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

Childhood obesity is a critical health equity issue. Research has found that disadvantaged groups are disproportionately affected and that social determinants in food, physical, and social environments contribute to childhood obesity risk. A study using nationally-representative data identified statistically significant increases in socioeconomic disparities (measured by a composite scale using parents’ education, occupation, and household income) in the rate of childhood obesity between 1998 and 2010 among kindergarten-aged children. Although there was a significant decrease in the rate of obesity among two- to four-year-olds from low-income families in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) between 2010 and 2014, the 2014 rate (14.5 percent) was still higher than the national prevalence among children between two to five years old between 2011 and 2014 (8.9 percent). While socioeconomic disparities are not the only equity issues related to childhood obesity (for example, disparities by race/ethnicity are also apparent), factors related to family self-sufficiency are important to consider when seeking to address inequities in childhood obesity rates, including for the early childhood years.  

One construct that has sparked considerable research and discussion among experts is food insecurity, which often coexists with obesity. Food insecurity is a term that describes when “access to adequate food is limited by a lack of money and other resources.” Research has not consistently found a direct relationship between food insecurity and obesity among children, though it may contribute indirectly. For example, household food insecurity can indirectly affect infant feeding practices (e.g., breastfeeding and the introduction of solid foods), which can contribute to childhood overweight. Moreover, food insecurity and poverty can create individual and family stress in early childhood, which in turn may contribute to childhood obesity risk. Community-level environmental factors are also associated with weight outcomes among young children. For example, one study found that higher prices for fresh produce were associated with higher body mass index (BMI) among children from infancy to age five, and another study found a positive association between neighborhood homicide rates and obesity prevalence among preschoolers from low-income families in New York.

Early childhood has been identified as a potentially critical period for obesity prevention, and some existing efforts have demonstrated success, especially with parental involvement. Given that many children spend considerable time in child care while their parents work, a number of obesity prevention interventions focus on center-based care settings. A recent article systematically reviewed 43 of these interventions to identify factors that contribute to effectiveness and found that more comprehensive obesity prevention programs, including those that included a parent engagement element, appeared to be the most successful at affecting anthropometric factors such as BMI.

There is some evidence that policy interventions and some federal nutrition assistance programs may help to reduce childhood obesity, though more research is warranted. For example, a national-level study found an association between participation in the Child and Adult Care Food Program (CACFP) and greater intake of milk and vegetables as well as some evidence of an association between CACFP participation and reduced likelihood of being overweight among low-income children. However, evidence suggests that CACFP has failed to reach many children who may need it. Emerging evidence also indicates that participation in WIC may help to facilitate childhood obesity prevention efforts. For example, in a New York State study, researchers found reductions in obesity among children ages one to four years following changes to the program, and a Massachusetts study found improvements on childhood obesity risk factors and small reductions in BMI among young, non-Asian children in a community where WIC services were enhanced. Other broad policy interventions, such as a tax on sugar-sweetened beverages, reduced tax subsidies for TV advertising to children, and policy changes in early childhood education settings may also provide cost-effective approaches to reducing obesity.

In summary, despite declines in recent years, early childhood obesity remains an important health equity issue. Challenges such as stress, poverty, and household and community food access are important to include in discussions of childhood obesity and health equity for a holistic understanding of the issue and possible solutions. Prevention efforts may benefit particularly from targeting the early childhood years, engaging families, and considering community factors such as child care and the local food environment, as well as examining further evidence regarding the role of policy interventions in early childhood obesity prevention.

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.
• Hunger and obesity: Understanding a food insecurity paradigm: Workshop summary: This report summarizes a workshop during which a range of experts discussed the complex relationship between the commonly co-occurring conditions of food insecurity and obesity, as well as possibilities for a future research agenda and prevention efforts.
• Local food prices and their associations with children’s weight and food security: This study found a relationship between higher local prices for fresh produce and higher BMI in children, as well as a relationship between higher prices of soft drinks and lower likelihood of being overweight.
• Stress in early life and childhood obesity risk: This report reviews literature investigating the links between early childhood stressors and childhood obesity risk and suggests prevention strategies.
• The Child and Adult Care Food Program and the nutrition of preschoolers: This study found that low-income participants in the Child and Adult Care Food Program had better intake of milk and vegetables as well as slightly reduced likelihood of obesity.
• Changing WIC changes what children eat: This study identified improvements in diet quality and reductions in obesity among children in New York State across a period during which changes were made to the program.

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