Document Type
Article
Publication Date
4-2026
Identifier
DOI: 10.1002/osp4.70124; PMCID: PMC12948713
Abstract
BACKGROUND: Obesity in childhood is complex; structural equation modeling (SEM) offers an approach to ascertain complicated relationships between weight and proximal (health behaviors, child health) and distal (family/household, community) variables. The objective of the study was to use SEM to map the influence of different etiological clusters on obesity in childhood.
METHODS: Secondary analysis of baseline data from patients and parents enrolled in a multi-site study of pediatric weight management was conducted. The primary outcome was weight status (utilizing percentage above the 95th percentile BMI, %95BMI). SEM was used to evaluate the influences of variables proximal and distal to child weight within the context of the Ecological Model of obesity in childhood.
RESULTS: Complete data on 375 child-parent dyads were imputed. Proximal factors (child stress and mobility, parent BMI) were significantly related to %95BMI; some distal factors (family level) did not have a direct effect on %95BMI, but did indirectly through proximal factors (such as child stress). Other distal factors (neighborhood deprivation represented by the Area Deprivation Index) were significantly related to %95BMI and family-level factors.
CONCLUSIONS: Except for the distal factor of neighborhood deprivation, proximal factors were the drivers of weight status. Distal factors did have indirect effects via proximal factors. SEM provides a means to investigate the complex contributors to childhood obesity, and could identify key leverage points for intervention.
Journal Title
Obes Sci Pract
Volume
12
Issue
2
First Page
70124
Last Page
70124
PubMed ID
41767161
Keywords
ecological model; family; obesity; pediatric; risk factors; structural equation modeling
Recommended Citation
Skelton JA, Rhodes ET, Hampl SE, Eneli I, Ip EH; SIT Study Research Group. Proximal and Distal Factors Associated With Obesity in Childhood: An Exploratory Structural Equation Model. Obes Sci Pract. 2026;12(2):e70124. Published 2026 Feb 27. doi:10.1002/osp4.70124
Comments
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Publisher's Link: https://onlinelibrary.wiley.com/doi/10.1002/osp4.70124