The causal effect of number of children on later-life overweight and obesity in parous women. An instrumental variable study

Thijs van den Broek*, Maria Fleischmann

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Many older women in Europe are overweight or obese. One of the factors linked to overweight and obesity among older women is childbearing. However, results of observational studies on the association between women's number of children and excess weight should be interpreted with caution, because they may be prone to bias due to residual confounders or reverse causation. We use data of women aged 50 and older with at least two births from seven waves the Survey of Health, Ageing and Retirement in Europe (n = 113,932) collected between 2004 and 2020. We adopt an instrumental variable approach that exploits the well-established preference for mixed-sex offspring to estimate the causal effect of number of children on older parous women's body mass index (BMI) and their risk of overweight (BMI >= 25 kg/m2) and obesity (BMI >= 30 kg/m2). The instrumental variable models provided evidence for a causal positive effect of having 3 + children as opposed to 2 children on mothers’ body mass index, overweight (BMI >= 25 kg/m2) risk and obesity (BMI >= 30 kg/m2) risk. Predicted BMI was 1.8 kg/m2 higher for mothers with 3 + children than for mothers with 2 children, and their predicted probability of overweight and obesity was 18.3 and 8.6 percentage points higher, respectively. Results remained virtually unchanged after adjusting for age, educational attainment, country and wave of data collection.

Original languageEnglish
Article number101528
Pages (from-to)1-7
Number of pages7
JournalPreventive medicine reports
Early online date18 Aug 2021
Publication statusPublished - Dec 2021

Bibliographical note

Funding Information:
The SHARE data collection has been funded by the European Commission, DG RTD through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N°211909, SHARE-LEAP: GA N°227822, SHARE M4: GA N°261982, DASISH: GA N°283646) and Horizon 2020 (SHARE-DEV3: GA N°676536, SHARE-COHESION: GA N°870628, SERISS: GA N°654221, SSHOC: GA N°823782) and by DG Employment, Social Affairs & Inclusion through VS 2015/0195, VS 2016/0135, VS 2018/0285, VS 2019/0332, and VS 2020/0313. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C, RAG052527A) and from various national funding sources is gratefully acknowledged (see

Publisher Copyright:
© 2021 The Author(s)

Copyright 2021 Elsevier B.V., All rights reserved.


  • Body mass index
  • Causal inference
  • Fertility
  • Obesity
  • Parity


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