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Journal of Pediatric Psychology logoLink to Journal of Pediatric Psychology
. 2015 Mar 21;40(7):649–656. doi: 10.1093/jpepsy/jsv023

Racial Differences in Obesity-Related Risk Factors Between 2-Year-Old Children Born of Overweight Mothers

Bernard F Fuemmeler 1,✉, Marissa Stroo 1, Chien-Ti Lee 2, Sharnail Bazemore 1, Brooke Blocker 1, Truls Østbye 3,4
PMCID: PMC4505075  PMID: 25797946

Abstract

Objective Investigate racial differences in a range of obesity-related socio-behavioral risk factors in children born of obese mothers. Methods 142 Black and 151 White 2-year-old children and their parents were surveyed on their physical activity environment, food environment, parental role modeling, eating behaviors, feeding practices, child physical activity, dietary intake, and eating behaviors; body mass index (BMI) for parents and children (BMI z-score) were calculated. Results In bivariate analyses, Black families reported significantly more risk factors for early-childhood obesity than White families, including greater availability of soda, more television viewing, and poorer dietary intake. In multivariate analyses adjusting for maternal and socioeconomic factors, the differences between Black and White families on factors including television watching and dietary intake remained significant. Conclusion These data show a greater number of risk factors for obesity among Black children and their families compared with White children even after adjustment for maternal BMI and socioeconomic status.

Keywords: children, home environment, obesity

There are substantial racial/ethnic differences in the prevalence of obesity. Between the ages of 2 and 5 years, the proportion of Black children with a body mass index (BMI) at or above the 95th percentile is 11.3%, twice the proportion for White children, and these differences persist through development (3.5%; Ogden, Carroll, Kit, & Flegal, 2014). Such findings suggest obesity-related risk factors present during early childhood may give rise to the differences observed through development.

The etiology of obesity is multifactorial, involving a combination of individual, familial, and societal factors (Egger & Swinburn, 1997; Nader et al., 2012). One very important risk factor for childhood obesity is having parents who are obese. Children with obese parents are 10–12 times more likely to be obese (Reilly et al., 2005; Whitaker, Jarvis, Beeken, Boniface, & Wardle, 2010). Children of obese parents also exhibit lower levels of physical activity, have a greater preference for high-fat foods, and lower preference for healthier foods (Morgan, Okely, Cliff, Jones, & Baur, 2008; Wardle, Guthrie, Sanderson, Birch, & Plomin, 2001). Other individual child-level risk factors include unhealthy diet, sedentary time, and eating characteristics or traits (e.g., low satiety responsiveness) (Collings et al., 2013; Fuemmeler, Lovelady, Zucker, & Ostbye, 2013). Parent modeling of health behaviors, parent feeding behaviors, or general parenting styles have also been linked to risk for obesity (Collings et al., 2013; Fuemmeler, Anderson, & Mâsse, 2011; Ostbye et al., 2013). The home environment, such as availability of healthy and unhealthy food or accessibility of safe play areas and toys used for physical activity, have also been examined relative to childhood obesity (Ostbye et al., 2013; Sallis, Prochaska, & Taylor, 2000).

Because early childhood is a critical period for the development of obesity over the life course, and because the gap in the prevalence of obesity between racial/ethnic groups widens early in development, it is important to identify early differences in risk factors to reduce racial and ethnic disparities (Dixon, Peña, & Taveras, 2012), but this research base is still limited. Hughes et al. (2006) and Fuemmeler et al. (2012) found that specific parental feeding practices and general parenting styles differ by race and that these differences in parenting may influence risk for obesity (Fuemmeler et al.). Taveras et al. (2010) found that Black preschool-aged children watched more television (TV) and consumed higher quantities of fast food and sugar-sweetened beverages (SSB) than their White counterparts. Perrin et al. (2014) reported that compared twith White mothers, Black, non-Hispanic mothers were more likely to provide constant access to food, such as putting their child to bed with a bottle, encouraging their child to finish breast milk or formula, and “bottle prop” (i.e., lean a bottle up against a blanket instead of hold it). In their sample, Black mothers also watched greater amounts of TV with their infants than their White counterparts (Perrin et al., 2014). These studies suggest that, Black and White children differ with respect to risk factors and behaviors related to obesity later, and some of these differences are present at an early age. Despite these studies, research in this area is still limited and would benefit from a better understanding of social determinants and risk factors from a number of different levels (e.g., home environment, parents’ behaviors, parenting, child eating characteristics), especially at this early developmental phase when prevention efforts may have its greatest impact.

