JOURNAL OF COMMUNITY HEALTH NURSING, 2007, 24(3), 167–176

Copyright © 2007, Lawrence Erlbaum Associates, Inc.

Association of Maternal Obesity and Childhood

Obesity: Implications for Healthcare Providers
Edith F. Durand, BSN, RN, Cynthia Logan, PhD, RN,
and Ann Carruth, DNS, RN
Southeastern Louisiana University, School of Nursing

The purpose of this critical appraisal was to assess the available literature on the association
of maternal obesity as a risk factor for childhood obesity and to explore the implications for
incorporating this evidence into practice. The increasing prevalence of childhood obesity,
with its documented adverse health effects, is a critical public health threat in the United
States and worldwide. Research studies have documented increased rates of childhood obe-
sity associated with maternal obesity. Healthcare providers are challenged to expand their
competencies to recognize the association of maternal obesity and childhood obesity and to
address both primary and secondary prevention of childhood obesity. Stopping the cycle of
obesity before it becomes the leading cause of preventable disease and death in the United
States is a priority for community health nurses.

Obesity has been found to be a strong predictor of several well-established risk factors for
increased morbidity and mortality. Reversing the obesity epidemic is an urgent priority
(Mokdad et al., 2003). Childhood obesity is a significant public health problem in the
United States and worldwide. During the 20th century, infant mortality rates and deaths
from infectious diseases decreased tremendously, and life expectancy increased by
greater than 30 years. Despite these successes, the statistics on overweight and obesity
have continued to head in the wrong direction. Data presented by the National Center for
Health Statistics (NCHS, 2005) indicated that the prevalence of overweight children,
ages 6 to 11 years, increased from 4% to almost 16% in the past 30 years. This increasing
prevalence of childhood obesity has led policymakers to rank it as a critical public health
threat for the 21st century. If this trend continues, the gains that were made with heart dis-
ease, diabetes, several forms of cancer, and many other chronic health problems may be
reversed. Unfortunately, overweight and obesity are risk factors for many of these
chronic health conditions (U.S. Department of Health and Human Services [DHHS],
2001).

Correspondence should be addressed to Edith F. Durand, Post Office Box 733, Albany, LA 70711.
E-mail: Edith.Durand@selu.edu
168 Durand, Logan, Carruth

Healthy People 2010 (DHHS, 2000) identified overweight and obesity as one of the
leading health indicators, which signifies that obesity is a major public health concern in
the United States. Obesity has been associated with a higher incidence of morbidity and a
poorer health-related quality of life than smoking, problem drinking, or poverty (Allison,
Fontaine, Manson, Stevens, & Van Itallie, 1999). In 2001, the U.S. Surgeon General re-
ported that overweight and obesity had reached epidemic proportions, and we are already
noting tragic results from these trends. Approximately 300,000 deaths in this country
were associated with overweight and obesity in 2001. If this trend continues, overweight
and obesity may soon compete with cigarette smoking as the leading cause of prevent-
able disease and death (DHHS, 2001; Manson & Bassuk, 2003). With the increased prev-
alence of childhood obesity, the association between maternal obesity and metabolic syn-
drome during childhood has implications for perpetuating the cycle of obesity, insulin
resistance, and their consequences (Boney, Verma, Tucker, & Vohr, 2005).

PURPOSE

The purpose of this critical appraisal was to assess the available literature on the associa-
tion of maternal obesity as a risk factor for childhood obesity and to explore the implica-
tions for incorporating this evidence into practice. Several studies have reported an in-
creased risk of childhood obesity in relation to maternal obesity. The risk of childhood
obesity is more than double for 2-year-olds and 4-year-olds if there was maternal obesity
in early pregnancy (Whitaker, 2004). A study by Salsberry and Reagan (2005) suggested
that maternal prepregnancy obesity influences early childhood obesity, which is perpetu-
ated as the child ages. The researchers conclude that these findings suggest that preven-
tion of childhood obesity should begin before pregnancy and in early childhood.

