O2176: The Influence of Residence on Pediatric Obesity in Texas: Are All Children at Equal Risk?

Background: Pediatric obesity is a growing epidemic, affecting an estimated 20% of children and adolescents in the United States. Several environmental and lifestyle factors have been linked to increased risk of childhood obesity, including fast food, decreased physical activity, and decreased access to outdoor recreation areas. We sought to identify disparities in individual and environmental factors contributing to childhood obesity that exist within a single county.

Methods: A random sample of 1000 obese (BMI >30) and 1000 non-obese (BMI < 30) pediatric patients ( < 18 years) living in a Texas county was obtained from pediatric clinic patients at our institution. Chart review was performed to obtain demographic data and home addresses for each patient. Data on grocery stores, fast food restaurants, parks, fitness and recreation centers, and street density for each residential census tract was collected from The National Neighborhood Data Archive. Social Vulnerability Index (SVI) was utilized for additional characterization of socioeconomic and residential features. The cohorts were compared using Wilcoxon rank-sum tests for individual factors and logistic regression models for multivariable analysis.

Results: A total of 2000 patients were included, 1000 per cohort, with a median age of 11 years (IQR 9-14 years) and consisting of 52% male patients. Controlling for other demographic factors, obesity risk was found to be higher with older age (OR=1.370, 95% CI=1.325-1.417, p< 0.001) and female sex (OR=1.237, 95% CI=1.325-1.014, p=0.036). Compared to white children, Black children were at higher obesity risk (OR=1.457, 95% CI=1.122-1.893, p=0.005) and Asian children had lower risk (OR=0.157, 95% CI=0.056-0.440, p< 0.001). Hispanic patients also had increased obesity risk compared to non-Hispanic (OR=1.671, 95% CI=1.339-2.778, p< 0.001). Increased number of recreation and fitness centers in a census tract reduced the odds of obesity (OR=0.788, 95% CI=0.736-0.845, p< 0.001). Obesity risk decreased with increased street density, a marker of urbanicity (OR=0.990, 95% CI=0.986-0.993, p< 0.001) but not with number of grocery stores, fast food restaurants, and parks in a census tract. The overall SVI ranking of a census tract did not significantly predict obesity risk, though higher scores (increased vulnerability) for SVI socioeconomic status category (OR=8.348, 95% CI=1.870-37.258, p=0.005) and SVI household characteristics category (OR=4.861, 95% CI=1.884-12.542, p=0.001) both were predictors for increased pediatric obesity.

Conclusion: Socioecological disparities in pediatric obesity may affect population groups and residential areas differently based on the complex interplay of personal and environmental factors. Identification of neighborhood and individual-level disparities associated with children at risk of obesity is valuable for resource allocation and development of targeted pediatric obesity prevention, including education measures targeted at older age patients and physical activity programs.