Community Influence on Adolescent Obesity: Race/Ethnic Differences

Using a sample of 20,000 adolescents (Add Health data), this study examined the influences of community poverty and race/ethnicity on adolescent obesity. Multilevel analyses revealed strong evidence for the unique influences of community poverty and race/ethnicity on adolescent obesity net of family characteristics. The prevalence of obesity is significantly higher in poor communities than in affluent communities; and it is higher among African Americans, Hispanics and Native Americans than among Whites. The interaction between race/ethnicity and community poverty indicates that race/ethnicity moderates the influence of community poverty on the prevalence of obesity. Although the prevalence of obesity is higher among minorities than among Whites, the influence of community poverty is stronger for Whites than for minorities, suggesting that unlike Whites, most minority groups may not accrue benefits of structural community advantages. The state of being overweight as the outcome variable provided essentially the same findings. The practical implications are discussed.     

Risky Sexual Behavior: A Race-specific Social Consequence of Obesity

Scant attention has been given to the consequence of actual weight status for adolescents’ sexual wellbeing. In this article, we investigate the race-specific connection between obesity and risky sexual behavior among adolescent girls. Propensity scores and radius matching are used to analyze a sample of 340 adolescents aged 16–17 who participated in the National Longitudinal Survey of Youth Young Adult Survey in 2000 or 2002. Nearly even numbers of these participants identified as white and black (183 and 157, respectively). We find that compared to their non-obese white peers, obese white adolescent girls exhibit higher rates of multiple sex partners and sex with older partners, and are also less likely to use condoms. None of these factors are significantly related to high BMI within the black sample. These findings indicate that the negative social consequences of obesity extend beyond future economic and marriage outcomes to adolescent white women’s sexual outcomes. They also highlight the importance of context: the implications of being obese during adolescence depend on cultural meanings of obesity.     

Adolescent Obesity and Young Adult Psychosocial Outcomes: Gender and Racial Differences

Using a sample of 7,881 African American (915 males and 1,073 females) and White (2,864 males and 3,029 females) adolescents from Waves 1 and 3 of the National Longitudinal Study of Adolescent Health, this study examined the psychosocial consequences that obese adolescents encounter as they reach young adulthood. Results indicate that obesity among adolescent females is associated with a lower status attainment in young adulthood than normal weight adolescent females. In addition, obese adolescent females have more depressive symptoms in young adulthood than normal weight females, even after controlling for prior depressive symptoms in adolescence. Obesity status among adolescent males is not associated with poorer psychosocial outcomes in young adulthood. We did not find evidence of an interaction between obesity status and race, indicating no significant differences in psychosocial outcomes for obese White compared to obese African American adolescents.

Invited Commentary: Childhood and Adolescent Obesity: Psychological and Behavioral Issues in Weight Loss Treatment

The prevalence of childhood and adolescent obesity has tripled in the past three decades. This increase has been accompanied by a dramatic rise in obesity-related health complications among American youth. Thus, many obese youth are now experiencing illnesses that will threaten their life expectancy in the absence of significant weight loss. Despite these concerns, a relatively modest body of research has focused on the treatment of adolescent obesity. Results from trials investigating the efficacy of behavioral and pharmacological treatments, like studies of these interventions with adults, suggest that individuals typically lose 5–10% of their initial weight. Unfortunately, weight regain is common. Given the increase in the number of obese adolescents, coupled with the modest results from more conservative treatment approaches, it is not surprising that bariatric surgery for adolescents who suffer from extreme obesity has grown in popularity. The weight losses after surgery are impressive and many adolescents, like adults, experience significant improvements in their physical and mental health postoperatively. However, only a small fraction of adolescents and adults who are heavy enough for bariatric surgery present for surgical treatment. Among those who undergo surgery, a significant minority appear to struggle with a number of behavioral and psychosocial issues that threaten their lifelong success. With all of this in mind, the current obesity problem in the United States and other Westernized countries likely will present a significant challenge to both current and future medical and mental health professionals who work with adolescents and young adults.     

Female Overweight and Obesity in Adolescence: Developmental Trends and Ethnic Differences in Prevalence, Incidence, and Remission

Despite substantial increases in the prevalence of adolescent overweight and obesity documented in recent decades, few studies have prospectively tracked their development during the entire adolescent period. The aims of this study were to characterize developmental trends in prevalence, incidence, and remission of overweight and obesity using annual data collected from ages 12 to 19 for 496 adolescent females. Ethnic differences between African American (n = 37), Latina (n = 96), and European American (n = 348) adolescents were also compared. The prevalence of overweight decreased slightly across adolescence and remission rates exceeded incidence (onset). Obesity was more chronic, with increasing incidence accompanied by decreasing remission rates. Middle through late adolescence was the period of greatest risk for the transition from overweight to obesity. African American and Latina females had higher overweight and obesity prevalence than European American females throughout adolescence. Differences in prevalence were driven by higher onset rates for African American and Latina females, whereas remission rates were comparable across ethnic groups. Results suggest that adolescence is not a high-risk period for onset of obesity for European American adolescent females, but is for African American and Latina adolescent females.     

Racial and Ethnic Disparities in Obesity During the Transition to Adulthood: The Contingent and Nonlinear Impact of Neighborhood Disadvantage

Neighborhood disadvantage in early adolescence may help explain racial and ethnic disparities in obesity during the transition to adulthood; however the processes may work differently for males and females and for minority groups compared to Whites. The present study examines the relationship between neighborhood disadvantage and young adult obesity and the extent to which it contributes to racial/ethnic disparities among males and females. Data are from waves I and III of The National Longitudinal Study of Adolescent Health (Add Health), a nationally representative sample of adolescents administered between 1994 and 2002. The final sample of 5,759 adolescents was 54% female, 63% White, 21% African American, 16% Hispanic, and 14 years of age, on average, at wave I. Using hierarchical logit models and controlling for prior obesity status, findings indicate that, for females, adolescent neighborhood disadvantage partially explains racial/ethnic disparities in young adult obesity. Further, neighborhood disadvantage increases the odds of becoming obese for adolescent females in a curvilinear form, and this relationship significantly varies between Whites and Hispanics. Neighborhood disadvantage does not increase the risk of obesity for males, regardless of race/ethnicity. Implications for obesity prevention are discussed.     

A Multi-Level Examination of the Association Between Older Social Models in the School Environment and Overweight and Obesity Among Younger Students

Few studies have examined how school characteristics are associated with obesity. The purpose of this study was to examine the student- and school-level characteristics associated with being overweight and obese among 12,049 students in grades 9 and 10 (junior students) attending 76 secondary schools in Ontario, Canada. The sample was 49.2% female and the average age was 14.7 years. Overall, 15.0% of the sample was considered overweight and 6.3% of the sample was considered obese. Multi-level regression analysis revealed significant between-school random variation for the likelihood of a junior student (grade 9 or 10) being overweight or obese. For each 1% increase in the prevalence of obese senior students (grade 11 and 12) at a school, the odds of a junior student at that school being overweight or obese increased significantly. Important student-level characteristics included physical activity, screen time sedentary behaviour (e.g., watching television), participation in varsity sports and gender. Future research should evaluate if the optimal population level impact for school-based obesity prevention programming might be achieved by targeting the schools that are putting students at the greatest risk.