Research roundup: Cultural considerations on childhood overweight and obesity

Overweight and obesity in children is a continuing public health issue in the United States. As of 2014, 17 percent of youth (aged 2-19 years) had obesity (Ogden et al., 2016). When including overweight statistics, 31.8 percent of youth (aged 2-19 years) have overweight or obesity (Ogden et al., 2014). Children with obesity are more likely to suffer from hypertension, Type 2 diabetes, asthma, obstructive sleep apnea, musculoskeletal/joint dysfunction and a variety of other issues (Pulgaron, 2013; Bass & Eneli, 2015). Obesity can also impact a child’s mental health and psychosocial functioning. Compared to children who have a healthy weight, those with obesity have higher rates of depression, social isolation, low self-esteem and poorer quality of life (Small & Aplasca, 2016). 

Although a serious concern for all youth groups, differences in obesity prevalence have been documented by race and ethnicity. Overall, non-Hispanic white and Asian youth have a significantly lower prevalence of obesity (14.7 percent and 8.6 percent respectively) compared to non-Hispanic black (19.5 percent) and Hispanic youth (21.9 percent) (Ogden et al., 2015). In view of the health and psychosocial effects, and the increased long-term health risks associated with childhood overweight and obesity, addressing the influences of race/ethnicity, residency and obesity-related lifestyle behaviors is critical. 

The following studies examine how a child’s racial/ethnic background and where they live are associated with differences both in obesity-related lifestyle behaviors and weight status. Throughout these summaries, we use the racial/ethnic terms used by the authors of the studies.

In addition to reviewing the following research summaries, psychologists are encouraged to explore the literature more completely to determine what may be useful to them in practice.

Jang, M., Grey, M., Sadler, L., Jeon, S., Nam, S., Song, H.J., & Whittemore, R. (2018). Obesity risk behaviours and their associations with body mass index (BMI) in Korean American children. Journal of Clinical Nursing. Advance online publication. https://dx.doi.org/10.1111/jocn.13982opens in new window.

Asian-American children are less likely to be overweight or obese compared with other racial ethnic groups (Ogden et al, 2014). However, due to genetic factors such as higher adipose distribution and higher body fat proportion with weight gain compared to non-Hispanic whites, they may be at increased risk for obesity-related complications such as diabetes (Hsu et. Al 2015). Despite this risk, there is limited data on obesity prevalence rates and risk factors for Asian children living in western countries. Asian-American children are often excluded from analyses due to small sample size or different Asian-American subgroups are frequently included together in one “other” category despite the diverse composition of Asian subgroups in the U.S. (Taveras et al. 2011, Jacob & Cho 2010). In this study, a cross-sectional design with 170 Korean-American children ages 8 to 14 was utilized by the researchers to better understand the obesity-risk behaviors of Korean-American children.

Height and weight were measured by a trained nursing researcher. Demographic data was collected from the parents. Health behaviors including diet behavior, physical activity and sedentary behavior of the children were measured with self-report subscales from the School-based Nutrition Monitoring Questionnaire. The children’s sleep duration was reported by the parents using typical bedtime and waketime reportings for both weekdays and weekends.

The researchers found that about 12 percent of the children in this study were obese and an additional 17 percent were overweight. In terms of health behaviors, only 38 percent met the dietary recommendations for fruits and vegetables. More than half (58 percent) met the recommendation of vigorous physical activity an average of three times per week while 65 percent played on at least one sports team. Fifty-nine percent of children went over the recommended daily screen time limit. Sixty percent of children during the week and 89 percent of children during the weekend met the sleep recommendations of the American Academy of Pediatrics. Further analysis to determine relationships between health behaviors and overweight/obesity found that only more screen time was associated with a higher BMI z-score (overweight/obesity measure). It is important to note, however, that only 8 percent of the variance in child BMI was explained by the health behaviors explored in this study.

Kenney, M.K., Wang, J., & Iannotti, R. (2014). Residency and racial/ethnic differences in weight status and lifestyle behaviors among U.S. youth. The Journal of Rural Health, 30(1), 89-100. https://dx.doi.org/10.1111/jrh.12034opens in new window.

