Obesity, race/ethnicity and life course socioeconomic status across the transition from adolescence to adulthood

Abstract

Background: Differences in the association of socioeconomic status (SES) with obesity may underlie the racial/ethnic disparities in obesity that increase dramatically across the transition to adulthood in the United States. The aim of this study was to examine racial/ethnic differences in the influence of life course SES on longitudinal obesity patterns from adolescence to adulthood.

Methods: Latent class analysis was used on a nationally representative, diverse sample of 12 940 adolescents followed into young adulthood (mean age = 21.7 years) to identify life course SES group profiles based on SES data in adolescence and young adulthood. Gender-stratified multinomial logistic regression models estimated the association of SES groups with obesity incidence and persistence versus staying non-obese.

Results: No significant interactions with race/ethnicity were observed, although racial/ethnic minorities had the highest obesity risk across SES groups. Racial/ethnic-pooled associations between disadvantaged SES exposure and higher obesity risk were strong but differed by gender. Males with a disadvantaged background who experienced early transitions into the labour force, marriage and residential independence had the highest risk of obesity incidence (relative risk ratio (RRR) = 1.64; 95% confidence interval (CI) 1.12 to 2.40), while females exposed to persistent adversity were at highest risk (RRR = 3.01, 95% CI 1.95 to 4.66). In general, SES group membership had a stronger relationship with obesity persistence than incidence.

Conclusions: The relationship between SES and obesity patterns is similar across race/ethnicity and differs by gender during the transition to adulthood. However, stronger associations with obesity persistence and enduring racial/ethnic disparities in obesity risk across SES groups suggest that these social factors play a larger role in disparities earlier in the life course.

Figure 1

Predicted* total young adult obesity, split into incidence and persistence from Wave I (1994-1995) to Wave III (2000-2001) for males (left panel) and females (right panel) from the National Longitudinal Study of Adolescent Health, across life course SES groups *Coefficients from multinomial logistic regression models estimating relative risk of longitudinal obesity patterns in males and females were used to predict the probability of obesity incidence (becoming obese from Wave I to Wave III) and persistence (staying obese from Wave I to Wave III) for a 22-year old of specified race/ethnicity and life course SES groups, holding all other variables constant.

Figure 2

Predicted* longitudinal obesity patterns from Wave I (1994-1995) to Wave III (2000-2001) for white and black females from the National Longitudinal Study of Adolescent Health, across selected life course SES groups *Coefficients from the multinomial logistic regression model estimating relative risk of longitudinal obesity patterns in females were used to predict the probability of obesity incidence (becoming obese from Wave I to Wave III) and persistence (staying obese from Wave I to Wave III), for a 22-year old female of specified race/ethnicity and life course SES groups, holding all other variables constant.