Understanding Childhood Obesity in America

Linkages Between Household Income, Community Resources, and Children's Behaviors

Taylor F. Eagle, BS; Anne Sheetz,MPH; Roopa Gurm, MS; Alan C. Woodward,MD; Eva Kline-Rogers,MS, RN, NP; Robert Leibowitz, PhD; Jean DuRussel-Weston, RN,MPH, CHES; LaVaughn Palma-Davis, MA; Susan Aaronson,MA, RD; Catherine M. Fitzgerald, MA, RD; Lindsey R. Mitchell, MPH; Bruce Rogers, BS; Patricia Bruenger, BA, CCRC; Katherine A. Skala,MPH, CHES; Caren Goldberg, MD; Elizabeth A. Jackson,MD, MPH; Steven R. Erickson, PharmD; Kim A. Eagle, MD


Am Heart J. 2012;163(5):836-843. 

In This Article

Abstract and Introduction


Background Understanding childhood obesity's root causes is critical to the creation of strategies to improve our children's health. We sought to define the association between childhood obesity and household income and how household income and childhood behaviors promote childhood obesity.
Methods We assessed body mass index in 109,634 Massachusetts children, identifying the percentage of children who were overweight/obese versus the percentage of children in each community residing in low-income homes. We compared activity patterns and diet in 999 sixth graders residing in 4 Michigan communities with varying annual household income.
Results In Massachusetts, percentage of overweight/obese by community varied from 9.6% to 42.8%. As household income dropped, percentage of overweight/obese children rose. In Michigan sixth graders, as household income goes down, frequency of fried food consumption per day doubles from 0.23 to 0.54 (P < .002), and daily TV/video time triples from 0.55 to 2.00 hours (P < .001), whereas vegetable consumption and moderate/vigorous exercise go down.
Conclusions The prevalence of overweight/obese children rises in communities with lower household income. Children residing in lower income communities exhibit poorer dietary and physical activity behaviors, which affect obesity.


Obesity rates among both US adults and children have been increasing steadily for several decades.[1–3] Studies[4] now clearly link childhood obesity with overweight or obese status in adulthood and, accordingly, with escalating rates of hypertension, diabetes, sleep apnea, stroke, myocardial infarction, and premature death.[5–7] Therefore, understanding the underpinnings of childhood obesity is critical in the national effort to curb this epidemic and its cruel impact on our nation's health and its health care expenditure.

Recent studies have identified both genetic and environmental factors, which account for the increases in childhood obesity in the United States.[8–10] Importantly, an emerging theory is that many members of our population may be genetically predisposed to develop obesity but only to the extent that their local environment allows or fosters an energy imbalance between calories of nutrients ingested versus calories expended.[9]

We recently reported that 3 behaviors were highly predictive of obesity (body mass index [BMI] ≥5th percentile) among 1,000 12-year-olds being studied in a community-wide initiative to reduce childhood obesity.[11] These included low weekly levels of moderate physical exercise, high levels of daily television viewing, and routine participation in a school lunch program. We were interested in studying the characteristics of the communities that affect these behaviors. The primary objective of the current study was to identify and compare environmental influences more directly, at the community level, between median household income and childhood obesity rates, and how these financial influences related to nutrition and recreational activity of middle school students.


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