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It's the first time in 30 years that we've had good news, researchers say
Perhaps Michelle Obama should be taken off GQ's least influential list; a report from the Robert Wood Johnson Foundation has found the first decline in the number of obese children in years.
New York City reported a 5.5 percent obesity decline from 2007 to 2011; Philadelphia reported a 5 percent decrease, and Los Angeles had a 3 percent decrease.
Experts are unsure of what caused these declines, but noted that all three cities have passed obesity reduction policies in the past years; Philadelphia has banned sugary drinks from vending machines, deep-fryers from cafeterias, and whole milk in favor of 1 percent and skim milk.
This is reportedly the first decline in 30 years. "It’s been nothing but bad news for 30 years, so the fact that we have any good news is a big story," Dr. Thomas Farley, the health commissioner in New York City, told The New York Times.
Researchers hope that other cities will also report a decline in obesity; these numbers might only be available for cities that consistently measure schoolkids' height and weight. Perhaps Mayor Bloomberg should get some more credit for his overbearing, ambitious big soda ban?
Childhood Obesity Rates Drop Slightly: CDCBy Steven Reinberg
TUESDAY, Aug. 6 (HealthDay News) -- There was a small but sure sign Tuesday that the fight against childhood obesity may yet be won: A new government report found that obesity rates among low-income preschoolers had declined slightly in at least 19 states.
After decades of increases, the report from the U.S. Centers for Disease Control and Prevention found that Florida, Georgia, Missouri, New Jersey, South Dakota, and the U.S. Virgin Islands saw at least a 1 percent decrease in their rate of obesity from 2008 through 2011. Rates in 20 states and Puerto Rico held steady, while rates increased slightly in three other states.
"For the first time in a generation, we are seeing obesity go in the right direction in 2- to 4-year-olds, and we are seeing it happen across the country," CDC Director Tom Frieden said during a noon press conference.
"It's encouraging, but we have a lot further to go," he added. "We hope this is the start of a trend getting us back into balance."
Frieden credited the trend to such efforts as First Lady Michele Obama's "Let's Move" program and better policies in the government's Women, Infants and Children's (WIC) program, as well as increases in breast-feeding, recognition that children need to be active and eating a more healthful diet by reducing things like juices and increasing consumption of whole fruits and vegetables, and also decreasing time in front of the TV or computer.
"Today's announcement reaffirms my belief that together, we are making a real difference in helping kids across the country get a healthier start to life," Michelle Obama said in a CDC news release.
She added, "We know how essential it is to set our youngest children on a path towards a lifetime of healthy eating and physical activity, and more than 10,000 child-care programs participating in the 'Let's Move! Child Care' initiative are doing vitally important work on this front. Yet, while this announcement reflects important progress, we also know that there is tremendous work still to be done to support healthy futures for all our children."
Earlier research found that about one in eight preschoolers is obese, Frieden said. In addition, children are "five times more likely to be overweight or obese as an adult if they are overweight or obese between the ages of 3 and 5 years," he noted.
For the report, which covered 40 states, the District of Columbia, the U.S. Virgin Islands and Puerto Rico, CDC researchers looked at weight and height for nearly 12 million children aged 2 to 4 who took part in federally funded maternal and child nutrition programs.
"Obesity in kids has gotten worse over the past generation far faster than anyone could have anticipated," Frieden said. "This has happened when there has been no change in our genetics, so it's clearly a result of changes in the environment and it will be changed back by more changes in the environment."
Reversing the obesity epidemic begins with getting children to eat better and be more active, Frieden said.
To help reduce childhood obesity, the CDC recommends changes that:
- Make it easier for families to buy healthy, affordable foods and drinks.
- Provide safe, free drinking water in parks, recreation areas, child-care centers and schools.
- Help schools provide safe play areas by opening gyms, playgrounds and sports fields before and after school and on weekends and during the summer.
- Help child-care providers adopt ways of improving nutrition and physical activity and limiting computer and television time.
