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Comment & Response
April 1, 2019

Additional Data to Explain Childhood Obesity—Reply

Author Affiliations
  • 1Department of Behavioural Science and Health, University College London, London, United Kingdom
  • 2University College London Great Ormond Street Institute of Child Health, London, United Kingdom
JAMA Pediatr. 2019;173(6):605-606. doi:10.1001/jamapediatrics.2019.0376

In Reply We thank Jaffer et al for their comments about the role of parental education as a moderator of genetic risk for childhood obesity. In our recently published article showing that the heritability of body mass index (BMI) was higher for children living in a more obesogenic home environment,1 there were indeed differences in parental education according to the home environment measure. Parental education is a well-established risk factor for childhood obesity, and previous studies have shown that the heritability of BMI in childhood varies according to parental education, with lower heritability estimates observed for children whose parents had higher educational attainment.2 However, what is less clear is the mechanism through which parental education influences childhood obesity risk. Our study goes beyond parental education to measure directly key aspects of the home environment that have been hypothesized to play a causal role in childhood obesity. Although there were differences in parental education according to the home environment measure, there was still considerable overlap; 40% of mothers living in a higher-risk home environment were classified as highly educated compared with 58% of mothers living in a lower-risk home environment.1 This indicates that the differences in heritability estimates cannot be entirely explained by the differences in parental education. In addition, parental educational level is not a feasible modifiable target for public health interventions; rather, the specific environmental exposures captured in the home environment measure (eg, food availability in the home) need to be targeted. Therefore, in our view, parental education cannot be used as a proxy measure for the complex environment that is the family home.

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