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

Traci A Bekelman; Dana Dabelea; Jody M Ganiban; Andrew Law; Alexandra McGovern Reilly; Keri N Althoff; Noel Mueller; Carlos A Camargo Jr; Cristiane S Duarte; Anne L Dunlop; Amy J Elliott; Assiamira Ferrara; Diane R Gold; Irva Hertz-Picciotto; Tina Hartert; Alison E Hipwell; Kathi Huddleston; Christine C Johnson; Margaret R Karagas; Catherine J Karr; Gurjit K Khurana Hershey; Leslie Leve; Somdat Mahabir; Cindy T McEvoy; Jenae Neiderhiser; Emily Oken; Andrew Rundle; Sheela Sathyanarayana; Christine Turley; Frances A Tylavsky; Sara E Watson; Rosalind Wright; Mingyu Zhang; Edward Zoratti; program collaborators for Environmental influences on Child Health Outcomes (ECHO)

doi:10.1002/oby.23235

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

Obesity (Silver Spring). 2021 Dec;29(12):2089-2099. doi: 10.1002/oby.23235. Epub 2021 Aug 31.

Authors

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

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.

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.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Body Mass Index
Child
Ethnicity*
Female
Hispanic or Latino*
Humans
Male
Prospective Studies

Abstract

Publication types

MeSH terms

Grants and funding