Children who use community health centers may be at a particularly high risk of being obese

Children who use community health centers may be at a particularly high risk of being obese, according to a new study. This association between obesity and the type of health delivery system used was present regardless of race, ethnicity or geographic characteristics.

Researchers studied nearly 2,500 children aged two to 11, in medically underserved areas of the mid-Atlantic states, West Virginia, and Puerto Rico. These medically underserved areas, mainly inner-city and rural sites, often have limited access to healthy foods and to opportunities for physical activity, noted the study leader, Nicolas Stettler, M.D., M.S.C.E., a pediatric nutrition specialist at The Children's Hospital of Philadelphia.

Those centers may offer opportune sites for health interventions: "Because community health centers are experienced in prevention and serve more than 4.7 million children in the U.S., they may be a particularly promising point of access and setting for pediatric obesity prevention," added Dr. Stettler. The study appears in the September issue of Pediatrics.

The team analyzed charts for 2,474 children using 30 community health centers in 2001. Defining overweight as a body mass index of greater than the 95th percentile of a reference population, the researchers found a higher prevalence of overweight children in 27 of the 30 centers, in comparison to children in the general population.

In the younger children, the prevalence of overweight was 22 percent compared to 10 percent in a nationally representative sample (the 1999-2002 National Health and Nutrition Examination Survey). In the older children the prevalence was 24 percent, compared to 16 percent in the national sample. The researchers found no significant differences in prevalence between ethnic groups in this sample, in contrast to what is observed in the general population. In addition, there were no differences in prevalence among children using community health centers in urban or rural areas.

There were also no significant differences in obesity prevalence between boys and girls.

The higher prevalence of overweight was particularly large in younger children in this sample, said Dr. Stettler, suggesting that obesity has an earlier onset in these children compared to the rest of the country. Regional differences may explain the differences, although smaller studies have found higher prevalence of childhood overweight in the community health setting in various regions of the country.

Further studies may clarify whether the findings in this research team's mid-Atlantic sample may apply to other regions of the United States.

"This sample was based on consultations at primary care clinics rather than being population based, which could also partially explain the high prevalence of overweight in the sample, because obese children are more likely to have chronic conditions, such as asthma, that require more frequent healthcare visits," said Dr. Stettler. "It is likely however, that the high prevalence of overweight in this study is also related to characteristics of medically underserved areas, particularly access to care."

More than 4.7 million children are patients at these centers, which are located in inner-city and rural areas and may be at increased risk for obesity, because medically underserved communities are also often areas in which access to healthy foods and physical activity opportunities are limited, creating a particularly "obesogenic" environment.

"Identifying this high-risk population based on use of community health centers may be useful for directing services, training and research resources to this population," said Dr. Stettler, adding that community health centers may be well positioned to deliver long-term treatments for pediatric obesity. "Such centers often provide continuity of care to patients over time, and their financial security is less dependent on the vagaries of private insurers."

The obesity epidemic continues to increase nationwide in both the pediatric and adult populations. It is important to target methods of prevention in order to alleviate the serious side effects that are often related to overweight and obesity, including type 2 diabetes, cardiovascular disease, and sleep apnea.

This study was funded in part by the Health Resources and Services Administration and Office of Public Health and Science, Penn-Cheney EXPORT Center of Excellence Inner City Health and the Nutrition Center of The Children's Hospital of Philadelphia. Dr. Stettler is supported in part by National Institutes of Health grant K23 RR16073.

Dr. Stettler's co-investigators were: Michael R. Elliott, Ph.D., and Michael J. Kallan, M.S., both of the Center for Clinical Epidemiology and Biostatistics at The University of Pennsylvania School of Medicine; Steven B. Auerbach, M.D., M.P.H., of the Health Resources and Services Administration, New York City; and Shiriki Kumanyika, Ph.D, M.P.H., also of Penn's Center for Clinical Epidemiology and Biostatistics.