. 2021 Dec;29(12):2089-2099.

doi: 10.1002/oby.23235. Epub 2021 Aug 31.

Regional and sociodemographic differences in average BMI among US children in the ECHO program

Traci A Bekelman¹, Dana Dabelea¹, Jody M Ganiban², Andrew Law³, Alexandra McGovern Reilly³, Keri N Althoff³, Noel Mueller³, Carlos A Camargo Jr⁴, Cristiane S Duarte⁵, Anne L Dunlop⁶, Amy J Elliott⁷, Assiamira Ferrara⁸, Diane R Gold⁹, Irva Hertz-Picciotto¹⁰, Tina Hartert¹¹, Alison E Hipwell¹², Kathi Huddleston¹³, Christine C Johnson¹⁴, Margaret R Karagas¹⁵, Catherine J Karr¹⁶, Gurjit K Khurana Hershey¹⁷, Leslie Leve¹⁸, Somdat Mahabir¹⁹, Cindy T McEvoy²⁰, Jenae Neiderhiser²¹, Emily Oken²², Andrew Rundle²³, Sheela Sathyanarayana²⁴, Christine Turley^{25

26}, Frances A Tylavsky²⁷, Sara E Watson²⁸, Rosalind Wright²⁹, Mingyu Zhang³, Edward Zoratti¹⁴; program collaborators for Environmental influences on Child Health Outcomes (ECHO)

Collaborators, Affiliations

Collaborators

program collaborators for Environmental influences on Child Health Outcomes (ECHO):
P B Smith, K L Newby, D K Benjamin, L P Jacobson, C B Parker, F P Perera, J B Herbstman, L A Croen, C B Blair, L Trasande, A N Alshawabkeh, J B Stanford, E B Clark, C Porucznik, J Gern, L Bacharier

Affiliations

¹ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
² Department of Psychological and Behavioral Sciences, The George Washington University, Washington, DC, USA.
³ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁴ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁵ Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University, New York, New York, USA.
⁶ Woodruff Health Sciences Center, School of Medicine and Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.
⁷ Avera Research Institute, Sioux Falls, South Dakota, USA.
⁸ Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
⁹ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
¹⁰ Department of Public Health Sciences, University of California, Davis, California, USA.
¹¹ Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
¹² Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹³ College of Health and Human Services, George Mason University, Fairfax, Virginia, USA.
¹⁴ Henry Ford Health System, Detroit, Michigan, USA.
¹⁵ Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.
¹⁶ Department of Environmental and Occupational Health Sciences, Department of Pediatrics, University of Washington, Seattle, Washington, USA.
¹⁷ Cincinnati Children's Hospital, Cincinnati, Ohio, USA.
¹⁸ Prevention Science Institute, University of Oregon, Eugene, Oregon, USA.
¹⁹ National Cancer Institute, NIH, Bethesda, Maryland, USA.
²⁰ Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.
²¹ Department of Psychology, Penn State University, Pennsylvania, Pennsylvania, USA.
²² Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
²³ Mailman School of Public Health, Columbia University, New York, New York, USA.
²⁴ University of Washington/Seattle Children's Research Institute, Seattle, Washington, USA.
²⁵ University of South Carolina, Columbia, South Carolina, USA.
²⁶ Atrium Health Levine Children's, Charlotte, North Carolina, USA.
²⁷ Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
²⁸ Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA.
²⁹ Icahn School of Medicine at Mount Sinai, New York, New York, USA.

PMID: 34467678
PMCID: PMC9088705
DOI: 10.1002/oby.23235

Regional and sociodemographic differences in average BMI among US children in the ECHO program

Traci A Bekelman et al. Obesity (Silver Spring). 2021 Dec.

. 2021 Dec;29(12):2089-2099.

doi: 10.1002/oby.23235. Epub 2021 Aug 31.

Authors

Collaborators

program collaborators for Environmental influences on Child Health Outcomes (ECHO):
P B Smith, K L Newby, D K Benjamin, L P Jacobson, C B Parker, F P Perera, J B Herbstman, L A Croen, C B Blair, L Trasande, A N Alshawabkeh, J B Stanford, E B Clark, C Porucznik, J Gern, L Bacharier

