult life should focus on prevention of the persistence of obesity from childhood into adulthood.
Concerns about the rising prevalence of obesity in children and adolescents have focused on the well documented associations between childhood obesity and increased cardiovascular risk1 and mortality in adulthood.2 Childhood obesity has considerable social and psychological consequences within childhood and adolescence,3 yet little is known about social, socioeconomic, and psychological consequences in adult life.
A recent systematic review found no longitudinal studies on the outcomes of childhood obesity other than physical health outcomes3 and only two longitudinal studies of the socioeconomic effects of obesity in adolescence. Gortmaker et al found that US women who had been obese in late adolescence in 1981 were less likely to be married and had lower incomes seven years later than women who had not been overweight, while men who had been overweight were less likely to be married.4 Sargent et al found that UK women, but not men, who had been obese at 16 years in 1974 earned 7.4% less than their non-obese peers at age 23.5
The study of adult outcomes of childhood obesity is difficult because obesity often continues into adult life and therefore poorer socioeconomic and educational outcomes may actually reflect confounding by adult obesity. Yet identifying outcomes related to obesity confined to childhood is important in determining whether people who are obese in childhood and who later lose weight remain at risk for adult adversity and inequalities.
We used longitudinal data from the 1970 British birth cohort to examine the adult socioeconomic, educational, social, and psychological outcomes of childhood obesity. We hypothesised that obesity limited to childhood has fewer adverse adult outcomes than obesity that persists into adult life.
Methods
Participants
The 1970 British cohort study (BCS70) is a continuing, multidisciplinary longitudinal study that takes as its subjects all people living in Great Britain who were born 5-11 April 1970. A total of 16 567 babies born in England, Scotland, and Wales were enrolled in the birth cohort, and they have been followed up at 5, 10, 16, 26, and 29-30 years. Additional people born in the same week who immigrated to the UK or were identified subsequently have been added to the cohort. Longitudinal follow-up was maintained through collection of multiple subject identifiers and mailing of annual birthday cards between follow-up surveys.6 We obtained electronic data from the various surveys of the BCS70 from the UK Data Archive, University of Essex, and supporting information and code for cleaning the databases and deriving summary variables from the Centre for Longitudinal Studies, London.6
At 10 years of age (in 1980), 15 995 cohort members were traced and invited to participate, and data were obtained on 14 875. Analysis showed a significant loss of children of single mothers (loss of 25% of estimated target) and children whose parents were born outside Great Britain (loss of 25% of estimated target). There were, however, no significant social class differences (gain of 1.7% in those with father in manual employment).7 In 2000, when participants were aged 29-30, 14 087 of an estimated 16 695 cohort members were traced and invited to participate, of whom 11 261 (68%) underwent interview.6 Marked efforts were made to recruit difficult to reach participants, and response bias compared with the birth survey was less than at 10 years: between the birth and 30 year surveys there was a loss of 17% for those with parents born outside Britain, 9% for children of teenage mothers, and 15% for children of single mothers. Loss of those from lower social classes was minimal at 4% loss from manual employment.6
Childhood data
Height was measured at 10 years of age by school medical staff with a standardised technique and recorded to the nearest 0.1 cm (or 0.25 inch). Weight was measured in underclothes with a beam balance and recorded to the nearest 0.1 kg (or 0.25 ounce). Body mass index z score at 10 years was calculated from height and weight with the revised UK 1990 growth reference.8 Obesity at 10 years was defined as body mass index 95th centile. Height and weight of parents were measured or self reported at parental interview in the 10 year survey. Body mass index z scores for parents were calculated from cohort mean and standard deviation. Birth weight was recorded in the original birth survey. Socioeconomic status in childhood was defined by social class (paternal occupation obtained from parental interview at 10 years) and maternal educational status at 10 years. Cognitive ability was assessed at 10 years by completion of the British ability scales (BAS); age appropriate T scores for each subscale and mean T score were calculated with reference norms appropriate for 1980.9
Adult data
Outcomes in adult life were obtained by completion of an interview on computer or self report as part of the 1999-2000 survey of the cohort when participants were aged 29-30. Height and weight were obtained by self report. Women who were pregnant at time of interview were asked to report their weight before pregnancy. Self reported data have been shown to be highly correlated with measured weight and height in adults in previous studies10 and are accepted as useful in epidemiological studies of risk factors for obesity and overweight.11 As under-reporting of weight in obese individuals and over-reporting of height may underestimate BMI, however, we chose to define self reported obesity as BMI 28.5 rather than the standard definition of 30, as recent data from a large UK epidemiological cohort showed that obese men and women underestimate their true BMI by a mean of 1.5.10 Adjustment by this amount is supported by internal data from the cohort: the relation between measured and self reported height and weight was examined at 16 years in a reduced sample of 2795 participants, with obese people more likely to underestimate their BMI. Cohort members who were obese at 10 years underestimated their BMI at 16 by a mean of 1.3 compared with 0.5 for non-obese people.12
