By Michael Smith, North American Correspondent, MedPage Today Published: August 13, 2008 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco. OREBRO, Sweden, Aug. 13 A klutzy kid has a good chance of turning out to be an obese adult, researchers here said. In a longitudinal birth cohort of people in Britain, obesity at age 33 was closely associated with measures of clumsiness at ages seven and 11, according to Walter Osika, M.D., and Scott Montgomery, Ph.D., of Orebro University Hospital. Dr. Montgomery is also at Imperial College London. The finding implies that the cognitive impairment in obese adults may have its roots in childhood, the researchers wrote online in BMJ. "Some aspects of poorer neurological function associated with adult obesity may have their origins in childhood," they concluded. Action Points -------------------------------------------------------------------------------- Explain to interested patients that obesity in adults has been shown to be associated with cognitive impairment and dementia, usually thought to be a consequence of the excess weight. However, some processes may begin earlier and this study investigated the link between poor coordination as a child -- potentially a marker of cognitive impairment -- and later obesity. The cohort analysis "cannot identify the specific biological processes linking poorer physical control and coordination in childhood with later obesity," the researchers said. But it does suggest that "some of the processes associated with poorer neurological function in obese adults have their origins in childhood," they concluded. The researchers studied data from a national child development study that is following everyone born in Britain between the third and ninth of March 1958, and still living there. At the start, there were about 17,000 participants, but attrition -- including such things as death and emigration -- has reduced the size of the cohort. For this analysis, 11,042 people had information on body mass index at age 33 and of those, 7,990 also had information on assessments and potential confounding factors at age seven and 6,875 had the information at age 11. At age seven, physical education teachers were asked to assess a child's physical control, scoring poor hand control, coordination, and overall clumsiness as certainly, somewhat, no, and unsure. At age 11, similar assessments were carried out by a physician, who measured weight and height, and also assessed performance on three tasks -- copying a simple design, marking squares on paper within one minute, and the time in seconds that it took to pick up 20 matches. Lower scores on the first two indicated a poorer performance, as did a higher score on the third. Finally, at age 33, trained interviewers measured height and weight and those with a body mass index of 30 or higher were classified as obese. Logistic regression analysis showed: Teachers reported that poor hand control, poor coordination, and clumsiness at age seven "certainly applied" more often among those who would be obese adults. For poor hand control, the odds ratio for obesity was 1.57, with a 95% confidence interval from 1.13 to 2.20, which was significant at P=0.008. For poor coordination, it was 2.30 with a 95% confidence interval from 1.52 to 3.46, which was significant at P<0.001. For clumsiness, it was 3.91, with a 95% confidence interval from 2.61 to 5.87, which was significant at P<0.001. Among the 6,875 participants who had assessments at age 11, poorer function was also associated with later obesity. The adjusted odds ratio for obesity -- the change in risk per unit increase in score -- was 0.88 for copying designs, with a 95% confidence interval from 0.81 to 0.96, which was significant at P=0.003 . It was 0.84 for marking squares, with a 95% confidence interval from 0.78 to 0.91, which was significant at P<0.001. And for picking up matches (where a higher score indicated poorer function) it was 1.14, with a 95% confidence interval from 1.06 to 1.24, which was significant at P<0.001. Adjustment for BMI at ages seven or 11 did not eliminate statistical significance for any of the associations, the researchers said. The researchers noted that the study cohort is generally representative of the original group, but attrition has been greatest among those of a lower social class, who are more likely to become obese, which may have affected the estimates. They also noted there are a large number of possible confounding factors that might have affected the analysis. "An accumulation throughout life of many associated cultural, personal, and economic exposures is likely to underlie the risks for obesity and some elements of associated neurological function," the researchers said. The study was supported by the Economic and Social Research Council. The researchers reported no competing interests. Additional source: British Medical Journal Source reference: Osika W, Montgomery SM "Physical control and coordination in childhood and adult obesity: longitudinal birth cohort study" BMJ 2008; 337: a699.