Prevalence of Childhood Obesity

Childhood obesity has received increasing attention as a public health problem; however,
findings have indicated that the rate of obesity and its complications are likely to continue
to increase (Whitaker, 2004). Researchers have estimated that 25% of all children in the
United States are overweight or at risk of becoming overweight (Ogden, Flegal, Carroll,
& Johnson, 2002; Rich et al., 2005). The increasing prevalence of childhood obesity has
been well documented (DHHS, 2000, 2001; NCHS, 2005). Childhood obesity has also
been reported to be a strong predictor of adult obesity (Whitaker, 2004).

Adverse Effects Associated with Childhood Obesity

Mokdad et al. (2003) reported a strong association between obesity and several major
health risk factors. Several studies have reported that obese children and adolescents are
 Association Of Maternal Obesity 169

at risk of becoming obese adults with obesity-related health conditions. NCHS (n.d.) pre-
sented data from the 1999–2002 National Health and Nutrition Examination Survey.
These data included findings for children and adolescents that suggest the likelihood of
another generation of overweight adults with increased risk for obesity-related health
problems. Researchers have also reported more immediate health risks including
psychosocial consequences, hypertension, elevated cholesterol levels, abnormal glucose
tolerance, and several other health problems occurring during childhood (Ogden et al.,
2002; Rich et al., 2005; Whitlock, Williams, Gold, Smith, & Shipman, 2005). Whitaker
(2004) reported that parents failed to perceive their toddler or preschooler as obese when
the child’s body mass index (BMI) exceeded the 95th percentile. These parents perceived
their children as healthy. The parent’s lack of knowledge regarding a child’s weight and
health status is an indicator that should be considered in developing effective prevention
and intervention programs.
The Bogalusa Heart Study has been sponsored by the National Institutes of Health
since 1972. It is the longest and most comprehensive study of a biracial, black and white,
population of children in the world. The focus of this study is the epidemiology of essen-
tial hypertension and coronary artery disease. Findings from this study have shown that
the physiologic changes responsible for atherosclerosis, coronary heart disease, and es-
sential hypertension begin during childhood. These are the major causes of adult coro-
nary disease, and they have been documented as early as 5 to 8 years of age. Obesity was
noted as one of the four major contributors to cardiovascular disease (Tulane Center for
Cardiovascular Health, 2005).
Data from the Bogalusa Heart Study was used by Freedman, Khan, Dietz, Srinivasan,
and Berenson (2001) to conduct a longitudinal study of 2,617 participants to assess the
relationship of childhood BMI to adult levels of lipids, insulin, and blood pressure. All
participants were initially examined at ages 2 to 17 years and received a follow-up exami-
nation at 18 to 37 years. They reported that childhood obesity is related to adult levels of
lipids, lipoproteins, blood pressure, and insulin. They also indicated that childhood obe-
sity is related to morbidity from coronary heart disease. The researchers noted the results
of seven other studies that have found childhood obesity to be predictive of adult morbid-
ity and mortality, particularly coronary heart disease. The researchers stressed that the re-
sults of this study emphasized the importance of both primary and secondary prevention
of childhood obesity.
Obesity has been significantly associated with several chronic diseases, including type
II diabetes, hypertension, hypercholesterolemia, asthma, arthritis, and poor health status
(Flegal, Carroll, Ogden, & Johnson, 2002; Mokdad et al., 2003). Other researchers have
also found that obesity is strongly associated with these chronic diseases, in addition to
ischemic heart disease, stroke, hypertensive heart disease, osteoarthritis, postmenopausal
breast cancer, colon cancer, endometrial cancer, and renal cancer (James et al., 2005).
Respiratory problems, gallbladder disease, and sleep apnea are additional health prob-
lems found to be associated with obesity (DHHS, 2004). Manson and Bassuk (2003) re-
ported that obesity is a major risk factor for premature mortality and cardiovascular dis-
170 Durand, Logan, Carruth

