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Editorial
December 9, 2019

Structure and Function in Cross-sectional Work—A Cautionary Tale

Author Affiliations
  • 1Duke Center for Childhood Obesity Research, Division of Primary Care Pediatrics, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
  • 2Massey Cancer Center, Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond
JAMA Pediatr. Published online December 9, 2019. doi:10.1001/jamapediatrics.2019.4722

In this issue of JAMA Pediatrics, Laurent et al1 extend our understanding of the associations among body mass index (BMI), brain structure (in this case cortical thickness), and executive functioning in children. Their analyses found that higher BMI in 9- to 10-year-old children was associated with lower scores on some measures of executive function and thinner cortical thickness, measured with structural magnetic resonance imaging. They observed inverse associations between BMI and cortical thickness in areas of the prefrontal cortex—a brain region key to regulating executive cognitive functions, such as attention, planning, decision-making, and problem solving. The authors also found that prefrontal cortical thickness partially mediated the association between BMI and 1 of 4 executive functioning tasks: list sorting (a measure of working memory). In this editorial, we highlight what is important about these findings while urging caution in interpretation because of the limitations of the study design and analysis and concern about perpetuating damaging weight stigma.

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