- Create partnerships with civic leaders, child-care providers and others to make changes to promote healthful eating and active living.
Dr. James Marks, senior vice president and director of the Health Group at the Robert Wood Johnson Foundation, called the report particularly welcome news because it shows progress among populations that are at higher risk for obesity.
"These signs of progress tell a clear story: we can reverse the childhood obesity epidemic. It isn't some kind of unstoppable force," said Marks. "Any community or state that makes healthy changes can achieve success. However, no single change is powerful enough by itself. It has taken a sustained, comprehensive approach in the places that have succeeded."
Dr. David Katz, director of the Yale University Prevention Research Center, said that "news about obesity has been far too grim for far too long."
"Over recent years, there has been, at last, some glimmers of hope, indications that rates of obesity are plateauing or even dipping slightly for some of the people, in some places," he said.
"But of course, there is that other half of the glass," Katz added.
"Obesity rates did not decline in the other 24 states in the analysis, despite widespread awareness of the problem and increasing efforts to address it. And we also know that rates of severe obesity continue to rise, suggesting that measures of our success may need to address not just how many are overweight, but how overweight are the many," he said.
Copyright © 2013 HealthDay. All rights reserved.
Childhood obesity rates continue to climb
Childhood obesity rates are still on the up, Government figures have shown.
The National Child Measurement Programme (NCMP) for the 2019/20 school year has found that obesity levels in Reception have gone up from 9.7% in 2018-19 to 9.9% in 2019-20.
The pattern continues among Year 6 children, where obesity prevalence has increased from 20.2% in 2018-19 to 21% in 2019-20.
The report has also unveiled there is a big disparity between rich and poor areas.
The document showed that 27.5% of Year 6 kids, aged 10 and 11, living in poor areas of the country were obese.
In comparison, only 11.9% of children of the same age who come from more affluent areas were deemed obese.
The pattern continued in younger age groups with 13.3% of Reception children, aged between four and five, living in poorer areas were obese. Only 6% of the same aged kids from richer backgrounds were considered overweight.
Boys are more prone to piling on the pounds with 10.1% of Reception children being deemed obese, compared with 9.7% of girls. In Year 6, 23.6% of boys were obese compared to 18.4% of girls.
Childhood obesity has been a concern for a number of years as the condition can lead to type 2 diabetes. Public Health England has said that the number of children with an unhealthy and potentially dangerous weight is a “national public health concern”.
The Government has published a series of stages to its overall childhood obesity plan. A sugar tax on fizzy drinks has already been introduced and in July 2020 it said tight restrictions on junk-food advertising would be brought in.
However, Caroline Cerny, Alliance Lead at the Obesity Health Alliance, said stricter action needs to be introduced more quickly.
She said: “In a year when public health has been propelled to the forefront of politics, we now need action on child health – not just words. Taking junk food out of the spotlight through restrictions on marketing and promotions – including the long overdue 9pm watershed on junk food adverts – should be the first step. The sooner action is taken, the sooner we can give all children the chance to grow up healthy.”
People who use Low Carb Program have achieved weight loss, improved HbA1c, reduced medications and type 2 diabetes remission.
As Childhood Obesity Improves, Will Kids in Poverty Be Left Behind?
TUESDAY, May 1, 2012 (Health.com) — The statistics are grim: Roughly one in six U.S. children are obese, and at last count nearly one in three were overweight, putting them at increased risk of health problems ranging from diabetes to being bullied at school.
There is a glimmer of good news. After two decades of dramatic growth, childhood obesity rates are showing signs of leveling off. Government researchers have even reported slight declines among certain subgroups (such as younger children and girls), leading some experts to speculate that the epidemic may have reached the high-water mark.
But there are also signs that this turnaround applies to some kids more than others. Obesity generally has been a bigger problem among children from low-income families, and a trickle of recent evidence suggests rates may be falling more slowly, or not at all, in this population. Federal surveys of predominantly low-income children have not found the same declines among 2- to 5-year-olds seen in more comprehensive national surveys, for instance.
