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Disparities in childhood overweight and obesity by income in the United States: an epidemiological examination using three nationally representative datasets

International Journal of Obesity volume 43, pages 1210–1222 (2019)Cite this article

Subjects

Abstract

Background/Objectives

Overweight and obesity (OWOB) is a global epidemic. Adults and adolescents from low-income households are at higher risk to be OWOB. This study examined the relationship between income and OWOB prevalence in children and adolescents (518 years) in the United States (US) within and across race/ethnicities, and changes in this relationship from 1971 to 2014.

Subjects/Methods

A meta-analysis of a nationally representative sample (N = 73,891) of US children and adolescents drawn from three datasets (i.e., National Health and Nutrition Examination Survey, National Longitudinal Survey of Youth, & the Early Childhood Longitudinal Program) which included 14 cross-sectional waves spanning 1971–2014 was conducted. The exposure was household income-to-poverty ratio (low income = 0.00–1.00, middle income = 1.01–4.00, high income >4.00) with prevalence of overweight or obesity (body mass index ≥ 85th percentile) as the outcome.

Results

Children and adolescents from middle-income and high-income households were 0.78 (95% CI = 0.72, 0.83) and 0.68 (95% CI = 0.59, 0.77) times as likely to be OWOB compared to children and adolescents in low-income households. Separate analyses restricted to each racial/ethnic group showed children and adolescents from middle- and high-income households were less likely to be OWOB compared to their low-income peers within the White, Hispanic, and Other race/ethnic groups. Children and adolescents from low-income households who were Black were not more likely to be OWOB than their high- and middle-income counterparts. Analyses within each income stratum indicated that race/ethnicity was not related to the prevalence of OWOB in low-income households. However, racial/ethnic differences in OWOB were evident for children and adolescents in middle- and high-income households. Disparities in the prevalence of OWOB between low-income children and adolescents and their middle- and high-income counterparts have increased from 1971 to 2014.

Conclusions

Income and OWOB are related in US children and adolescents. Racial/ethnic differences in the prevalence of OWOB emerge in middle- and high-income households. Disparities in OWOB prevalence are growing.

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References

  1. Ogden CL, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D, Kit BK, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA. 2016;315:2292–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Cote AT, Harris KC, Panagiotopoulos C, Sandor GG, Devlin AM. Childhood obesity and cardiovascular dysfunction. J Am Coll Cardiol. 2013;62:1309–19.

    PubMed  Google Scholar 

  3. Bacha F, Gidding SS. Cardiac abnormalities in youth with obesity and type 2 diabetes. Curr Diab Rep. 2016;16:1–9.

    CAS  Google Scholar 

  4. Mohanan S, Tapp H, McWilliams A, Dulin M. Obesity and asthma: pathophysiology and implications for diagnosis and management in primary care. Exp Biol Med. 2014;239:1531–40.

    Google Scholar 

  5. Narang I, Mathew JL. Childhood obesity and obstructive sleep apnea. J Nutr Metab 2012; 2012:1–8.

  6. Pollock NK. Childhood obesity, bone development, and cardiometabolic risk factors. Mol Cell Endocrinol. 2015;410:52–63.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Bammann K, Gwozdz W, Pischke C, Eiben G, Fernandez-Alvira JM, De Henauw S, et al. The impact of familial, behavioural and psychosocial factors on the SES gradient for childhood overweight in Europe. A longitudinal study. Int J Obes. 2017;41:54.

    CAS  Google Scholar 

  8. Shrewsbury V, Wardle J. Socioeconomic status and adiposity in childhood: a systematic review of cross‐sectional studies 1990–2005. Obesity. 2008;16:275–84.

    PubMed  Google Scholar 

  9. Barriuso L, Miqueleiz E, Albaladejo R, Villanueva R, Santos JM, Regidor E. Socioeconomic position and childhood-adolescent weight status in rich countries: a systematic review, 1990–2013. BMC Pediatr. 2015;15:129.

    PubMed  PubMed Central  Google Scholar 

  10. Miech RA, Kumanyika SK, Stettler N, Link BG, Phelan JC, Chang VW. Trends in the association of poverty with overweight among US adolescents, 1971-2004. JAMA. 2006;295:2385–93.

    CAS  PubMed  Google Scholar 

  11. Bonney A, Mayne DJ, Jones BD, Bott L, Andersen SE, Caputi P, et al. Area-level socioeconomic gradients in overweight and obesity in a community-derived cohort of health service users—a cross-sectional study. PLoS ONE. 2015;10:e0137261.

