Hispanic and Black US Children's Paths to High Adolescent Obesity Prevalence

What is already known about this subject: The prevalence of child obesity in the U.S. is higher among Hispanic and black than white children. Racial/ethnic disparities have widened with the development of the child-obesity epidemic. Obese minority children are at greater risk of being obese also as adults. What this study adds By 8(th) grade, Hispanic and black children are both 50% more likely to be obese than are non-Hispanic white children. High obesity emerges more strongly by Kindergarten age among Hispanic children than among black children. Overweight and obese Hispanic and black children are less likely to return to normal weight levels than are overweight and obese white children. OBJECTIVE: The study aims to identify the ages contributing most to the development of higher obesity prevalence in the 8th grade (approximately age 14) among Hispanic and black children than among non-Hispanic white children in the United States. METHODS: Using the nationally representative Early Childhood Longitudinal Study (ECLS-K), a sample of 17, 420 children in kindergarten in 1999, followed in 1st, 3rd, 5th and 8th grades through 2007, was analysed. First, 'normal', 'overweight' and 'obese' weight-status categories in each grade were assigned from US Centers for Disease Control body mass index percentiles. Second, probabilities of being in each of the three weight-status categories in kindergarten and of transitioning between categories after kindergarten were estimated by logistic regression. These probabilities were then used as parameters of a weight-status trajectory simulation model from which a decomposition analysis was performed. RESULTS: Obesity prevalence in the 8th grade was equally high among Hispanic (25.0%, 95% confidence interval [CI]: 22.3, 27.8%) and black children (25.1%; 95% CI: 20.9, 29.6%) compared to white children (17.4%; 95% CI: 15.9, 19.0%). As much as 73% of the Hispanic-white 8th grade obesity disparity was generated by 3rd grade and 44% by kindergarten. In contrast, only 15% of the black-white obesity 8th grade disparity was generated by kindergarten, whereas 75% was generated between the 3rd and 8th grades and 53% between the 5th and 8th grades. CONCLUSIONS: Although adolescent obesity is equally prevalent among Hispanic and black children, obesity emerges and is sustained earlier in Hispanic children. Diagnosis and prevention strategies should be designed accordingly.