"Certainly, the burden of the obesity epidemic is carried by kids in low-income communities," says Shakira Suglia, Sc.D., an assistant professor of epidemiology at Columbia University&aposs Mailman School of Public Health, in New York City.
A new study appearing in the May issue of the journal Pediatrics offers the latest evidence that less affluent children are faring worse when it comes to obesity. The study, which included a diverse group of nearly 37,000 Massachusetts children under age six, found that between 2004 and 2008 the obesity rate fell by 1.6 and 2.6 percentage points among boys and girls, respectively.
As the researchers expected, however, the falloff was more pronounced among children with non-Medicaid health insurance than among those on Medicaid, the government-funded health plan for low-income families.
"Unfortunately there seems to be some socioeconomic disparity in this decline," says lead researcher Xiaozhong Wen, M.D., a postdoctoral fellow at Harvard Medical School, in Boston.
A nationwide trend?
It&aposs not yet clear whether this pattern is occurring elsewhere. Although the children in the study broadly resemble their peers nationwide (the ones with health insurance, at least), the study was limited to just 14 health centers in and around Boston, all of which are part of the same health-care network.
"We should be cautious about assuming that this trend found in one practice in eastern Massachusetts generalizes to the entire U.S.," says John Cawley, Ph.D., a professor of economics and co-director of the Institute on Health Economics, Health Behaviors and Disparities at Cornell University, in Ithaca, N.Y.
With that caveat, Wen&aposs study does echo reports from elsewhere in the country.
In a 2010 study in the American Journal of Public Health, for instance, UCLA researchers tracked obesity rates among a representative sample of California teenagers. The overall rate was unchanged from 2001 to 2007, they found, but only because the declines among teens from middle- and high-income families were canceled out by a sharp increase among those living in poverty, especially the boys.
"When we looked at [obesity] rates broken down by income, we saw that for adolescents whose family incomes are below the poverty line, those rates have gone up, and not just slightly, but rather dramatically," says the lead author of that study, Susan Babey, Ph.D., a senior research scientist at the UCLA Center for Health Policy Research, in Los Angeles.
Wen and his colleagues don&apost draw any firm conclusions from their findings, but Wen has some theories about why the declines in obesity were smaller among children on Medicaid. "The health insurance is a proxy, or indicator, for some underlying…reasons for this disparity," he says. "I think they may be the family environment, how the parents feed the children, how do they control or monitor the child&aposs eating or physical activity."
Compared to more affluent children, Wen says, kids on Medicaid may be less likely to live in neighborhoods where they can play and exercise safely outdoors, and their caretakers are less likely to have access to supermarkets selling fresh, healthy foods.
Babey cites several of the same possible reasons. Lower-income parents who are working full-time or at more than one job may have less time to be physically active and model this sort of healthy behavior for their kids, she says. And when time is tight, she adds, it&aposs easier𠅊nd sometimes cheaper—to rely on fast-food meals than to buy and prepare fresh food.
No easy answers
A lack of exercise opportunities and access to healthy foods are almost certainly part of the story, Suglia says. She emphasizes, though, that behaviors that contribute to obesity often occur against a backdrop of physical and psychological challenges that can make weight watching an afterthought.
In a recent study, also published in Pediatrics, Suglia found that preschool-age girls in big cities were more likely to be obese if they&aposd undergone stressful experiences such as witnessing household violence, having a mother who was depressed or abusing alcohol or drugs, or living in a tenuous housing situation.
"When you talk about all these risk factors that we looked at—in terms of violence, and moving around a lot, and depressionrtainly childhood obesity goes down the importance rank," she says. "We&aposre talking about families that are worried about where they&aposre going to live, or is there a safe place to be. That just makes it harder."