Data on other adult outcomes included occupational status, annual net income, employment history, educational and vocational achievements, marital and relationship history, and the presence of a long standing illness ( 6 months' duration) significantly limiting home or work activities. Mental health was assessed by confidential completion of the Rutter malaise inventory, a 24 item self completed scale designed to assess psychiatric morbidity in epidemiological samples: scores 7 suggested psychiatric morbidity.13
Analysis
We divided participants into four categories of obesity: not obese in childhood or adulthood, obese in childhood only, obese in adulthood only, and obese in childhood and adulthood (persistent obesity). Frequency differences between groups were investigated with 2 tests. For each adult outcome we then constructed multivariable models using logistic regression to calculate odds ratios for the risk of that outcome conferred by childhood and adult obesity. We did this in two ways. Firstly, we examined the risk of each outcome posed by each of the four obesity categories, using never obese as the reference category. Secondly, to test for possible bias introduced by this double dichotomisation of child and adult obesity variables into four categories,14 we entered the childhood obesity and adult obesity variables as main effects and then tested for the significance of the interaction between child and adult obesity. In both sets of analyses we included childhood variables (height at 10 years, maternal and paternal body mass index z scores, maternal education, and social class) and adult variables (height and social class) as potential confounding factors. We also included height because body mass index is not completely independent of height, and stature has been associated with adult socioeconomic status.5 Data were analysed with Stata 8.
Results
Our sample comprised 8490 participants for whom we knew body mass index at 10 and 30 years (forming 75% of participants at 30 years). Table 1 shows details of the participants at 10 and 30 years. Overall, 362 (4.3%) people were obese at 10 years and 1380 (16.3%) were obese at 30, with about 52% of those obese in childhood also obese at 30 years. One hundred and seventy three (2.0%) were obese in childhood only, 1191 (14%) in adulthood only, and 189 (2.2%) had persistent obesity. Childhood obesity increased the risk of adult obesity in men (odds ratio 4.8, 95% confidence interval 3.3 to 6.8; P < 0.0001) and women (4.7, 3.2 to 6.9; P < 0.0001) after adjustment for social class and maternal education in childhood, parental BMI z scores, height, and adult social class. Follow-up at 30 years of those with valid BMI at 10 years showed similar loss to follow-up to that reported for the entire cohort, with a higher loss of men and those from lower social classes. Obesity at 10 years was not associated with loss to follow-up at 30 years.
Table 1 Characteristics of participants with valid measurement of body mass index during follow-up. Figures are percentage (number) unless stated otherwise
Table 2 shows the prevalence of adverse adult outcomes in the four categories of obesity for men and women. For men, there were significant differences between groups for educational and social outcomes, social class, and long standing illness. For women, there were significant differences in all outcomes apart from unemployment and longstanding illnesses.
Table 2 Prevalence of adverse outcomes associated with childhood, adulthood, and persistent obesity*
Mean annual net income was significantly lower in women who were obese in childhood and persistently obese compared with those not obese at either period (mean for not obese ￡12 954 ($24 581; 18 962) (SE ￡802); obese in childhood only ￡10 549 (SE ￡904); obese in adulthood only ￡11 409 (SE ￡2075); persistent obesity ￡9653 (SE ￡685); P < 0.0001). These differences, however, were not significant when they were adjusted for childhood socioeconomic status and parental BMI z scores. Mean annual net income was not associated with obesity category in men.
Table 3 shows adjusted odds ratios for the risk of each adult outcome posed by the four obesity categories. In these analyses, obesity limited to childhood was not significantly associated with any adult outcomes in either sex. Analysis of childhood obesity as a main effect adjusted for adult obesity similarly found that childhood obesity was not associated with any adult outcomes measured in either sex (data not shown). Persistent obesity in men was not significantly associated with any adverse adult outcomes measured, while in women, persistent obesity predicted higher risk of never having been gainfully employed and not having a current partner. In men, obesity limited to adulthood was associated with a higher risk of longstanding illness and leaving school with no qualifications but with a lower risk of never having married or not having a current partner. In women, obesity limited to adulthood was associated with higher risk of psychological disorder and longstanding illness. The same associations for adult obesity were found in each sex when adult obesity was entered as a main effect adjusted for childhood obesity (data not shown). Reanalysis of educational outcomes with adjustment for cognitive ability at 10 years did not materially change results (data not shown).
