New research reveals surprising facts about simple behaviors that may alter a child’s health legacy for life. In addition, Elsie Taveras, M.D., M.P. H., lead author of the study, found that national efforts to address the problem may be missing the most critical window for intervention—especially in Black and Hispanic children. “When it comes to preventing disparities in obesity, we may have missed the boat if we haven’t done something for these children by age 2,” said Taveras, a 2007-2010 Robert Wood Johnson Foundation Physician Faculty Scholar.
For the study, “Racial/Ethnic Differences in Early-Life Risk Factors for Childhood Obesity,” published in the March 2010 issue of Pediatrics, (the April issue online), Taveras and her colleagues looked at behaviors and practices from birth to age 2 in a group of 1,826 White, Black and Hispanic women. They discovered that many factors--some related to culture, others associated with economic and educational background--predisposed children, especially Blacks and Hispanics, to being overweight as toddlers and potentially as adults. "Many of the risks we found have been documented in previous research, but what’s unique about our study is that every single factor was found to disproportionately burden children from these backgrounds,” Taveras said.
Among the families studied, children who were breastfed for less than 6 months; fed solid foods before age 4 months; drank sugar-laden beverages; had television in their bedrooms; got less than 12 hours of sleep per night; or had contact with cigarette smoke were far more likely to be overweight. While Hispanic and Black children had greater exposure to every factor, neither race nor socioeconomic status offered a complete explanation for the disparities found.
The Role of Culture
“Our Black cohort was from several different places—the Caribbean, Africa and America, that’s why we used Black instead of African American. Our Hispanic group also represented a broad range--Mexicans, Dominicans, Puerto Ricans and others,” said Taveras, noting that most study participants were middle class. “The women were recruited when they sought prenatal care in their first trimester. They had medical insurance and the average household income was $70,000. We really tried to figure out what was attributable to culture, socioeconomic status or other issues.”
The data showed that the Black and Hispanic women at the upper end of the income scale were just as likely to breastfeed their babies for six months or more as White women. “The initial racial and ethnic difference we observed in breastfeeding rates disappeared when we adjusted for socioeconomic status,” explained Taveras, a pediatrician at Children’s Hospital Boston and assistant professor of population medicine at Harvard Medical School. “The same is true for maternal smoking. These factors were no different in Whites and high-income Blacks and Hispanics.”
Yet culture appeared to play a significant role in whether Black and Hispanic parents at all income levels chose to feed children solid foods before age 4 months, expose children to sugar-sweetened beverages or allow a television to be placed in the child’s bedroom. “There was a huge difference—a much higher rate--of televisions in bedrooms in Black and Hispanic households. Television watching is associated with obesity because it contributes to inactivity and exposure to marketing for calorie-dense foods,” Taveras said. “Black and Hispanic children were also much less likely to get 12 hours of sleep in a 24-hour period and sleep appears to prevent excess weight gain.”
New Opportunities for Prevention
Taveras hopes that parents and caregivers will see the study as encouraging news. “These are workable risk factors. It’s nearly impossible for a physician or a person to immediately address a risk as complex as socioeconomic status,” she said, “but the message here is to teach parents to make healthier choices for their children and that is doable.”
“There’s also a perfect link between these findings and what other programs, including First Lady Michelle Obama’s Let’s Move initiative, are doing with schools and communities,” said Taveras who is also an advisor to the Institute of Medicine’s (IOM) new committee on addressing obesity in children from birth to age 5.
“Until now, obesity prevention efforts have excluded children under age 3, but programs that work with older children or focus on national action should also consider younger children. For example, there are very few indoor programs to help toddlers be physically active in a safe, open space and children are still exposed to marketing of unhealthy foods on television,” Taveras said. “Diet is another issue. All programs can work to cut access to sugar-sweetened foods for children under age 2 and cut exposure to fast food for children as young as age 3.”
Rather than viewing her research as an indicator that obesity prevention after age 2 is ineffective, Taveras advises, “our research should be seen as another component that can be used to address the problem by starting at an earlier age.”
Taveras began the epidemiological research that led to her findings after becoming a Robert Wood Johnson Foundation Physician Faculty Scholar and adds, “I’m really excited about this paper. As researchers we seldom have the time to do the things we genuinely have a passion to do. I’ve always been interested in childhood obesity, disparities and working in areas where I would have an opportunity to make a difference. The program helped make that possible.”
The Robert Wood Johnson Foundation Physician Faculty Scholar Program strengthens the academic productivity of junior medical school faculty dedicated to improving health and health care. Under the program, scholars receive funds to support a research project; receive national and local mentorship and work with other scholars.