Disparities In Childhood Obesity Research Articles

BMI Growth Profiles Among Black Children from Immigrant and US-Born Families.

A large body of research has documented racial/ethnic disparities in childhood obesity in the United States (US) but less work has sought to understand differences within racial groups. Longitudinal studies are needed to describe BMI trajectories across development, particularly for Black children from immigrant families who have been underrepresented in childhood obesity research. The current study utilizes BMI data collected longitudinally from ages 5 to 8 years and growth mixture modeling to (1) identify and visualize growth patterns among Black children from primarily Caribbean immigrant families, and (2) to compare these patterns to growth trajectories among Black children from US-born families. First, we identified four classes or trajectories of growth for Black children from immigrant families. The largest trajectory (70% of the sample) maintained non-overweight throughout the study period. A second trajectory developed overweight by age 8 (25%). Two small trajectory groups demonstrated high rates of moderate and severe obesity-i.e., specifically, a trajectory of accelerated weight gain ending in moderate/severe obesity (3%), and a trajectory of early severe obesity with BMI decreasing slightly with age (2%). We identified a very similar four class/trajectory model among Black children from US-born families, and compared the model to the one for children from immigrant families using multi-group growth mixture modeling. We found that the patterns of growth did not differ significantly between the populations, with two notable exceptions. Among Black children from immigrant families, ∼ 5% were classified into the two heavier BMI trajectories, compared to ∼ 11% of children from US-born families. Additionally, among children with an accelerated weight gain trajectory, children from immigrant families had lower BMIs on average at each time point than children from US-born families. These findings describe the multiple trajectories of weight gain among Black children from immigrant families and demonstrate that although these trajectories are largely similar to those of Black children from US-born families, the differences provide some evidence for lower obesity risk among Black children from immigrant families compared to Black children from US-born families. As this study is the first to describe BMI trajectories for Black children from immigrant families across early and middle childhood, future work is needed to replicate these results and to explore differences in heavier weight trajectories between children from immigrant and US-born families.

O.3.3-6 Brazilian immigrant parents' preferences for content and intervention modalities for the design of a family-based intervention to promote their preschool-age children’s healthful energy balance-related behaviors

Abstract Purpose Childhood obesity is a complex public health problem disproportionally affecting racial/ethnic minority populations and children in immigrant families. Promoting healthful energy balance-related behaviors (EBRBs) in young children, a fundamental obesity preventative strategy, is critical for addressing health disparities in childhood obesity among ethnic minority and immigrant populations. Accumulating evidence indicates that unhealthful EBRBs, including poor eating behaviors (e.g., high consumption of unhealthy foods and sugar-sweetened beverages [SSBs]), inadequate physical activity (PA), excessive sedentary behavior/screen time, and short sleep duration, increase the risk of childhood overweight and obesity. Brazilians are a rapidly growing ethnic immigrant population in the United States (U.S.) and currently, there is a lack of childhood obesity prevention interventions addressing the needs of Brazilian preschool-age children. Methods Guided by the family ecological model, this formative cross-sectional study assessed the preferences (content, intervention modality, and language) of 52 individual Brazilian immigrant families (27 mothers, 25 fathers) for the development of a family-based intervention to promote healthful energy balance-related behaviors (EBRB). Results Overall, 85% or more of parents reported being interested or very interested in content related to five (increase fruits and vegetables, reduce unhealthy foods and sugar-sweetened beverages, increase physical activity, and reduce screen time) out of the seven assessed EBRBs. Group sessions delivered by community health workers (CHWs), email, and text messages were the preferred intervention modalities with most parents (71.2%) indicating a preference for content delivered in Portuguese. Interventions integrating multiple components such as workshops offered by CHWs, text messaging using SMS and WhatsApp, and printed materials should all be considered. Conclusions Future steps should include investigating different communication channels and their integration into a pilot test of a linguistic and cultural-sensitive family-based intervention to promote healthful EBRBs of preschool-age children in Brazilian families in the U.S.

