Pubertal Status
Children's pubertal status was measured beginning at age 9 years during an annual health and physical development assessment conducted by a nurse or pediatric endocrinologist. Tanner criterion staging was used to assess boys' and girls' pubertal development; the original protocol proposed by Tanner19 was used to measure genital and pubic hair development in boys, and an amended version proposed by Herman-Giddens and Bourdony20 was used to measure breast and pubic hair development in girls. Thirty-four girls were excluded from analyses examining the effects of pubertal status on weight gain because they were early maturers, with breast development classified as greater than Tanner stage 2 at age 9 years. Previous studies have shown a link between earlier maturation and elevated weight status, so we wanted to remove this confound.21- 23