# Odds of Developing Overweight or Obesity Increase with Height Decile in Tall Healthy Weight Kindergarteners: Longitudinal Results from the West Virginia Coronary Artery Risk Detection In Appalachian Communities (WV CARDIAC) Project

## TL;DR

Tall kindergarten children with healthy weights are more likely to become overweight or obese later, suggesting height could help identify early obesity risk.

## Contribution

Identifies kindergarten height as a novel predictor of future obesity risk in children with healthy BMI.

## Key findings

- Taller kindergarten children had faster BMI growth trajectories.
- Tallest healthy-weight children had 3x higher odds of becoming overweight/obese.
- Height percentile was a significant predictor after controlling for BMI, age, and sex.

## Abstract

Childhood obesity is a strong predictor of adult obesity and chronic health complications. Prevention initiatives are most successful when implemented before excess weight gain, but tools to screen healthy weight children for obesity risk are lacking. Laboratory studies suggest that tall stature could be an early indicator of later obesity. We sought to test the hypothesis that kindergarten height is associated with body mass index (BMI) trajectories through second and fifth grade in Appalachian school children.

Children with BMI data in kindergarten and second or fifth grade (n = 9059) were obtained from the West Virginia Coronary Artery Risk Detection In Appalachian Communities (WV CARDIAC) Project. BMI percentile trajectories were calculated using high performance mixed modeling to save the best linear unbiased predictor random effect slopes. Subset analyses were performed on children with healthy weight BMI in kindergarten (n = 5786). Linear mixed models on BMI trajectories and logistic regression models on children in the second or fifth grade with overweight/obesity were conducted.

After we controlled for sex, age, and kindergarten BMI, kindergarten height percentile was associated with rapid BMI trajectories (linear mixed models Est. = 0.01, P < .0001). For children in the healthy BMI weight category, the odds of developing overweight/obesity increased with each height decile. The tallest children in kindergarten (top decile) had 3 times the odds of developing overweight/obesity compared with the first decile (OR 2.97, 95% CI 2.15-4.10).

Obesity-prevention initiatives could greatly benefit from considering tall stature and rapid growth velocity in early childhood as potential indicators of obesity risk, even if children fit within a healthy BMI category.