The Combined Effects of Social Determinants of Health on Childhood Overweight and Obesity

Abstract

Background: To characterize the association between multiple social determinants of health (SDOH) and overweight and obesity among US children. Methods: We conducted a cross-sectional analysis using the 2016-2020 National Survey of Children's Health. SDOH domains consisted of Economic Stability, Social and Community Context, Neighborhood and Built Environment, and Health Care Access and Quality. We used ordinal logistic regression to model associations between SDOH and weight status and calculate predicted probabilities of having overweight or obesity for various SDOH profiles. Results: Data from 81,716 children represented a weighted sample of 29,415,016 children ages 10-17 years in the United States. Of these, 17% had overweight and 17% had obesity. Compared with children with the theoretically lowest-risk SDOH profile, children with the highest-risk SDOH profiles in all four domains had an odds ratio of having a higher BMI category of 4.38 (95% confidence interval 1.67-7.09). For the lowest risk profile, the predicted probability of obesity varied from 8% to 11%, depending on race. For the highest risk profile, the predicted probability of obesity varied from 26% to 34%, depending on race. Conclusions: While high-risk values in each SDOH domain were associated with higher predicted probability of overweight and obesity, it was the combination of highest risk values in all the SDOH domains that led to greatest increases. This suggests a complex and multilayered relationship between the SDOH and childhood obesity, necessitating a comprehensive approach to addressing health equity to reduce childhood obesity.

Keywords: childhood obesity; disparities; social determinants of health.

Figure 1.

Healthy People 2030 Social Determinants of Health Domains and the corresponding NSCH measures included in this analysis. NSCH, National Survey of Children's Health.

Figure 2.

Odds ratios for having a higher vs. lower BMI status, for children with different combinations of SDOH variables set to their theoretical lowest- or highest-risk values (specifications in Supplementary Appendix SA1), with 95% confidence intervals. (A) The odds ratios when each SDOH domain is elevated to the highest risk one at a time. (B) The odds ratios when each SDOH domain is elevated to the highest risk cumulatively. All odds ratios are with respect to the lowest-risk SDOH profile (labeled “None”). Each SDOH domain is noted as follows: ES, HCAQ, NBE, SCC. ES, economic stability; HCAQ, health care access and quality; NBE, neighborhood and built environment; SCC, social and community context; SDOH, social determinants of health.

Figure 3.

Predicted probability of overweight (A, B) and obesity (C, D), for children with different combinations of SDOH variables set to their theoretical lowest- or highest-risk values (specifications in Supplementary Appendix SA1), with 95% confidence intervals. (A, C) The predicted probability of overweight (A) and obesity (C) when each SDOH domain is elevated to the highest risk one at a time. (B, D) The predicted probability of overweight (B) and obesity (D) when each SDOH domain is elevated to the highest risk cumulatively. The lowest-risk SDOH profile is labeled “None.” Each SDOH domain is noted as follows: ES, HCAQ, NBE, SCC. The adjusting covariates are set to the median or modal value: sex: female, age: 14, parental education level: college degree or higher, special health care needs: none, days with physical activity per week: 1–3, and year: 2018.