Although obesity is on the rise among all demographic groups, prevalence rates differ across gender and ethnic groups. Results from the National Health and Nutrition Examination Survey (NHANES) indicate that non-Hispanic black female children and adolescents had the highest overweight rates and were significantly more likely to be overweight than non-Hispanic white female children and Mexican American female children (Ogden et al., 2006). This trend continues into adulthood, when non-Hispanic black women are more likely than any other subgroup to be obese. Among males, Mexican American children and adolescents had significantly higher overweight rates than non-Hispanic white and non-Hispanic black children and adolescents.
Consequences of Pediatric Obesity
The consequences of pediatric obesity are numerous, and their severity has been realized only in recent years. Serious consequences can be seen in childhood and into adulthood, including increased risk for a variety of physical and psychosocial difficulties.
Studies have found that obese and overweight children are at elevated risk for type 2 diabetes, sleep apnea, arthritis, gallstones, and some types of cancer (Ravussin & Swinburn, 1992; Thompson, Edelsburg, Kinsey, & Oster, 1998; Wang & Dietz, 2002). Psychosocial costs include increased risk for negative self-concepts, lower popularity, peer victimization, and lower overall quality of life (Davison & Birch, 2001; Erickson, Robinson, Haydel, & Killen, 2000; Storch, et al., 2007; Thompson & Tantleff-Dunn, 1998; Whitaker, Wright, Pepe, Seidel, & Dietz, 1997).
Overweight children are also at risk for obesity into adulthood, which in turn is associated with a number of medical and mental health risks (Freedman et al., 2001). Beyond individual consequences, the costs of the increasing prevalence of obesity to the national health care system promise to be substantial.
In light of the myriad of direct and indirect consequences of pediatric obesity for the individual and the nation, public attention and rhetoric on the subject have escalated recently. The discussion has focused on a number of important topics, including policy issues, prevention efforts, and intervention strategies. Each of these will be explored in greater detail throughout the book, but we offer an overview here as a way of framing some of the most important issues.
Pediatric obesity has increased two- to threefold in the past thirty years in the United States and continues to rise. As one of the most frequent pediatric chronic conditions, it is important to define populations of children at higher risk for obesity to direct limited resources for treatment, prevention, and research. Individual risk factors such as parental overweight or television viewing have been well described but are not particularly useful to direct resources to the most vulnerable children. Nationally representative surveys show that Mexican American and non-Hispanic black children are at higher risk for obesity than are non-Hispanic white children. Data on the prevalence of overweight in Asian American and non-Mexican American Latino children, particularly children from Puerto Rico, are scarce. Among non-Hispanic white adolescents, overweight is more frequent with lower socioeconomic status, whereas in non-Hispanic black and Mexican American adolescents this association is less clear or may be in the opposite direction. Although the associations of ethnicity, race, and socioeconomic factors with pediatric overweight are relatively well defined, other important social health determinants are less well understood. For example, it is unclear if children living in medically underserved areas and using community health centers are at increasing risk for overweight or if urban, suburban, or rural US areas have the highest prevalence of pediatric overweight. These are important questions to answer to adequately plan public health and research efforts and train health professionals.
Community health centers are community-based organizations partially funded by the federal government (through the Health Resources and Service Administration [HRSA] under Title III) to deliver health care in medically underserved areas. More than 4.7 million children are clients of these centers, mainly located in inner-city and rural areas, and they may be at increased risk for obesity, because medically underserved communities are also often areas in which access to healthy foods and physical activity opportunities are limited, creating a particularly “obesogenic” environment. Because community health centers respond directly to the communities that they serve, depend less on funding from private insurers, and are successful in reducing health care-access disparities, they may constitute a particularly promising setting for pediatric obesity prevention and treatment if it is confirmed that they serve a high-risk population.
The aims of this study were to describe the prevalence of overweight in children who are clients of community health centers in medically underserved areas of HRSA regions II and III, compare this prevalence to nationally representative data, and contrast prevalence data between geographic areas and racial/ethnic groups.