Table 3 Adjusted* odds ratios (95% confidence intervals) for the associations of childhood, adulthood, and persistent obesity with adverse adult outcomes
Discussion
Srinivasan SR, Myers L, Berenson GS. Predictability of childhood adiposity and insulin for developing insulin resistance syndrome (syndrome X) in young adulthood: the Bogalusa heart study. Diabetes 2002;51: 204-9.
Hoffmans MD, Kromhout D, de Lezenne CC. The impact of body mass index of 78,612 18-year old Dutch men on 32-year mortality from all causes. J Clin Epidemiol 1988;41: 749-56.
Reilly JJ, Methven E, McDowell ZC, Hacking B, Alexander D, Stewart L, et al. Health consequences of obesity. Arch Dis Child 2003;88: 748-52.
Gortmaker SL, Must A, Perrin JM, Sobol AM, Dietz WH. Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med 1993;329: 1008-12.
Sargent JD, Blanchflower DG. Obesity and stature in adolescence and earnings in young adulthood. Analysis of a British birth cohort. Arch Pediatr Adolesc Med 1994;148: 681-7.
Bynner J, Butler N, Ferri E, Shepherd P, Smith K. The design and conduct of the 1999-2000 surveys of the national child development study and the 1970 British birth cohort study. UK data archive. London: Centre for Longitudinal Studies, Institute of Education, 2002. (CLS Cohort Studies Working Paper 1.)
Butler NR, Despotidou S, Shepherd P. The 1970 British birth cohort study: ten year follow-up: a guide to the BCS70. Swindon: Economic and Social Research Council, 2000.
Cole TJ, Freeman JV, Preece MA. Body mass index reference curves for the UK, 1990. Arch Dis Child 1995;73: 25-9.
Elliot CD. British ability scales technical handbook. Windsor: NFER-Nelson, 1983.
Spencer EA, Appleby PN, Davey GK, Key TJ. Validity of self-reported height and weight in 4808 EPIC-Oxford participants. Public Health Nutr 2002;5: 561-5.
Goodman E, Strauss RS. Self-reported height and weight and the definition of obesity in epidemiological studies. J Adolesc Health 2003;33: 140-1.
Crawley HF, Portides G. Self-reported versus measured height, weight and body mass index amongst 16-17 year old British teenagers. Int J Obes Relat Metab Disord 1995;19: 579-84.
Rodgers B, Pickles A, Power C, Collishaw S, Maughan B. Validity of the malaise inventory in general population samples. Soc Psychiatry Psychiatr Epidemiol 1999;34: 333-41.
Maxwell SE, Delaney HD. Bivariate median splits and spurious statistical significance. Psychol Bull 1993;113: 181-90.
Lake JK, Power C, Cole TJ. Child to adult body mass index in the 1958 British birth cohort: associations with parental obesity. Arch Dis Child 1997;77: 376-81.
Power C, Manor O, Matthews S. Child to adult socioeconomic conditions and obesity in a national cohort. Int J Obes Relat Metab Disord 2003;27: 1081-6.
Chinn S, Rona RJ. Prevalence and trends in overweight and obesity in three cross sectional studies of British children, 1974-94. BMJ 2001;322: 24-6.
Laitinen J, Power C, Ek E, Sovio U, Jarvelin MR. Unemployment and obesity among young adults in a northern Finland 1966 birth cohort. Int J Obes Relat Metab Disord 2002;26: 1329-38.
Mustillo S, Worthman C, Erkanli A, Keeler G, Angold A, Costello EJ. Obesity and psychiatric disorder: developmental trajectories. Pediatrics 2003;111: 851-9.
Goodman E, Whitaker RC. A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics 2002;109: 497-504.
Onyike CU, Crum RM, Lee HB, Lyketsos CG, Eaton WW. Is obesity associated with major depression? Results from the third national health and nutrition examination survey. Am J Epidemiol 2003;158: 1139-47.
Ferraro KF, Thorpe RJ Jr, Wilkinson JA. The life course of severe obesity: does childhood overweight matter? J Gerontol B Psychol Sci Soc Sci 2003;58: S110-9.
Wright CM, Parker L, Lamont D, Craft AW. Implications of childhood obesity for adult health: findings from thousand families cohort study. BMJ 2001;323: 1280-4.(Russell M Viner, honorary senior lecture)