Disparities in Elevated Body Mass Index in Youth Receiving Care at Community Health Centers

Abstract

Childhood obesity has increased significantly in the United States. Racial subgroups are often grouped into categories in research, limiting our understanding of disparities. This study describes the prevalence of obesity among youth of diverse racial and ethnic backgrounds receiving care at community health centers (CHCs). This cross-sectional study describes the prevalence of elevated body mass index (BMI) (≥85th percentile) and obesity (≥95th percentile) in youth aged 9 to 19 years receiving care in CHCs in 2014. Multilevel logistic regression estimated the prevalence of elevated BMI and obesity by age, race/ethnicity, and sex. Among 64 925 youth, 40% had elevated BMI and 22% were obese. By race, obesity was lowest in the combined Asian/Pacific Islander category (13%); however, when subgroups were separated, the highest prevalence was among Native Hawaiians (33%) and Other Pacific Islanders (42%) and the lowest in Asians. By sex, Black females and Hispanic and Asian males were more likely to be obese. By age, the highest prevalence of obesity was among those aged 9 to 10 years (25%). Youth served by CHCs have a high prevalence of obesity, with significant differences observed by race, sex, and age. Combining race categories obscures disparities. The heterogeneity of communities warrants research that describes different populations to address obesity.

Figure 1.

Model estimates of elevated BMI and obesity by race/ethnicity and sex in all CHCs. The model-based estimates of elevated BMI and obesity prevalence by race/ethnicity and sex are presented. Estimates were compared between sexes (male vs female) within each racial/ethnic group, and prevalence estimates for each sex within each racial/ethnic category were also compared between groups using NH white as the reference group. ^aRace/Ethnicity P < .05; ^bRace/Ethnicity and Sex P value < .05; NH, Non-Hispanic; PI, Pacific Islander; Ref, reference group; BMI indicates body mass index; CHCs, community health centers.

Figure 2.

Model estimates of elevated BMI and obesity by age and sex. (a) The mean age of the sample was 14.2 years. 1 standard deviation (SD) = 3.16 years. (b) In both sexes, we found that older age is associated with a lower prevalence of both elevated BMI and obesity. (c) For the age by sex interaction, younger males had higher estimates of elevated BMI (45%) than younger females (40%), whereas older males had lower estimates of elevated BMI (36%) than older females (38%). (d) Younger males were more likely to be obese than younger females; however, with older age, the difference in estimated obesity prevalence between males and females was smaller (5.2% vs 1.7%, respectively). ^aSex and Age P value < .05. BMI indicates body mass index.

Figure 3.

Model estimates of elevated BMI and obesity by Asian and PI subgroups and sex. (a) The estimates of elevated BMI and obesity by Asian and PI subgroups and sex are shown. With Asians as the reference group, differences in the prevalence of obesity by race were significant (P < .001) when compared with Native Hawaiians and OPI. (b) The dotted line represents the prevalence of both outcomes when the Asian/PI subgroups are aggregated to highlight the difference in the prevalence observed when the subgroups are disaggregated. (c) Asian males were more likely to have elevated BMI (34%) and obesity (16%) than Asian females (19% and 6%, respectively; P < .001). The highest prevalence estimates for elevated BMI and obesity were consistent among OPI, and men in this group (55% and 38%) were more likely to have elevated BMI (55%) and obesity (38%) than females (50% and 29%, respectively; P < .001). BMI indicates body mass index; PI, Pacific Islander; OPI, Other Pacific Islander.