These factors, however, were not associated with higher obesity rates in preschool-age boys, which highlights the difficulty of making sweeping conclusions about obesity and socioeconomic status. Children from low-income families are hardly a monolithic population, and research suggests the relationship between obesity and family income varies widely by gender, age, ethnicity, and geographical area. In Babey&aposs study of California teens, for instance, boys accounted for almost the entire increase in obesity rates among teens living in poverty.
A 2006 study in the American Journal of Clinical Nutrition that looked at several decades of national data found that obesity was clearly tied to socioeconomic status only among white girls. No consistent relationship was found among Mexican-American children, and black adolescent girls were actually more likely to be obese if they were from affluent families.
Nutrition tips may not be enough
Experts agree that some headway has been made in the fight against childhood obesity. The encouraging signs among preschoolers reported in national surveys and in Wen&aposs study may reflect the widespread attention paid to obesity in recent years, says Kristine Madsen, M.D., an assistant professor of pediatrics at the University of California, San Francisco.
"One of the most important things that&aposs happened in the last decade is a tremendous increase in public awareness of the problem," says Madsen, who specializes in interventions targeting obese kids. "I think environments are changing. Day care centers, I think, are actually more aware than they used to be of some of these issues."
Likewise, Madsen says, school-based campaigns—such as those urging children and parents to be more active, cut their consumption of sugary drinks, and limit portion sizes—seem to be getting through, although more work remains to be done.
As part of their ongoing research, she and her colleagues recently found that when lower-income kids cut down their soda consumption, they tended to switch to juice—which can itself be high in calories—rather than water. The disparities seen in Wen&aposs study "may reflect parents making efforts, but not always making efforts in the right direction," Madsen says.
Efforts to fight obesity in low-income families will need to take into account the extra challenges these families face, Suglia says. "I think more and more, there&aposs an awareness that you can&apost just tell someone, &aposEat healthy.&apos"
Childhood overweight and obesity rates fall slightly overall but rise among disadvantaged families
Credit: CC0 Public Domain
Although the overall prevalence of overweight and obesity in children and adolescents has fallen slightly over the past decade, the rates of both conditions have increased in the most disadvantaged neighbourhoods. This is the conclusion of a new study based on data from more than one million children in Catalonia, which was carried out by the Barcelona Institute for Global Health (ISGlobal)—a centre supported by "la Caixa"—and the IDIAPJGol Institute.
Levels of childhood overweight and obesity have plateaued in many middle- and high-income countries over the past decade, but prevalence rates remain high. In Spain, around 41% of children aged 6 to 9 years were overweight and/or obese in 2015—the second-highest prevalence rate in Europe. In the Catalonia region, childhood overweight and obesity rates are similar to those of Spain as a whole.
The new study, published in Jama Network Open, was based on data from 1.1 million children and adolescents in Catalonia aged 2 to 17 years with at least one height and weight record in the Information System for Research in Primary Care (SIDIAP) between 2006 and 2016. The children were divided into three age groups: 2-5 years, 6-11 years and 12-17 years. Prevalence rates and time trends for overweight and obesity were calculated and stratified by socio-demographic characteristics: age, sex, urban/rural residence, nationality, and the socioeconomic deprivation score of the family's census tract, as calculated using the MEDEA index.
In general, the findings showed that the prevalence of overweight and obesity decreased slightly in both sexes and all age groups. During the ten-year study period, rates of overweight and obesity fell from 40% to 38% in girls aged 6 to 11 years and from 42% to 40% in boys of the same age group. However, prevalence rates rose in the most deprived urban areas and in children of non-Spanish nationalities.
In areas with lower socio-economic levels, rates of overweight and/or obesity increased slightly, whereas wealthier areas saw a significant decrease, leading to a wider inequality gap. For example, between 2006 and 2016, the obesity rate in girls aged 6 to 11 years fell by 15.8% in neighbourhoods with the highest socio-economic level but increased by 7.3% in the most disadvantaged areas.