    PubMed  PubMed Central  Google Scholar 

  12. Chang VW, Lauderdale DS. Income disparities in body mass index and obesity in the United States, 1971-2002. Arch Intern Med. 2005;165:2122–8.

    PubMed  Google Scholar 

  13. Jones-Smith JC, Dieckmann MG, Gottlieb L, Chow J, Fernald LCH. Socioeconomic status and trajectory of overweight from birth to mid-childhood: the early childhood longitudinal study-birth cohort. PLoS ONE. 2014;9:e100181.

    PubMed  PubMed Central  Google Scholar 

  14. Sobal J, Stunkard AJ. Socioeconomic status and obesity: a review of the literature. Psychol Bull. 1989;105:260.

    CAS  PubMed  Google Scholar 

  15. Freedman DS, Ogden CL, Flegal KM, Kettel Khan L, Serdula MK, Dietz WH. Childhood overweight and family income. MedGenMed. 2007;9:26–26.

    PubMed  PubMed Central  Google Scholar 

  16. Freedman DS, Wang J, Thornton JC, Mei Z, Pierson RN, Dietz WH, et al. Racial/ethnic differences in body fatness among children and adolescents. Obesity. 2008;16:1105–11.

    PubMed  Google Scholar 

  17. Wang Y, Zhang Q. Are American children and adolescents of low socioeconomic status at increased risk of obesity? Changes in the association between overweight and family income between 1971 and 2002. Am J Clin Nutr. 2006;84:707–16.

    CAS  PubMed  Google Scholar 

  18. Ogden CL, Carroll MD, McDowell MA, Flegal KM. Obesity among adults in the United States—no statistically significant change since 2003-2004. NCHS Data Breif, 2007. p. 1–8.

  19. Ogden CL. Prevalence of obesity among youths by household income and education level of head of household—United States 2011–2014. MMWR Morbid Mortality Weekly Rep. 2018;67:186–89.

    Article  PubMed  PubMed Central  Google Scholar 

  20. National Center for Education Statistics. Early Childhood Longitudinal Program (ECLS). 2017 [cited 3 Jan 2018]. https://nces.ed.gov/ecls/.

  21. Bureau of Labor Statistics. National Longitudinal Surveys. 2017 [cited 3 Jan 2018]. https://www.bls.gov/nls/.

  22. Centers for Disease Control and Prevention (CDC) and National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Questionnaire. 2014 [cited 2 Oct 2014]. http://www.cdc.gov/nchs/nhanes.htm.

  23. Department of Health and Human Services. Department of Health and Human Services Poverty Guidelines for 2017. 2017 [cited 10 Nov 2017]. https://aspe.hhs.gov/poverty-guidelines.

  24. Kuczmarski R, Ogden C, Guo S, Grummer-Strawn L, Flegal K, Mei Z, et al. CDC growth charts for the US: methods and development. Vital Health Stat. 2002;11:1–190.

    Google Scholar 

  25. Anderson SE, Whitaker RC. Prevalence of obesity among us preschool children in different racial and ethnic groups. Arch Pediatr Adolesc Med. 2009;163:344–8.

    PubMed  Google Scholar 

  26. Sutton, AJ, KR Abrams, DR Jones, DR Jones, TA Sheldon, F Song. Methods for meta-analysis in medical research. (Wiley, Hoboken, NJ 2000).

  27. Braveman PA, Cubbin C, Egerter S, Williams DR, Pamuk E. Socioeconomic disparities in health in the United States: what the patterns tell us. Am J Public Health. 2010;100(S1):S186–S196.

    PubMed  PubMed Central  Google Scholar 

  28. Cameron AJ, Spence AC, Laws R, Hesketh KD, Lioret S, Campbell KJ. A review of the relationship between socioeconomic position and the early-life predictors of obesity. Curr Obes Rep. 2015;4:350–62.

    PubMed  Google Scholar 

  29. Adler NE, Boyce T, Chesney MA, Cohen S, Folkman S, Kahn RL, et al. Socioeconomic status and health: the challenge of the gradient. Am Psychol. 1994;49:15.

    CAS  PubMed  Google Scholar 

  30. Cardel M, Johnson S, Beck J, Dhurandhar E, Keita A, Tomczik A, et al. The effects of experimentally manipulated social status on acute eating behavior: a randomized, crossover pilot study. Physiol Behav. 2016;162:93–101.

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Goodman E, Maxwell S, Malspeis S, Adler N. Developmental trajectories of subjective social status. Pediatrics 2015:136:1–10.

  32. Goodman E, Adler NE, Kawachi I, Frazier AL, Huang B, Colditz GA. Adolescents 9 perceptions of social status: development and evaluation of a new indicator. Pediatrics. 2001;108:e31.