ease. Researchers have noted that obesity has increased the risk of all of these chronic
health conditions; however, diabetes is the disease that is most closely linked to obesity.
The incidence of diabetes has increased as the prevalence of obesity increased (Flegal et
al., 2002). Researchers have also noted that 60% of children ages 5 to 10 years show evi-
dence of at least one risk factor for cardiac disease (Freedman, Dietz, Srinivasan, &
Berenson, 1999).
Researchers have additionally reported more immediate health risks. including
psychosocial consequences, hypertension, elevated cholesterol levels, abnormal glucose
tolerance, and several other health problems occurring during childhood (Ogden et al.,
2002; Rich et al., 2005; Whitlock et al., 2005). Additional health problems reported to
occur during childhood included hypertriglyceridemia, increased low-density
lipoproteins, decreased high-density lipoproteins, increased heart rate, increased cardiac
output, hyperinsulinemia, glucose intolerance, an increase in fibrous plaques in the coro-
nary arteries, and asthma (Rich et al., 2005). Boney et al. (2005) reported that childhood
obesity has contributed to an increased incidence of type II diabetes mellitus and meta-
bolic syndrome during childhood. Obesity and type II diabetes are both preventable
(Mokdad et al., 2003).
Exposure to maternal obesity was found to be a strong predictor of a child’s risk for the
development of metabolic syndrome (Boney et al., 2005). Furthermore, Rich et al. (2005)
reported that almost all organ systems are adversely affected by childhood obesity. Re-
searchers have noted that obese individuals faced the challenges of decreased productiv-
ity, social stigmatization, and high healthcare costs (DHHS, 2004).

Association of Maternal Obesity and Childhood Obesity

In a retrospective cohort study (Whitaker, Wright, Pepe, Seidel, & Dietz, 1997), height
and weight measurements were obtained from the records of 854 young adults and their
parents who were long-term members of a health maintenance organization. The findings
indicated that parental obesity more than doubles the risk that a child, under 10 years of
age, will become an obese adult. Prior to the age of 3 years old, the obesity status of the
parents was found to be the primary predictor of obesity in adulthood. This same study
reported that an obese 3-year-old child is almost eight times more likely to become an
obese young adult. The researchers concluded that parental obesity is a critical factor in
predicting a child’s risk of obesity in adulthood.
Heude et al. (2005) researched the relationship of parent–child anthropometric mea-
surements and their evolution over time. They reported a stronger relationship of
mother–child obesity than with father–child obesity. The findings from their prospective
study showed that a mother’s BMI predicted the evolution of her children’s BMI through
puberty. They noted that maternal BMI was associated with the BMI of her children at
birth, and that maternal adiposity may act early in life on the adiposity of her child. The
 Association Of Maternal Obesity 171

