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Sleep Habits and How They Influence Obesity in Children

Nicole Sharratt

In recent years, there have been numerous studies looking into the effect that sleep has on

weight and obesity. There have been a number of studies that focus on children and sleep

deprivation. Focusing on the sleep habits in children, research is able to show if early in life

sleep issues have an impact on their weight as they age.

This paper will first provide a brief background on studies done within the past seven

years, focusing on sleep habits of different individuals and the association between those habits

and different measurements of weight. Next, a general conclusions from research section will

highlight the influence that sleep has on hormone imbalances in individuals and how those

changes influence an individuals weight. It will also discuss the difference between sleep

duration and sleep quality, and how sleep quality plays a prominent role in childhood obesity.

Finally, this paper proposes a study to further the research in this field.

Background on Research on Topic

The increased prevalence of childhood obesity is a growing issue that many researchers

have begun to focus on. According to the Center for Disease Control and Prevention (CDC), the

percentage of children under the age of eleven that meet the qualifications of being obese has

increased to nearly 18%. This is more than double the number of children who were obese in the

1980s (Childhood, 2015). The effect that sleep has on the rate of obesity has become a topic of

great interest to many of these researchers. The World Health Organization (WHO) states that

childhood obesity undermines childrens physical, social and psychological well-being. It is also

a risk factor for adult obesity later on (2016).

It is crucial that this research is not just focusing on sleep duration. Sleep duration is

based solely on the number of hours that a person spends asleep each night (Jarrin, 2013). While

this is important to the conversation about how sleep effects the overall weight of an individual,

other sleep habits are proving to have an even greater impact on individuals. There are many

definitions regarding what sleep problems are, for example in the study conducted by Alamian et

al., Richman defined it as an individual waking during 5 or more nights in a week, as well as

staying awake for more than 20 minutes after waking. Lozoff defined it as the child waking at

least three times in a night as well as parental disturbances due to the waking. And finally,

Zuckerman defined sleep problems as severe disturbances reported by the parents along with

waking at least three times during a single night (2016). All of these factors and more are being

considered in the current research.

There is a wide range of study designs that have been used in order to collect information

that is as accurate as possible, but that also provides researchers with the clearest view of how

this information applies to their questions.

General Conclusions from Current Research

Many studies have focused on sleep duration and the link it has with individuals who are

overweight or obese. Often times they have come to the conclusion that there is an association,

but research cannot always conclusively say what that association is. Many recent studies

however, have begun to focus on more than just sleep duration, which has led them to being able

to more confidently say that there is a strong connection between the quality of sleep that an

individual gets and the likelihood that they are going to be overweight. Looking at children has

been especially enlightening in recent research. There have been many studies that have been

able to show that not only do the sleep habits greatly influence a childs weight, but the

hormones often have an even greater influence on a childs future weight.

Synthesized Finding # 1: Hormone Imbalances Influences Childhood Obesity

Many studies have found that the hormonal changes that occur during poor sleep are a

contributing factor in childhood obesity. The study conducted by Jarrin, McGrath, and Drake

(2013), found that sleep disruptions had the ability to modify many of the appetite regulating

hormones, such as glucose, leptin, and ghrelin, that are responsible for regulating the signals sent

to the body regarding energy intake and expenditure. This means that the body, because of lack

of sleep is unable to regulate and properly determine if there is a need for more food and energy

to be consumed. This results in increased consumption of food, especially unhealthy foods,

which leads to an increase in weight gain (Jarrin et al., 2013). Al-Otaibi (2016), determined

something similar in the adults that were studied. They discovered that the students who were

poor sleepers and experienced poor sleep quality were more likely to skip breakfast and exhibit

low physical activity. They dont provide any additional information on what the cause of this

could be, but with the information from many other studies, it is reasonable to assume that

hormone levels are affected by this poor sleep.

Contributing to the same breadth of knowledge surrounding hormones, Almain, et al.

(2016), found that the changes in both the hormones leptin and ghrelin, due to lack of quality

sleep have led to decreased energy expenditure and an increase in energy intake. Almain et al.s

(2016) study was focused on infants who were under 15 months in age, and Jarrin et al. (2013),

focused on adolescents under the age of 17. This shows that hormone changes have the potential

to be influential not just when adolescents are going through puberty, but are crucial starting

from when we are born. The study conducted by Bell and Zimmerman (2010) however, are not

as quick to agree with the conclusion that low leptin and high ghrelin levels are linked to short

sleep duration in children. They concluded that there has not been enough studies on children in

order to confidently say that the relationship has been proven in adults is also present in children.