    CAS  PubMed  Google Scholar 

  33. Coleman-Jensen A, Gregory C, Singh A. Household food security in the United States in 2013. 2014.

  34. Nettle D, Andrews C, Bateson M. Food insecurity as a driver of obesity in humans: the insurance hypothesis. Behav Brain Sci. 2017;40:1–53.

  35. Swinburn B, Egger G, Raza F. Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. Prev Med. 1999;29:563–70.

    CAS  PubMed  Google Scholar 

  36. Morland K, Wing S, Roux AD, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002;22:23–29.

    PubMed  Google Scholar 

  37. Walker RE, Block J, Kawachi I. The spatial accessibility of fast food estaurants and convenience stores in relation to neighborhood schools. Appl Spat Anal Policy. 2014;7:169–82.

    Google Scholar 

  38. Janssen I, Boyce WF, Simpson K, Pickett W. Influence of individual-and area-level measures of socioeconomic status on obesity, unhealthy eating, and physical inactivity in Canadian adolescents. Am J Clin Nutr. 2006;83:139–45.

    CAS  PubMed  Google Scholar 

  39. Drewnowski A. Obesity and the food environment: dietary energy density and diet costs. Am J Prev Med. 2004;27:154–62.

    PubMed  Google Scholar 

  40. Sallis JF, Nader PR, Broyles SL, Berry CC, Elder JP, McKenzie TL, et al. Correlates of physical activity at home in Mexican-American and Anglo-American preschool children. Health Psychol. 1993;12:390.

    CAS  PubMed  Google Scholar 

  41. Sallis JF, Johnson MF, Calfas KJ, Caparosa S, Nichols JF. Assessing perceived physical environmental variables that may influence physical activity. Res Q Exerc Sport. 1997;68:345–51.

    CAS  PubMed  Google Scholar 

  42. Powell LM, Slater S, Chaloupka FJ, Harper D. Availability of physical activity–related facilities and neighborhood demographic and socioeconomic characteristics: a national study. Am J Public Health. 2006;96:1676–80.

    PubMed  PubMed Central  Google Scholar 

  43. Pratt CA, Boyington J, Esposito L, Pemberton VL, Bonds D, Kelley M, et al. Childhood Obesity Prevention and Treatment Research (COPTR): interventions addressing multiple influences in childhood and adolescent obesity. Contemp Clin Trials. 2013;36:406–13.

    PubMed  PubMed Central  Google Scholar 

  44. Dooyema CA, Belay B, Foltz JL, Williams N, Blanck HM. The childhood obesity research demonstration project: a comprehensive community approach to reduce childhood obesity. Child Obes. 2013;9:454–9.

    PubMed  Google Scholar 

  45. Baranowski T, Baranowski JC, Cullen KW, Thompson DI, Nicklas T, Zakeri IF, et al. The fun, food, and fitness project (FFFP): The Baylor GEMS pilot study. Ethn Dis. 2003;13(Supp/1):S1–30.

    Google Scholar 

  46. Klesges RC, Obarzanek E, Kumanyika S, Murray DM, Klesges LM, Relyea GE, et al. The Memphis Girls’ Health Enrichment Multi-site Studies (GEMS): an evaluation of the efficacy of a 2-year obesity prevention program in African American girls. Arch Pediatr Adolesc Med. 2010;164:1007–14.

    PubMed  PubMed Central  Google Scholar 

  47. Robinson TN, Matheson DM, Kraemer HC, Wilson DM, Obarzanek E, Thompson NS et al. A randomized controlled trial of culturally tailored dance and reducing screen time to prevent weight gain in low-income African American girls: Stanford GEMS. Arch Pediatr Adolesc Med 2010;164:995–1004.

  48. Luepker RV, Perry CL, McKinlay SM, Nader PR, Parcel GS, Stone EJ, et al. Outcomes of a field trial to improve children’s dietary patterns and physical activity. JAMA. 1996;275:768–76a

    CAS  PubMed  Google Scholar 

  49. Economos CD, Hyatt RR, Must A, Goldberg JP, Kuder J, Naumova EN, et al. Shape Up Somerville two-year results: a community-based environmental change intervention sustains weight reduction in children. Prev Med. 2013;57:322–7.

    PubMed  Google Scholar 

  50. Taveras EM, Perkins M, Anand S, Woo Baidal JA, Nelson CC, Kamdar N, et al. Clinical effectiveness of the massachusetts childhood obesity research demonstration initiative among low‐income children. Obesity. 2017;25:1159–66.