The purpose of the current study was to evaluate racial differences in BMI z-score and obesity-related social and behavioral risk factors in a sample of 2-year-old Black and White children who share a common risk factor for obesity—being born to an overweight or obese mother. This provides the opportunity to examine risk factors for obesity beyond this highly influential risk factor. The study examined parental behaviors and feeding practices, the home health environment, child dietary intake, TV time and time playing outdoors, and child eating traits. These factors have been shown to be associated with childhood obesity in various populations. Studies that can identify racial differences in obesity-related risk factors have the potential to lead to clearer frameworks for obesity prevention from which to build more targeted interventions. We hypothesized that Black children would be heavier and that the obesiogenic parenting behaviors and home environment would be more common in Black families compared with their White counterparts.

Method

Participants

Participants were recruited from three large obstetrics clinics in the Southeastern United States for a larger behavioral randomized controlled trial, Active Mother’s Postpartum (AMP) (Ostbye et al., 2008, 2009). AMP was designed to enhance weight loss in postpartum women who were overweight or obese before pregnancy. Eligibility was based on BMI ≥ 25 measured at the 6-week postpartum obstetrics appointment. Women who did not speak English or were aged <18 years were excluded from participation. Participants were randomized at 6–8 weeks postpartum to either the AMP intervention (n = 225) or the attention control group (n = 225). The 9-month AMP intervention included follow-up assessments (at 12 and 24 months postpartum) and focused on improving maternal lifestyle behaviors. The intervention did not specifically involve the adoption of any specific parenting styles or efforts to improve the health of their newborn infant. The results showed a mean weight loss at 1-month postintervention (12 months postpartum) of 0.90 kg (SD = 5.1 kg) in the intervention group and 0.36 kg (SD = 4.9 kg) in the control group; this was not statistically significant. There were also no significant group differences in improvement in diet or increased physical activity (see Østbye et al., 2009).

At the end of their final AMP follow-up (24 months postpartum), and on their return to the lab, mothers and their 2-year-old children were invited to participate in an observational study, “AMP Too for Twos! (AMP2).” Of the 450 participants from the main AMP study, 309 agreed to participate. For the purposes here, participants who reported a race/ethnicity other than non-Hispanic Black or White were excluded (n = 16). As part of AMP2, resident partners (n = 248) of the mothers were also contacted and invited to participate in a mail-in survey: 211 were completed. The University’s institutional review board approved all study procedures.

Measures

Child Anthropometrics

At 2 years of age, child weight and standing height were measured using a Seca portable stadiometer and Tanita BWB-800 scale. Age- and gender-adjusted BMI z-scores were calculated using the Centers for Disease Control and Prevention SAS macro (Centers for Disease Control and Prevention, 2010).

Parental Health Behaviors

Percent of kilocalories from fat in maternal and partner diets was measured using the National Cancer Institute’s (NCI) Percentage Energy from Fat Screener (National Cancer Institute), which consists of 17 items; each item measured a Likert scale assessing how often certain foods are consumed/prepared and a self-report question ranking fat in diet as high, medium, or low. In previous studies, the self-administered NCI fat screener has been shown to significantly correlate with interviewer-administered 24-hr dietary recalls (Thompson et al., 2008; Williams et al., 2008). Dietary screeners are useful in situations that do not require assessment of total energy intake, and although not as accurate as 24-hr recalls, they are used extensively to characterize a population’s median intake or compare population subgroups in terms of higher or lower intakes.

A brief self-report food frequency questionnaire assessed the frequency of SSB, including (1) non-diet sodas and (2) other SSB. The two items were combined and dichotomized into none versus any. The specific questions are widely used by public health programs, and were based on the Women Infants and Children diet survey.

Mothers and their partners were also asked to report the number of hours they spend per day watching TV. Amount of TV viewing is positively correlated with BMI, percentage of fat, light-intensity physical activity and is negatively correlated with cardiorespiratory fitness and moderate to vigorous physical activity (Pettee, Ham, Macera, & Ainsworth, 2009).

