Generational Status,Family Structure,and Phenotypic Severity of Obesity in Children Attending a Pediatric Obesity Clinic: A Retrospective Longitudinal Study

Abstract

Background:

Whether children’s generational status (i.e., immigrant generation based on country of birth) or family structure (i.e., household composition) influences phenotypic obesity severity, or outcomes of its management, remains unclear. We investigated associations of generational status and family structure with phenotypic obesity severity, its change over time, and persistence in a lifestyle-modification program among children with obesity attending a pediatric obesity clinic in Montreal (Canada).

Methods:

This retrospective longitudinal analysis used medical records from children (2–17 years) who were followed between 2017 and 2023. We compared BMI z-score (BMIz) and clinical obesity prevalence at baseline and program persistence and changes in BMIz and blood pressure (BP) over follow-up, according to generational status and family structure.

Results:

Among the 568 included children, 362 (63.7%) had a first- or second-generation immigrant background, and 201 (35.4%) lived in non-two-parent families. At baseline, compared with children of third generation or more, those of first or second generation had lower BMIz (3.33 [95% CI: 3.22, 3.45] vs. 3.62 [95% CI: 3.47, 3.77]; p = 0.02) but a similar prevalence of clinical obesity (47.6% [95% CI: 42.6, 53.2] vs. 53.4% [95% CI: 47.0, 60.7]; p = 0.15). No differences were observed by family structure at baseline. Over follow-up (mean ± SD: 12.7 ± 12.8 months), program persistence and reductions in BMIz and BP were similar across groups.

Conclusions:

Although generational status and family structure remain relevant for tailoring counseling, we found no evidence that they are meaningfully associated with phenotypic obesity severity, its change over time, or persistence in this program.