Race and Ethnicity in Childhood Obesity

Abstract Many early life risk factors for childhood obesity are more prevalent among blacks and Hispanics than among whites and may explain the higher prevalence of obesity among racial/ethnic minority children. Eliminating racial/ethnic disparities in health and health care is a national priority, and obesity is a prime target. During the last 30 years in the United States, the prevalence of obesity among children has dramatically increased, sparing no age group. Obesity in childhood is associated with adverse cardio-metabolic outcomes such as hypertension, hyperlipidemia, and type II diabetes and with other long-term adverse outcomes, including both physical and psychosocial consequences. By the preschool years, racial/ethnic disparities in obesity prevalence are already present, suggesting that disparities in childhood obesity prevalence have their origins in the earliest stages of life. Several risk factors during pregnancy are associated with increased risk of offspring obesity, including excessive maternal gestational weight gain, gestational diabetes, and smoking during pregnancy, antenatal depression, and biological stress. During infancy and early childhood, rapid infant weight gain, infant feeding practices, sleep duration, child’s diet, physical activity, and sedentary practices are associated with the development of obesity. Studies have found substantial racial/ethnic differences in many of these early life risk factors for childhood obesity. It is possible that racial/ethnic differences in early life risk factors for obesity might contribute to the high prevalence of obesity among minority preschool-age children and beyond. Understanding these differences may help inform the design of clinical and public health interventions and policies to reduce the prevalence of childhood obesity and eliminate disparities among racial/ethnic minority children.

Race and Ethnicity in Childhood Obesity

Race is a group whose inherited physical characteristics distinguish it from other groups. Races refer to broad division of people based on their biological characteristics such as color of skin, color of hair and their facial features. These differences developed among humans in prehistoric times due to different groups of people developing in different parts of the world isolated from each other. Originally all humans in the world belonged to one of the other of these pure races. However in today's world it is difficult to find people of that time. Most of the people living now have mixed racial ancestry. Ethnicity refers to the common characteristics of a group of people that distinguish them from most other people of the same society. Ethnicity is based on commonality of ancestry, culture, language, nationality, or religion, or a combination of these things. Biological characteristics that play a part in racial differences may be visible in an ethnic group, but these characteristic do not form a criteria for defining an ethnic group. Although childhood obesity is increasing in all ethnic and racial groups, its prevalence is higher in nonwhite populations. The reasons for the differences in prevalence of obesity among groups are complex, likely involving genetics, physiology, culture, socioeconomic status, environment and interactions among these variables as well as others not fully recognized. The relationship between race and ethnicity in childhood obesity is that obesity disproportionately affects certain minority youth populations. NHANES found that African American and Mexican American adolescents ages 12-19 were more likely to be overweight, at 21 percent and 23 percent respectively, than non-Hispanic White adolescents (14 percent). In children 6-11 years old, 22 percent of Mexican American children were overweight, whereas 20 percent of African American children and 14 percent of non-Hispanic White children were overweight. In addition to the children and teens that were overweight in 1999-2002, another 15 percent were at risk of becoming overweight. In a national survey of American Indian children 5-18 years old, 39 percent were found to be overweight or at risk for overweight. In most of the states examined, blacks had the highest prevalence (number of existing cases in a defined group of people during a specific time period) of obesity, followed by Hispanics, and then whites. Greater prevalence’s of obesity for non-Hispanic blacks and whites were found in the Midwest and South. Among Hispanics lower prevalence was observed in the Northeast compared to other regions. At least three reasons may account for the racial and ethnic differences in obesity. First, racial and ethnic groups differ in behaviors that contribute to weight gain; second explanation may be differences in individual attitudes and cultural norms related to body weight. A third explanation may be differences in access to affordable, healthful foods and safe locations to be physically active; this limited access may negatively impact diet and physical activity levels. An ethnic group as subpopulations is that low -income and some racial and ethnic subpopulations are more likely to suffer from obesity. Inequities in the physical and social environment may contribute to disparities in pediatric obesity, but there is little empirical evidence to date. This study explored whether neighborhood-level socioeconomic factors attenuate racial and ethnic disparities in obesity among youth in the USA and whether individual-level socioeconomic status (SES) interacts with neighborhood deprivation. In addition, although some of the risk factors for obesity are relatively ubiquitous in settings where American children and youth spend their time in the mall or at home, epidemiologic evidence shows that African-American, Hispanic/ Latino, American Indian/Alaska Native, and Pacific Islander populations and children experiencing poverty are more likely to live in environments with inadequate support for health-promoting behaviors. Assessing the impact of these different environments presents an enormous challenge for tracking progress against obesity in diverse populations. Racial/ethnic minority children bear a disproportionate share of the burden of obesity and its related comorbidities. The degree of obesity also differs among racial/ethnic minority children. Compared to non-Hispanic white children, non-Hispanic black girls and Hispanic boys had almost 2-fold greater odds of being severely obese. The urban populations of the United States are at a higher risk for obesity than their suburban and rural counterparts. The ethnicity of the urban residents plays a factor in their obesity. In the USA the prevalence of overweight among children aged 4–12 years rose twice as fast in Hispanic and African–American groups compared with white groups over the period 1986–1998. The socioeconomic aspect of the urban area neighborhoods is also a larger factor in the obesity of American urban youth. Culture can influence the utilization of health services; affecting the likelihood that childhood obesity can be prevented or effectively treated in specific ethnic groups. Although physical activity is obviously important in energy balance, intensive physical activity interventions in obese children have produced only small changes in body weight, with somewhat greater changes in metabolic and cardiovascular indexes. Obesity is disproportionately prevalent among racial/ethnic minority children and recent trends suggest these disparities are widening. Our findings suggest that modifiable risk factors throughout the life course, including factors during infancy and early childhood, as well as social conditions in childhood and trans-generational obesity, are critical to understanding how disparities in childhood obesity arise. They also imply that efforts to eliminate racial/ethnic disparities in childhood obesity should focus on preventing these early life risk factors within the socio-environmental context in which they occur. Studies of race and health frequently invoke racism, prejudice, and discrimination as possible reasons for high levels of morbidity and mortality among black and among other racial and ethnic minorities. Obesity is highly stigmatized in our society. Overweight and obese individuals are vulnerable to negative bias, prejudice and discrimination in many different settings, including the workplace, educational institutions, and health care facilities and even within interpersonal relationships. Despite the increasing prevalence of obesity, it appears that incidences of weight discrimination are only becoming worse. Obesity now affects one in five children in the United States. Discrimination against overweight children begins early in childhood and becomes progressively institutionalized. Because obese children tend to be taller than their no overweight peers, they are apt to be viewed as more mature. The inappropriate expectations that result may have an adverse effect on their socialization.

References

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Wang YC, Gortmaker SL, Taveras EM. Trends and racial/ethnic disparities in severe obesity among US children and adolescents, 1976-2006. International journal of pediatric obesity : IJPO : an official journal of the International Association for the Study of Obesity. 2010 Mar 17; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835398/ http://www.ncbi.nlm.nih.gov/books/NBK24680/

Puhl, R.M., Andreyeva, T., & Brownell, K.D (2008). Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America. International Journal of Obesity. doi: 10.1038/ijo.2008.22
http://www.obesityaction.org/educational-resources/resource-articles-2/weight-bias/weight-discrimination-a-socially-acceptable-injustice