Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 147 No. 3738 (2017)

Individual development and potential determinants of excess weight in children and adolescents: a longitudinal study

  • Alexandra Papandreou
  • Matthias Bopp
  • Julia Braun
  • Kaspar Staub
  • David Faeh
Cite this as:
Swiss Med Wkly. 2017;147:w14501



Excess body weight is a major public health concern already at a young age. The aim of this study was to track weight status among pupils aged 6–14 years in the City of Zurich, to examine the association between sociodemographic and environmental factors and excess weight at school entry and excess weight gain thereafter.


Longitudinal study.


Data were from the medical examinations routinely performed at public schools in Zurich, the largest city in Switzerland. Weight and height were measured in kindergarten (mean age: 5.9 years), grade 1 (7.2 years), grade 4 (10.1 years) and grade 8 (14.2 years).


The study included 7145 children who enrolled in kindergarten in 2003/04 or 2004/05 and had more than one measurement of weight and height.


Body weight and height were measured by physicians or nurses during the medical examinations at schools. For each measurement point, body mass index (BMI) was calculated and converted to the age- and sex-specific BMI z-scores and BMI percentiles. The stability of children’s weight status categories, sociodemographic and environmental factors associated with excess weight gain and with overweight/obesity at school entry were investigated using multiple linear and logistic regression models.


The prevalence of overweight/obesity increased between kindergarten and grade 8 (from 17.6 to 26.0%). Overall, 86.2% of the children remained in the same weight category; 10.8% shifted to a higher and 3% to a lower category. There was a strong correlation between migration background and overweight/obesity at school entry (odds ratios between 1.62 and 3.42, all p <0.05). In addition, boys with Southern/Eastern European background (+2.29 BMI percentile, p = 0.023) and girls in lower level school type (+12.98 BMI percentile, p <0.001) had the highest risk for excess weight gain over a school period.


Overweight/obesity developed prior to school entry and mostly persisted through childhood. In order to better exploit obesity prevention potential, measures to prevent the development of the excess weight need to be implemented at a very early stage in life.