Association and potential mediators between socioeconomic status and childhood obesity in China: findings from a national cohort study

ObjectiveSocioeconomic status (SES) is associated with childhood obesity, but the underlying factors remain unknown. This study aimed to identify mediators that may explain SES disparities in childhood obesity in China. MethodsNationally representative longitudinal data from the China Education Panel Survey of 11 019 children (13.03 ± 0.79) collected from 2013‒2014 to 2016‒2017 academic years. Overweight/obesity was defined using Chinese national body mass index cut-points. Principal component analysis was used to convert the four SES indicators (maternal and paternal education, and occupation) into one comprehensive variable. Mediation analysis for SES disparities in childhood obesity was conducted using structure equation models. ResultsThe prevalence of overweight/obesity was 12.8%, and was higher in boys than in girls (17.8% vs. 7.6%, P < 0.001) at baseline. Among boys, relative risk (RR) of obesity was 1.23 (95% CI: 1.09 to 1.40, P < 0.001) for per unit change in SES. There was no significant association between obesity and SES among girls. Mediation analyses showed that among boys, birth weight, being the only child in the family and children's self-perceived weight status mediated 70.0% of the effects of SES on obesity. No mediation effect was detected in girls. ConclusionsChinese boys are more likely to be overweight or obese than girls. SES may impact childhood obesity through birth weight, being the only child in the family and children's self-perceived body weight status in boys, but not in girls. More attention should be made to address childhood obesity in high SES families among boys. Interventions targeting at these mediators are needed.

P31-006-23 Disparities in Childhood Obesity and Early Life BMI Gains Associated With COVID-19 in a Large Rural Health System

P31-006-23 Disparities in Childhood Obesity and Early Life BMI Gains Associated With COVID-19 in a Large Rural Health System

Body Mass Index Trajectories and Biomarkers of Cardiometabolic Risk in Children from Low-Income and Racially and Ethnically Diverse Households.

Background: This study examined the associations between BMI trajectories and emerging cardiometabolic risk (CMR) in children living in low-income and racially and ethnically diverse households in the United States. Methods: Data were drawn from NET-Works randomized intervention trial and NET-Works 2 prospective follow-up study (N = 338). BMI was measured across 6 follow-up visits and biomarkers of cardiometabolic risk (CMR) at the sixth visit. Group-based trajectory modeling identified child BMI trajectories. Adjusted multivariable linear regressions evaluated the associations between BMI trajectories and CMR. Results: We identified two BMI trajectories: 25% followed a trajectory of steep BMI increase, and 75% followed a moderate decreasing BMI trajectory over time. Relative to children in the moderate decreasing trajectory, children in the increasing trajectory had higher adjusted mean levels of C-reactive protein [CRP; 3.3; 95% confidence interval (CI): 1.6 to 5.0], leptin (63.1; 95% CI: 44.3 to 81.8), triglycerides (35.4; 95% CI: 22.1 to 48.6), triglyceride/high-density lipoprotein (HDL) ratio (1.2; 95% CI: 0.8 to 1.6), hemoglobin A1c (HbA1C; 0.1; 95% CI: 0.03 to 0.2), fasting glucose (1.8; 0.1 to 3.5) and insulin (8.8; 95% CI: 6.5 to 11.0), overall CMR score (0.7; 95% CI: 0.5 to 0.9), and lower adiponectin (-1.3; 95% CI: -2.5 to -0.1) and HDL (-10.8; 95% CI: -14.3 to -7.4). Conclusions: Children with high BMIs early in childhood were more likely to maintain an accelerated BMI trajectory throughout childhood, which was associated with adverse CMR in pre-adolescence. To advance health equity and support children's healthy weight and cardiovascular health trajectories, public health efforts are needed to address persistent disparities in childhood obesity and CMR.

Trends and Persistent Disparities in Child Obesity During the COVID-19 Pandemic.