Parent Feeding Practices

The Parental Feeding Style Questionnaire (PFSQ; Wardle, Sanderson, Guthrie, Rapoport, & Plomin, 2002) is a 27-item measure rated on a Likert scale ranging from 1 (Never) to 5 (Always). Both internal consistency reliability and validity have been established with the PFSQ. The measure yields four subscales: Control Feeding (CF; 10 items), Emotional Feeding (EM; 5 items), Encouragement Feeding (EN; 8 items), and Instrumental Feeding (IF; 4 items). Sample items from each subscale include the following: “I allow my child to choose, which foods to have for meals” (CF); “I give my child something to eat to make him/her feel better when s/he is feeling upset” (EM); “I encourage my child to eat a variety of foods” (EN); “I reward my child with something good to eat when s/he is well behaved” (IF). Higher scores indicate a greater parental endorsement of the feeding practice measured by the respective subscale. In this sample, Cronbach’s α for the CF, EM, EN, and IF subscales were 0.77 (0.79 for Whites; 0.77 for Blacks), 0.84 (0.82 for Whites; 0.85 for Blacks), 0.77 (0.73 for Whites; 0.80 for Blacks), and 0.63 (0.65 for Whites; 0.61 for Blacks), respectively. All of the four items were correlated with the total at a value of ≥ 0.32, suggesting no item discriminated poorly (Nunnally & Bernstein, 1994).

Home Health Environment

Mothers were asked to report how often healthy snacks (e.g., raisins, pretzels, or Cheerios), vegetables (e.g., fresh, canned, or frozen), fruit (e.g., fresh, canned, or frozen), soda or sugary beverages (e.g., Coke, Pepsi, Hi-C, and Sunny D; not including 100% fruit juices or diet drinks). They also reported on how often toys that encouraged physical activity were available in or around their homes (e.g., balls, tricycle). All of these items were rated on a 5-point Likert scale ranging from 0 (Never) to 4 (Always). Mean response to the fruits and vegetable questions were calculated and combined into one item. The items were all dichotomized into often or always (≥3) responses versus all other.

Child Dietary Intake

Child dietary intake was assessed similarly to the Feeding Infants and Toddlers Study (Ziegler, Briefel, Clusen, & Devaney, 2006). The primary caregiver (in nearly all cases, the mother) completed a 24-hr dietary recall by telephone on two randomly selected days over a 2-week period. Before the call, mothers were given a packet with two-dimensional visuals including examples of age-appropriate food portions and eating implements (e.g., “sippy-cups” and small bowls). If children attended daycare, mothers were given a form for the daycare provider to record the child’s dietary intake (type and amount of food eaten). Recalls were completed using the Nutrition Data System for Research (University of MN) (Moshfegh et al., 2008; Ziegler et al., 2006), which yields an estimate of energy intake, percent energy from fat, added sugars (in grams), and servings of sweet drinks (soda, sweet tea, etc.). Diet recall data were available for 226 of the 293 (77%) children. There were no differences in primary demographic characteristics (maternal education and child’s race) between mothers who provided dietary information and those who did not (Fuemmeler et al., 2013).

Child TV Time and Time Playing Outdoors

Parents were asked to report on the number of hours their child watches TV and plays outside on weekdays and weekends. Weekday and weekend TV time was dichotomized to identify children who spent >2 hr per day watching TV, as recommended by American Academy of Pediatrics (2014).

Child Eating Characteristics

The Children’s Eating Behavior Questionnaire (CEBQ; Wardle, Guthrie, Sanderson, & Rapoport, 2001) contains 35 items measured on a Likert scale ranging from 1 (Never) to 5 (Always) and yields eight subscales. For this study, we restricted our analyses to the following subscales: Food Responsiveness (FR), Enjoyment of Food (EF), Desire to Drink (DD), and Satiety Responsiveness plus Slowness in Eating (SR). The SR subscales were combined as they have been shown to load onto the same factor (Wardle, Guthrie, Sanderson, & Rapoport, 2001). The EF, FR, and DD domains reflect a general avidity toward eating and food, with higher scores indicating greater avidity. Sample items include the following: “If allowed, my child would eat too much” (FR); “My child loves food” (EF); and “If given the chance, my child would always be having a drink” (DD). The SR domain reflects how easily a child reaches satiety (e.g., “My child cannot eat a meal if he/she has had a snack just before”). The CEBQ has been shown to have high internal consistency, good test–retest reliability, stability over time (Ashcroft, Semmler, Carnell, van Jaarsveld, & Wardle, 2008; Wardle, Guthrie, Sanderson, & Rapoport, 2001). Furthermore, the four subscales of CEBQ have been correlated with weight (Webber, Hill, Saxton, Van Jaarsveld, & Wardle, 2009), indicating good convergent validity. In this sample, Cronbach’s αs for the EF, FR, DD, and SR subscales were .86 (.85 for Whites; .87 for Blacks), .79 (.65 for Whites; .84 for Blacks), .85 (.84 for Whites; .83 for Blacks), and .73 (.70 for Whites; .74 for Blacks), respectively.

