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

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.The prevalence of obesity in very young children is high and has increased rapidly in the United States since the 1970 s [1,2]. Some evidence suggests that obesity is associated with child externalizing behavior problems [3-7], but an association has not been observed in all studies or in children of both sexes [5,8-11], and there is controversy regarding the magnitude [12] and directionality of any association [4,5,11], as well as the age when these associations might first be evident. Externalizing behavior problems are characterized by aggressive, oppositional, disruptive, or inattentive behaviors beyond those that would be expected given a child's age and develop