Jeroen de Bont, researcher at ISGlobal and IDIAPJGol and lead author of the study, commented: "The data can be extrapolated to Spain as a whole and they may reflect the impact of the 2008 economic crisis, which exacerbated inequality within urban areas and increased the number of vulnerable families, who may be more likely to follow unhealthy nutritional habits."
Children from North, Central and South America—the vast majority of whom were Latin American—had the highest rates of overweight and/or obesity. Specifically, 56% of boys and 50% of girls of these nationalities between the ages of 6 and 11 years were overweight and/or obese. Children of African and Asian nationalities saw the largest increase in overweight or obesity during the study period.
"With the exception of Latin America, children of non-Spanish nationalities were less overweight and/or obese at the start of the study, but their prevalence rates increased over the years until they reached the levels of overweight and/or obesity in Spanish children. This trend was especially pronounced in African and Asian children," commented de Bont. The children's "gradual adoption of the Western lifestyle and eating habits" could explain these findings, he added.
Talita Duarte-Salles, researcher at IDIAPJGol and co-coordinator of the study, commented: "These prevalence rates are alarming, since obesity in childhood and adolescence is associated with health consequences later in life, including cardiovascular, musculoskeletal and endocrine diseases."
The study also found that children between 6 and 7 years of age were the most vulnerable to developing overweight and/or obesity. "These findings demonstrate the importance of public health promotion programmes at early ages where primary healthcare professionals can play a key role in identifying overweight children during routine visits," commented Duarte-Salles.
"Specific health initiatives focused on the most vulnerable groups are urgently needed to address the high prevalence of childhood overweight and obesity in Spain and worldwide," concluded ISGlobal researcher Martine Vrijheid, co-coordinator of the study.
Obesity Rate for Young Children Plummets 43% in a Decade
Federal health authorities on Tuesday reported a 43 percent drop in the obesity rate among 2- to 5-year-old children over the past decade, the first broad decline in an epidemic that often leads to lifelong struggles with weight and higher risks for cancer, heart disease and stroke.
The drop emerged from a major federal health survey that experts say is the gold standard for evidence on what Americans weigh. The trend came as a welcome surprise to researchers. New evidence has shown that obesity takes hold young: Children who are overweight or obese at 3 to 5 years old are five times as likely to be overweight or obese as adults.
A smattering of states have reported modest progress in reducing childhood obesity in recent years, and last year the federal authorities noted a slight decline in the obesity rate among low-income children. But the figures on Tuesday showed a sharp fall in obesity rates among all 2- to 5-year-olds, offering the first clear evidence that America’s youngest children have turned a corner in the obesity epidemic. About 8 percent of 2- to 5-year-olds were obese in 2012, down from 14 percent in 2004.
“This is the first time we’ve seen any indication of any significant decrease in any group,” said Cynthia L. Ogden, a researcher for the Centers for Disease Control and Prevention, and the lead author of the report, which will be published in JAMA, The Journal of the American Medical Association, on Wednesday. “It was exciting.”
She cautioned that these very young children make up a tiny fraction of the American population and that the figures for the broader society had remained flat, and had even increased for women over 60. A third of adults and 17 percent of youths are obese, the federal survey found. Still, the lower obesity rates in the very young bode well for the future, researchers said.
There was little consensus on why the decline might be happening, but many theories.
Children now consume fewer calories from sugary beverages than they did in 1999. More women are breast-feeding, which can lead to a healthier range of weight gain for young children. Federal researchers have also chronicled a drop in overall calories for children in the past decade, down by 7 percent for boys and 4 percent for girls, but health experts said those declines were too small to make much difference.
Barry M. Popkin, a researcher at the University of North Carolina at Chapel Hill who has tracked American food purchases in a large data project, said families with children had been buying lower-calorie foods over the past decade, a pattern he said was unrelated to the economic downturn.
He credited those habits, and changes in the federally funded Special Supplemental Nutrition Program for Women, Infants and Children, for the decline in obesity among young children. The program, which subsidizes food for low-income women, reduced funding for fruit juices, cheese and eggs and increased it for whole fruits and vegetables.