Other Variables

Within the survey, parents also reported on their age, marital status, level of education, household income, and their child's sex and race. Mothers reported Child’s birth weight and gestational weeks when they first enrolled in the AMP study (6–8 weeks postpartum). Mother’s and child’s weights and heights were measured at the study visit. Weights and heights of the mothers’ partners were self-reported.

Statistical Analysis

The detailed demographic characteristics for all participants and stratified by race (i.e., Black vs. White) were tabulated. Next, multiple linear regressions or logistic regression models were developed to assess racial differences (White as the reference group) in each risk factor adjusted for maternal age, education, household income, marital status, maternal BMI, child gender, and AMP study arm (treatment vs. control). In adjusted models that examined differences with respect to partner behaviors, partner’s BMI was used instead of maternal BMI.

Results

Table I shows the sample characteristics of the 293 children participating in the study. Table II provides the percentages and means and standard deviations for the behavioral and social risk factors for the overall sample and for Blacks and Whites separately. Table III presents the results adjusted for covariates.

Table I.

Parent and Child Characteristics Overall and by Race

Sample characteristics Overall (n = 293) Black (n = 142) White (n = 151) M Difference (or χ2) p
Maternal age at survey- M ± SD 32.81 ± 5.39 31.50 ± 5.65 34.04 ± 4.84 −2.53 <.001
Marital status
 Married (%) 215 (73.4%) 69 (48.6%) 146 (96.7%) (86.67) <.001
 Cohabitated (%) 33 (11.3%) 31 (21.8%) 2 (1.3%) (30.79) <.001
Maternal education-college degree (%) 166 (56.7%) 57 (40.1%) 109 (72.2%) (30.60) <.001
Household income (69.17) <.001
 1 = Up to $15,000 20 (7.0%) 18 (13.0%) 2 (1.4%) – –
 2 = $15,001–$30,000 62 (21.8%) 51 (37.0%) 11 (7.5%) – –
 3 = $30,001–$45,000 42 (14.7%) 23 (16.7%) 19 (12.9%) – –
 4 = $45,001–$60,000 37 (13.0%) 13 (9.4%) 24 (16.3%) – –
 5 = $60,001 or more 124 (43.5%) 33 (23.9%) 91 (61.9%) – –
Mother's BMI 33.0 ± 7.47 35.7 ± 8.08 30.5 ± 5.85 5.18 <.001
Partner's BMI 28.5 ± 5.05 29.1 ± 5.66 28.2 ± 4.65 0.93 .21
Toddler BMI z-score - M ± SD 0.49 ± 0.96 0.52 ± 1.07 0.46 ± 0.84 0.05 .63
Toddler Birth Weight - M ± SD 6.94 ± 1.46 6.57 ± 1.59 7.27 ± 1.24 −0.70 <.001
Gestation in weeks - M ± SD 38.5 ± 2.08 38.3 ± 2.49 38.6 ± 1.59 −0.27 .27
Toddler gender (0.23) .63
 Male 165 (56.3%) 82 (57.8%) 83 (55.0%) – –
 Female 128 (43.7%) 60 (42.3%) 68 (45.0%) – –
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Table II.

