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Prevalence of Obesity in Children in Alabama and Texas Participating in Social Programs
To the Editor: An increasing number of US children are becoming obese. In a nationally representative sample, Ogden et al1 found that 10.4% of children aged 2 to 5 years had a body mass index (BMI) above the 95th percentile. The numbers were even higher among older children: 15.3% among those aged 6 to 11 years, and 15.5% among those aged 12 to 19 years. Similarly, data from the Youth Behavior Risk Surveillance Survey (YBRSS)2 found a 14% prevalence of overweight among Texas youth and 12% among Alabama youth, both higher than the national prevalence rate of 10%. We examined the prevalence of overweight children by race, sex, and income in these 2 states with higher prevalence rates.
Methods
We examined admissions records (which contain demographic information) of all children aged 3 to 5 years enrolled in Head Start programs in Birmingham, Ala; Northeast Alabama; and Houston, Tex in 2001. To supplement these data, we also examined similar records for Hi5+, a school-based fruit and vegetable promotion program for third-grade children in Birmingham, Ala. Demographic data, including sex, race, and income, were collected via self-administered surveys of the children's parents. The Hi5+ sample is similar to the Birmingham metropolitan statistical area in its racial mixture and income distribution. For each child we calculated age- and sex-specific BMI percentiles. Children were categorized as overweight if they were at or above the 95th percentile. "Low income" was defined as less than or equal to 185% of the poverty level.
Results
Among the 1968 children enrolled in Head Start, 305 (15.5%) were overweight. In all racial and sex categories, the prevalence of overweight was significantly higher in the Head Start sample than those reported by Ogden et al (Table 1). Among the 1585 children in the Hi5+ sample, 24.4% were overweight. Each race and sex category of Hi5+ consistently exceeded the prevalence rate for overweight in Alabama as found in YRBSS data. In the Hi5+ sample, the prevalence of overweight among children from low-income families was not significantly different than that among children from higher-income families for any of the 4 race-by-sex categories.
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Table. Body Mass Index Status of Children Compared Across NHANES, Children Enrolled in Head Start Programs, and Children Participating in Hi5+
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Comment
The prevalence of overweight in our Head Start sample in Texas and Alabama is much higher than that reported either by Ogden et al or by the YRBSS. Like Ogden et al, however, we found differences in the prevalence of overweight by race and sex. Although the Hi5+ sample also had a higher prevalence of overweight than was found by Ogden et al, there were no differences by sex or race. In an area with a higher baseline prevalence of obesity, overweight in childhood may be less likely to be affected by race, sex, or income. This suggests that the epidemiology of pediatric obesity in Alabama, and perhaps in similar states, is quantitatively and qualitatively different from the national sample.
Michelle Feese, MPH;
Frank Franklin, MD, PhD;
Marianne Murdock, PhD, RD;
Kathy Harrington, MAEd, MPH;
Maria Brown-Binns, MS
Department of Pediatrics
School of Medicine
University of Alabama at Birmingham
Theresa Nicklas, DrPH, LN;
Sheryl Hughes, PhD
Department of Pediatrics
Miriam Morales, BS
Baylor College of Medicine
Houston, Tex
1. Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA. 2002;288:1728-1732.
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2. US Centers for Disease Control and Prevention (CDC). Youth Risk Behavior Surveillance System. Atlanta, Ga: US Department of Health and Human Services, CDC; 2001.
Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.
JAMA. 2003;289:1780-1781.
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