Ability to delay gratification at age 4 years and risk of overweight at age 11 years

Objectives: To determine if limited ability to delay gratification (ATDG) at age 4 years is independently associated with an increased risk of being overweight at age 11 years and to assess confounding or moderation by child body mass index z score at 4 years, self-reported maternal expectation of child ATDG for food, and maternal weight status. Design: Longitudinal prospective study. Setting: Ten US sites. Participants: Participants in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Main Exposure: Ability to delay gratification at 4 years, measured as pass or fail on a validated task. Outcome Measures: Overweight at 11 years, defined as a body mass index greater than or equal to the 85th percentile based on measured weight and height. Results: Of 805 children, 47% failed the ATDG task. Using multiple logistic regression, children who failed the ATDG task were more likely to be overweight at 11 years (relative risk, 1.29; 95% confidence interval, 1.06-1.58), independent of income to needs ratio. Body mass index z score at 4 years and maternal expectation of child ATDG for food did not alter the association, but maternal weight status reduced the association significantly. Conclusions: Children with limited ATDG at age 4 years were more likely to be overweight at age 11 years, but the association was at least partially explained by maternal weight status. Further understanding of the association between the child's ATDG and maternal and child weight status may lead to more effective obesity intervention and prevention programs.