Cumulative risk of overweight in U.S. adolescents supports a social ecology model of obesity

Abstract

The social ecology model of overweight recognizes both proximal behavioral and broader environmental risk factors (RF). This study aimed to validate the model using data from the National Longitudinal Study of Adolescent Health (Add Health). Survey items for 6073 respondents were used to calculate relative risk (RR) for 30 variables representing sociodemographic and behavioral RF for overweight. Fourteen RF were identified as significant [P(RR=1)<0.05]. The number of significant RF was counted for each participant, and a cumulative risk model was created reflecting incidence of overweight with increasing number of RF (Figure 1). Participants were divided into quartiles for total risk factors. RR of overweight for quartiles 2–4 compared to quartile 1 are as follows (quartile: RR [95% CI]): second: 1.5 [1.3–1.8]; third: 1.9, [1.6–2.2]; fourth: 2.3 [2.0–2.7]. Risk for overweight increased in a dose dependent manner with increasing risk factors (p < 0.05). Consideration of the total number of risk factors explains more risk variation than consideration of any single risk factor. This significant cumulative risk effect supports the social ecology model of overweight, as increases in total risk cannot be explained by either sociodemographic or % > 85th BMI percentile∗ behavioral RF in isolation. Research supported by the Brigham Young University Honors Program. Figure 1Open in figure viewerPowerPoint Cumulative risk of overweight