Posted by Miranda Carver Martin, Self-Sufficiency Research Clearinghouse Staff

Childhood obesity continues to be widely recognized as a public health concern. While growing evidence has found that obesity prevention efforts may be particularly important during early childhood, obesity is more prevalent among school-aged children (aged 6-11 years) and adolescents (aged 12-19 years), at 17.5% and 20.5%, respectively. Obesity rates also vary by other demographic characteristics; analyses using nationally-representative data from between 1988-1994 and 2013-2014 identified disparities by race/ethnicity and found higher rates of obesity among children and youth from households in which the head of the household did not hold greater than a high school degree. As both household- and community-level socioeconomic characteristics indicate associations with childhood weight status, self-sufficiency-related discussions are relevant to larger efforts to address circumstances impeding the attainment of health equity and to reduce disparities in the prevalence of obesity among children and adolescents. 

Childhood obesity is a complex issue that interacts with many aspects of children’s well-being, with implications for outcomes beyond related physical health consequences. Researchers have investigated numerous possible contributors and consequences of childhood obesity and have found that characteristics of children’s social and physical environments may play a role in its prevalence. Additionally, some cross-sectional and longitudinal research suggests a complicated relationship between weight status and school-related outcomes whereby children and adolescents who are obese can experience adverse outcomes such as more absences from school. Moreover, children and youth who are overweight or obese often experience being stigmatized or discriminated against based on their weight, which may further serve as a barrier to attaining a healthy weight status and affect their well-being in other ways, such as by increasing stress.

Researchers have highlighted the importance of the school context for understanding and addressing obesity among children and adolescents. A great deal of work has been done to test the effects of school-based interventions targeting “lifestyle” behaviors such as healthy eating and physical activity. There has been some inconsistency in findings among these studies, with some reviews concluding that school-based interventions have demonstrated the potential for positive impacts on children’s weight status, while others indicate that the evidence for these interventions has not been particularly promising overall. This inconsistency is further complicated by variability in program components such as program duration and parental involvement, which research suggests can influence an intervention’s effectiveness. It is also unclear whether school-based interventions hold the potential for reducing socioeconomic disparities in childhood obesity.  

Other approaches focusing on schools from an environment-focused perspective have also been proposed and tested, such as altering the food environment present in schools, which may show promise for further investigation. Some investigators have further called for an examination of the food environment not only within schools, but also surrounding them in the form of options offered by nearby retailers. However, further research is needed to understand the mechanisms underlying any observed associations between the surrounding food environment and students’ weight outcomes.

Discussion of the food environment in and around schools has inevitably included the National School Lunch Program and the School Breakfast Program, and some research has investigated whether participation in these programs is related to children’s weight status. However, food insecurity and food assistance program expert Craig Gundersen points out that while the existing evidence regarding the effects of these programs on childhood obesity is inconclusive thus far, research suggests that these programs do work to reduce food insecurity; therefore, suggestions for changing the school meal programs to address the more recent goal of reducing obesity should also be considered relative to their foundational goals of reducing food insecurity, which could be inadvertently affected by the changes.

Additional research is needed to gain a more comprehensive understanding of the circumstances that contribute to and mitigate the prevalence of childhood obesity, as well as how children and youth experience it. However, a large body of research has been dedicated to advancing an understanding of the issue and investigating possible solutions. Prevention efforts have been accompanied by calls to incorporate a health equity approach; for example, the Centers for Disease Control and Prevention’s (CDC) Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities makes recommendations for incorporating health equity into existing programming, such as targeting the structural/system level rather than the individual level, and building multi-sector partnerships. This focus is consistent with suggestions by other experts that collaboration across multiple sectors and a focus on the social determinants of health may hold promise for widespread impact. While schools may represent a key sector for obesity prevention efforts, numerous aspects of environmental, geographic, and social contexts likely require attention to reduce disparities in the prevalence and consequences of obesity among children and adolescents.

The SSRC Library contains numerous reports and stakeholder resources about obesity and links to self-sufficiency, including:

• SSRC Selections: Early Childhood Obesity: SSRC Selections highlight research, evaluation reports, and other publications that inform the field about key issues in, and effective practices for, fostering economic self-sufficiency. This set of selections is focused on resources related to early childhood obesity.
• Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014: This article details the rates of childhood obesity among various demographic groups and analyzes changes over time. The data presented indicate socioeconomic and racial/ethnic disparities.
• Community socioeconomic deprivation and obesity trajectories in children using electronic health records: This article provides longitudinal evidence of a link between community-level disadvantage and the rate of increase in BMI over time.
• Educational outcomes associated with childhood obesity in the United States: Cross-sectional results from the 2011–2012 National Survey of Children’s Health: This study found that children and teens who were obese more commonly experienced poorer school-related outcomes.
• Stigma and the perpetuation of obesity: This article reviews the ways that stigma and discrimination based on weight can lead to adverse outcomes, including serving as a barrier to attaining a healthy weight status.
• Food assistance programs and child health: This article evaluates a series of proposed changes to the Supplemental Nutrition Assistance Program (SNAP) and the federal school meal programs in light of existing evidence regarding their effects on obesity and food insecurity.
• A systematic review of the effectiveness of individual, community and societal level interventions at reducing socioeconomic inequalities in obesity amongst children: This article investigates the potential of interventions at various levels to address socioeconomic disparities in childhood obesity.

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