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Pediatrics

Understanding childhood obesity in the US: the NIH environmental influences on child health outcomes (ECHO) program

International Journal of Obesity volume 44, pages 617–627 (2020)Cite this article

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Abstract

Background

Few resources exist for prospective, longitudinal analysis of the relationships between early life environment and later obesity in large diverse samples of children in the United States (US). In 2016, the National Institutes of Health launched the Environmental influences on Child Health Outcomes (ECHO) program to investigate influences of environmental exposures on child health and development. We describe demographics and overweight and obesity prevalence in ECHO, and ECHO’s potential as a resource for understanding how early life environmental factors affect obesity risk.

Methods

In this cross-sectional study of 70 extant US and Puerto Rico cohorts, 2003–2017, we examined age, race/ethnicity, and sex in children with body mass index (BMI) data, including 28,507 full-term post-birth to <2 years and 38,332 aged 2–18 years. Main outcomes included high BMI for age <2 years, and at 2–18 years overweight (BMI 85th to <95th percentile), obesity (BMI ≥ 95th percentile), and severe obesity (BMI ≥ 120% of 95th percentile).

Results

The study population had diverse race/ethnicity and maternal demographics. Each outcome was more common with increasing age and varied with race/ethnicity. High BMI prevalence (95% CI) was 4.7% (3.5, 6.0) <1 year, and 10.6% (7.4, 13.7) for 1 to <2 years; overweight prevalence increased from 13.9% (12.4, 15.9) at 2–3 years to 19.9% (11.7, 28.2) at 12 to <18 years. ECHO has the statistical power to detect relative risks for ‘high’ BMI ranging from 1.2 to 2.2 for a wide range of exposure prevalences (1–50%) within each age group.

Conclusions

ECHO is a powerful resource for understanding influences of chemical, biological, social, natural, and built environments on onset and trajectories of obesity in US children. The large sample size of ECHO cohorts adopting a standardized protocol for new data collection of varied exposures along with longitudinal assessments will allow refined analyses to identify drivers of childhood obesity.

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Acknowledgements

The authors wish to thank our ECHO colleagues; the medical, nursing, and program staff; as well as the children and families participating in the ECHO cohorts.

Funding

Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, under Award Numbers U2COD023375, U24OD023382, UG3OD023271, UG3OD023289, UG3OD023286, UG3OD023248, UH3OD023290, P50 ES009600, UG3OD023275 NIEHS P01ES022832, EPA RD 83544201, UG3OD023286, 4UG3OD023287-03, K01HL141589, UG3OD023285, UG3OD023316, UG3OD023289, UG3OD023289, UG30D023318, UH3OD023249, 1UG1HD090899-01, UG3OD023320, UG3 (UH3) OD023305.

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Authors and Affiliations

  1. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA

    Frances A. Tylavsky

  2. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    Assiamira Ferrara, Monique M. Hedderson & Yeyi Zhu

  3. RTI International, Research Triangle Park, Triangle Park, NC, USA

    Diane J. Catellier

  4. Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA

    Emily Oken & Marie-France Hivert

  5. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Xiuhong Li & Andrew Law

  6. Departments of Epidemiology and Pediatrics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Denver, CO, USA

    Dana Dabelea

  7. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Andrew Rundle

  8. Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA

    Diane Gilbert-Diamond & Margaret R. Karagas

  9. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Carrie V. Breton

  10. Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA

    Andrea E. Cassidy-Bushrow

  11. Welch Center for Epidemiology, Prevention and Clinical Research, Johns Hopkins University Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Noel T. Mueller

  12. Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA

    Kelly J. Hunt

  13. National Heart, Lung, and Blood Institute, Bethesda, MD, USA

    S. Sonia Arteaga

  14. NIH Office of the Director, ECHO Program, Bethesda, MD, USA

    Tania Lombo

  15. Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA

    Somdat Mahabir

  16. Department of Obstetrics and Gynecology, Institute of Environmental Health Sciences, Wayne State University, Detroit, MI, USA

    Doug Ruden

  17. Departments of Pediatrics and Epidemiology, University of Colorado, Denver, CO, USA

    Katherine Sauder

  18. Department of Pediatrics and Centro SOL, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Sarah Polk

  19. Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

    Nicole L. Mihalopoulos

  20. Department of Pediatrics, Emory University, Atlanta, GA, USA

    Miriam Vos

  21. Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV, USA

    Lee Pyles

  22. National Institute of Nursing Research and Environmental Influences on Child Health Outcomes Program, National Institutes of Health, Rockville, MD, USA

    Mary Roary

  23. Department of Pediatrics and Obstetrics, Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Judy Aschner

  24. Departments of Pediatrics, Environmental Medicine and Population Health, NYU School of Medicine, New York, NY, USA

    Leonardo Trasande

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  1. Frances A. Tylavsky
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Correspondence to Leonardo Trasande.

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Members of the Environmental influences on Child Health Outcomes are listed at the Supplementary Information “ECHO Program Collaborators”.

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Tylavsky, F.A., Ferrara, A., Catellier, D.J. et al. Understanding childhood obesity in the US: the NIH environmental influences on child health outcomes (ECHO) program. Int J Obes 44, 617–627 (2020). https://doi.org/10.1038/s41366-019-0470-5

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