  1. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–81. doi:.
  2. de Onis M, Lobstein T. Defining obesity risk status in the general childhood population: which cut-offs should we use? Int J Pediatr Obes. 2010;5(6):458–60. doi:.
  3. Ramachandran A, Chamukuttan S, Shetty SA, Arun N, Susairaj P. Obesity in Asia--is it different from rest of the world. Diabetes Metab Res Rev. 2012;28(Suppl 2):47–51. doi:.
  4. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303(3):235–41. doi:.
  5. Olds T, Maher C, Zumin S, Péneau S, Lioret S, Castetbon K, et al. Evidence that the prevalence of childhood overweight is plateauing: data from nine countries. Int J Pediatr Obes. 2011;6(5-6):342–60. doi:.
  6. O’Brien M, Nader PR, Houts RM, Bradley R, Friedman SL, Belsky J, et al. The ecology of childhood overweight: a 12-year longitudinal analysis. Int J Obes. 2007;31(9):1469–78. doi:.
  7. Gortmaker SL, Must A, Sobol AM, Peterson K, Colditz GA, Dietz WH. Television viewing as a cause of increasing obesity among children in the United States, 1986-1990. Arch Pediatr Adolesc Med. 1996;150(4):356–62. doi:.
  8. Fiorito LM, Marini M, Francis LA, Smiciklas-Wright H, Birch LL. Beverage intake of girls at age 5 y predicts adiposity and weight status in childhood and adolescence. Am J Clin Nutr. 2009;90(4):935–42. doi:.
  9. Huang CJ, Hu HT, Fan YC, Liao YM, Tsai PS. Associations of breakfast skipping with obesity and health-related quality of life: evidence from a national survey in Taiwan. Int J Obes. 2010;34(4):720–5. doi:.
  10. Wang Y, Beydoun MA. The obesity epidemic in the United States--gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev. 2007;29(1):6–28. doi:.
  11. Dunton GF, Kaplan J, Wolch J, Jerrett M, Reynolds KD. Physical environmental correlates of childhood obesity: a systematic review. Obes Rev. 2009;10(4):393–402. doi:.
  12. Singh AS, Mulder C, Twisk JWR, van Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9(5):474–88. doi:.
  13. Datar A, Shier V, Sturm R. Changes in body mass during elementary and middle school in a national cohort of kindergarteners. Pediatrics. 2011;128(6):e1411–7. doi:.
  14. Stamm H, Gebert A, Guggenbühl L, Lamprecht M. Excess weight among children and adolescents in Switzerland--prevalence and correlates for the early 2010s. Swiss Med Wkly. 2014;144:w13956.
  15. Murer SB, Saarsalu S, Zimmermann MB, Aeberli I. Pediatric adiposity stabilized in Switzerland between 1999 and 2012. Eur J Nutr. 2014;53(3):865–75. doi:.
  16. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320(7244):1240–3. doi:.
  17. Cole TJ, Lobstein T. Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes. 2012;7(4):284–94. doi:.
  18. Petrini L, Camenzind P, Hämmig O, Bopp M, eds. Gesundheit im Kanton Zürich: Band 1: Ergebnisse der Schweizerischen Gesundheitsbefragung 2012. Institut für Epidemiologie, Biostatistik und Prävention der Universität Zürich. 2014
  19. Murer SB, Saarsalu S, Zimmermann J, Herter-Aeberli I. Risk factors for overweight and obesity in Swiss primary school children: results from a representative national survey. Eur J Nutr. 2016;55(2):621–9. doi:.
  20. Mustillo S, Worthman C, Erkanli A, Keeler G, Angold A, Costello EJ. Obesity and psychiatric disorder: developmental trajectories. Pediatrics. 2003;111(4 Pt 1):851–9. doi:.
  21. Hesketh K, Wake M, Waters E, Carlin J, Crawford D. Stability of body mass index in Australian children: a prospective cohort study across the middle childhood years. Public Health Nutr. 2004;7(2):303–9. doi:.
  22. Wheaton N, Millar L, Allender S, Nichols M. The stability of weight status through the early to middle childhood years in Australia: a longitudinal study. BMJ Open. 2015;5(4):e006963. doi:.
  23. Kurth BM, Schaffrath Rosario A. Übergewicht und Adipositas bei Kindern und Jugendlichen in Deutschland [Overweight and obesity in children and adolescents in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2010;53(7):643–52. Article in German. doi:.
  24. Neovius M, Janson A, Rössner S. Prevalence of obesity in Sweden. Obes Rev. 2006;7(1):1–3. doi:.
  25. Furnham A, Badmin N, Sneade I. Body image dissatisfaction: gender differences in eating attitudes, self-esteem, and reasons for exercise. J Psychol. 2002;136(6):581–96. doi:.
  26. Bundesamt für Statistik BFS. Gesundheitsstatistik 2014. (accessed November 2015)
  27. Cattaneo A, Monasta L, Stamatakis E, Lioret S, Castetbon K, Frenken F, et al. Overweight and obesity in infants and pre-school children in the European Union: a review of existing data. Obes Rev. 2010;11(5):389–98. doi:.
  28. Jeannot E, Mahler P, Elia N, Cerruti B, Chastonnay P. Sociodemographic and Economic Determinants of Overweight and Obesity for Public-school Children in Geneva State, Switzerland: A Cross-sectional Study. Int J Prev Med. 2015;6(1):39. doi:.
  29. Nagel G, Wabitsch M, Galm C, Berg S, Brandstetter S, Fritz M, et al. Determinants of obesity in the Ulm Research on Metabolism, Exercise and Lifestyle in Children (URMEL-ICE). Eur J Pediatr. 2009;168(10):1259–67. doi:.
  30. Lobstein T, Baur L, Uauy R ; IASO International Obesity TaskForce. Obesity in children and young people: a crisis in public health. Obes Rev. 2004;5(s1, Suppl 1):4–85. doi:.
  31. Faeh D, Braun J, Bopp M. Prevalence of obesity in Switzerland 1992-2007: the impact of education, income and occupational class. Obes Rev. 2011;12(3):151–66. doi:.
  32. Guessous I, Joost S, Jeannot E, Theler JM, Mahler P, Gaspoz JM, et al.; GIRAPH Group. A comparison of the spatial dependence of body mass index among adults and children in a Swiss general population. Nutr Diabetes. 2014;4(3):e111. doi:.
  33. Joost S, Duruz S, Marques-Vidal P, Bochud M, Stringhini S, Paccaud F, et al. Persistent spatial clusters of high body mass index in a Swiss urban population as revealed by the 5-year GeoCoLaus longitudinal study. BMJ Open. 2016;6(1):e010145. doi:.
  34. Moser A, Panczak R, Zwahlen M, Clough-Gorr KM, Spoerri A, Stuck AE, et al.; Swiss National Cohort. What does your neighbourhood say about you? A study of life expectancy in 1.3 million Swiss neighbourhoods. J Epidemiol Community Health. 2014;68(12):1125–32. doi:.
  35. Whitaker RC, Dietz WH. Role of the prenatal environment in the development of obesity. J Pediatr. 1998;132(5):768–76. doi:.
  36. Gale CR, Martyn CN, Kellingray S, Eastell R, Cooper C. Intrauterine programming of adult body composition. J Clin Endocrinol Metab. 2001;86(1):267–72.
  37. Gillman MW, Rifas-Shiman SL, Camargo CA, Jr, Berkey CS, Frazier AL, Rockett HR, et al. Risk of overweight among adolescents who were breastfed as infants. JAMA. 2001;285(19):2461–7. doi:.
  38. Lindsay AC, Sussner KM, Kim J, Gortmaker S. The role of parents in preventing childhood obesity. Future Child. 2006;16(1):169–86. doi:.
  39. Muckelbauer R, Libuda L, Clausen K, Toschke AM, Reinehr T, Kersting M. Immigrational background affects the effectiveness of a school-based overweight prevention program promoting water consumption. Obesity (Silver Spring). 2010;18(3):528–34. doi:.
  40. Staub K, Rühli FJ, Woitek U, Pfister C. BMI distribution/social stratification in Swiss conscripts from 1875 to present. Eur J Clin Nutr. 2010;64(4):335–40. doi:.

Most read articles by the same author(s)

1 2 > >>