Another possible explanation is that some combination of state, local and federal policies aimed at reducing obesity is starting to make a difference. Michelle Obama, the first lady, has led a push to change young children’s eating and exercise habits and 10,000 child care centers across the country have signed on. The news announcement from the C.D.C. included a remark from Mrs. Obama: “I am thrilled at the progress we’ve made over the last few years in obesity rates among our youngest Americans.”
New York City under Mayor Michael R. Bloomberg also made a major push to combat obesity. The city told restaurants to stop using artificial trans fats in cooking and required chain restaurants to display calorie information on their menus.
Many scientists doubt that anti-obesity programs actually work, but proponents of the programs say a broad set of policies applied systematically over a period of time can affect behavior.
The obesity rate for preschoolers — 2- to 5-year-olds — has fluctuated over the years, but Dr. Ogden said the pattern became clear with a decade’s worth of data. About one in 12 children in this age group was obese in 2012. Rates for blacks (one in nine) and Hispanics (one in six) were much higher.
Researchers welcomed the drop but cautioned that only time will tell if the progress will be sustained.
“This is great news, but I’m cautious,” said Ruth Loos, a professor of preventive medicine at the Icahn School of Medicine at Mount Sinai hospital in New York. “The picture will be clearer when we have a few more years of data.”
Still, she added that the 2- to 5-year-olds “might be riding a new wave,” in which changes in habits and environment over many years are finally sinking in. She noted that people who are now 60 years old caught the beginning of what she called the obesity wave that carried the next generation with it.
“Once the obesity epidemic emerged in the 1980s, it took us a while to realize that something bad was happening,” Dr. Loos said. “We’ve been trying to educate parents and families about healthy lifestyles, and maybe it’s finally having an effect.”
Tom Baranowski, a professor of pediatrics at Baylor College of Medicine, said there was not enough data to determine whether the decline would spread to older children. Since 2003, the rate for youths over all — ages 2 to 19 — has remained flat, said Dr. Ogden, author of the C.D.C. report.
But 2- to 5-year-olds are perhaps the most significant age group, as it is in those years that obesity — and all the disease risk that comes with it — becomes established, and it is later very difficult to shake, said Dr. Jeffrey P. Koplan, a professor of medicine and public health at Emory University in Atlanta.
“You have to say maybe some real progress is taking place at the very time it can have the most impact,” Dr. Koplan said. He said he believed the decline was real, as the finding followed several studies that detected patterns of decline among young children, including one by researchers in Massachusetts and the large study by the C.D.C. of low-income children.
“The weight of evidence is becoming more marked,” he said. Still, he cautioned that the age group was only a small slice of American society: “One blossom doesn’t make a spring.”
Trends in Childhood and Adolescent Obesity Rates
Reports about obesity rates leveling off and even decreasing slightly among some populations have been in the news recently. According to a 2013 report from the Centers for Disease Control and Prevention, for example, the prevalence of obesity in preschoolers from low-income families over the last few years has decreased in 19 of 43 U.S. states and territories included in the study. Michigan was one state with decreasing obesity rates for preschoolers from low-income families from 2008 – 2011, while Ohio’s rates remained the same.
Such reports are very encouraging, but there is still much more work to be done to bring down obesity rates.
In adolescents aged 12 – 17, obesity rates appear to have leveled off over the last few years, with about 17% of that age group considered obese. Despite this plateau, however, Harvard University researchers note some interesting socioeconomic trends in a recent article, “Increasing Socioeconomic Disparities in Adolescent Obesity.”
Study results outlined in the article suggest that the obesity rate is actually climbing among adolescents from less educated families, while the rate among those from more educated families is decreasing. In the study, parental education was used as an indicator of socioeconomic status, and similar patterns were also seen when using family income as an indicator of socioeconomic status. (The same trends were not seen in children aged 2 – 11 years.)
