Race, Sex, and Socioeconomic Disparities in Overweight and Obesity Development Among Previously Healthy-Weight Children

Abstract

Objective Some young healthy-weight (HW) toddlers and preschoolers develop overweight/obesity (OW/OB) in later childhood. Our study aims to identify demographic risk factors for OW/OB incidence in 8-10-year[y]-old children with HW history between ages 2-5y.Methods This retrospective longitudinal cohort study used data from the electronic medical record at an urban tertiary childrens hospital. 2-5-year-olds born between 10/2007-05/2011 were included if they (1) had an outpatient visit with anthropometric data at 2-5y and 8-10y & (2) had HW from ages 2-5y. Predictor variables were sex, race/ethnicity, language, insurance & zip code. Main outcome was body mass index (BMI) percentile (%ile) category at 8-10y, determined by the highest %ile reached: HW (5-84%ile), OW (85-94%ile), mild-moderate OB (95-98%ile), severe OB (99%ile). Statistical analyses included descriptive frequencies and multinomial logistic regression.Results Of 7043 initially HW patients, 1070 (15%) developed OW and 863 (12%) developed OB by 8-10y. Severe OB risk factors were African-American race (OR 4.66; 2.45-8.67), Hispanic ethnicity (OR 2.99; 1.61-5.55) & public insurance (OR 3.69; 2.19- 6.24). Female sex was protective (OR 0.54; 0.36-0.79).Conclusion One-quarter of previously HW young children developed OW/OB by age 8-10y; African-American, Hispanic, male and publicly insured children have the highest risk of developing severe OB. While factors associated with OW/OB in this cohort are familiar, these findings suggest that clinicians should direct specific attention to young HW patients with these risks to prevent excessive BMI increase.

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