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Externalizing behavior in early childhood and body mass index from age 2 to 12 years: longitudinal analyses of a prospective cohort study

Sarah E Anderson1*, Xin He2, Sarah Schoppe-Sullivan3 and Aviva Must4

Author Affiliations

1 Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, USA

2 Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA

3 Department of Human Development and Family Science, The Ohio State University College of Education and Human Ecology, Columbus, Ohio, USA

4 Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA

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BMC Pediatrics 2010, 10:49  doi:10.1186/1471-2431-10-49

Published: 14 July 2010



Some evidence suggests that obesity and behavior problems are related in children, but studies have been conflicting and have rarely included children under age 4. An association between behavior problems in early childhood and risk for obesity could suggest that a common set of factors contribute to both. Our research objectives were to determine the extent to which externalizing behavior in early childhood is related to body mass index (BMI) in early childhood and through age 12, and to evaluate whether these associations differ by sex and race.


Data from the NICHD Study of Early Child Care and Youth Development were analyzed. Externalizing behaviors at 24 months were assessed by mothers using the Child Behavior Checklist. BMI was calculated from measured height and weight assessed 7 times between age 2 and 12 years. Linear mixed effects models were used to assess associations between 24 month externalizing behavior and BMI from 2 to 12 years, calculate predicted differences in BMI, and evaluate effect modification.


Externalizing behavior at 24 months was associated with a higher BMI at 24 months and through age 12. Results from a linear mixed effects model, controlling for confounding variables and internalizing behavior, predicted a difference in BMI of approximately 3/4 of a unit at 24 months of age comparing children with high levels of externalizing behavior to children with low levels of externalizing behavior. There was some evidence of effect modification by race; among white children, the average BMI difference remained stable through age 12, but it doubled to 1.5 BMI units among children who were black or another race.


Our analyses suggest that externalizing behaviors in early childhood are associated with children's weight status early in childhood and throughout the elementary school years, though the magnitude of the effect is modest.