The COVID-19 pandemic has been associated with increases in pediatric obesity and widening pre-existing disparities. To better understand the pandemic's long-term impacts, we evaluated trends in obesity across different demographic groups during the pandemic through December 2022. Using a retrospective cohort design, we analyzed electronic health record data from a large pediatric primary care network. Logistic regression models fit using generalized estimating equations estimated odds ratios (ORs) for changes in the level and trajectory of obesity across 2-year month-matched periods: prepandemic (June 2017 to December 2019) and pandemic (June 2020 to December 2022). Among a cohort of 153,667 patients with visits in each period, there was a significant increase in the level of obesity at the pandemic onset [OR: 1.229, 95% confidence interval (CI): 1.211-1.247] followed by a significant decrease in the trend for obesity (OR: 0.993, 95% CI: 0.992-0.993). By December 2022, obesity had returned to prepandemic levels. However, persistent sociodemographic disparities remain.

Novel Differentially Methylated Regions Identified by Genome-Wide DNA Methylation Analyses Contribute to Racial Disparities in Childhood Obesity.

The magnitude of the childhood obesity epidemic and its effects on public health has accelerated the pursuit of practical preventative measures. Epigenetics is one subject that holds a lot of promise, despite being relatively new. The study of potentially heritable variations in gene expression that do not require modifications to the underlying DNA sequence is known as epigenetics. Here, we used Illumina MethylationEPIC BeadChip Array to identify differentially methylated regions in DNA isolated from saliva between normal weight (NW) and overweight/obese (OW/OB) children and between European American (EA) and African American (AA) children. A total of 3133 target IDs (associated with 2313 genes) were differentially methylated (p < 0.05) between NW and OW/OB children. In OW/OB children, 792 target IDs were hypermethylated and 2341 were hypomethylated compared to NW. Similarly, in the racial groups EA and AA, a total of 1239 target IDs corresponding to 739 genes were significantly differentially methylated in which 643 target IDs were hypermethylated and 596 were hypomethylated in the AA compared to EA participants. Along with this, the study identified novel genes that could contribute to the epigenetic regulation of childhood obesity.

Organizational trust, usability, and inclusivity are key implementation facilitators for a proposed assets-based mobile health intervention.

Assets-based interventions can address child health disparities by connecting families to existing community resources. Community collaboration when designing interventions may identify barriers and facilitators to implementation. The objective of this study was to identify crucial implementation considerations during the design phase of an asset-based intervention to address disparities in childhood obesity, Assets for Health. We conducted focus groups and semi-structured interviews with caregivers of children (<18 years) (N = 17) and representatives of community-based organizations (CBOs) which serve children and families (N = 20). Focus group and interview guides were developed based on constructs from the Consolidated Framework for Implementation Research. Data were analyzed using rapid qualitative analysis and matrices were used to identify common themes within and across groups of community members. Desired intervention characteristics included an easy-to-use list of community programs that could be filtered based on caregiver preferences and local community health workers to promote trust and engagement among Black and Hispanic/Latino families. Most community members felt an intervention with these characteristics could be advantageous versus existing alternatives. Key outer setting characteristics which were barriers to family engagement included families' financial insecurity and lack of access to transportation. The CBO implementation climate was supportive but there was concern that the intervention could increase staff workload beyond current capacity. Assessment of implementation determinants during the intervention design phase revealed important considerations for intervention development. Effective implementation of Assets for Health may depend on app design and usability, fostering organizational trust and minimizing the costs and staff workload of caregivers and CBOs, respectively.

Understanding drivers of micro-level disparities in childhood body mass index, overweight, and obesity within low-income, minority communities

The focus of childhood obesity disparities has been mainly on macro-level disparities, such as, between lower versus higher socioeconomic groups. But, less is known about micro-level disparities, that is disparities within minority and low-income populations. The present study examines individual and family level predictors of micro-level obesity disparities. We analyze data on 497 parent–child dyads living in public housing communities in Watts, Los Angeles. Cross-sectional multivariable linear and logistic regression models were estimated to examine whether individual and family level factors predict children’s BMI z-scores, overweight, and obesity in the sample overall and separately by child’s gender and age group. Child characteristics of our study sample included mean age 10.9 years, 74.3% Hispanic, 25.7% Non-Hispanic Black, 53.1% female, 47.5% with household income below $10,000, 53.3% with overweight or obesity, and 34.6% with obesity. Parental BMI was the strongest and most consistent predictor of child zBMI, overweight, and obesity, even after controlling for parent’s diet and activity behaviors and home environment. The parenting practice of limiting children’s screentime was also protective of unhealthy BMI in younger children and females. Home environment, parental diet and activity behaviors, and parenting practices related to food and bedtime routines were not significant predictors. Overall, our findings show that there is considerable heterogeneity in child BMI, overweight, and obesity even within low-income communities with similar socioeconomic and built environments in their neighborhoods. Parental factors play an important role in explaining micro-level disparities and should be an integral part of obesity prevention strategies in low-income minority communities.