Descriptive Statistics of Risk Factors for Childhood Obesity Overall and by Race

Risk factors of childhood obesity Overall (n = 293) Black (n = 142) White (n = 151) M difference (or χ2) p
Home environment
 Healthy snacks in home (often/always) 258 (88.4%) 110 (77.5%) 148 (98.7%) (31.87) <.001
 Fruits and vegetables in home (often/always) 260 (89.0%) 120 (84.5%) 140 (93.3%) (5.82) .016
 Soda in home (often/always) 106 (36.2%) 60 (42.3%) 45 (30.6%) (4.41) .036
 Toys for physical activity (often/always) 277 (94.5%) 129 (90.9%) 145 (98.6%) (7.28) .007
Maternal behaviors
 TV hours per day 2.40 ± 1.36 2.89 ± 1.52 1.94 ± 1.01 0.94 <.001
 % Kcal from fat (NCI) 31.9 ± 5.80 34.3 ± 6.29 29.7 ± 4.26 4.53 <.001
 Consuming sweet beverages (Yes) 177 (60.6%) 113 (79.6%) 64 (42.7%) (41.63) <.001
Partner behaviors
 TV hours per day 2.86 ± 1.41 3.57 ± 1.51 2.45 ± 1.18 1.11 <.001
 % Kcal from fat (NCI) 32.4 ± 3.7 33.5 ± 3.6 31.8 ± 3.58 1.65 .002
 Consuming sweet beverages (Yes) 152 (75.6%) 66 (89.2%) 86 (67.7%) (11.69) .001
Parent feeding practices
 Control (C) 3.87 ± 0.54 3.84 ± 0.56 3.90 ± 0.53 0.05 .404
 Emotional (EM) 1.65 ± 0.63 1.68 ± 0.71 1.62 ± 0.54 0.06 .421
 Encouragement (EN) 3.93 ± 0.56 3.83 ± 0.63 4.03 ± 0.47 0.20 .003
 Instrumental (I) 1.71 ± 0.60 1.75 ± 0.64 1.68 ± 0.56 0.07 .302
Toddler behaviors
 TV hours per weekday >2 hr 214 (75.4%) 86 (63.7%) 128 (85.9%) (18.80) <.001
 TV hours per weekend >2 hr 208 (72.7%) 78 (57.4%) 130 (86.7%) (30.90) <.001
 Hours playing outside on weekday 2.48 ± 1.60 2.72 ± 1.83 2.26 ± 1.30 0.46 .015
 Hours playing outside on weekend 2.97 ± 1.52 3.08 ± 1.77 2.87 ± 1.24 0.21 .243
 Average energy 1237.4 ± 317.4 1271.5 ± 360.6 1207.2 ± 271.7 64.29 .136
 % energy from fat 31.43 ± 6.41 32.17 ± 6.38 30.77 ± 6.38 1.40 .101
 Average servings of sweetened drinks 0.32 ± 0.57 0.51 ± 0.70 0.16 ± 0.35 0.12 <.001
 Average added sugars (g) 35.0 ± 24.4 38.9 ± 30.0 31.6 ± 17.5 7.32 .029
Toddler eating characteristics
 Food responsiveness (FR) 2.30 ± 0.78 2.46 ± 0.94 2.15 ± 0.56 0.31 .001
 Enjoyment of food (EF) 3.76 ± 0.74 3.79 ± 0.82 3.73 ± 0.66 0.06 .488
 Desire to drink (DD) 3.40 ± 1.02 3.65 ± 1.01 3.16 ± 0.97 0.49 <.001
 Satiety responsiveness/slowness in eating (SR) 2.97 ± 0.50 2.87 ± 0.54 3.08 ± 0.44 0.21 <.001
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Bold text indicates p < .05.

Table III.

Comparison Between Black and White (Referent) Toddlers on Social and Behavioral Factorsa

Social and behavioral factors b (SE) B OR (95% CI) p
Home environment
 Healthy snacks in home 0.13 (0.03–0.62) <.01
 Fruits and vegetables in home 0.70 (0.26–1.90) .48
 Soda in home 1.45 (0.77–2.71) .25
 Toys for physical activity 0.25 (0.56–1.15) .08
Maternal behaviors
 TV hours per day 0.55 (0.19) 0.20 <.01
 % Kcal from fat (NCI) 2.01 (0.78) 0.17 <.01
 Consuming sweet beverages 2.10 (1.10–3.99) <.05
Partner behaviorsb
 TV hours per day 0.75 (0.21) 0.25 <.001
 % Kcal from fat (NCI) 0.86 (0.60) 0.15 .15
 Consuming sweet beverages 2.69 (1.08–6.68) .03
Parent feeding practices
 Control (C) −0.05 (0.08) −0.05 .53
 Emotional (EM) −0.07 (0.09) −0.06 .42
 Encouragement (EN) −0.16 (0.08) −0.15 .05
 Instrumental (I) −0.02 (0.09) −0.02 .79
Toddler behaviors
 TV hours per weekday >2 hr 0.34 (0.16–0.71) <.01
 TV hours per Weekend >2 hr 0.24 (0.12–0.49) <.001
 Average energy 60.1 (55.6) 0.09 .28
 % Kcal from fat (Nutrition Data System) 0.28 (1.12) 0.02 .80
 Average servings of sweet drinks 0.11 (0.03) 0.31 <.001
 Average added sugars 8.97 (4.24) 0.18 <.05
 Hours playing outside on weekday 0.25 (0.23) 0.08 .28
 Hours playing outside on weekend −0.11 (0.22) −0.04 .60
Toddler eating characteristics
 Food responsiveness (FR) 0.32 (0.11) 0.21 <.01
 Enjoyment of food (EF) 0.17 (0.11) 0.12 .11
 Desire to drink (DD) 0.36 (0.15) 0.18 <.05
 Satiety responsiveness/slowness in eating (SR) −0.24 (0.08) −0.24 <.01
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Note. aModels control for mothers age, educational attainment, household income, marital status, mother’s BMI and AMP group assignment.

bModels assessing partner’s behaviors include all of the same covariates as in other models, but include partner’s BMI rather than mother’s BMI.