Synthesized Finding # 2: Poor Sleep Quality Influences Childhood Obesity

Many studies have discovered that sleep quality has a greater impact on childhood weight

than sleep duration alone. Many studies in the past have focused solely on the amount of time an

adult spends sleeping each night and attempting to determine if there is relationship between that

and obesity. There is still research that needs to be done on children, and the study done by Halal

et al, (2016), has discovered that there is a relationship between young children, under the age of

four, sleeping for fewer than 10 hours per night and the risk of being overweight or obese by the

time that they were four. They found that the children had a 32% higher risk than their

counterparts if they were sleeping for fewer than 10 hours in a night. This is a crucial study,

because it allows other researchers to build upon this information and attempt to determine if the

results that have been seen in adults will also been seen in children. Sleep time and quality sleep

at night is crucial and has been proven to be the part of sleep that has the greatest effect on

weight. Bell and Zimmerman (2010) found that napping during the day did not have an effect on

obesity at any age. This means that even if individuals attempt to make up for the lack of sleep

during the night, it is not going to have the same effect that any sleep at night does.

Sleep duration is often not found to be correlated with obesity in children. More often, it

is the sleep problems and disturbances that are more significantly associated with obesity.

Ferranti et al. (2016) found that sleep quality also leads to a pro-fat hormonal pattern because

of the sleep disturbances that lead to an increase in cortisol levels, which are not seen with sleep

duration alone. Jarrin et al. (2013), discovered that once they entered covariates such as age, sex,

physical activity and many others into their models, sleep duration was no longer associated with

any of the measures of obesity, but sleep disturbances were significantly associated. This is

extremely similar to a result that Almain et al. (2016) found as well. Their study was focused on

infant sleep problems, and once they adjusted for the covariates, the infants were found to have a

much higher risk of being overweight by the time they entered 6th grade.

Need for Further Research

After reviewing current research, a gap in the current research is that many of the studies,

including, Jarrin et al. (2013), Alamian et al. (2016), and Ferranti et al.(2016), focus solely on

children and obesity as a result of poor sleep quality during childhood. There is an important gap

regarding how poor sleep and obesity as a child translates into adolescences and older. Halal et

al. focuses on sleep in the first years of life, but ends its study at the age of four. Alamian et al.

(2016) had a similar study, but they only followed children until grade six. It is important to see

how these factors translate into life later on, and if early childhood sleep quality will have an

effect on a childs weight past the age of 12.

A longitudinal study of children starting at birth all the way until 18 would establish

whether childhood sleep quality issues relate to obesity later on in adolescence and life.

Participants would be recruited similar to how they were recruited in the study done by Alamian

et al. (2016). During that study, they contacted mothers from over 24 hospitals. Also similar to

Alamian et al. (2016) babies that are severely underweight or premature would be excluded from

the study. It would be important to recruit many families, as with longitudinal studies, many
people drop out or do not complete the study. Halal et al. (2016) recruited over 4,000 individuals,

and about 3,800 completed the study and follow up measurements. In order to make sure that all

of the participants are treated ethically this study would need to adopt a few different procedures.

They would need to ensure that there are no identifying characteristics included in any of the

information, so that the privacy of participants is protected. Such as with the study conducted by

Halal et al. (2016), it is crucial that the parent or guardian of the participant signs a written

consent form.

In order to collect data on these individuals over a span of 18 years, it will be important

to follow a set-up that combines multiple aspects from different studies. In Halal et al. (2016),

children were evaluated at birth for length and weight. Maternal reports of infant behaviors

would be taken from birth until age 5. These surveys would need to be done every two weeks.

This is similar to the study done by Alamian et al. (2016). This reporting would have mothers

respond to whether there were any night wakings, the frequency of these wakings, and how

long the wakings lasted. After the age of 5, these would be self reported by the children. Halal et

al. (2016) evaluated their children at age 1, 2, and 4 for their study. A similar tactic would be

used as well. Evaluating the children for weight and height every 2 years would allow for better

tracking of how their sleep is affecting their weight.

Focusing on the weight and height of the children every two years will allow the

establishment of a BMI according to the WHO guidelines for what constitutes an obese and

overweight BMI, if applicable. Keeping track of this information will allow for the comparison

of BMI and sleep quality to see if there is a correlation. As with Jarrin et al. (2013), it will be

important to control for covariates such as physical activity, diet and socioeconomic status. All of
these will be determined in a similar fashion with different surveys. This will allow for better

comparison between sleep quality and BMI. Finally to analyze the data, software such as SPSS

20 will be used. This is the same software that was used by Jarrin et al. (2013) during their

research study.

Many of the studies mentioned above have performed studies during a specific period of

time, such as up until age 4 or until grade 6. The proposed study would expand that time period

in order to see how much of an affect sleep quality throughout childhood has on obesity as they

continue to grow through adolescences. This study will offer greater insight into how much sleep

quality plays a role in weight, not just in early childhood before the age 5, but as they continue to

grow into young adults. There are definitely challenges that will be associated with a study of

this size, getting families to continue the study over this large period of time being the greatest.

