Social Determinants of Overweight and Obesity Among Children in the United States

BACKGROUND: Childhood obesity is one of the foremost threats to population health in the United States (U.S.) leading to the emergence of co-morbidities and increased healthcare cost. We explore the influence of selected social determinants of health (SDOH) on overweight and obesity among U.S. children. METHODS: We utilized the National Survey of Children’s Health (NSCH) 2016-17 dataset for this analysis. Overweight was defined as Body Mass Index (BMI) ≥ 85(th) to<95(th), while obesity was defined as BMI ≥95(th) percentile for age and sex. Based on the literature and pathway plausibility, we examined several SDOH variables as predictors of childhood overweight or obesity in the US. Survey log-binomial regression models were built to generate prevalence ratio (PR) estimates to capture the associations between SDOH and overweight or obesity. RESULTS: About 30.6 million children were surveyed of which 9.5 million (31.0%) were either overweight or obese. The likelihood of obesity was elevated among non-Hispanic Black and Hispanic children (PR = 1.53; 95% CI = 1.01-2.31) and (PR = 1.50; 95% CI = 1.18-1.90) respectively. Overweight was more frequent in younger children, children of single parents, and children who lived in a neighborhood with no amenities. Parental attainment of college education, health insurance coverage, female gender, and language spoken in home other than Spanish were protective against overweight or obesity. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: SDOH represent markers of overweight or obesity in children. We recommend the development of innovative interventions using SDOH risk and protective pathways as guide to address the current epidemic of childhood overweight and obesity.