Bold text indicates p < .05.

Sample Characteristics

Compared with White children, Black children had mothers who were younger (M = 31.50 years, SD = 5.65 vs. M = 34.04 years, SD = 4.84), less likely to be married (48.6% vs. 96.7%), had a higher BMI (M = 35.70, SD = 8.08 vs. M = 30.52, SD = 5.85), less likely to have a college degree (40.1% vs. 72.2%), and less likely to have a household income ≥ $60,000 (23.9% vs. 61.9%). Birth weight was lower in Blacks than Whites (M = 6.57 lbs., SD = 1.59 vs. M = 7.27 lbs., SD = 1.24). Black children had similar BMI z-scores as White children (M = 0.52, SD = 1.07 vs. M = 0.46, SD = 0.84).

Home Environment and Parent Behaviors

Compared with White children, Black children had less access to healthy snacks in the home (78% vs. 99% often or always had access), fruits and vegetables in the home (85 vs. 93%), greater availability of soda in the home (42% vs. 31%), and had less access to toys for physical activity in the home (91% vs. 99%). As for maternal and partner behaviors, compared with White children, Black children had parents who watched more hours of TV per day (2.89 vs. 1.94, Cohen’s d = 0.74 for mothers; 3.57 vs. 2.45, Cohen’s d = 0.83 for partners), consumed a greater percentage of energy from fat (34% vs. 30% for mothers, Cohen’s d = 0.86; 34% vs 32% for partners, Cohen’s d = 0.47), and were more likely to consume SSB (80% vs. 43% for mothers; 89% vs. 68%, for partners). These differences were all statistically significant. With the exception of White parents endorsing more encouraging-type feeding practices (4.03 vs. 3.83, Cohen’s d = 0.36), no other statistically significant differences were observed in parental feeding practices.

Child Behaviors and Eating Characteristics

With respect to TV time and time playing outdoors, White children watched significantly more than the recommended 2 hr of TV on weekdays and weekends than Black children (86% vs. 64% on the weekdays and 87% vs. 57% on the weekends). White children, however, spent significantly fewer hours playing outside on weekdays (2.3 vs. 2.7 hr, Cohen’s d = −0.29), but similar amounts to Black children on the weekends (2.9 vs. 3.1 hr, Cohen’s d = −0.14).

With respect to diet, White and Black children were reported by their parents to have similar energy intake (1,271 average daily kcal for Blacks vs. 1,207 average daily kcal for Whites, Cohen’s d = 0.20). The composition of daily diet was similar between the two groups with respect to the average percent energy from fat (32% for Blacks vs. 31% for Whites, Cohen’s d = 0.22); however, compared with White children, Black children consumed significantly more servings of sweetened drinks (0.51 average daily servings vs. 0.16 average daily servings, Cohen’s d = 0.64) and more grams of added sugar (38.9 vs. 31.6, Cohen’s d = 0.30).

With respect to child eating characteristics, Black children had significantly higher scores on scales representing avidity toward food, such as DD (3.7 vs. 3.2, Cohen’s d = 0.49) and the FR (2.5 vs. 2.2, Cohen’s d = 0.40), and significantly lower scores on the scale measuring responsiveness to satiety cues (2.9 vs. 3.1, Cohen’s d = −0.43).