researchers concluded that this maternal effect seems to continue throughout childhood,
strengthening with puberty. Arluk, Branch, Swain, and Dowling (2003) conducted a
study that revealed maternal obesity as the strongest independent predictor of childhood
obesity.
Sherman, Alexander, Dean, and Kim (1995) studied the risk factors for obesity in
Mexican American and Anglo children. Findings of this study suggested the major risk
factors of childhood obesity in Mexican Americans include male sex, maternal percep-
tion of the child’s weight status at 9 months of age, and high maternal BMI. The research-
ers found the important risk factors of childhood obesity in Anglos include high birth
weight, maternal perception of the child’s weight status at 9 months of age, and high ma-
ternal BMI.
Maternal perception of the child’s weight was also investigated by Baughcum,
Chamberlin, Deeks, Powers, and Whitaker (2000). In this study, obesity was more preva-
lent in mothers with less education, high school or less; the incidence of obesity was also
higher in their preschool children. Most mothers were accurate in their perceptions of their
own weight status; however, only one in five mothers perceived their overweight children
as overweight. This misperception of the children’s weight status was more common in
mothers with less education, and may be a barrier to prevention of childhood obesity.
Whitaker (2004) conducted a retrospective cohort study of 8,494 low-income children
who were enrolled in the Women, Infants, and Children (WIC) supplemental nutrition pro-
gram in Ohio. Data analysis revealed a strong association between maternal obesity during
the first trimester of pregnancy and the obesity of her child at 2 and 4 years of age. A com-
parison of children of obese and normal weight mothers confirmed that over 24% of chil-
dren born to obese mothers were also obese by 4 years of age if their mothers had been obese
during the first trimester of pregnancy. In contrast, only 9% of children whose mothers were
normal weight in the first trimester of pregnancy were obese at 4 years old. After the re-
searcher controlled for several independent variables, the relative risk of childhood obesity
associated with maternal obesity in the first trimester of pregnancy was 2.0 at 2 years of age,
2.3 at 3 years of age, and 2.3 at 4 years of age. The relative risk indicated that maternal obe-
sity in early pregnancy was a strong predictor of childhood obesity, more than doubling the
risk of obesity at 2 to 4 years of age for low-income children. The data revealed, after adjust-
ing for all of the covariates, that the child’s risk of obesity also increased with increasing
maternal BMI level in the first trimester of pregnancy.
About 50% of infants in the United States meet the financial eligibility requirements
for WIC. Of the women receiving WIC, nearly one-third are already obese when they
conceive. About 25% of 4-year-olds who were born to obese mothers are already obese.
Previous studies indicated that obese 4-year-olds who had obese mothers will be three
times more likely to be obese as young adults (Whitaker, 2004).
Further research has strengthened the knowledge base of the relationship of maternal
obesity and childhood obesity. Salsberry and Reagan (2005) analyzed data on more than
3000 children and found a significant relationship between a mother’s prepregnancy
172 Durand, Logan, Carruth

weight and her child’s weight. They reported several prenatal variables that increase the
probability of a child becoming overweight or remaining overweight. The prenatal char-
acteristics linked to childhood obesity were black race, Hispanic ethnicity, maternal
smoking during pregnancy, and maternal prepregnancy obesity. The independent vari-
able that had the greatest impact on a child’s weight was the mother’s BMI within 1 to 2
months prior to conception. They noted that a child is more likely to develop obesity at 2
or 3 years of age if the mother was obese prior to pregnancy, and this trend is perpetuated
as the child ages. Maternal obesity prior to conception was noted to increase the child’s
risk of obesity almost threefold by age 7, compared to a child whose mother had a
prepregnancy BMI within normal limits. These findings also revealed that the degree of
risk for childhood obesity increased with the mother’s prepregnancy weight category.
The researchers noted that these findings highlighted the importance of prepregnancy
counseling, with an emphasis on achieving a healthy weight before becoming pregnant
for overweight or obese women.
Research studies have shown that prepregnancy obesity in mothers is not only associ-
ated with childhood obesity, but also obesity in early adult life (Laitinen, Power, &
Jarvelin, 2001; Stettler et al., 2000). Laitinen et al. presented a longitudinal study that an-
alyzed the BMI of 6,280 subjects at birth and at 1, 14, and 31 years of age. This study pro-
vided further evidence of the influence of maternal obesity before pregnancy and child-
hood obesity in all social groups. It also verified that as the mother’s BMI increased, the
offspring’s BMI would be correspondingly higher from birth to 31 years old. The re-
searchers included a high maternal BMI before pregnancy as one of the variables that can
be a predictor of obesity in adulthood.

