Open Access Highly Accessed Research article

Risk factors for childhood obesity: shift of the entire BMI distribution vs. shift of the upper tail only in a cross sectional study

André M Toschke12*, Rüdiger von Kries2, Andreas Beyerlein2 and Simon Rückinger2

Author Affiliations

1 King's College London, Division of Health and Social Care Research, Department of Public Health Sciences, 7th Floor Capital House, 42 Weston St, London, SE1 3QD, UK

2 Ludwig-Maximilians-University of Munich, Division of Pediatric Epidemiology at the Institute of Social Pediatrics and Adolescent Medicine, Munich, Germany

For all author emails, please log on.

BMC Public Health 2008, 8:115  doi:10.1186/1471-2458-8-115

Published: 10 April 2008



Previous studies reported an increase of upper body mass index (BMI) quantiles for formula fed infants compared to breastfed infants, while corresponding mean differences were low. The aim of this study was to assess the impact of known risk factors for childhood obesity on the BMI distribution.


Data on 4,884 children were obtained at obligatory school entry health examinations in Bavaria (Germany). Exposure variables were formula feeding, maternal smoking in pregnancy, excessive TV-watching, low meal frequency, poor parental education, maternal overweight and high infant weight gain. Cumulative BMI distributions and Tukey mean-difference plots were used to assess possible shifts of BMI distributions by exposure.


Maternal overweight and high infant weight gain shifted the entire BMI-distribution with an accentuation on upper quantiles to higher BMI values. In contrast, parental education, formula feeding, high TV consumption, low meal frequency and maternal smoking in pregnancy resulted in a shift of upper quantiles only.


The single shifts among upper parts of the BMI distribution might be due to effect modification of the corresponding exposures by another environmental exposure or genetic predisposition. Affected individuals might represent a susceptible subpopulation of the exposed.