Adjusted Analyses

In the adjusted analyses (Table III), racial differences remained for several of the home environment, parenting, and child behaviors, except for fruits and vegetables in the home, availability of soda in the home, toys for physical activity in the home, and hours playing outside on the weekday. Compared with White children, Black children were less likely to have healthy snacks in the home (OR = 0.13, 95% CI: 0.03–0.62, p values < .01). Parents of Black children, compared with White children, watched more hours of TV per day (b = 0.55 for mothers and 0.75 for partners; p values < .001), consumed more kilocalories from fat (b = 2.01for mothers; b = 0.86, p values < .01), and were more likely to consume SSB (OR = 2.10, 95% CI: 1.10–3.99 for mothers and OR = 2.69, 95% CI: 1.08–6.68 for partners, p values < .001). With respect to feeding practices, Black parents endorsed less encouraging feeding practices (b = −0.16, p values = .05), but no other differences were significant. Black children were less likely to exceed the recommended 2 hrs of TV on the weekday and weekend (OR = 0.34, 95% CI: 0.16–0.71, p < .01; OR = 0.24, 95% CI: 0.12–0.49) compared with White children; however, their average servings of SSB and energy intake of added sugars was greater than their White counterparts (b = 0.11 for servings of sweet drinks and 8.97 for added sugars; p values < .001). With respect to eating characteristics, Black children had higher scores on FR and DD and lower scores on satiety responsiveness (b = 0.32 for FR, b = 0.36 for DD, and b = −0.24 for SR, p values < .05), eating characteristics associated with greater weight gain in childhood.

Discussion

In this sample of 2-year-old children, there were a series of differences in a wide range of social and behavioral risk factors for childhood obesity. These factors included aspects of the home health environment, parent diet and sedentary behaviors, the quality of children’s dietary intake, and child eating characteristics that may increase children’s risk for obesity. For nearly all these factors, Black children were at a disadvantage relative to their White counterparts. These differences remained after controlling for potential confounders, in particular maternal BMI and socioeconomic indicators. The study is unique in that these differences were examined among a sample of children whose mothers were obese postpartum. Thus, all children, both Black and White, shared a common risk factor for childhood obesity (Lawrence et al., 2014; Schack-Nielsen, Michaelsen, Gamborg, Mortensen, & Sorensen, 2010) and the observations here reflect differences that are not necessarily attributable only to maternal obesity.

The overall findings of this study point to a number of differences in likely “obesiogenic factors” during early childhood. Compared with White mothers, Black mothers reported less availability of healthy snacks in the home. The health behaviors of mothers and fathers also differed, with more time spent watching TV and greater dietary fat intake among Black mothers and fathers compared with their White counterparts. Black 2-year-olds consumed more servings of SSB and more added sugars than White 2-year-olds. Black children also had higher scores on measures of eating behavior traits that have been associated with a higher BMI in childhood, such as higher in FR, DD, and lower in satiety responsiveness. The only finding that deviated from this consistent pattern was that, compared with White children, fewer Black children watched >2 hr of TV. Still, TV viewing was high in both groups with >50% exceeding the recommended amount in each group.

Our results concur with findings by Wang and Zhang (2006), who observed that weight differences between Blacks and Whites have been widening over time, even as the relationship between socioeconomic status (SES) and obesity has been weakening. Thus, while SES clearly does play a role in obesity, it cannot fully explain the racial differences in obesity risk factors (Dixon et al., 2012). Different historical, cultural, and socio-environmental contexts beyond SES must also be contributing to the differences observed between Black and White children (Kumanyika, 2008).

A particularly concerning finding in this study was the amount of SSB and added sugar that these young children were reported to be consuming. A recent study using the Early Childhood Longitudinal Survey—Birth Cohort (n = 9,600) showed that at age 2 years SSB intake was not associated with childhood obesity at that age, but children drinking more than one serving a day at age 2 years (9.3% in their sample) demonstrated greater increases in BMI through age 4 years than their counterparts consuming less than one serving daily (DeBoer, Scharf, & Demmer, 2013). In our sample, 17% of Black children consumed more than one serving per day compared with 5% of White children (χ2 = 8.51, p < .05; data not shown). Overall sugar intake was also greater among Black children compared with White children. Our findings of racial differences in sugar intake are consistent with studies of both younger (Taveras et al., 2010) and older children (Giammattei, Blix, Marshak, Wollitzer, & Pettitt, 2003) and point to a need to better understand what may be contributing to these differences at this early age.

The home environment and parenting factors play a role in diet and physical activity especially at a young age (Ostbye et al., 2013). Having an obese parent can moderate the effects of obesity risk factors on BMI in the preschool age (Fuemmeler et al., 2013), which makes studying risk factors among obese parents particularly relevant. What the current study highlights is that obesity risk factors show variation between Black and White children. In this sample, Black parents reported less healthy lifestyle behaviors than their White counterparts and SES did not fully explain this. What this study is not able to determine is the types of beliefs and values linked to culture that may be influencing these different patterns. Qualitative studies are needed to better understand historical and cultural factors contributing to these values and the differences in obesity risk factors observed here and in other studies (Hughes et al., 2013).