High Prevalence of Overweight Among Pediatric Users of Community Health Centers
Nicolas Stettler, MD, MSCE, Michael R. Elliott, PhD, Michael J. Kallan, MS, Steven B. Auerbach, MD, MPH and Shiriki K. Kumanyika, PhD, MPH
Obesity Among Racial/Ethnic Groups
Although obesity has increased for all children and adolescents over time, NHANES data indicate disparities among racial/ethnic groups. The following graphs compare the prevalence for racial/ethnic groups of adolescent boys and girls aged 12 through 19 years.
Racial/Ethnic Comparison: Boys Aged 12–19 Years
The most recent NHANES data (2003–2006) showed that for boys, aged 12–19 years:
- The prevalence rate of obesity was higher among adolescent non-Hispanic black boys (22.9%) and Mexican American boys (21.1%) than among non-Hispanic white boys (16.0%).
Data from NHANES III (1988–1994) through NHANES 2003–2006 showed that adolescent non-Hispanic black boys experienced the largest increase in the prevalence of obesity (12.2%) compared to the increases among Mexican American (7.0%) and non-Hispanic white boys (4.4%).
- Among non-Hispanic white boys, the prevalence of obesity increased from 11.6% to 16.0%.
- Among non-Hispanic black boys, the prevalence of obesity increased from 10.7% to 22.9%.
- Among Mexican American boys, the prevalence of obesity increased from 14.1% to 21.1%.
Adolescent Boys Prevalence of Obesity by Race/Ethnicity (Aged 12–19 Years)
National Health and Nutrition Examination Surveys
Racial/Ethnic Comparison: Girls Aged 12–19 Years
The most recent NHANES data (2003–2006) showed that for girls, aged 12–19 years:
- Non-Hispanic black girls had the highest prevalence of obesity (27.7%) compared to that of non-Hispanic white (14.5%) and Mexican American 19.9%) girls.
Data from NHANES III (1988–1994) through NHANES 2003–2006 showed that non-Hispanic black adolescent girls experienced the largest increase in the prevalence of obesity (14.5%) compared to non-Hispanic white adolescent (7.1%) and Mexican American adolescent (10.7%) girls.
Adolescent Girls Prevalence of Obesity by Race/Ethnicity (Aged 12–19 Years)
National Health and Nutrition Examination Surveys
- Among non-Hispanic white girls, the prevalence of obesity increased from 7.4% to 14.5%.
- Among non-Hispanic black girls, the prevalence of obesity increased from 13.2% to 27.7%.
- Among Mexican American girls, the prevalence of obesity increased from 9.2% to 19.9%.
The ethnic differences found in this study likely resulted from a complex interaction between socioeconomic, environmental, and cultural factors. For example, previous results from the Add Health study suggest that environmental influences exert an important positive influence on physical activity levels, whereas socioeconomic factors exert an influence on inactivity (47). It may also be possible that the ethnic differentials observed in this study could be the result of differential reporting of physical activity and inactivity, perhaps due to cultural influences and expectations that may differentially lead to over- or underreporting of activity and inactivity. Future work will help to elucidate the complex interactions between these factors and how they relate to overweight among U.S. adolescents.
In summary, these findings suggest that overweight prevalence is high and adolescents are engaging in high levels of inactivity and low levels of moderate to vigorous physical activity. We find that reductions in television and video viewing are likely to reduce overweight of U.S. adolescents. In addition, we find that an increase in moderate to vigorous physical activity represents another potentially successful strategy for reducing overweight among U.S. adolescents. Both approaches, and particularly an approach that combines reductions in inactivity and promotion of physical activity, are likely to result in marked reductions in overweight prevalence among our nation’s youth. However, we must begin to consider the differences in behavior in different ethnic subpopulations, as well as differences in underlying factors that influence behavior differentials, as we devise intervention strategies.
Elissa Jelalian, Ph.D.
Warren Alpert Medical School of Brown University
Providence, RI USA