Obesity Prevalence Among U.S. Children and Adolescents Investigated for Maltreatment

Background: No study to date has examined the prevalence of obesity in a nationally representative sample of children who were part of a Child Protective Services (CPS) investigation for abuse and neglect. Further, no study has been able to examine differences in obesity risk by child and family demographics and maltreatment case characteristics.  Therefore the purpose of this study is to (1) determine the prevalence and correlates of obesity among children investigated for abuse and neglect in the U.S. and (2) examine associations between obesity, child race/ethnicity and family material hardship, history of a prior investigation, type of alleged maltreatment, and credibility of allegation by child sex and developmental age.

 

Methods: Participants were drawn from the 2008 cohort of the National Survey of Child and Adolescent Well-being (NSCAW2), a national probability study of 5,873 children ages birth to 17 under investigation for maltreatment. Based on child weight reported by caregivers, we estimated prevalence of obesity (>95^th percentile) among children age 2 through 17 (n=2948). Sex-specific logistic regression models by developmental age were used to identify obesity risk factors including child race and investigation case characteristics.

Results: Among children ages 2-17, obesity prevalence was 25%. A greater proportion of investigated males 2-17 were obese (30%) than females (21%).  The sub-groups with the highest rates of obesity were 6-11 year old Hispanic boys (1 in every 2.4 were obese) and 2-5 year old non-Hispanic White boys (1 in every 2.7 were obese). Girls 2-5 with a sexual abuse allegation were at 3.5 greater odds of obesity than girls with a neglect allegation. African-American boys ages 12-17 were at .3 decreased odds of obesity than White boys, and boys ages 12-17 with a physical abuse allegation were at .2 decreased odds of obesity than boys with a neglect allegation. Girls ages 12-17 with family history of a prior investigation were at 4.0 greater odds of obesity than girls without a prior investigation.  Compared to a national sample of children of the same developmental ages taken from National Health and Nutrition Examination Survey, 1.5 times as many CPS investigated children were obese as youth in the general U.S. population.  The greatest difference in obesity rates between the CPS investigated and national samples was among the 2-5 year old children (28% and 10% obese, respectively).  

 

Conclusions: Youth investigated for maltreatment in 2008 have high obesity rates compared to national peers.  The high prevalence of childhood obesity among preschool and elementary school-aged CPS investigated children is of particular concern. Children who are obese at very young ages are more likely to remain obese throughout childhood, and thus are more likely to experience physical and mental health comorbidities.  Furthermore, youth with a history of abuse or neglect are more likely to exhibit emotional and behavioral problems compared to their non-abused peers, and stress, trauma history, and compromised coping skills could all exacerbate unhealthy coping behaviors that lead to weight gain.