Rising Social Inequalities in US Childhood Obesity, 2003–2007

Purpose

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.

Methods

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] ≥85th and ≥95th percentiles, respectively). Logistic regression was used to model odds of obesity.

Results

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 White, 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.

Conclusions

Social inequalities in obesity and overweight prevalence increased because of more rapid increases in prevalence among children in lower socioeconomic groups.

Introduction

Social inequalities in health have not only remained substantial in the United States (U.S.) but have also risen over the past several decades 1, 2, 3, 4. Inequalities in chronic disease risk factors such as smoking, obesity, physical inactivity, and poor diet have contributed greatly to the persistence and/or widening of the health gradients 1, 2, 3, 4. Dramatic increases in the overall prevalence over time and the existence of substantial social group disparities have brought childhood obesity to the forefront of the national health policy and research agenda 5, 6. Because of a relatively high prevalence and a three-fold increase in the rate during the past 3 decades, childhood obesity is seen as a major public health problem in the U.S. 5, 6, 7, 8.

While substantial racial/ethnic and socioeconomic disparities in U.S. childhood obesity are well documented 3, 6, 9, the extent to which social disparities in obesity and overweight prevalence have changed over time is less well examined. Moreover, previous studies analyzing trends in social disparities have focused on, besides age and gender, only one other dimension of social status—namely, family poverty status (poor vs. non-poor) 3, 10, 11. Temporal analyses of a wider range of social determinants of childhood obesity, such as parental education, household employment, family structure, place of residence, household language use, and neighborhood safety are either rare or have not yet been attempted. Such an analysis is important in that it could help identify social groups who may not only be at high risk but who may also have experienced significant increases in their childhood obesity rates and who therefore can be targeted for obesity prevention programs 5, 6.

The purpose of this study was (1) to provide latest estimates of and changes in obesity and overweight prevalence among children and adolescents aged 10–17 years from detailed racial/ethnic and socioeconomic groups using two large, nationally representative samples of U.S. children in 2003 and 2007 and (2) to examine temporal changes in social gradients in childhood obesity and overweight before and after adjusting for behavioral and neighborhood characteristics.