Is Unhealthy Weight Being Overlooked in Foster Care? Comparing Body Mass Index of Children in out-of-Home Care with National Estimates

Purpose: Childhood obesity continues to be a public health concern. There are currently many efforts underway to prevent obesity and promote healthy eating and exercise for most of the U.S. child population (Story, Sallis, & Orleans, 2009). However, children in foster care are overlooked in epidemiological studies and evidence-based intervention strategies. This omission is curious considering the evidence that children who have been sexually abused and physically neglected are at risk for both high and low body mass indexes (BMI; Steele & Buchi, 2008). No study to date has examined the full range of BMI, from low to high, for children in the foster care system. Therefore, the purpose of this study is to compare national estimates of BMI for children in out-of-home care and children in the general U.S. population.

Methods: The National Survey of Child and Adolescent Well-being Round 2 (NSCAW II), which is a study of children who have come into contact with the child welfare system in 2008, was used for this study. Baseline data on 2 to 17 year-olds placed in out-of-home care following a maltreatment investigation was used (N=2505). National estimates were taken from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) of 2 to 19 year-olds (Ogden et al., 2010; N=3281). BMI was used to classify weight status based on gender-specific BMI-for-age growth charts developed by the CDC. Recommended cutoff criteria consists of 4 levels: BMI values above the 95th percentile are considered obese, above the 85th percentile are considered overweight, between the 5th percentile and 85th percentile are considered at a healthy weight, and below the 5th percentile are considered underweight. Sample weights were used to obtain both NSCAW II and NHANES bivariate and multivariate results.

Results: Only 36% of children in out-of-home care have a healthy BMI, compared to 66% for all children in the U.S. Further, 60% of children in out-of-home care are overweight or obese – a rate that is almost twice the national rate of 31%. Slightly fewer than 5% of children in out-of-home care are underweight, compared to slightly more than 3% of children in the U.S. Among children in out-of-home care, the percentage underweight is highest among children 2 to 5 years old (9%) – a rate that is over 3 times the national rate of 2.8%. Regression models showed that Hispanic males are 2.4 times greater odds (p<.05) of being obese compared to Caucasian males in care. For females, younger age was associated with 2.4 (p<.06) and 3.0 (p<.05) greater odds of being obese compared to adolescent females in care.

Implications: This study reports the first national estimates of BMI for children in the foster care system. Findings show that a disproportionate number of children in foster care are overweight or obese compared to national averages, with Hispanic males and younger females at the highest risk for obesity. Child welfare providers need to consider healthy BMI as a well-being goal and possibly target nutritional services to Hispanic males and young females.