    PubMed  Google Scholar 

  51. Butte NF, Hoelscher DM, Barlow SE, Pont S, Durand C, Vandewater EA, et al. Efficacy of a community‐versus primary care–centered program for childhood obesity: TX CORD RCT. Obesity. 2017;25:1584–93.

    PubMed  Google Scholar 

  52. Anchondo IM, Satter E, Danaher C, Estes PR. MA-CORD: Stop ineffective childhood obesity inverventions. Child Obes. 2015;11:731–2.

    PubMed  Google Scholar 

  53. Barkin SL, Heerman WJ, Sommer EC, Martin NC, Buchowski MS, Schlundt D, et al. Effect of a behavioral intervention for underserved preschool-age children on change in body mass index: a randomized clinical trial. JAMA. 2018;320:450–60.

    PubMed  PubMed Central  Google Scholar 

  54. Moore SM, Borawski EA, Cuttler L, Ievers-Landis CE, Love TE. IMPACT: a multi-level family and school intervention targeting obesity in urban youth. Contemp Clin Trials. 2013;36:574–86.

    PubMed  Google Scholar 

  55. Sherwood NE, French SA, Veblen-Mortenson S, Crain AL, Berge J, Kunin-Batson A, et al. NET-Works: linking families, communities and primary care to prevent obesity in preschool-age children. Contemp Clin Trials. 2013;36:544–54.

    PubMed  PubMed Central  Google Scholar 

  56. Robinson TN, Matheson D, Desai M, Wilson DM, Weintraub DL, Haskell WL, et al. Family, community and clinic collaboration to treat overweight and obese children: Stanford GOALS—a randomized controlled trial of a three-year, multi-component, multi-level, multi-setting intervention. Contemp Clin Trials. 2013;36:421–35.

    PubMed  Google Scholar 

  57. Flegal KM, Ogden CL, Yanovski JA, Freedman DS, Shepherd JA, Graubard BI, et al. High adiposity and high body mass index–for-age in US children and adolescents overall and by race-ethnic group. Am J Clin Nutr. 2010;91:1020–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  58. Nelson DA, Barondess DA. Whole body bone, fat and lean mass in children: comparison of three ethnic groups. Am J Phys Anthropol. 1997;103:157–62.

    CAS  PubMed  Google Scholar 

  59. Ellis KJ, Abrams SA, Wong WW. Monitoring childhood obesity: assessment of the weight/height2 index. Am J Epidemiol. 1999;150:939–46.

    CAS  PubMed  Google Scholar 

  60. Daniels SR, Khoury PR, Morrison JA. The utility of body mass index as a measure of body fatness in children and adolescents: differences by race and gender. Pediatrics. 1997;99:804–7.

    CAS  PubMed  Google Scholar 

  61. Chang VW. Racial residential segregation and weight status among US adults. Soc Sci Med. 2006;63:1289–303.

    PubMed  Google Scholar 

  62. LaVeist T, Pollack K, Thorpe R Jr, Fesahazion R, Gaskin D. Place, not race: disparities dissipate in southwest Baltimore when blacks and whites live under similar conditions. Health Aff. 2011;30:1880–7.

    Google Scholar 

  63. Hajat A, Kaufman JS, Rose KM, Siddiqi A, Thomas JC. Long-term effects of wealth on mortality and self-rated health status. Am J Epidemiol. 2010;173:192–200.

    PubMed  PubMed Central  Google Scholar 

  64. Williams DR. Race, socioeconomic status, and health the added effects of racism and discrimination. Ann N Y Acad Sci. 1999;896:173–88.

    CAS  PubMed  Google Scholar 

  65. Saez E, Zucman G. Wealth inequality in the United States since 1913: Evidence from capitalized income tax data. Q J Econ. 2016;131:519–78.

    Google Scholar 

  66. Hernandez DC, Pressler E. Accumulation of childhood poverty on young adult overweight or obese status: race/ethnicity and gender disparities. J Epidemiol Community Health 2014;68:478–84.

    Article  PubMed  Google Scholar 

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Author notes

  1. Kellee White

    Present address: UMD School of Public Health, University of Maryland, 4200 Valley Dr #2242, College Park, MD, 20742, USA

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  1. Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Public Health Research Center, 921 Assembly St. rm 130, Columbia, SC, 29201, USA

    Robert G. Weaver, Keith Brazendale, Ethan Hunt, Mark A. Sarzynski, Michael W. Beets & Kellee White

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Weaver, R.G., Brazendale, K., Hunt, E. et al. Disparities in childhood overweight and obesity by income in the United States: an epidemiological examination using three nationally representative datasets. Int J Obes 43, 1210–1222 (2019). https://doi.org/10.1038/s41366-019-0331-2

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