Motor competence and body mass index in the preschool years: a pooled cross-sectional analysis of 5545 children from eight countries

Background: One in five preschool children are overweight/obese, and increased weight status over time increases the risks of poorer future health. Motor skill competence (MC) may be a protective factor - giving children the ability to participate in health enhancing physical activity. Yet we do not know when the relationship between motor competence and weight status first emerges or whether it is evident across the body mass index (BMI) spectrum. This study examined the association between MC and BMI in a multi-country sample of 5545 preschoolers (54.36 ± 9.15 months of age; 50.5% boys) from eight countries. Methods: Quantile regression analyses were used to explore the associations between MC (assessed using the Test of Gross Motor Development -2nd/3rd edition), and quantiles of BMI (15th; 50th; 85th; and 97th percentiles), adjusted for sex, age in months, and country. Results: Negative associations of locomotor skills, ball skills, and overall MC with BMI percentiles (p < .005) were seen, which became stronger at the higher end of the BMI distribution (97th percentile). Regardless of sex, for each raw score point increase in locomotor skills, ball skills and overall MC scores, BMI is reduced by 8.9%, 6.8%, and 5.1%, respectively, for those preschoolers at the 97th BMI percentile onwards. Conclusion: Public health policies should position MC as critical for children´s obesity prevention from early childhood onwards. Robust longitudinal and experimental designs are encouraged to explore a possible causality pathway between MC and BMI from early childhood.