Weight Changes in Overweight and Obesity Among Children in Foster Care for One Year

Background: One of the goals for foster care is improvement in the child’s well-being, which includes normalization of weight. The purpose of this study was to explore weight changes in a sample of predominantly racial/ethnic minority children (N = 360; newborn to 19 years old) in foster care in Los Angeles, CA. The specific aims were to examine (1) the prevalence of high weight categories (≥ 95 (obesity) and ≥ 85 (overweight/obesity) percentile) upon entrance to foster care (T1) and after one year in foster care (T2), (2) the comparison of high weight categories of our sample to national statistics, and (3) the relationship of change in weight status after one year in foster care to age, reason for entry into foster care, and placement.

Methods: Medical record data were abstracted for foster children who attended an initial medical appointment when they entered foster care and another 10-14 months later (M = 12.3 months). Data included birth date, gender, ethnicity, exam date with recorded weight and height (length for children under 2 years old), reason for placement in foster care, and placement type. Age and gender-adjusted weight percentile ranking were calculated utilizing the CDC 2000 growth chart. Chi square tests and McNemar tests comparing paired proportions were performed to determine whether there were significant changes in proportions of obesity or overweight/obesity over time. The frequency of changes in weight categories from T1 to T2 was categorized: (1) decreased in weight, (2) remained at overweight or obese, (3) increased in weight, (4) remained normal. Chi-square test or Fisher’s exact test were used to evaluated the association between age category at T1, placement, and reason for child welfare involvement with the change in weight category.

Results: The proportion of obese children and overweight/obese children between age 2 and 5 were significantly lower at T2 than T1. There were no significant changes in the prevalence of obesity for the total population at T2. Children age 6 or older had a higher prevalence of obesity and overweight/obesity compared to national statistics at both T1 and T2. Age predicted the change in weight between T1 and T2. The age groups with the highest percentage in each weight category were: remain normal weight for age under 2 years old; decreased weight for age 2-5; increased weight for age 6-11; and remained obese for age 12-19. Parental drug use was related to weight category, with most children remaining normal weight. Placement was not related to weight change.

Conclusions: Obese children 6 years or older should be targeted for weight reduction since a change in home environment did not normalize their weight. The pediatric health and child welfare systems can work together by including weight percentiles in foster care files and training/monitoring child welfare caregivers in weight reduction interventions. Future studies on how environment or lifestyle changes in foster care are related to weight loss for 2-5 year olds and research on comorbidities associated with obesity of children in foster care are needed.