Cited by 9Obesity, Physical Activity, DietHealth disparities and outcomesObesity and Health Practices

Associations of Longitudinal BMI-Percentile Classification Patterns in Early Childhood with Neighborhood-Level Social Determinants of Health

Open access
Gupta, Mehak, Phan, Thao-Ly T., Lê-Scherban, Félice, Eckrich, Daniel, Bunnell, H. Timothy, Beheshti, Rahmatollah·2025·Childhood Obesity

Abstract

Background: Understanding social determinants of health (SDOH) that may be risk factors for childhood obesity is important to developing targeted interventions to prevent obesity. Prior studies have examined these risk factors, mostly examining obesity as a static outcome variable. Methods: We extracted electronic health record data from 2012 to 2019 for a children’s health system that includes two hospitals and wide network of outpatient clinics spanning five East Coast states in the United States. Using data-driven and algorithmic clustering, we have identified distinct BMI-percentile classification groups in children from 0 to 7 years of age. We used two separate algorithmic clustering methods to confirm the robustness of the identified clusters. We used multinomial logistic regression to examine the associations between clusters and 27 neighborhood SDOHs and compared positive and negative SDOH characteristics separately. Results: From the cohort of 36,910 children, five BMI-percentile classification groups emerged: always having obesity ( n = 429; 1.16%), overweight most of the time ( n = 15,006; 40.65%), increasing BMI percentile ( n = 9,060; 24.54%), decreasing BMI percentile ( n = 5,058; 13.70%), and always normal weight ( n = 7,357; 19.89%). Compared to children in the decreasing BMI percentile and always normal weight groups, children in the other three groups were more likely to live in neighborhoods with higher poverty, unemployment, crowded households, single-parent households, and lower preschool enrollment. Conclusions: Neighborhood-level SDOH factors have significant associations with children’s BMI-percentile classification and changes in classification. This highlights the need to develop tailored obesity interventions for different groups to address the barriers faced by communities that can impact the weight and health of children living within them.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1089/chi.2023.0157

Cites

97 of 97 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 8

  1. Izzuddin M Aris, Sheryl L Rifas-Shiman, Ling-Jun Li, Seungmi Yang, Mandy B Belfort, Jen- nifer Thompson, Marie-France Hivert, Rita Patel, Richard M Martin, Michael S Kramer, et al. Association of weight for length vs body mass index during the first 2 years of life with cardiometabolic risk in early adolescence. JAMA network open, 1(5):e182460- e182460, 2018.
  2. Alex Y Chen and José J Escarce. Peer reviewed: Family structure and childhood obesity, early childhood longitudinal study-kindergarten cohort. Preventing chronic disease, 7 (3), 2010.
  3. Arin M Connell and Alice A Frye. Growth mixture modelling in developmental psychology: Overview and demonstration of heterogeneity in developmental trajectories of adoles- cent antisocial behaviour. Infant and Child Development: An International Journal of Research and Practice, 15(6):609-621, 2006.
  4. Geoffrey J McLachlan, Sharon X Lee, and Suren I Rathnayake. Finite mixture models. Annual review of statistics and its application, 6:355-378, 2019.
  5. Andrew A Neath and Joseph E Cavanaugh. The bayesian information criterion: back- ground, derivation, and applications. Wiley Interdisciplinary Reviews: Computational Statistics, 4(2):199-203, 2012.
  6. Karen L Nylund, Tihomir Asparouhov, and Bengt O Muthén. Deciding on the number of classes in latent class analysis and growth mixture modeling: A monte carlo simulation study. Structural equation modeling: A multidisciplinary Journal, 14(4):535-569, 2007.
  7. Sani M Roy, Jordan G Spivack, Myles S Faith, Alessandra Chesi, Jonathan A Mitchell, Andrea Kelly, Struan FA Grant, Shana E McCormack, and Babette S Zemel. Infant bmi or weight-for-length and obesity risk in early childhood. Pediatrics, 137(5), 2016.
  8. Elsie M Taveras, Matthew W Gillman, Ken Kleinman, Janet W Rich-Edwards, and Sheryl L Rifas-Shiman. Racial/ethnic differences in early-life risk factors for childhood obesity. Pediatrics, 125(4):686-695, 2010.

Cited by

Sorted by citations

Authors
Gupta, M., Phan, T.-L. T., Lê-Scherban, F., Eckrich, D., Bunnell, H. T., & Beheshti, R.
Affiliations
  • Southern Methodist University (US)
  • Nemours Children's Health System (US)
  • Epidemiology & Biostatistics, and Urban Health Collaborative Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
  • University of Delaware (US)
Venue
Childhood Obesity
Published
2025-01-01
Volume
21
Issue
1
Pages
65-75
ISSN
  • 2153-2168 (ISSN-L)
  • 2153-2176
OpenAlex
W4401871369
Cited by
9
References
97
Citations by year
2026: 5 · 2025: 2 · 2024: 2
FWCI
3.73
Type
journal article
Language
en
Open access
Locations
  • Childhood Obesity (publishedVersion)
  • medRxiv (acceptedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by-nc-nd)
Funders
  • National Institutes of Health
  • National Institute of General Medical Sciences (P20GM103446, U54GM104941, P20GM113125)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
Keywords
body mass index percentiles, early childhood, neighborhood poverty, household crowding, single-parent families, preschool enrollment, obesity prevention

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review