So what is leading to these health disparities? Families of low socioeconomic status may lack access to healthy food the finances to purchase healthy food that can be more expensive, such as fresh fruits and vegetables education to make healthy choices on a budget and/or community resources that promote regular physical activity.
It is important to recognize that adolescents from families with low socioeconomic status continue to need support in the fight against obesity. We need to provide better education, especially related to health and nutrition. We also need to increase access to healthy foods and provide more opportunities for physical activity. Without a greater focus on disadvantaged youth, the increasing gap in obesity rates will likely continue.
There is no one strategy for addressing the obesity epidemic, so as a community, we must continue to develop varied initiatives and interventions that reach all populations.
Chloe Berdan, MS, RD, LD, is a clinical dietitian with ProMedica Advocacy and Community Health, and her main passion is promoting childhood and adolescent health and wellness. She has a bachelor of science degree in Health and Sport Studies from Miami University and a master of science degree in Clinical Nutrition from Rush University.
QUESTION 2: How might socioeconomic factors influence racial/ethnic differences in childhood obesity?
Socioeconomic factors are likely to exert a profound influence on health, although there are conflicting points of view on their link to childhood obesity. Data on household SES are often limited to self-reported parental education and income levels. Percent poverty and poverty-to-income ratios have also been used to stratify survey participants by income groups. These twin indexes of parental education and household income levels, however, fail to fully convey the complexities of SES and social class.
One definition of social stratification is unequal distribution of privileges among population subgroups. The focus on current incomes can mask major underlying disparities in material resources (e.g., car, house) and accumulated wealth. Access to resources and services may not be equivalent for a given level of education or income. Neighborhood of residence may influence access to healthy foods, opportunities for physical activity, the quality of local schools, time allocation, and commuting time.
There are major racial differences in wealth at a given level of income. Whereas whites in the bottom quintile of income had some accumulated resources, African Americans in the same income quintile had 400 times less or essentially none. There are further race-dependent differences in income by different levels of education, as well as differences in neighborhood poverty at different levels of income. An SES gradient for self-reported health status for adults has been observed within each racial and ethnic group, while differences by race/ethnicity within each socioeconomic stratum were less pronounced (18).
Childhood experiences of SES can be defined by race/ethnicity, household economic resources, or some combination of both. Across school districts, the proportion of children eligible for free school meals, one index of SES, is a reliable predictor of childhood obesity rates. Additional indexes of social class, social capital, or social context are rarely obtained in research surveys on diets and health. Measures of accumulated wealth and access to resources and services are usually not included in studies of children's diets and childhood obesity. Causal relations between SES factors and obesity rates cannot be convincingly inferred from cross-sectional studies. To complicate matters, data on education and income tend to be treated as confounding factors in analyses and not as independent variables of interest.
Socioeconomic position and social class permeate every aspect of life and have a cumulative (sometimes generational) effect on health status throughout the life cycle. Controlling for SES variables, however, is very difficult because many, if not most, of these variables are unobserved. Thus, some researchers have cautioned against resorting to default explanations based on race/ethnicity or culture (18). One caution is that the construct of race in the U.S. is tied to many factors, such as a past history of disadvantage and discrimination (19). The construct of culture may represent in part adaptation to limited options or the prevailing economic conditions.
The present approach is to define SES variables and their potential impact on childhood obesity rates in terms of three critical intermediate constructs: money, place, and time.
The role of money
One hypothesis linking SES variables and childhood obesity is the low cost of widely available energy-dense but nutrient-poor foods. Fast foods, snacks, and soft drinks have all been linked to rising obesity prevalence among children and youth (20). Fast food consumption, in particular, has been associated with energy-dense diets and to higher energy intake overall. Calorie for calorie, refined grains, added sugars, and fats provide inexpensive dietary energy, while more nutrient-dense foods cost more (21), and the price disparity between the low-nutrient, high-calorie foods and healthier food options continues to grow. Whereas fats and sweets cost only 30% more than 20 years ago, the cost of fresh produce has increased more than 100%. More recent studies in Seattle supermarkets showed that foods with the lowest energy density (mostly fresh vegetables and fruit) increased in price by almost 20% over 2 years, whereas the price of energy-dense foods high in sugar and fat remained constant (22).
