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Trends in the Association of Poverty With Overweight Among US Adolescents, 1971-2004
Richard A. Miech, PhD, MPH;
Shiriki K. Kumanyika, PhD, MPH;
Nicolas Stettler, MD, MSCE;
Bruce G. Link, PhD;
Jo C. Phelan, PhD;
Virginia W. Chang, MD, PhD
JAMA. 2006;295:2385-2393.
Context Prevalence of adolescent overweight in the United States has increased substantially during the past 3 decades. Whether socioeconomic disparities in adolescent overweight increased, decreased, or remained constant during this period is not known.
Objective To examine trends in adolescent overweight from 1971 to 2004 by family poverty status, as well as trends in potentially relevant eating and physical activity behaviors.
Design, Setting, and Participants Four cross-sectional, nationally representative surveys (US National Health and Nutrition Examination Surveys [NHANES] of 1971-1974, 1976-1980, 1988-1994, and 1999-2004) were examined for trends in the prevalence of overweight among adolescents aged 12 to 17 years by family poverty status.
Main Outcome Measures Prevalence of adolescent overweight, defined as body mass index at or above the 95th percentile for age and sex in the 2000 Centers for Disease Control and Prevention growth charts. Intermediate outcomes were physical inactivity in the past 30 days, proportion of caloric intake from sweetened beverages (24-hour recall), and whether respondent skipped breakfast (24-hour recall).
Results Trends in the association of adolescent overweight with family poverty differed by age stratum (P = .01). In 12- to 14-year-old adolescents, prevalence did not significantly differ by family poverty status in any of the surveys; however, among non-Hispanic black adolescents, overweight prevalence increased faster in nonpoor vs poor families. In contrast, a widening disparity that disfavored adolescents from poor families was present in the 15- to 17-year-old adolescents. This trend was similar among male, female, non-Hispanic white, and non-Hispanic black adolescents, resulting in an overall prevalence of overweight in 1999-2004 more than 50% higher among adolescents in poor vs nonpoor families (23.3% vs 14.4%, respectively; P<.001). Additional analyses suggest that physical inactivity, sweetened beverage consumption, and skipping breakfast may contribute to these disparities.
Conclusions Trends of increasing overweight showed a greater impact in families living below the poverty line vs not living below the poverty line among older (15-17 years) but not younger (12-14 years) adolescents. Furthermore, physical inactivity, high consumption of sweetened beverages, and breakfast skipping may be candidate targets for prevention programs aimed at reducing this recently emerged disparity.
Author Affiliations: Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (Dr Miech); Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia (Drs Kumanyika and Stettler); Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pa (Dr Stettler); Departments of Epidemiology (Dr Link) and Sociomedical Sciences (Drs Link and Phelan), Mailman School of Public Health, Columbia University, New York, NY; New York State Psychiatric Institute, New York (Dr Link); and Veterans Affairs Center for Health Equity Research and Promotion, Department of Medicine, University of Pennsylvania School of Medicine, and Department of Sociology, University of Pennsylvania, Philadelphia (Dr Chang).
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