There are a lot of factors that play into not continuing in a longitudinal study. Moving away, it

being too time consuming, or simply no longer caring to take part. There would have to be some

sort of benefit to entice families to keep participating.

Even though this study may be difficult to achieve because of the long duration, there are

ways to make it more feasible. Having a larger sample size will help with the drop-out rate, for

example, Bell et al. (2010), had a sample size of just under 2000 individuals. This would ensure

that when there was drop-out, the study would not be ruined by a lack of sample size. Another

way to make this study more feasible and realistic would be to incorporate the study into school.

Ferranti et al. (2016), had children fill out questionnaires during school. This would ensure that

given the transfer rate is not too high, students would be regularly giving information regarding

their sleep in a controlled setting. Then directly from the school, the information could be

transferred to the researchers.

Alamian, A., Wang, L., Hall, A. M., Pitts, M., & Ikekwere, J. (2016). Infant sleep problems and

childhood overweight: Effects of three definitions of sleep problems. Preventive

Medicine Reports, 4, 463468.

Al-Otaibi, H. H. (2016). Associations between sleep quality and different measures of obesity in

saudi adults. GJHS Global Journal of Health Science, 9(1), 1-9. doi:10.5539/gjhs.v9n1p1

Bell JF, Zimmerman FJ. (2010). Shortened nighttime sleep duration in early life and subsequent

childhood obesity. Arch Pediatr Adolesc Med., 164(9), 840-845.


Childhood Obesity Facts. (2015). Retrieved October 08, 2016, from

Ferranti, R., Marventano, S., Castellano, S., Giogianni, G., Nolfo, F., Rametta, S., . . . Mistretta,

A. (2016). Sleep quality and duration is related with diet and obesity in young adolescent

living in Sicily, Southern Italy. Sleep Science, 9(2), 117-122.


Halal, C. S. E., Matijasevich, A., Howe, L. D., Santos, I. S., Barros, F. C., & Nunes, M. L.

(2016). Short sleep duration in the first years of life and obesity/overweight at age 4

years: A birth cohort study. The Journal of Pediatrics, 168, 99103.e3.

Jarrin, D. C., McGrath, J. J., & Drake, C. L. (2013). Beyond sleep duration: Distinct sleep

dimensions are associated with obesity in children and adolescents. International

Journal of Obesity, 37(4), 552558.

World Health Organization. (2016). Report on the commission on ending childhood obesity.

Retrieved from

Appendix - Study Analysis Table

Citation Halal, C. S. E., Matijasevich, A., Jarrin, D. C., McGrath, J. J., & Drake, C. L. Al-Otaibi, H. H. (2016). Associations
Information Howe, L. D., Santos, I. S., Barros, F. (2013). Beyond sleep duration: Distinct between sleep quality and different
C., & Nunes, M. L. (2016). Short sleep dimensions are associated with measures of obesity in saudi adults.
sleep duration in the first years of life obesity in children and GJHS Global Journal of Health Science,
and obesity/overweight at age 4 years: adolescents. International Journal of 9(1), 1-9. doi:10.5539/gjhs.v9n1p1
A birth cohort study. The Journal of Obesity, 37(4), 552558.
Pediatrics, 168, 99103.e3.


cles/PMC4691233/pdf/main.pdf PMC4956466/pdf/nihms4038.pdf /gjhs/article/view/57770/31963

Purpose To determine if there is a relationship To determine if sleep disturbances and To examine any association between
between short sleep time and weight patterns may have more of an impact of obesity and sleep quality as well as some
in young children. obesity than just sleep length. lifestyle habits.

Study Cohort, longitudinal study Recruitment through flyers in community Cross sectional study, convenience
Design and through classrooms. sampling over a 1-month period.
Participants classified into 2 groups.

Participants 4231 Brazilian children recruited 240 healthy children and adolescents age 8 233 female students at King Faisal
through their mothers within 24 hours to 17. University in Saudi Arabia.
of delivery between January 1, 2004
and December 31, 2004.

Data Interview of mothers using Body measurements were taken by research Through questionnaire with socio-
Collection questionnaire for information about assistants. Sleep duration was self reported demographic questions, anthropometric
their personal history. Children by youth, Sleep disturbances was found measurements and indicators, The
evaluated at birth and home visits at 1, through 43 item scale. Sleep patterns were Pittsburgh Sleep Quality Index, and
2, and 4 years old. Data on sleep self-reported. Data was analyzed using questions about lifestyle and physical
collected at follow up visits about 2 software. activity.
weeks leading up to interview.