THEORETICAL FRAMEWORK

The Health Belief Model (HBM) is a theory developed by Hochbaum, Leventhal, and
Rosenstock, social psychologists, to research behaviors related to public health problems
(Rosenstock, 1974). HBM has been beneficial in previous research to study health be-
haviors that facilitate or hinder disease prevention. A mother’s perception of the risks of
childhood obesity and her readiness to make changes to prevent these risks can be exam-
ined with the HBM, which is based on value expectancy theory. No existing studies have
applied the behavior change constructs of the HBM to maternal obesity as a risk factor
for childhood obesity. The HBM is beneficial when attempting to explain or predict an
individual’s health behaviors regarding prevention of a disease. It is based on the belief
that an individual will comply with a health-related recommendation if she believes that a
negative health condition can be avoided, that her compliance will prevent this condition,
and that she is capable of complying with this health-related recommendation. The HBM
has been applied to the study of voluntary behaviors of individuals when the individuals
have no symptoms of the predicted health problems (Becker, 1974).
 Association Of Maternal Obesity 173

When applied to prevention of childhood obesity, the HBM proposes that the mother
will modify her behavior prior to conception if two conditions are met. She believes that
specific actions will prevent childhood obesity and she has the incentive to make these
modifications. This model indicates that the mother’s personal decision to take action to
prevent childhood obesity is based on her perception of several important factors. First,
the mother must perceive that her child is susceptible to obesity due to her prepregnancy
and/or first trimester obesity. The next factor to consider is the mother’s perception of the
severity of childhood obesity, including the immediate and lifetime consequences. The
mother’s perception of the benefits of preventing childhood obesity is another important
factor in determining her choice to take action. She must believe that maintaining her
weight within normal limits prior to pregnancy and during the first trimester will reduce
her child’s risk of obesity. She may perceive many personal barriers to reducing her
weight, or maintaining a normal weight. Also, a variety of cues may be required to moti-
vate her to take action. Many variables, including her social environment and level of ed-
ucation, may affect the mother’s decisions. There are also many variables that will affect
her confidence in her ability to take the required actions to prevent obesity in her child
(Glanz, Rimer, & Lewis, 2002).

IMPLICATIONS FOR HEALTHCARE PROVIDERS

Preventable adverse health effects of childhood obesity should be addressed more ag-
gressively by healthcare providers, starting with the basic level of education in nursing.
Evidence-based practice requires educational preparation at the earliest level. The
knowledge that maternal obesity is a known risk factor for childhood obesity should be
the impetus for changes in the practice of nursing. Population-based care should design
community health interventions based on epidemiological studies, behavioral modifica-
tion of risk, and intergenerational family dynamics. As a result, future generations may
experience an increase in the quality and years of their lifespan. Increasing the quality
and number of years of healthy life is one of the two goals of Healthy People 2010
(DHHS, 2000).
The challenge for community health nurses (CHNs) is that only a scant number of
obesity prevention interventions have been developed for children and adolescents
(Reynolds & Spruijt-Metz, 2006). Even more difficult is assisting individuals in losing
weight, given that approximately 80% of overweight individuals are unsuccessful at
maintaining a weight loss of 10% of their body weight for 1 year (Wing & Phelan, 2005).
Early intervention for the prevention of childhood obesity must include identification of
prepregnancy maternal risk factors (see Table 1). Additionally, research findings on pre-
dictive risk factors clearly indicate the need for reexamination of family dynamics’ im-
pact on obesity.
174 Durand, Logan, Carruth

TABLE 1
Early Intervention to Halt the Vicious Cycle of Childhood Obesity

Note. Derived from Becker (1974) and Glanz, Rimer, and Lewis (2002).

CHNs are in an advantageous position to provide primary prevention of childhood obe-

sity, starting with education of teenage and young adult women during clinic encounters
prior to conception. CHNs are skilled at identifying infants who are at high risk for many
adverse health consequences. They can also use these skills to identify infants who are at
risk of obesity due to prepregnancy and/or first trimester obesity of the mother. These in-
fants may benefit from more frequent follow-up visits for monitoring that would include
providing health promotion information and age-appropriate anticipatory guidance.
A recent study (Rhee, DeLago, Arscott-Mills, Mehta, & Davis, 2005) concluded that
parents are more likely to be ready to make changes to help their child lose weight when
the child is 8 years old or older. Future research should examine readiness and motivation
across the lifespan to change health habits and attitudes. Stopping the cycle of obesity be-
fore it becomes the leading cause of preventable disease and death in the United States is
a priority for CHNs.

