Cesarean Section and the Risk of Overweight in Grade 6 Children


Liang Wang, MD, DrPH, MPH, Assistant Professor in the Department of Biostatistics and Epidemiology. His current research interests are obesity, chronic disease epidemiology, maternal and child health, and health disparities. He received national honors as an Outstanding Author from the Maternal and Child Health Section of the American Public Health Association for two separate papers.

Dr. Wang was the PI for a university-funded project investigating the role of prenatal maternal smoking on the development of childhood overweight or obesity and PI of behavioral/social factors with stroke that lead two first author peer-reviewed publications in Pediatric Obesity and Neuroepidemiology, respectively, as well as the Co-I of sleep problems and overweight among American youth project. In addition, he is a certificated SAS 9 programmer. He currently serves as a co-investigator of the Team Up for Healthy Living research project. Team Up is a federally funded R01 research program using peer facilitators to deliver an intervention to prevent adolescent obesity. He recently published a paper titled: ‘Cesarean section and the risk of overweight in grade 6 children’ in the European Journal of Pediatrics.

Background of the study

Effective strategies are needed to confront the global obesity epidemic. One possible strategy is to identify modifiable risk factors that occur during the perinatal stage of development. Over the past two decades, there has been a marked increase in the rates of cesarean sections (C-sections) worldwide, and a few studies have suggested a possible relation between delivery mode and body mass index in youth. The findings of the few studies that investigated the relationship between delivery mode and the risk of childhood overweight and obesity have been generally inconsistent. Thus, we aimed to examine the association of C-section and the risk of childhood overweight and obesity.


This study showed that grade sixth children delivered by C-section were more likely to be overweight or obese compared to children delivered vaginally. We also found that the said relationship varied according to the gender of the child. For example, male children delivered by C-section had an increased risk of being overweight or obese while female children delivered by C-section had an increased risk only of being overweight.


In many middle- and upper-income countries, C-sections are increasing and may eventually surpass vaginal births as the primary delivery mode. These findings suggest that targeting women of reproductive ages with educational interventions and policy development may be worthwhile. However, further longitudinal studies are warranted to examine the long-term effect of delivery mode on the risk of childhood overweight and obesity.

Additional research

The current study has several limitations including the lack of parental and perinatal information. We hope to test our hypothesis with a more complete set of longitudinal data in order to more effectively evaluate the long-term effects of delivery mode on the risk of childhood overweight and obesity.

Increasing awareness

The media and other news outlets are needed to generate awareness of this issue among women and obstetricians in order to ensure that the best mode of child delivery is chosen given the health of the mother and the child.

Advice from the field

I would encourage people who are getting into this field to seek out mentors that can help them further develop their research and analytical skills.

About the department

The Department of Biostatistics and Epidemiology is one of the five departments of ETSU’s College of Public Health. Our department offers both Master’s level and Doctoral level degrees in Public Health with Concentration in Epidemiology (MPH, DrPH) and in Biostatistics (MPH). ETSU’s College of Public Health is the only Council on Education in Public Health (CEPH) accredited School of Public Health in Tennessee.