Body Mass Index Trajectories among the Healthy Communities Study Children: Racial/Ethnic and Socioeconomic Disparities in Childhood Obesity.

The purpose of this study is to identify statistically distinguishable trajectories of childhood body mass index (BMI), an important indicator of developmental status of children, and to provide a summary description of demographic characteristics of children based on these distinctive trajectories. Using data from the Healthy Communities Study (HCS), a large longitudinal dataset with oversamples of Hispanic and Black children across 130 communities in the USA, a group-based trajectory analysis approach was used to estimate trajectories of children based on their BMI-z scores. The three most distinguishable BMI trajectory groups identified for the HCS children show no marked increase or decrease in standardized BMI over an age range of 2 to 11. Approximately 28.5% of children were in a trajectory group with consistently obese BMI-z scores for their sex and age. The patterns of BMI trajectory groups identified for boys and girls are similar, but BMI-z scores for boys tend to be slightly higher than those for girls. These BMI trajectories are characterized by racial/ethnic and socioeconomic status disparities. Hispanic and Black children were more likely to be in the obese trajectory group than White children. Children with parents having less education, or children from low family income level, were more likely to be in the obese trajectory group than counterpart children. The findings suggest that BMI disparities exist from the early years of childhood and persist across childhood, with higher BMI associated with Black and Hispanic children as well as those from low socioeconomic status backgrounds.

Trends in school-neighbourhood inequalities and youth obesity: Repeated cross-sectional analyses of the public schools in the state of California.

It is currently unknown whether the relationship between affluence of school neighbourhoods and prevalence of youth overweight/obesity is uniform across demographic subgroups and areal context in the United States. We examined association between school-neighbourhood income tertiles and school-level overweight/obesity (OVOB) prevalence, using data on body mass index of fifth, seventh, and nineth graders who attended public schools in California in 2001 and 2010 (n=1 584 768), using multiple logistic regression models. Overall, OVOB prevalence was higher in lower-income school neighbourhoods, with a steeper income-OVOB gradient for girls. Among boys, the gradient became steeper in 2010 than 2000. Among Asian and White girls, the negative gradients were steepest in rural areas. For African-American students in all areas and Latino boys in rural areas, there was less clear evidence of inverse income-OVOB gradients. Addition of fast-food restaurant availability to the models did not change the observed inverse school-neighbourhood income-obesity gradients. The findings suggest the needs to investigate reasons for this variability with consideration to combinations of sociodemographic, economic, and environmental risk factors that may contribute to disparities in childhood obesity.

From childhood obesity risk to healthy growth in the U.S.: A 10-year social work research & policy update

Childhood obesity is a major health issue and a prominent chronic health condition for children in the United States (U.S.), caused by a multitude of factors. Most existing models of childhood obesity prevention have not worked, yielding little to no effect on improving weight status or the proximal health behaviors most attributed to obesity risk: nutritional intake, physical activity, sedentary behaviors, and sleep. There is an urgent need for new approaches to prevent health disparities that are responsive to impacts of economic inequality on healthy child growth in marginalized populations. In this Short Commentary, a social justice update is provided to motivate a new generation of research that promotes equitable and healthy child growth under present-day social, economic, and political circumstances. Social work-specific research and policy recommendations are provided to guide future research that targets underlying social and economic determinants of weight-related health disparities in childhood. Recommendations include research on cross-disciplinary metrics to better capture reductions in health disparities and the development and testing of policy and system interventions that address structural issues and strengthen health resources in marginalized communities. Progress in reducing disparities in childhood obesity will likely remain inhibited until recommendations from social work research are incorporated to strengthen existing medical and public health models and redirect the childhood obesity epidemic toward equitable, healthy child growth.