Results Of the 3799 that completed the study, When covariates were considered, sleep Approximately of the good sleepers
they found 503 of the children to be disturbances and sleep pattern significantly were of normal weight, while forty
obese/overweight. There was a 32% related to all of the obesity measures, while percent of the poor sleepers had high
higher risk of being overweight if the sleep duration did not. body fat percentages. Poor quality sleep
child got 10 or fewer hours of sleep. was associated with those who only slept
an average of 5 hours/day.

Weaknesses Focuses solely on sleep duration of Small population size, not random group, Focuses of Saudi Adults, not those in the
children. population came solely from volunteers. U.S.. Volunteer, convenience sample.

Strengths Large population size that leads proof Evidence that it is more than sleep duration Focused on sleep quality of the
to sleep having a drastic effect on that is affecting the weight of people. Sleep participants, such as sleep duration,
weight of young children. type is more relevant to weight gain. efficiency, and disturbances.

Relevance to Focuses on young children and how Provides evidence that more than just sleep Includes data about sleep quality, but
Topic sleep effects their weight at a later age amount goes into effecting a childs weight. also other factors that could be
influencing boy weight.

Citation Alamian, A., Wang, L., Hall, A. M., Bell JF, Zimmerman FJ. (2010). Shortened Ferranti, R., Marventano, S., Castellano, S.,
Information Pitts, M., & Ikekwere, J. (2016). Infant nighttime sleep duration in early life and Giogianni, G., Nolfo, F., Rametta, S., . . .
sleep problems and childhood subsequent childhood obesity. Arch Mistretta, A. (2016). Sleep quality and
overweight: Effects of three definitions Pediatr Adolesc Med., 164(9), 840-845. duration is related with diet and obesity in
of sleep problems. Preventive Medicine doi:10.1001/archpediatrics.2010.143. young adolescent living in Sicily, Southern
Reports, 4, 463468. Italy. Sleep Science, 9(2), 117-122. doi:10.1016/j.slsci.2016.04.003


les/PMC5008059/ px?articleid=383686

Purpose To determine if there is a relationship To determine the association between To determine the association between sleeping
between infant sleep problems and later daytime and nighttime sleep duration and habits, diet, and weight status in adolescent
childhood obesity. obesity later in childhood and population in Sicily, Italy.

Study Design Multi-site longitudinal study Prospective cohort, longitudinal Randomly selected schools after stratification.

Participants 1364 eligible mothers with healthy 2569 children in the PSID at follow-up, Students from randomly selected schools,
newborns of which 895 children 990 were 0-59 months formed the younger invited to participate. 1643 provided consent.
completed through grade 6. cohort, and 1579 were aged 60-154 1586 were included in the analysis.

Data Sleep problems as infants at 6 months Questionnaire including questions Questionnaire administered during school
Collection and 15 months obtained by maternal regarding demographic data, hours. No time restriction. Clinical visit to
reports. Height and weight measured in psychological and behavioral assessments acquire anthropometric measurements, after
lab visit in Grade 6 by research of the parents and children. Time-use the questionnaire. Demographic information
assistants. Maternal information was diaries recorded primary and secondary collected in first part, educational level next,
collected over periods of time, 1 month, activities for children during a 24-hour physical activity, and information related to
24 months, etc. Data analyzed against period. sleep patterns.
excluded sample.

Results Poor sleep practices in infancy, can lead In the younger cohort low nighttime sleep Boys had larger proportion of overweight and
to early childhood sleep problems, had increased odds of overweight and obesity compared to girls. Longer sleep
which could potentially lead to an obesity. Daytime sleep was not associated. duration resulted in better weight control.
increase in weight. In the older cohort, there was no Adolescents with late bedtime had a higher
association between low nighttime sleep intake of extra food.
and a shift in weight status.

Weaknesses First study of this kind, because it Only focused on sleep duration, not any This study calculated sleep duration by
looked at 3 individual definitions, so other factors that influence the quality of looking at the difference between bed time and
not possible to compare with other data sleep that an infant or child experiences. wake time, but didnt consider if the person
from other studies. slept all the way through the night without

Strengths Uses 3 definitions of sleep problems in Determined that daytime sleep has no Randomly chosen schools, which allowed for
infants, to determine if there is an effect on obesity at any age. This shows the study to have a diverse range of SES
increased risk of that child being that napping does not make up for lack of among participants.
overweight by 6th grade. quality nighttime sleep.

Relevance Looks at how sleep disturbances as an Provides more information on the fact that Looks at how sleep and wake times can have
to Topic infant could possibly increase the risk nighttime sleep is more important, and an effect on a childs likelihood of being
of a child being overweight and obese cannot be substituted with sleep during the overweight or obese. Along with other factors
later on. day. that can contribute to weight.