**Background:** Childhood obesity is a global public health challenge, with an estimated 39 million children under 5 years affected worldwide. In China, the prevalence of overweight and obesity in children under 6 years is 6.8% and 3.6%, respectively. Early childhood is a critical period for establishing dietary habits, and the order in which foods are consumed at a meal may influence energy intake and weight status. However, few studies have examined the relationship between eating order and childhood obesity in real-world settings. This study aimed to investigate whether consuming vegetables first versus meats/fish first at the start of a meal is associated with overweight and obesity in Chinese preschoolers.
**Methods:** A population-based cross-sectional study was conducted using a self-administered online survey distributed via the WeChat-combined Wen-Juan-Xing platform to parents of preschoolers in Taizhou, Zhejiang Province, China, from December 1, 2021, to January 31, 2022. A total of 3,200 parents were invited, and 2,049 completed the questionnaire (response rate 64.03%). After excluding duplicate submissions (n = 10), children outside the age range of 3–7 years (n = 29), extreme height/weight values (n = 75), and children with thinness (n = 419), 1,562 participants were included. Children's BMI was calculated from parent-reported height and weight, converted to age- and sex-standardized z-scores, and weight status was classified using International Obesity Task Force (IOTF) cutoffs. Eating order was assessed by a single question: "Does your child usually eat vegetables or meats/fish first at start of meal?" with two response options. Covariates included sex, age, residence (urban/rural), parental education, one-child family status, and annual household income. Chi-squared tests, Student's t-tests, and logistic regression were used for analysis.
**Key Results:** Among the 1,562 children (830 boys, 732 girls; mean age not directly reported but range 3–6 years), the mean BMI z-score was 0.725 ± 1.600. The proportion of normal weight, overweight, and obesity was 77.1%, 10.3%, and 12.6%, respectively. Overall, 52.1% of children ate vegetables first and 47.9% ate meats/fish first. No significant difference in BMI z-score was observed between the vegetables-first group (0.768 ± 1.638) and the meats/fish-first group (0.679 ± 1.554) (P = 0.274). Children who ate meats/fish first had higher parental education levels, higher household income, higher proportion of urban residence, and higher proportion of fathers with overweight/obesity (all P < 0.05). Children with parents affected by obesity had higher rates of overweight and obesity (P < 0.001 for mothers, P = 0.007 for fathers). In the subgroup of children whose mothers had obesity (n = 34), the BMI z-score was significantly higher in the meats/fish-first group (2.891 ± 2.098) compared with the vegetables-first group (0.845 ± 1.984) (P = 0.007). After adjusting for residence, number of children, income, and parental education, eating meats/fish first was associated with a 12.21 times higher risk of being overweight (95% CI: 1.22–121.74, P = 0.033) in children of mothers with obesity. No significant association was found in children of fathers with obesity or in the non-obese parental subgroups.
**Clinical Implications:** This study found no overall association between eating order and weight status in Chinese preschoolers, suggesting that the sequence of vegetable and meat/fish consumption at the start of a meal is not a major determinant of childhood obesity in the general population. However, the striking 12-fold increased risk of overweight among children of mothers with obesity who ate meats/fish first—though based on a very small sample (n = 34) with a wide confidence interval—suggests that eating order may be a modifiable behavioral target in this high-risk subgroup. The findings reinforce the importance of familial clustering of obesity and the role of maternal obesity as a risk factor. Given the cross-sectional design, small subgroup size, reliance on self-reported data, and lack of adjustment for total energy intake, physical activity, and other confounders, these results should be interpreted with caution. Future longitudinal studies with larger sample sizes and objective dietary assessments are needed before clinical recommendations on eating order can be made.