Affiliations

¹ Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
² Department of Psychological and Behavioral Sciences, The George Washington University, Washington, DC, USA.
³ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁴ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁵ Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University, New York, New York, USA.
⁶ Woodruff Health Sciences Center, School of Medicine and Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.
⁷ Avera Research Institute, Sioux Falls, South Dakota, USA.
⁸ Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
⁹ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
¹⁰ Department of Public Health Sciences, University of California, Davis, California, USA.
¹¹ Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
¹² Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹³ College of Health and Human Services, George Mason University, Fairfax, Virginia, USA.
¹⁴ Henry Ford Health System, Detroit, Michigan, USA.
¹⁵ Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.
¹⁶ Department of Environmental and Occupational Health Sciences, Department of Pediatrics, University of Washington, Seattle, Washington, USA.
¹⁷ Cincinnati Children's Hospital, Cincinnati, Ohio, USA.
¹⁸ Prevention Science Institute, University of Oregon, Eugene, Oregon, USA.
¹⁹ National Cancer Institute, NIH, Bethesda, Maryland, USA.
²⁰ Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.
²¹ Department of Psychology, Penn State University, Pennsylvania, Pennsylvania, USA.
²² Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
²³ Mailman School of Public Health, Columbia University, New York, New York, USA.
²⁴ University of Washington/Seattle Children's Research Institute, Seattle, Washington, USA.
²⁵ University of South Carolina, Columbia, South Carolina, USA.
²⁶ Atrium Health Levine Children's, Charlotte, North Carolina, USA.
²⁷ Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
²⁸ Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA.
²⁹ Icahn School of Medicine at Mount Sinai, New York, New York, USA.

PMID: 34467678
PMCID: PMC9088705
DOI: 10.1002/oby.23235

Abstract

Objective: The aim of this study was to describe the association of individual-level characteristics (sex, race/ethnicity, birth weight, maternal education) with child BMI within each US Census region and variation in child BMI by region.

Methods: This study used pooled data from 25 prospective cohort studies. Region of residence (Northeast, Midwest, South, West) was based on residential zip codes. Age- and sex-specific BMI z scores were the outcome.

Results: The final sample included 14,313 children with 85,428 BMI measurements, 49% female and 51% non-Hispanic White. Males had a lower average BMI z score compared with females in the Midwest (β = -0.12, 95% CI: -0.19 to -0.05) and West (β = -0.12, 95% CI: -0.20 to -0.04). Compared with non-Hispanic White children, BMI z score was generally higher among children who were Hispanic and Black but not across all regions. Compared with the Northeast, average BMI z score was significantly higher in the Midwest (β = 0.09, 95% CI: 0.05 to 0.14) and lower in the South (β = -0.12, 95% CI: -0.16 to -0.08) and West (β = -0.14, 95% CI: -0.19 to -0.09) after adjustment for age, sex, race/ethnicity, and birth weight.

Conclusions: Region of residence was associated with child BMI z scores, even after adjustment for sociodemographic characteristics. Understanding regional influences can inform targeted efforts to mitigate BMI-related disparities among children.

PubMed Disclaimer

Conflict of interest statement

CONFLICT OF INTEREST

Dr. Althoff reports personal fees from The All of Us study and from Trio Health. The other authors declared no conflict of interest.

Figures

**FIGURE 1**
Residential codes of participants, 2000 to 2018. Among the 14,313 children included in our study population, 12,943 had 5-digit zip codes of residence (and are included in this map), hailing from 3,014 unique zip codes across the United States. ECHO, Environmental influences on Child Health Outcomes

See this image and copyright information in PMC

Comment in

What can regional estimates of the prevalence of obesity tell us about what risk factors we should target?
Dietz WH. Dietz WH. Obesity (Silver Spring). 2021 Dec;29(12):1992-1993. doi: 10.1002/oby.23272. Epub 2021 Sep 14. Obesity (Silver Spring). 2021. PMID: 34519157 No abstract available.

References

1. Skinner AC, Ravanbakht SN, Skelton JA, Perrin EM, Armstrong SC. Prevalence of obesity and severe obesity in US children, 1999–2016. Pediatrics. 2018;141(3):e20173459. doi:10.1542/peds.2017-3459 - DOI - PMC - PubMed
1. Smith JD, Fu E, Kobayashi MA. Prevention and management of childhood obesity and its psychological and health comorbidities. Annu Rev Clin Psychol. 2020;16:351–378. - PMC - PubMed
1. Rahman T, Cushing RA, Jackson RJ. Contributions of built environment to childhood obesity. Mt Sinai J Med. 2011;78:49–57. - PubMed
1. Caprio S, Daniels SR, Drewnowski A, et al. Influence of race, ethnicity, and culture on childhood obesity: implications for prevention and treatment. Obesity (Silver Spring). 2008;16(12):2566–2577. - PubMed
1. Ash T, Agaronov A, Young T, Aftosmes-Tobio A, Davison KK. Family-based childhood obesity prevention interventions: a systematic review and quantitative content analysis. Int J Behav Nutr Phys Act. 2017;14(1):113. doi:10.1186/s12966-017-0571-2 - DOI - PMC - PubMed

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Regional and sociodemographic differences in average BMI among US children in the ECHO program

Collaborators

Affiliations

Regional and sociodemographic differences in average BMI among US children in the ECHO program

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Molecular Biology Databases