Rising Social Inequalities in US Childhood Obesity, 2003-2007

U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD 20857, USA.
Annals of epidemiology (Impact Factor: 2). 01/2010; 20(1):40-52. DOI: 10.1016/j.annepidem.2009.09.008
Source: PubMed


This study examines changes between 2003 and 2007 in obesity and overweight prevalence among U.S. children and adolescents 10 to 17 years of age from detailed racial/ethnic and socioeconomic groups.
The 2003 (N=46,707) and 2007 (N=44,101) National Survey of Children's Health were used to calculate overweight and obesity prevalence (body mass index [BMI] > or = 85th and > or = 95th percentiles, respectively). Logistic regression was used to model odds of obesity.
In 2007, 16.4% of U.S. children were obese and 31.6% were overweight. From 2003 to 2007, obesity prevalence increased by 10% for all U.S. children but increased by 23%-33% for children in low-education, low-income, and higher unemployment households. Obesity prevalence increased markedly among Hispanic children and children from single-mother households. In 2007, Hispanic, non-Hispanic Black, [corrected] and American Indian children had 3.0-3.8 times higher odds of obesity and overweight than Asian children; children from low-income and low-education households had 3.4-4.3 times higher odds of obesity than children from higher socioeconomic households. The magnitude of racial/ethnic and socioeconomic disparities in obesity and overweight prevalence increased between 2003 and 2007, with substantial social inequalities persisting even after controlling for behavioral factors.
Social inequalities in obesity and overweight prevalence increased because of more rapid increases in prevalence among children in lower socioeconomic groups.

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    • "Income inequalities in health are substantial in the United States and have risen over the past several decades [1]. While ample evidence suggests that poorer children do not perform as well as higher income children on a wide variety of health, occupational, and educational measures, the evidence is inconclusive on the association between family income and childhood body mass index (BMI). "
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    ABSTRACT: Background An emerging body of research suggests the trajectory of a family’s income affects children’s health and development more profoundly than the often-measured income at a single time point. The purpose of this study was to examine the associations between changes in family income status, early-life risk factors, and body mass index (BMI) z-score trajectory from age 2 to 15 years. Methods This longitudinal study employed a birth cohort (n = 595) located in a rural region of New York State. Data were collected through an audit of medical records and mailed questionnaires. Family low-income and BMI z-score trajectories were identified using latent-class modeling techniques that group children based on similar trends across time. We examined five early-life risk factors in relation to income and BMI z-score trajectories: maternal overweight/obesity, maternal gestational weight gain, maternal smoking during pregnancy, breastfeeding duration, and early-life weight gain trajectory. We used multinomial logistic regression models to estimate the odds of being in a BMI z-score trajectory group based on income trajectory and early-life risk factors. Results Children who remain low-income throughout childhood were more likely to maintain overweight (AOR = 2.55, 95% CI = 1.03, 5.42) and children who moved into low-income during childhood were more likely to be obese (AOR = 2.36, 95% CI = 1.12, 5.93) compared to children who were never low-income. Maternal overweight/obesity was significantly associated with a child become obese (AOR = 8.31, 95% CI = 3.80, 18.20), become overweight (AOR = 2.37, 95% CI = 1.34, 4.22), and stay overweight (AOR = 1.79, 95% CI = 1.02, 3.14). Excessive gestational weight gain was associated with increased likelihood of a child becoming overweight trajectory (AOR = 2.01, 95% CI = 1.01, 4.00). Conclusions Our findings further supports the growing evidence that there are several preventable early-life risk factors that could be targeted for intervention. This study provides new evidence that remaining in low-income and moving into low-income increases risk for adolescent overweight and obesity.
    Full-text · Article · May 2014 · BMC Public Health
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    • "Multiple factors, including genetic, environmental, cultural and socio-economic status may influence corporal weight [12-18]. Researchers of child and adolescent obesity have mainly focused on individual factors such as gender, socio-economic position, physical activity, sedentary habits, nutrition and sleep duration [12,13,19]. Evidence also suggests that environmental and family factors influence adopted habits, particularly in children [14-16,20,21]. "
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    ABSTRACT: There is a growing worldwide trend of obesity in children. Identifying the causes and modifiable factors associated with child obesity is important in order to design effective public health strategies.Our objective was to provide empirical evidence of the association that some individual and environmental factors may have with child excess weight. A cross-sectional study was performed using multi-stage probability sampling of 978 Spanish children aged between 8 and 17 years, with objectively measured height and weight, along with other individual, family and neighborhood variables. Crude and adjusted odds ratios were calculated. In 2012, 4 in 10 children were either overweight or obese with a higher prevalence amongst males and in the 8-12 year age group. Child obesity was associated negatively with the socio-economic status of the adult responsible for the child's diet, OR 0.78 (CI95% 0.59-1.00), girls OR 0.75 (CI95% 0.57-0.99), older age of the child (0.41; CI95% 0.31-0.55), daily breakfast (OR 0.59; p = 0.028) and half an hour or more of physical activity every day. No association was found for neighborhood variables relating to perceived neighborhood quality and safety. This study identifies potential modifiable factors such as physical activity, daily breakfast and caregiver education as areas for public health policies. To be successful, an intervention should take into account both individual and family factors when designing prevention strategies to combat the worldwide epidemic of child excess weight.
    Full-text · Article · Jan 2014 · BMC Pediatrics
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    • "Despite marked improvements in overall health and life expectancy, health inequalities in the USA have not only remained substantial but have also increased over time [9, 21–23]. Inequalities in chronic disease risks such as obesity, smoking, physical inactivity, and poor diet have contributed greatly to the persistence and/or widening of the health gradients [1, 2, 21–23]. The purpose of this study was to examine trends in obesity and overweight prevalence and body mass index (BMI) among major API subgroups and to identify those subgroups who are at high risk of obesity and who have experienced substantial increases in their obesity rates. "
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    ABSTRACT: We examined trends in adult obesity and overweight prevalence among major Asian/Pacific Islander (API) subgroups and the non-Hispanic whites from 1992 to 2011. Using 1992–2011 National Health Interview Surveys, obesity, overweight, and BMI differentials were analyzed by logistic, linear, and log-linear regression. Between 1992 and 2011, obesity prevalence doubled for the Chinese, the Asian Indians, the Japanese, and the Hawaiians/Pacific Islanders; and tripled for the Filipinos. Obesity prevalence among API adults tripled from 3.7% in 1992 to 13.3% in 2010, and overweight prevalence doubled from 23.2% to 43.1%. Immigrants in each API subgroup had lower prevalence than their US-born counterparts, with immigrants’ obesity and overweight risks increasing with increasing duration of residence. During 2006–2011, obesity prevalence ranged from 3.3% for Chinese immigrants to 22.3% for the US-born Filipinos and 41.1% for the Native Hawaiians/Pacific Islanders. The Asian Indians, the Filipinos, and the Hawaiians/Pacific Islanders had, respectively, 3.1, 3.8, and 10.9 times higher odds of obesity than those of the Chinese adults. Compared with Chinese immigrants, the adjusted odds of obesity were 3.5–4.6 times higher for the US-born Chinese and the foreign-born Filipinos, 9 times higher for the US-born Filipinos and whites, 3.8–5.5 times higher for the US-born and foreign-born Asian Indians, and 21.9 times higher for the Native Hawaiians. Substantial ethnic heterogeneity and rising prevalence underscore the need for increased monitoring of obesity and obesity-related risk factors among API subgroups.
    Full-text · Article · Oct 2013
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