Maternal Mediterranean Diet Adherence and Its Associations with Maternal Prenatal Stressors and Child Growth

Psychosocial and physiologic stressors, such as depression and obesity, during pregnancy can have negative consequences, such as increased systemic inflammation, contributing to chronic disease for both mothers and their unborn children. These conditions disproportionately affect racial/ethnic minorities. The effects of recommended dietary patterns in mitigating the effects of these stressors remain understudied. We aimed to evaluate the relations between maternal Mediterranean diet adherence (MDA) and maternal and offspring outcomes during the first decade of life in African Americans, Hispanics, and Whites. This study included 929 mother-child dyads from the NEST (Newborn Epigenetics STudy), a prospective cohort study. FFQs were used to estimate MDA in pregnant women. Weight and height were measured in children between birth and age 8 y. Multivariable linear regression models were used to examine associations between maternal MDA, inflammatory cytokines, and pregnancy and postnatal outcomes. More than 55% of White women reported high MDA during the periconceptional period compared with 22% of Hispanic and 18% of African American women (P<0.05). Higher MDA was associated with lower likelihood of depressive mood (β = -0.45; 95% CI: -0.90, -0.18; P=0.02) and prepregnancy obesity (β = -0.29; 95% CI: -0.57, -0.0002; P=0.05). Higher MDA was also associated with lower body size at birth, which was maintained to ages 3-5 and 6-8 y-this association was most apparent in White children (3-5 y: β = -2.9, P=0.02; 6-8 y: β = -3.99, P=0.01). If replicated in larger studies, our data suggest that MDA provides a potent avenue by which effects of prenatal stressors on maternal and fetal outcomes can be mitigated to reduce ethnic disparities in childhood obesity.

Childhood obesity risk factors by race and ethnicity.

Childhood obesity is a public health concern that often worsens with age. Although several risk factors at the child and maternal levels have been identified in cross-sectional studies, less is known about their long-term contribution to racial/ethnic disparities in childhood obesity. This study examines child- and maternal-level factors associated with the growth trajectories of White, Black, and Latino children. Group-based trajectory models were used to identify BMI z score trajectories from birth to 9 years of age among White, Black, and Latino children. The associations of child- and maternal-level factors with the trajectory group identified as atrisk for obesity were examined using adjusted logistic regression analysis, stratified by race/ethnicity. Among White children, fast-food consumption (odds ratio [OR]=1.66; 95% CI: 1.09-2.52) was associated with higher odds of following an at-risk trajectory. Among Black and Latino children, prepregnancy BMI was associated with following an at-risk trajectory (OR=1.05; 95% CI: 1.03-1.08 for Black children, and OR=1.12; 95% CI: 1.07-1.17 for Latino children). These findings showed racial/ethnic differences in the risk factors that influence the likelihood of obesity during childhood. Further research is needed to identify modifiable racial/ethnic specific risk factors to guide obesity-prevention interventions.

Impact of a Farm-to-School Nutrition and Gardening Intervention for Native American Families from the FRESH Study: A Randomized Wait-List Controlled Trial.

Establishing healthy eating habits during childhood is critical to prevent chronic diseases that develop in adulthood. Tribally owned Early Childhood and Education (ECE) programs signify fundamental influence in childhood obesity disparities. A strategy to improve diet is the use of school gardens; however, few studies have used rigorous methods to assess diet and health outcomes. The purpose of this manuscript is to describe results from the six-month Food Resource Equity for Sustainable Health (FRESH) study among Native American families. We aimed to recruit 176 families of children attending Osage Nation ECE programs in four communities. Two communities received the intervention and two served as wait-list controls. Outcomes included change in dietary intake, body mass index, health status, systolic blood pressure (adults only), and food insecurity in children and parents. There were 193 children (n = 106 intervention; n = 87 control) and 170 adults (n = 93 intervention; n = 77 control) enrolled. Vegetable intake significantly increased in intervention children compared to controls for squash (p = 0.0007) and beans (p = 0.0002). Willingness to try scores increased for beans in intervention children (p = 0.049) and tomatoes in both groups (p = 0.01). FRESH is the first study to implement a farm-to-school intervention in rural, tribally owned ECEs. Future interventions that target healthy dietary intake among children should incorporate a comprehensive parent component in order to support healthy eating for all household members.

