The role of center-based care programs as determinants of body mass index variations in early childhood

• In Event: 3-003 - Studying Biosocial Developmental Processes with Secondary and Administrative Data

Abstract

Childhood overweight is growing at an alarming rate and represents one of the main challenges of public health globally, including many developing countries. In Chile, about 34% of children under 6 years old are overweight or obese (Chilean Ministry of Health, 2014), the highest childhood obesity rate in Latin-America (WHO, 2016). Socioeconomic and lifestyle factors that may lead to inadequate eating behaviors in early-childhood, such as parental food habits and exercising conduct, and household routines, are the main drivers of childhood overweight (Reilly John, et al., 2005). However, attendance to center-based care at early ages tends to moderate overweight growth (Maher Erin, et al., 2008).
We examined the association between attendance at center-based care and the probability that a child is overweight, and the determinants of BMI variation in toddlers. We use a secondary dataset the Longitudinal Survey in Early Childhood (ELPI) (2010 and 2012), a Chilean nationally representative dataset. The sample is children who were <24 months old in 2010 (n=1,396). First, we used a difference-in-difference (DID) model to compare changes in the BMI of children participating in a center-based care program and children in maternal care. Second, we combined a DID framework with propensity-score matching tecniques. The inclusion of matching models accounts for specification biases. Third, we used a logit model, controlling for baseline demographic and socioeconomic covariates, to estimate the probability that children who were <24 months old in 2010 were overweight in 2012. We defined being overweight employing the bmi-for-age index using WHO standards for children with the same age and sex (+2SD from the mean). Finally, we examined the association between the probability of being overweight in 2012 and the BMI gains/losses between 2010 and 2012 for children in maternal and center-based care.
Overall, the results showed smaller BMI differences between 2010 and 2012 for children who attended center-based care relative to children in maternal care. The effect is more robust using the Matching-DID model (p-value<0.05). Conditional on child, family and household characteristics, the variables in 2010 most strongly associated with child overweight in 2012 were mother’s BMI (p<0.001), mother´s chronic diseases, and child lifestyle (hours of TV and hours of sleep).
The results suggest that public policies should encourage the participation in center-based care to avoid child overweight. This study forms part forms part of a project that uses secondary data from Colombia, Uruguay and Chile to study the association between attendance at center-based care and child obesity.

Authors

• Marigen Narea, Pontificia Universidad Católica de Chile
  Presenting Author

• Kasim Allel, Pontificia Universidad Catolica