Miech, R. A., Kumanyika, S. K., Stettler, N., Link, B. G., Phelan, J. C., & Chang, V. W. (2006). Journal of the American Medical Association, 295(20), 2385-2393.
During the past three decades, the prevalence of adolescent overweight in the United States has increased substantially. Recent national efforts by the Department of Health and Human Services advocate for efforts to reduce health disparities (U.S. Department of Health and Human Services, 2000). Central to this goal, with regard to adolescent overweight and its attendant comorbidities, are data on socioeconomic differences in the prevalence and trends of overweight. Toward this goal, this study was designed to examine the trends in the prevalence of overweight among adolescents aged 12-17 years by family poverty status in four nationally representative cross-sectional data sets spanning from 1971 to 2004. Overweight, the primary outcome measure, was defined as body mass index (BMI) at or above the 95th percentile for age and sex in the 2000 Centers for Disease Control and Prevention growth charts. Intermediate outcome measures included physical inactivity in the past 30 days, proportion of caloric intake from sweetened beverages (as determined by a 24-hour recall), and whether participants skipped breakfast (24-hour recall). Results indicated that the trends in the association of adolescent overweight with family poverty differed by age stratum (P = .01). In 12-14-year-old adolescents, prevalence did not differ significantly by family poverty status in any of the other surveys; however, among non-Hispanic black adolescents, overweight prevalence increased faster in nonpoor versus poor families. A widening disparity that disfavored adolescents from poor families was present in the 15-17-year-old adolescents. This observed trend was similar among male, female, non-Hispanic white, and non-Hispanic black adolescents. Taken together, this resulted in an overall prevalence of overweight in 1999-2004 that was 50% higher from the adolescents in poor versus nonpoor families (23.3% vs. 14.4%, respectively; P < .001). Supplementary analyses also suggest that physical inactivity, sweetened beverage consumption, and skipping breakfast contribute to these observed disparities in adolescent overweight. Collectively, these results indicate that poor families, those living below the poverty line, have an excess burden of overweight in older (15-17 years old) but not younger (12-14 years old) adolescents. These results support the usefulness of a life course perspective that considers results specific to life stages, and also points to the importance of potentially modifiable health behaviors associated with overweight as potential targets for prevention programs designed to reduce this recently identified disparity.
Laura L. Hayman
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