Maternal Periconceptional Stressors, Mediterranean Diet Adherence, and Child Outcomes

ObjectivesTo evaluate the relationships between maternal periconceptional Mediterranean diet adherence and 1) maternal periconceptional BMI, 2) subsequent maternal depression during pregnancy, 3) prenatal inflammatory cytokine IL-17A, 4) child birthweight, and 5) child weight-for-height at ages 0–8 years in African American, Hispanic and White mother-child dyads from the Newborn Epigenetics STudy (NEST).MethodsFood frequency questionnaires were used to estimate periconceptional Mediterranean diet adherence in mothers. Maternal depression during pregnancy was assessed using the Centers for Epidemiological Studies Depression scale. Weight and height were measured in children between birth and age 8 years. Linear and logistic regression models were used to examine associations between maternal adherence to a Mediterranean diet, inflammatory cytokines and pregnancy and postnatal outcomes, adjusted for education, maternal age at delivery, maternal smoking, gestational age, age and sex of child, breastfeeding, parity, maternal BMI.ResultsAdherence to a Mediterranean diet varied widely by ethnicity with > 55% of White mothers reporting high adherence during the periconceptional period, compared to 22% of Hispanic mothers, and 18% of African American mothers (P < 0.05). Higher adherence to this diet was associated with lower risk of depressive mood (β = −0.45, p = 0.02) and pre-pregnancy obesity (β = −0.29, p = 0.05). Higher maternal adherence to this diet pattern was also associated with lower body weight at birth, that was maintained to ages 3–5 and 6–8 years—these associations were most apparent in White children (3–5 years: β = −2.9, p = 0.02; 6–8 years: β = −3.99, p = 0.01). Higher diet adherence was associated with lower levels of prenatal IL-17A levels in African American mother-child dyads (β = 0.21, p = 0.03).ConclusionsOur data suggest that maternal Mediterranean diet adherence provides a potent avenue by which effects of prenatal stressors on maternal and fetal outcomes can be mitigated to reduce ethnic disparities in childhood obesity.Funding SourcesThis research was funded by grants from the National Institute of Minority Health and Health Disparities and the National Institute of Environmental Health Sciences, and supported in part by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences.

Maternal Stress and Excessive Weight Gain in Infancy.

Rapid weight gain in infancy increases the risk of developing obesity early in life and contributes significantly to racial and ethnic disparities in childhood obesity. While maternal perceived stress is associated with childhood obesity, little is known about the impact it has on infant weight gain. Therefore, this study explores the impact of maternal perceived stress on change in weight-for-length (WFL) z-scores and the risk of rapid weight gain in infancy. We conducted a secondary data analysis of the longitudinal Nurture birth cohort (n = 666). Most mothers in the cohort were non-Hispanic/Latinx Black (71.6%). About one-half of mothers had a body mass index (BMI) greater than 25 prior to pregnancy, were unemployed, and had a low income. Most infants in the cohort were born full-term and were of normal weight. Data were collected at 3-, 6-, 9-, and 12-months postpartum. At each assessment, mothers completed the Cohen’s Perceived Stress Scale (PSS), and research assistants weighed and measured each infant. Tertiles were used to compare mothers with high and low perceived stress. A mixed model analysis of repeated measures assessed the associations between baseline perceived stress and the change in infant WFL z-scores over time. Log-binomial models assessed the association between baseline perceived stress and rapid weight gain, defined as a change in WFL z-score > 0.67 standard deviations from three to twelve months. Just under one-half of the infants (47%) experienced rapid weight gain between three and twelve months of age. Birthweight for gestational age (RR = 1.18, 95% CI = 1.08–1.29, p-value = 0.004), gestational age at birth (RR = 1.07, 95% CI = 1.01–1.14, p-value = 0.031), and weeks breastfed (0.99, 95% CI 0.99–1.00, p-value 0.044) were associated with risk of rapid weight gain in unadjusted analyses. WFL z-scores increased significantly over time, with no effect of perceived stress on change in WFL z-score or risk of rapid weight gain. Rapid weight gain in infancy was prevalent in this sample of predominately Black infants in the Southeastern US. We did not find evidence to support the hypothesis that maternal perceived stress influenced the risk of rapid weight gain. More work is needed to identify and assess the risk factors for rapid weight gain in infancy and to understand the role that maternal stress plays in the risk of childhood obesity so that prevention efforts can be targeted.

