JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 103, NOS. 9 & 10, SEPTEMBER/OCTOBER 2011 917 o r i g i n a l c o m m u n i c a t i o n Overweight in School-Aged Children Associated With Emotional and Behavioral Difficulties: Results From a National Sample Vera S. Taylor, MSTC, ALP; Jiali Ye, PhD; Dominic Mack, MD, MBA; Yvonne Fry-Johnson, MD, MSCR; Quentin Smith, MD; Charlie L. Harris, PhD; C hild overweight and obesity have become a global epidemic affecting children of all ages and ethnic and socioeconomic backgrounds. 1-3 The percent- age of children and teens that are overweight has more than doubled in the past 30 years. Statistics show about 17% of American children aged 2 to 19 years, or 1 in 6, are overweight. 4 Further, the latest data continue to sug- gest that overweight and obesity are having a greater effect on minorities, including blacks and Mexican Americans. For children, body mass index (BMI) is used to screen for obesity, overweight, healthy weight, or under- weight. Using age- and gender-adjusted growth charts for children, overweight is defined as BMI (weight in kilograms / height in meters squared) in the 95th percen- tile, and being at risk for overweight is defined as BMI in the 85th and less than 95th percentile. 5 When the overweight definition is applied to data from earlier national health examination surveys, it is apparent that overweight in children and adolescents was relatively stable 6 from the 1960s to 1980. However, the increase in the prevalence of high BMI for age among US children that was previously seen between the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and NHANES 2003-2004 was not observed 7 between 2003-2004 and 2005-2006. Biology, social and physical environment, behaviors, as well as the availability of services influence children’s health. 8 In 2010, there were 75.2 million children in the United States with nearly equal numbers in each age group: 0 to 5 years (25.3 million), 6 to 11 years (25.1 million), and 12 to 17 years (24.8 million). 9 One study using data from the 2001, 2002, and 2003 National Funding/Support: This project was supported by a grant from the Office of Minority Health: cooperative agreement MPC- MP061011 and project OMH-MSM-1-06. Objective: To determine whether there is an association between perceived pediatric overweight and emotional/ behavioral difficulties among children ages 4 to 17 years in the United States. Design: A cross-sectional study Setting: Interview of an adult knowledgeable about a child’s emotional and physical health. All statistical analyses were completed using SPSS 17.0. Participants: A total of 7096 noninstitutionalized children aged 4 to 17 years identified in the 2007 National Health Interview Survey. Outcome Measures: Included in the 2007 National Health Interview Survey were 7096 noninstitutionalized children aged 4 to 17 years. After controlling for age, gender, race, poverty status, education of mother, family structure, and health sta- tus, this study found that 7.4% of the children appeared to be overweight and 5.2% had emotional/behavioral difficulties. It also found that caregivers who indicated that their child had a problem with being overweight were more likely to report that the child experienced emotional/behavioral difficulties compared to caregivers who did not report perceived over- weight in their child. Characteristics of the children most fre- quently reported to be overweight included Hispanic race, older children (ages 15-17 years), and those with higher pov- erty rates and poorer health status. Conclusion: The continual increase in pediatric overweight and associated emotional/behavioral difficulties suggests a need for replicable interventions that teach child caregivers to recognize and prevent overweight among vulnerable populations. Keywords: body weight n children/adolescents n psychology J Natl Med Assoc. 2011;103:917-921 Author Affiliations: Departments of Pediatrics (Dr Fry-Johnson), Psychiatry and Behavioral Sciences (Dr Smith), Family Medicine (Ms Taylor and Dr Harris), and Psychiatry and Behavioral Sciences (Dr Harris); Maternal and Child Health Research (Dr Fry-Johnson); and National Center Primary Care (Drs Ye and Mack), Morehouse School of Medicine, Atlanta, Georgia. Correspondence: Vera S. Taylor, Director, Faculty Development Program and Clinical Instructor, Department of Family Medicine, National Center Primary Care, Morehouse School of Medicine, MSTC, ALP, 720 Westview Dr SW, Atlanta, GA 30310 (vstaylor@msm.edu, vastaylor@gmail.com).