Lower-cost foods make up a greater proportion of the diet of lower-income individuals (23). In U.S. Department of Agriculture (USDA) studies, female recipients of food assistance had more energy-dense diets, consumed fewer vegetables and fruit, and were more likely to be obese. Healthy Eating Index scores are inversely associated with body weight and positively associated with education and income (24).
The importance of place
Knowing the child's place of residence can provide additional insight into the complex relationships between social and economic resources and obesity prevalence. Area-based SES measures, including poverty levels, property taxes, and house values, provide a more objective way to assess the wealth or the relative deprivation of a neighborhood (25). All these factors affect access to healthy foods and opportunities for physical activity.
Living in high-poverty areas has been associated with higher prevalence of obesity and diabetes in adults, even after controlling for individual education, occupation, and income. In the Harvard Geocoding Study, census tract poverty was a more powerful predictor of health outcomes than race/ethnicity (25). Childhood obesity prevalence also varies by geographic location. The California Fitnessgram data showed that higher prevalence of childhood obesity was observed in lower-income legislative districts. In Los Angeles, obesity in youth was associated with economic hardship level and park area per capita. Thus, the built environment and disadvantaged areas may contribute in significant ways to childhood obesity.
The poverty of time
The loss of manufacturing jobs, the growth of a service economy, and the increasing number of women in the labor force have been associated with a dramatic shift in family eating habits, from the decline of the family dinner to the emerging importance of snacks and fast foods (26). The allocation of time resources by individuals and households depends on SES.
The concept of “time poverty” addresses the difficult choices faced by lower-income households. When it comes to diet selection, the common trade-off is between money and time. One illustration of the dilemma is provided by the Thrifty Food Plan (TFP), a recommended diet meeting federal nutrition recommendations at the estimated cost of $27 per person per week (27). While this price is attractive, it has been estimated that TFP menus would require the commitment of 16 h of food preparation per week. By contrast, a typical working American woman spends only 6 h per week, whereas a nonworking woman spends 11 h per week, preparing meals (28). Thus, TFP may provide adequate calories at low cost but requires an unrealistic investment in time.
Childhood Obesity Rates Decline in Massachusetts
by Sharon Gloger Friedman for Boston Health News Examiner
Researchers at the Harvard Pilgrim Health Care Institute found a drop in obesity rates among Massachusetts infants and preschoolers, reports the Boston Globe.
The study, which analyzed the electronic medical records of nearly 37,000 children from birth to age 5 in Eastern Massachusetts, was recently published in the journal Pediatrics. Researchers reported the percentage of obese girls under age 6 dropped from 9 percent to slightly less than 6 percent from 2004 to 2008. The percentage of obese boys under age 6 fell from nearly 11 percent to a little less than 9 percent during the same time period.
Although this trend is encouraging, we need to consider that the scientific definition of obesity is excessive body fat, a body composition issue. Using weight and BMI as proxy measures for obesity is problematic. Because I have always measured the body composition of my patients, I know that many patients lose too much lean body mass with traditional calorie-restricted diets even as they lose weight.
Recent research has suggested that what you eat is more important than how much you eat. Excessive fructose primarily from sugar and HFCS is the driving force behind insulin resistance and central obesity. When you throw high glycemic carbohydrates into the mix you end up with magnified glucose spikes that can eventually trigger a chronic brain dysfunction disease called Carbohydrate Associated Reversible Brain syndrome or CARB syndrome. Because the brain plays a key role in auto-regulating fat stores, people with CARB syndrome start to store extra fat at any caloric intake.
What’s even worse is they can develop up to 21 brain dysfunction symptoms that can interfere with their ability to learn at school. To maintain normal body composition and brain function, children should limit their intake of sugar, HFCS and high glycemic carbohydrates.