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SSRC Notes: The complexity of obesity among school-aged children and adolescents

Date Added to Library: 
Tuesday, October 10, 2017 - 20:33
Organizational Author: 
Self-Sufficiency Research Clearinghouse
Individual Author: 
Martin, Miranda Carver
Reference Type: 
Published Date: 
Published Date (Date): 
Wednesday, October 11, 2017

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:

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