O2146: Social Determinants of Obesity in Children

Background: The rate of childhood obesity in the United States continues to climb at an alarming rate. According to the recent American Academy of Pediatrics clinical practice guidelines, obesity affects over 14 million children currently. Several authors have demonstrated a relationship between the social determinants of health and the prevalence of obesity. The interrelation between these social determinants provides some clues into designing prevention strategies. However, most population-based data are derived from questionnaires pertaining to food insecurity, housing stability, and family financial condition from administrative databases.
We seek to more clearly understand how local socioeconomic and environmental factors affect the determinants of obesity, and to pinpoint locations with high prevalence of these determinants.

Project Description:

Methods:
Institutional IRB approval was obtained for this project. The medical records from all outpatient encounters at a large Children's healthcare system were deidentified and reviewed. Records that included BMI percentile as well as responses to a standardized questionnaire regarding food insecurity were included in the analysis. The addresses of all patients were then anonymously geo-coded to specific census tracts using ArcGIS® software. We then applied methodology to assign Childhood Opportunity Index (COI) scores to each tract.
The prevalence of obesity based upon food insecurity answers and on the COI (stratified into five categories from very low to very high) were calculated and compared. Differences were evaluated using chi squared test of independence.

Results:
There were a total of 39,511 individual patient encounters identified for the year 2022. The rate of positive food insecurity responses was 4%. The overall obesity rate in the population was 16.6%. Patients with food insecurity were 1.6 times as likely to be obese, (26% vs 16.6%) (p < 0.0001).
COI could be determined in 30,338 encounters. The rate of obesity was 1.8 times higher in the low/very low vs. high/very high COI categories (p <.0001). In addition, patients who reported food insecurity were 3.5 times more to have a low/very low vs. high/very high COI (p < 0.0001).

Discussion: In our population of patients, food insecurity correlates with obesity. These findings are consistent with previous reports. In addition, we found that census trac-level COI also correlates with both food insecurity and obesity. Recent studies have suggested that programs such as Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Healthy, Hunger-Free Kids Act of 2010 may be having an impact on childhood obesity. Understanding the social determinants of obesity with a greater level of detail will allow local organizations and state governments to better target interventions designed to alleviate food insecurity, as well as other social determinants. It will also allow us to determine the effects of such interventions more precisely.

Conclusion: Childhood obesity correlates with both food insecurity and census tract-specific COI.