Children in low-income areas face a higher risk of obesity when exposed to limited food access early in life. Efforts to improve food availability during pregnancy and infancy could significantly reduce childhood obesity rates.
Study: Neighborhood Food Access in Early Life and Trajectories of Child Body Mass Index and Obesity. Image Credit: Suzanne Tucker / Shutterstock.com
A recent JAMA Pediatrics study investigates associations between early childhood food accessibility, household income, child body mass index (BMI) trajectories, and adiposity risk.
The health impacts of food insecurity on children
Food insecurity affects millions of Americans each year, with current estimates indicating that over 10% of households in the United States were food insecure in 2022. Families with children are disproportionately affected by food insecurity, which has been shown to increase the risk of childhood obesity and, as a result, long-term health issues such as cardiovascular disease and diabetes.
Longitudinal studies have often examined how food insecurity affects the risk of obesity in late childhood or adolescence. However, early childhood has higher developmental plasticity and may significantly impact long-term health outcomes. Thus, improving awareness of the associations between early-life food insecurity and childhood obesity could support the development of preventative interventions to reduce future chronic illnesses.
About the study
In the present study, researchers examine whether residing in low-income communities with limited access to food during early childhood is associated with child BMI trajectories and adiposity risk. To this end, data were obtained from the United States Environmental Influences on Child Health Outcomes (ECHO) consortium participants between January 1, 1994, and March 31, 2023. All mother-child pairs provided a geocoded address during gestation or initial years of life and child BMI information.
The study exposures included residences in low-income communities with limited access to food. These communities have federal poverty rates of 20% or more and median family incomes of 80% or less than the statewide median family income.
The nearest grocery in these communities was at least half a mile away in urban areas and 10 miles or more away in rural regions. Urban areas had over 2,500 inhabitants, whereas rural areas had less than 2,500. All definitions adhered to the Food Access Research Atlas (FARA) guidelines.
Primary outcome measures were BMI Z scores, obesity, and severe obesity up to 15 years of age. BMI values were calculated using the World Health Organization (WHO) criteria or the United States Centers for Disease Control and Prevention (CDC) reference. Sex- and age-specific BMIs exceeding the 95th percentile indicated obesity, whereas BMI values of 120% or greater than the 95th percentile reflected severe obesity.
Linear mixed-effects models were used to analyze and calculate risk ratios (RR). Study covariates included maternal age, race, ethnicity, education, number of individuals in a household, insurance status, prenatal smoking or exposure to secondhand smoke, parity, and the child's social sex and birth year. Maternal pre-pregnancy BMI, weight gain during pregnancy, gestational diabetes, and gestational hypertension or preeclampsia were also considered in the analysis.
Study findings
Among 28,359 children from 55 cohorts, 52% were male, 67% were white, and 79% were non-Hispanic. About 23% of children lived in households with low income and limited food accessibility during gestation, 24% of whom resided in these homes during early childhood. Among 17,620 mothers, 51% attained college-level education, and 67% had private insurance during pregnancy.
Living in homes with low income and inadequate access to food during pregnancy increased the risk of children born to these mothers exhibiting higher BMI values by five, ten, and 15 years of age. These children were also at an increased risk of obesity by five, ten, and 15 years of age, with RR values of 1.4, 1.7, and 2.1, respectively. The risk of severe obesity was also greater in these children by five, ten, and 15 years, with RR values of 1.2, 1.5, and 1.9, respectively.
The strongest associations were observed for children residing in communities with low family income and limited food accessibility during pregnancy and early childhood. Cumulative exposure to resource deprivation over time had a detrimental impact on the child's outcomes.
Similar results were observed for individuals living in communities with low household incomes and limited food availability during early childhood. When alternate definitions were used for low financial income and limited access to food, the results remained unchanged, even when additional adjustments were made for prenatal factors related to child obesity.
Conclusions
Living in communities with low household income and inadequate food access during early childhood increases the risk of a higher BMI and adiposity during childhood. Pregnancy and early infancy are critical periods of exposure to neighborhood food availability, thus implying that improving food access throughout these life stages may help reduce the risk of child obesity.
The study findings advocate for financial investments in early childhood food access, such as encouraging new supermarkets, establishing healthy-choice pantries, and enhancing access to better food options in small retail venues. Future studies should investigate whether these efforts actually reduce childhood obesity rates.
Journal reference:
- Aris, I. M., Wu, A. J., Lin, P. D., et al. (2024). Neighborhood Food Access in Early Life and Trajectories of Child Body Mass Index and Obesity. JAMA Pediatrics. doi:10.1001/jamapediatrics.2024.3459