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


The Relationship Between Household Income and BMI of Children in Massachusetts

The relationship between childhood weight and household income across communities in Massachusetts is illustrated Figure 1. The percentage of overweight and obese students was first assessed by BMI screening in grades 1, 4, 7, and 10 in the communities. The percentage of students in each community fulfilling criteria for overweight/obese (BMI ≥85th percentile for age/gender) is designated on the y-axis. The percentage of households within each community with low income is plotted from the smallest to largest across the x-axis. The overall percentage of overweight/obese was as low as 9.6% and as high as 42.8%. The percentage of low income in households in each community varied from 2.4% to a high of 69.5%. The graph illustrates that as household income drops, there is a higher likelihood of that community's children being either overweight or obese. This is particularly true, as one changes from high-income to medium-income communities. There appears to be a threshold effect at or near 15% low income. One of these communities (see arrow) was a distinct outlier compared with other communities of similar mean income. In this community, overweight or obese status was less frequent than other communities with similar mean household income.

Figure 1.

The graph plots percentage of students who are obese or overweight (y-axis) versus percentage of households within each school district coming from low-income households (x-axis) for 80 school districts in Massachusetts, including 109,634 students screening at grades 1, 4, 7, and 10 for fiscal year 2009–2019. Point estimates are bracketed by 95% CIs.

Relationship Between Household Income and Childhood Health Behaviors at the Microlevel

Figure 2 lists the percentage of overweight or obese students participating in Project Healthy Schools in 4 communities in Michigan, and Figure 3 lists the mean income of community households providing students to schools that are part of Project Healthy Schools. Note that Ann Arbor students have overweight or obese status in 33.2%, whereas in Detroit, 47.7% are overweight or obese. For Ann Arbor, data from 5 schools are represented; for the Owosso/Corunna/Perry, MI region, 4 schools; for Ypsilanti, 2 schools; and for Detroit, 2 schools. The highest mean income was $64,668 in Ann Arbor, MI, whereas the lowest was observed at $25,797 in Detroit, MI.

Figure 2.

Lists the percentage of students with baseline BMI ≥85th percentile participating in Project Healthy Schools in 4 communities in Michigan.

Figure 3.

Lists the mean household income for 4 communities participating in Michigan's Project Healthy Schools initiative.

Baseline food consumption and physical activity, based on standardized questionnaire responses for sixth graders participating in Project Healthy Schools, are illustrated in Figure 4, Figure 5, according to which community the school resided in. Figure 4, note that children residing in Ann Arbor were less likely to report recent consumption of meat, French fries, and fried food but more likely to consume fruit and vegetables and milk than 12-year-old students in Detroit. Similarly Figure 5 illustrates differences in physical activity among students residing in the 4 regions. Most importantly, time spent per day watching television was significantly different among children residing in the 4 communities and was much higher in Detroit, for example, than in Ann Arbor.

Figure 4.

Graphs baseline food consumption survey responses of sixth grade children participating in Project Healthy Schools initiative in 4 communities in Michigan.

Figure 5.

Graphs baseline physical activity survey results from sixth grade children participating in Project Healthy Schools initiative in Michigan.


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