Canadian Journal of Public Health

, Volume 109, Issue 4, pp 489–497 | Cite as

Severe obesity in children 17 to 24 months of age: a cross-sectional study of TARGet Kids! and Better Outcomes Registry & Network (BORN) Ontario

  • Meloja Satkunam
  • Laura N. Anderson
  • Sarah Carsley
  • Jonathon L. Maguire
  • Patricia C. Parkin
  • Ann E. Sprague
  • Geoff D. C. Ball
  • Catherine S. BirkenEmail author
  • on behalf of the TARGet Kids! Collaboration and Team ABC
Quantitative Research



International data suggest the prevalence of severe obesity in young children may be increasing, yet no Canadian data are available. The objectives of this study were to examine definitions of severe obesity and to evaluate associated risk factors among young children in Ontario.


A cross-sectional study was conducted in children 17 to 24 months of age using two Ontario data sources: TARGet Kids! (n = 3713) and BORN Ontario (n = 768). Body mass index z score (zBMI) definitions were adapted from the World Health Organization (WHO) (z score > 3) and the US Centers for Disease Control (CDC) (> 120% of the 95th percentile) and applied to define severe obesity in young children. Multinomial logistic regression was used to evaluate associations between demographic and pregnancy risk factors and zBMI categories.


A total of 1.1% (95% CI, 0.8–1.4) of children met the adapted WHO definition of severe obesity compared to 0.3% (95% CI, 0.2–0.6) using the CDC definition. Median neighbourhood household income (OR = 0.80, 95% CI, 0.69–0.93) and maternal pre-pregnancy BMI (OR = 1.08, 95% CI, 1.01–1.15) were associated with severe obesity in unadjusted analyses. After adjustment for potential confounders, the OR for the association between maternal pre-pregnancy BMI and severe obesity was 1.04 (95% CI, 0.94–1.15).


More than 1% of Ontario children met the adapted WHO definition of severe obesity in very early childhood. Modifiable risk factors were identified. Future studies are needed to understand the terminology, prevalence, and risk factors for severe obesity in young children across Canada.


Obesity Obesity, morbid Obesity, pediatric Obesity, childhood onset Body mass index 



Selon les données internationales, la prévalence de l’obésité sévère chez les jeunes enfants pourrait être en hausse, mais il n’existe pas de données canadiennes à ce sujet. Nous avons voulu examiner les définitions de l’obésité sévère et évaluer les facteurs de risque associés chez les jeunes enfants en Ontario.


Nous avons mené une étude transversale auprès d’enfants de 17 à 24 mois à l’aide de deux sources de données ontariennes : TARGet Kids! (n = 3713) et BORN Ontario (n = 768). Nous avons adapté les définitions du score-z de l’indice de masse corporelle (IMC) de l’Organisation mondiale de la santé (OMS) (score-z > 3) et des Centers for Disease Control américains (CDC) (>120% du 95e centile) et nous les avons appliquées pour définir l’obésité sévère chez les jeunes enfants. Par régression logistique multinomiale, nous avons évalué les associations entre les facteurs de risque démographiques et liés à la grossesse et les catégories du score-z de l’IMC.


Un total de 1,1% (IC de 95% : 0,8–1,4) des enfants répondaient à la définition de l’obésité sévère adaptée de celle de l’OMS, et 0,3% (IC de 95% : 0,2–0,6) répondaient à la définition adaptée de celle des CDC. Le revenu médian des ménages selon le quartier (rapport de cotes [RC] = 0,80, IC de 95% : 0,69–0,93) et l’IMC maternel avant la grossesse (RC = 1,08, IC de 95% : 1,01–1,15) étaient associés à l’obésité sévère dans nos analyses non ajustées. En tenant compte des facteurs confusionnels possibles, le RC de l’association entre l’IMC maternel avant la grossesse et l’obésité sévère était de 1,04 (IC de 95% : 0,94–1,15).


Plus de 1% des enfants ontariens répondent à la définition de l’obésité sévère de l’OMS pour les très jeunes enfants. Nous avons repéré des facteurs de risque modifiables. Il faudrait pousser la recherche pour comprendre la terminologie, la prévalence et les facteurs de risque de l’obésité sévère chez les jeunes enfants à l’échelle du Canada.


Obésité Obésité morbide Obésité pédiatrique Indice de masse corporelle 



We thank all of the participating families for their time and involvement in TARGet Kids! and are grateful to all practitioners who are currently involved in the TARGet Kids! practice-based research network.


Funding for this study was received from the Canadian Institutes of Health Research.

Compliance with ethical standards

Conflict of interest

JLM received an unrestricted research grant for a completed investigator-initiated study from the Dairy Farmers of Canada (2011–2012) and Ddrops provided non-financial support (vitamin D supplements) for an investigator-initiated study on vitamin D and respiratory tract infections (2011–2015). PCP received unrestricted research grants for completed investigator-initiated studies from Danone Institute of Canada (2002–2004 and 2006–2009), Dairy Farmers of Ontario (2008–2010), and Mead Johnson Nutrition provided non-financial support (Fer-In-Sol® liquid iron supplement) (2011–2017) for an ongoing investigator-initiated trial of iron deficiency in young children that was funded by Canadian Institutes of Health Research (FRN # 115059). These agencies had no role in the design, collection, analyses or interpretation of the results of this study or in the preparation, review, or approval of the manuscript. All other authors declare they have no conflicts of interest.

Supplementary material

41997_2018_65_MOESM1_ESM.docx (15 kb)
Supplemental Table 1 (DOCX 15 kb)


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Copyright information

© The Canadian Public Health Association 2018

Authors and Affiliations

  • Meloja Satkunam
    • 1
    • 2
  • Laura N. Anderson
    • 1
    • 2
  • Sarah Carsley
    • 2
    • 3
  • Jonathon L. Maguire
    • 3
    • 4
    • 5
    • 6
  • Patricia C. Parkin
    • 3
    • 5
    • 6
    • 7
  • Ann E. Sprague
    • 8
  • Geoff D. C. Ball
    • 9
  • Catherine S. Birken
    • 3
    • 5
    • 6
    • 7
    Email author
  • on behalf of the TARGet Kids! Collaboration and Team ABC
    • 3
  1. 1.Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
  2. 2.Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoCanada
  3. 3.Institute for Health Policy, Management, and EvaluationUniversity of TorontoTorontoCanada
  4. 4.The Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s HospitalTorontoCanada
  5. 5.Department of Nutritional SciencesUniversity of TorontoTorontoCanada
  6. 6.Department of Pediatrics, Faculty of MedicineUniversity of TorontoTorontoCanada
  7. 7.Division of Paediatric Medicine, Department of PaediatricsThe Hospital for Sick ChildrenTorontoCanada
  8. 8.Better Outcomes Registry & Network (BORN) OntarioOttawaCanada
  9. 9.Faculty of Medicine and Dentistry, Department of Pediatrics, Edmonton Clinic Health AcademyUniversity of AlbertaEdmontonCanada

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