REFERENCES

Allison, D. B., Fontaine, K. R., Manson, J. E., Stevens, J., & VanItallie, T. B. (1999). Annual deaths attribut-
able to obesity in the United States [Electronic version]. Journal of the American Medical Association,
282, 1530–1538.
 Association Of Maternal Obesity 175

Arluk, S. L., Branch, J. D., Swain, D. P., & Dowling, E. A. (2003). Childhood obesity’s relationship to time
spent in sedentary behavior. Military Medicine, 168, 583–586.
Baughcum, A. E., Chamberlin, L. A., Deeks, C. M., Powers, S. W., & Whitaker, R. C. (2000). Maternal per-
ceptions of overweight preschool children. Pediatrics, 106, 1380–1386.
Boney, C. M., Verma, A., Tucker, R., & Vohr, B. R. (2005). Metabolic syndrome in childhood: Association
with birth weight, maternal obesity, and gestational diabetes mellitus [Electronic version]. Pediatrics,
115, e290–e296. Retrieved February 14, 2006, from www.pediatrics.org
Flegal, K. M., Carroll, M. D., Ogden, C. L., & Johnson, C. L. (2002). Prevalence and trends in obesity among
US adults, 1999–2000 [Electronic version]. Journal of the American Medical Association, 288,
1723–1727.
Freedman, D. S., Dietz, W. H., Srinivasan, S. R., & Berenson, G. S. (1999). The relation of overweight to car-
diovascular risk factors among children and adolescents: The Bogalusa heart study [Electronic version].
Pediatrics, 103, 1175–1182.
Freedman, D. S., Khan, L. K., Dietz, W. H., Srinivasan, S. R., & Berenson, G. S. (2001). Relationship of
childhood obesity to coronary heart disease risk factors in adulthood: The Bogalusa heart study [Elec-
tronic version]. Pediatrics, 108, 712–717.
Glanz, K., Rimer, B. K., & Lewis, R. M. (Eds.). (2002). Health behavior and health education: Theory, re-
search, and practice. San Francisco: Jossey-Bass.
Heude, B., Kettaneh, A., Rakotovato, R., Bresson, J. L., Borys, J. M., Ducimetiere, P., et al. (2005).
Anthropometric relationships between parents and children throughout childhood: The
Fleurbaix-Laventie Ville Sante study. International Journal of Obesity, 29, 1222–1229.
James, W. P. T., Jackson-Leach, R., Mhurchu, C. N., Kalamara, E., Shayeghi, M., Rigby, N. J., et al. (2005).
Overweight and obesity. In M. Ezzati, A. D. Lopez, A. Rodgers, & C. J. L. Murray (Eds.), Comparative
Quantification of Health Risks (pp. 497–596). Geneva, Switzerland: World Health Organization. Re-
trieved February 26, 2006, from http://www.who.int/publications/cra/chapters/volume1/0497–0596.pdf
Laitinen, J., Power, C., & Jarvelin, M. R. (2001). Family social class, maternal body mass index, and age at
menarche as predictors of adult obesity [Electronic version]. The American Journal of Clinical Nutrition,
74, 287–294.
Manson, J. E. & Bassuk, S. S. (Eds.). (2003). Obesity in the United States: A fresh look at its high toll [Elec-
tronic version]. Journal of the American Medical Association, 289, 229–230.
Mokdad, A. H., Ford, E. S., Bowman, B. A., Dietz, W. H, Vinicor, F., Bales, V. S., et al. (2003). Prevalence of
obesity, diabetes, and diabetes-related health risk factors, 2001 [Electronic version]. Journal of the Amer-
ican Medical Association, 289, 76–79.
National Center for Health Statistics. (2005). Health, United States, 2005: With chartbook on trends in the
health of Americans (DHHS Publication No. 2005–1232). Washington, DC: U.S. Government Printing
Office.
National Center for Health Statistics. (n.d.). Prevalence of overweight among children and adolescents:
United States, 1999–2002 [Electronic version]. Retrieved February 25, 2006, from http://www.cdc.gov/
nchs/products/pubs/pubd/hestats/overwght99.htm
Ogden, C. L., Flegal, K. M., Carroll, M. D., & Johnson, C. L. (2002). Prevalence and trends in overweight
among US children and adolescents, 1999–2000 [Electronic version]. Journal of the American Medical
Association, 288, 1728–1732.
Reynolds, K. D., & Spruijt-Metz, D. (2006). Translational research in childhood obesity prevention. Evalua-
tion & The Health Professions, 29, 219–245.
Rhee, K. E., DeLago, C. W., Arscott-Mills, T., Mehta, S. D., & Davis, R. K. (2005). Factors associated with
parental readiness to make changes for overweight children [Electronic version]. Pediatrics, 116,
e94–e101. Retrieved October 6, 2006, from www.pediatrics.org
Rich, S. S. DiMarco, N. M., Huettig, C., Essery, E. V., Andersson, E., & Sanborn, C. F. (2005). Perceptions of
health status and play activities in parents of overweight Hispanic toddlers and preschoolers. Family &
Community Health, 28, 130–141.
Rosenstock, I. M. (1974). Historical origins of the health belief model. In Becker, M. H. (Ed.), The health be-
lief model and personal health behavior (pp. 1–8). Thorofare, NJ: Charles B. Slack.
176 Durand, Logan, Carruth