There are few studies to which we can compare our results regarding the differences between Black and White children on eating characteristics. These eating characteristics reflect self-regulation of eating, especially the satiety responsiveness subscale, which measures a child’s ability to respond to internal satiety cues. We found that Black and White children differed in eating characteristics. The standardized beta coefficients from the adjusted models suggest that these differences were small for FR and DD and medium for satiety responsiveness. The extent to which these differences relate to a greater risk of obesity over development remains to be investigated; however, Black children may be at greater risk for poorer regulation of eating starting at an early age. More research focusing on minority preschool-age children’s ability to regulate their energy intake is warranted.

With respect to parent feeding practices, we found few differences. The exception was “encouragement,” with Black mothers reporting less of this type of feeding practice. It may be that the differences between the two groups reflect difference in normative expectations or beliefs. For instance, some of the encouragement items reflect praising and encouraging children to eat new foods or try a variety of foods. This may be viewed as more valued among White mothers; whereas among Black mothers, the expectation is to eat what has been provided. Encouraging food variety and offering new foods during the preschool years helps shape a child’s acceptance of a diverse diet, including eating more fruits and vegetables (Cooke, Carnell, & Wardle, 2006). Research on parent feeding practices has only recently begun to include racially/ethnically diverse samples (Hurley, Cross, & Hughes, 2011); thus, it will be important for future research to identify the different ways parents of different cultures encourage their children to try new foods. Such findings will prove useful in improving exposure-based interventions designed to encourage food acceptance in preschool-age children.

The findings should be interpreted within the context of some limitations. First, participants were toddlers of mothers who volunteered for a large randomized clinical trial to prevent weight gain. All women were obese and thus these findings may not generalize to women in the recommended BMI range. Also, participants who volunteer for obesity studies may differ than the general population. Of note, however, our participants were fairly comparable with the county population from which the study sample arose with respect to maternal age at birth (71%, 21–34 years of age in the county; 71% in the study sample) and to education (45% with a bachelor’s degree or higher in the county; 57% in the study sample). Black women were overrepresented in the in the sample (39% in the county; 49% in the study sample), Whites were approximately representative (53% in the county; 51% in the study sample), and Hispanic mothers were underrepresented (14% in the county; 6% in the study sample). The low representation of Hispanics was expected given that English language proficiency was one of the criteria for inclusion in the trial. The nearly equal numbers of Black and White participants, however, allowed for comparisons among children that shared a common risk factor.

All measures relating to the mother and the child were reported by the mother herself. Such single-source methodology may introduce bias toward observing stronger associations than there may otherwise be. Another limitation was that direct measures of the parents’ or child’s physical activity (e.g., accelerometers) levels were not performed. Our measure of TV viewing, while a meaningful predictor of weight, should not be directly interpreted as physical inactivity. Studies of race differences using direct measures of physical activity for both parents and their children would add to this growing literature. The mainly null findings regarding differences in home environment should also be interpreted with caution. Future studies should use home visits to assess availability and accessibility of healthy and unhealthy foods. Also, of note is that study staff measured heights and weights for mothers and their children, but the partner’s measurements self-reported. Notable in this study was the use of 24-hr dietary recall to assess energy intake as well as intake of sugary beverages. Although less precise than doubly labeled water for assessing energy expenditure, this strategy is often used in epidemiologic studies and allows for the assessment of components of dietary quality relevant to childhood obesity and chronic disease (e.g., grams of sugar, percent energy from fat; Nicklas et al., 2004).

Taken together, these data support the growing consensus that racial disparities exist in obesity-related risk factors beginning at an early age. Consistent racial differences, for most factors showing that Black children are worse off than their White counterparts, were observed. Continued research using mixed methods (qualitative and quantitative) is needed to inform well-designed interventions. The need for more research, however, must be balanced with the alarming findings from this and other studies that document the high level of sugary and sweetened beverage intake during the early years of development. Both Black and White parents should be advised to refrain from providing their young 2-year-old children with added dietary sugar. Clinicians also need to be aware of racial differences in obesity-related risk factors and greater attention is needed to develop methods to support clinicians when intervening with families of different racial ethnic backgrounds. Such approaches could help to mitigate the public health burden of childhood obesity and the notable disparities observed between Black and White families.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health (R01 DK064986 to T.O.; R01 DK064986S to T.O. and B.F.F.); and the National Cancer Institute at the National Institutes of Health (K07CA124905 to B.F.F.).

Conflicts of interest: None declared.

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