Racial/ethnic disparities in childhood obesity: The role of school segregation.

Recent studies have observed that racial or ethnic adult health disparities revealed in national data dissipate in racially integrated communities, supporting the theory that "place, not race" shapes the nature and magnitude of racial/ethnic health disparities. This study tested this theory among children. In 2020, the racial/ethnic childhood obesity disparities within integrated schools and between segregated schools were estimated using statewide cross-sectional data collected in 2019 on fifth, seventh, and ninth grade students from California public schools. School segregation accounted for a large part of the obesity disparities between White children and children of color (Latino, Black, and Filipino children). In racially integrated schools, obesity disparities were much smaller than those in statewide data, whereas racial or ethnic childhood obesity disparities were larger when comparing children in majority-White schools with those attending schools with a majority enrollment of children of color, except for Asian children, who generally had lower obesity rates than their White peers. School-level racial segregation is a salient contributor to racial/ethnic childhood obesity disparities. Reducing obesity disparities may be particularly effective if place-level interventions target socioeconomically disadvantaged integrated schools and segregated schools attended primarily by children of color.

Potentially modifiable mediators for socioeconomic disparities in childhood obesity in the United States.

The aim of this study was to examine modifiable mediators for socioeconomic disparities in childhood obesity in the United States. This study used the data of 1,211 mother-child dyads from a US national birth cohort from pregnancy to 6 years post partum. Socioeconomic status was indicated by maternal education (college graduate vs. less) and family income (>185% vs. ≤185% of the poverty line). Single- and multiple-factor mediation analyses were conducted for socioeconomic disparities in childhood obesity at 6 years, adjusting for demographics. The confounder-adjusted relative risk of childhood obesity was 1.79 for low maternal education and 1.42 for low family income. Low-maternal-education-related obesity was individually mediated by maternal preconception BMI (percentage of indirect effect, 8.8%), smoking during pregnancy (7.0%), infant weight gain (14.4%), child sleep duration (11.4%), and TV viewing during weekdays at 6 years (4.9%). Low-family-income-related obesity was mediated by maternal preconception BMI (18.5%), smoking during pregnancy (6.3%), child sleep duration (12.8%), and the home learning environment at 6 years (26.2%). In multiple-mediator analysis, significant mediators together mediated 54.0% of maternal-education-related or 39.4% of family-income-related disparities. Maternal preconception BMI, smoking during pregnancy, infant weight gain, child sleep, TV viewing, and the home learning environment substantially mediated socioeconomic disparities in childhood obesity in the United States.

Text Messages to Curb Sugar-Sweetened Beverage Consumption among Pregnant Women and Mothers: A Mobile Health Randomized Controlled Trial.

Racial, ethnic, and socioeconomic disparities in childhood obesity in the United States (U.S.) originate in early life. Maternal sugar-sweetened beverage (SSB) consumption is an early life risk factor for later offspring obesity. The goal of this study was to test the effects of policy-relevant messages delivered by text messages mobile devices (mHealth) on maternal SSB consumption. In this three-arm 1-month randomized controlled trial (RCT), pregnant women or mothers of infants in predominantly Hispanic/Latino New York City neighborhoods were randomized to receive one of three text message sets: graphic beverage health warning labels, beverage sugar content information, or attention control. The main outcome was change in maternal self-reporting of average daily SSB consumption from baseline to one month. Among 262 participants, maternal SSB consumption declined over the 1-month period in all three arms. No intervention effect was detected in primary analyses. In sensitivity analyses accounting for outliers, graphic health warning labels reduced maternal SSB consumption by 28 kcal daily (95% CI: −56, −1). In this mHealth RCT among pregnant women and mothers of infants, graphic health warning labels and beverage sugar content information did not reduce maternal SSB consumption.