Salsberry, P. J., & Reagan, P. B. (2005). Dynamics of early childhood overweight. Pediatrics, 116,
1329–1338.
Sherman, J. B., Alexander, M. A., Dean, A. H., & Kim, M. (1995). Obesity in Mexican-American and Anglo
children. Progress in Cardiovascular Nursing, 10(1), 27–34.
Stettler, N., Tershakovec, A. M., Zemel, B. S., Leonard, M. B., Boston, R. C., Katz, S. H., et al. (2000). Early
risk factors for increased adiposity: a cohort study of African American subjects followed from birth to
young adulthood [Electronic version]. The American Journal of Clinical Nutrition, 72, 378–383.
Tulane Center for Cardiovascular Health. (2005). The Bogalusa heart study 1972–2005: History of the
Bogalusa heart study. Retrieved March 22, 2006, from http://www.som.tulane.edu/cardiohealth/
bog.html
U.S. Department of Health and Human Services. (2000). Healthy people 2010 (2nd ed.). Washington, DC:
U.S. Government Printing Office.
U.S. Department of Health and Human Services. (2001). The surgeon general’s call to action to prevent and
decrease overweight and obesity 2001 [Electronic version]. Retrieved February 25, 2006, from http://
www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.2
U.S. Department of Health and Human Services. (2004). Understanding mechanisms of health risk behavior
change in children and adolescents [Electronic version]. Retrieved February 17, 2006, from http://
grants.nih.gov/grants/guide/pa-files/PA-04–121.html
Whitaker, R. C. (2004). Predicting preschooler obesity at birth: The role of maternal obesity in early preg-
nancy [Electronic version]. Pediatrics, 114, e29–e36. Retrieved February 17, 2006, from www.pediat-
rics.org
Whitaker, R. C., Wright, J. A., Pepe, M. S., Seidel, K. D., & Dietz, W. H. (1997). Predicting obesity in young
adulthood from childhood and parental obesity [Electronic version]. The New England Journal of Medi-
cine, 337, 869–873.
Whitlock, E. P., Williams, S. B., Gold, R., Smith, P. R., & Shipman, S. A. (2005). Screening and interventions
for childhood overweight: A summary of evidence for the US preventive services task force [Electronic
version]. Pediatrics, 116, e125–e144. Retrieved February 21, 2006, from www.pediatrics.org
Wing, R. R. & Phelan, S. (2005). Long-term weight loss maintenance [Electronic version]. The American
Journal of Clinical Nutrition, 82, 222S–225S.