To effectively tackle racial/ethnic disparities in obesity, it is important to understand what contributing factors are more common or magnified in racial/ethnic minorities and how the environments of minority children might amplify the effects of these factors. In this study, the authors explored the coexisting influences of race/ethnicity and place of residency (metropolitan or metro versus nonmetropolitan or nonmetro) on the prevalence of youth obesity. The authors also examined the differences in behaviors (physical activity, consumption of fatty foods and screen time) that may be associated with racial/ethnic and residency differences in youth obesity.

A secondary data analysis was conducted using results from 8,363 adolescents on the U.S. Health Behavior in School-Aged Children survey from the World Health Organization. Lifestyle behaviors, age and height/weight (used to calculate BMI) were self-reported. Obesity was defined as greater than or equal to the 95th percentile in BMI-for-age. Metro status was determined based on the neighborhood location of the school each student attended as the survey was anonymous. 

When comparing all metro youth to all nonmetro youth, results indicated no difference in obesity prevalence rates, daily physical activity, fatty snack food consumption or increased screen time. Significant differences were found, however, looking at obesity prevalence and lifestyle behaviors by race-ethnicity and metro versus nonmetro status. Nonmetro black youth had the highest risk of obesity (26 percent), rate of consuming fatty snack foods (86 percent), and rate of increased screen usage (91 percent) compared to white metro youth (11 percent, 69 percent, 80 percent respectively). Compared to black metro youth, black nonmetro youth were 1.71 times more likely to be obese if they had low physical activity levels, 1.61 times more likely if they frequently consumed fatty snack foods and a 1.64 times increased likelihood of being obese if they exceeded the American Academy of Pediatrics recommended limit (two hours per day) of screen time. The same types of nonmetro versus metro differences were not seen for white and Hispanic adolescents or adolescents of other race/ethnicities. Interestingly, while nonmetro Hispanic youth reported higher obesity rates than white metro youth, lifestyle behavior rates were similar.

Penilla, C., Tschann, J.M., Sanchez-Vaznaugh, E.V., Flores, E., & Pzer, E.J. (2017). Obstacles to preventing obesity in children aged 2 to 5 years: Latino mothers’ and fathers’ experiences and perceptions of their urban environments. International Journal of Behavioral Nutrition and Physical Activity, 14, 148. https://doi.org/10.1186/s12966-017-0605-9opens in new window.

As mentioned previously, the prevalence of obesity in the United States varies by race and ethnicity. In 2011-2012, Ogden et. al (2014) found that 17 percent of Latino children aged 2 to 5 years were considered obese compared to 4 percent of non-Latino preschoolers. The following study sought to understand what social and environmental characteristics in an urban environment impact familial relationships and serve as barriers to healthy eating and an active lifestyle for Latino children.

Six focus groups (two with mothers, two with fathers and two mixed) were conducted in San Francisco with 49 Latino parents (27 mothers and 22 fathers) of Mexican, Guatemalan or Salvadoran descent who had at least one child between ages 2 and 5. A focus group guide was utilized with questions and probes to delve into parental concerns with childhood obesity, determine the type and amount of food offered to children, and to explore perceptions of factors correlated with child weight such as soda consumption and physical activity.

The authors reported four structural categories as obstacles to families’ abilities to provide healthy food and active lifestyles for their young children:

Employment (not discussed in mothers only focus group)

• A parent’s highest priority.
• Long work hours keep parents from their children.
• Bad economy, low wages, and high healthy food costs prohibit preferred home and food environment.

Day care

• Types and amounts of foods consumed at preschool influenced what was then eaten at home (too full or overly hungry based on what and how much served, only allowed to bring certain foods to school).
• Preschools and daycares (especially family-based) are not consistently serving healthy food options (often processed foods offered, ice cream with grandma).
• More physical activity for children is desired.

Neighborhood environments

• An abundance of liquor stores, fast food, and soda reported.
• More advertisements are viewed for processed food and sugary beverages than healthy options.
• More clean and safe parks are needed to prevent childhood obesity. Relatives, however, help increase opportunities for physical activities.