Overweight, Obesity and Underweight Is Associated with Adverse Psychosocial and Physical Health Outcomes among 7-Year-Old Children: The ‘Be Active, Eat Right’ Study Amy van Grieken 1 , Carry M. Renders 2,3 , Anne I. Wijtzes 1 , Remy A. Hirasing 3,4 , Hein Raat 1 * 1 Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands, 2 Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands, 3 EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands, 4 Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands Abstract Background: Limited studies have reported on associations between overweight, and physical and psychosocial health outcomes among younger children. This study evaluates associations between overweight, obesity and underweight in 5- year-old children, and parent-reported health outcomes at age 7 years. Methods: Data were used from the ‘Be active, eat right’ study. Height and weight were measured at 5 and 7 years. Parents reported on child physical and psychosocial health outcomes (e.g. respiratory symptoms, general health, happiness, insecurity and adverse treatment). Regression models, adjusted for potential confounders, were fitted to predict health outcomes at age 7 years. Results: The baseline study sample consisted of 2,372 children mean age 5.8 (SD 0.4) years; 6.2% overweight, 1.6% obese and 15.0% underweight. Based on parent-report, overweight, obese and underweight children had an odds ratio (OR) of 5.70 (95% CI: 4.10 to 7.92), 35.34 (95% CI: 19.16; 65.17) and 1.39 (95% CI: 1.05 to 1.84), respectively, for being treated adversely compared to normal weight children. Compared to children with a low stable body mass index (BMI), parents of children with a high stable BMI reported their child to have an OR of 3.87 (95% CI: 1.75 to 8.54) for visiting the general practitioner once or more, an OR of 15.94 (95% CI: 10.75 to 23.64) for being treated adversely, and an OR of 16.35 (95% CI: 11.08 to 24.36) for feeling insecure. Conclusion: This study shows that overweight, obesity and underweight at 5 years of age is associated with more parent- reported adverse treatment of the child. Qualitative research examining underlying mechanisms is recommended. Healthcare providers should be aware of the possible adverse effects of childhood overweight and also relative underweight, and provide parents and children with appropriate counseling. Citation: van Grieken A, Renders CM, Wijtzes AI, Hirasing RA, Raat H (2013) Overweight, Obesity and Underweight Is Associated with Adverse Psychosocial and Physical Health Outcomes among 7-Year-Old Children: The ‘Be Active, Eat Right’ Study. PLoS ONE 8(6): e67383. doi:10.1371/journal.pone.0067383 Editor: Amanda Bruce, University of Missouri-Kansas City, United States of America Received December 4, 2012; Accepted May 17, 2013; Published June 25, 2013 Copyright: ß 2013 van Grieken et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This study is financed by a grant from ZonMw, the Netherlands Organization for Health Research and Development (50-50110-98-355). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: h.raat@erasmusmc.nl Introduction The prevalence of overweight and obesity is increasing worldwide and has become a public health challenge [1]. The tracking of childhood overweight and associated health conse- quences into adulthood is of concern [2,3,4]. Several serious physical conditions are associated with overweight and, especially obesity, among children including asthma, sleep problems, cardiovascular diseases and type-2 diabetes [4,5]. Also psychoso- cial conditions such as lower self-esteem, depressive feelings and body dissatisfaction [6,7,8,9,10,11,12,13] are associated with overweight or obesity in childhood and adolescence. A decrease in self-esteem or more depressive symptoms may be caused by weight-related teasing or bullying that may start in childhood and continue into adolescence [10,11,13,14,15,16,17]. Children can experience different types and varying amounts of weight-related teasing [6,8,10,12,15,16,17,18]. For example, teasing may be peer-related or parent-related and may be daily or sporadic. Moreover, girls and boys report differences in the type and amount of teasing they experience [11]. Most studies have evaluated psychosocial outcomes of over- weight and obesity in adolescents and older children (7–12 years) [10,11,13,14,15,16,17] whereas few have evaluated the association between overweight and health outcomes in younger children aged e.g. 5–8 years [18,19,20]. Studying the association among younger children, and evaluating changes in weight and potential changes in health outcomes with longitudinal studies, may help to develop appropriate (preventive) interventions for children and PLOS ONE | www.plosone.org 1 June 2013 | Volume 8 | Issue 6 | e67383