Obesity disparities greater among children attending racially segregated schools
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Racial and ethnic disparities in obesity prevalence are greater among children attending more racially segregated schools compared with those attending integrated schools, according to study findings published in Obesity.
In data obtained from California public schools, obesity prevalence rates among Filipino, Latino and Black children attending racially diverse schools were much closer to the rates observed in white children, whereas in schools where most of the student body was from a racial/ethnic minority background, the prevalence of obesity among Filipino, Latino and Black children was significantly greater compared with white children attending a mostly white-segregated school.
“Segregation is an important place-level factor that contributes to racial/ethnic obesity disparities among school-aged children,” Brisa N. Sánchez, PhD, the Dornsife Endowed Professor of Biostatistics in the department of epidemiology and biostatistics at Drexel University in Philadelphia, told Healio. “The research suggests that to close racial/ethnic obesity disparities, leveling the playing field is important. This could be done by ensuring schools and their surrounding communities in poor and disadvantaged places have similar resources as those in schools attended by predominately white children.”
Sánchez and colleagues conducted a cross-sectional study of 1,271,980 students enrolled in fifth, seventh and ninth grades in 8,933 California public schools during the 2018-2019 school year who participated in the California FitnessGram physical fitness test. BMI calculations were collected from FitnessGram assessments and compared with the CDC’s BMI reference distributions to categorize children into a healthy fitness zone, needs improvement or high risk, with needs improvements corresponding to having overweight and high risk corresponding to obesity. Schools were considered to be integrated if they had unmasked data available for more than 10 children of color and 10 white children. Schools labeled as segregated toward children of color had data available for more than 10 children of color but 10 or fewer white children, whereas white segregated schools had data available for 10 children of color or fewer, and more than 10 white children.
Obesity rates differ between segregated, integrated schools
In the full study cohort, Latino children had the highest prevalence of overweight or obesity at 48%, followed by Black children at 42%, Filipino children at 31%, white children at 28% and Asian children at 24%. White students had similar rates of overweight and obesity in both integrated and segregated schools.
Among students attending integrated schools, the difference in overweight and obesity prevalence between Latino and white children shrunk from 19% overall to 11%. The gap between Black and white children decreased from 13% overall to 6%, and the difference in overweight and obesity prevalence between Filipino and white students declined from 3% overall to white children having a 1% higher prevalence rate compared with Filipino children.
Among children attending segregated schools, the gap in overweight and obesity prevalence increased between Latino and white children from 19% overall to 22%, between Black and white children from 13% overall to 18% and between Filipino and white children from 3% overall to 8%. No differences were observed between white and Asian students in any school setting.
Steps for reducing obesity disparities in schools
Sánchez said clinicians’ knowledge about the influence of place-level characteristics on obesity can enhance their impact on obesity prevention and reductions in obesity disparities.
“Clinical recommendations for management of child obesity could incorporate features of children’s schools or school neighborhoods,” Sánchez said. “As a simple example, more specific counseling for children and their families about physical activity can be tailored to include recommendations to get involved in school-based sports, if they are available, or more strongly recommend walking to and from schools if safe routes to schools are available. These physical activity resources and safety near and around schools are all factors associated with segregation.”
Additionally, Sánchez emphasized the importance of health care professionals’ roles in assisting with the development of population-level interventions to reduce obesity disparities.
“Population-level interventions are fundamental for obesity prevention and reductions of disparities because they apply to entire populations and can improve health outcomes for all,” Sánchez said. “Effective design of these population interventions requires understanding the views of many stakeholders, from the needs of communities, to how people’s health or disease profiles manifest, and how clinicians address those in the delivery of health care. For example, physicians may lead efforts within their communities or lend their expertise on child obesity to others’ efforts, such as supporting policies to regulate sugar-sweetened beverages or implement safe routes to schools. By understanding environmental contributions to obesity and disparities, physicians and other clinicians can wield their powerful voices and expertise to improve population health beyond clinical encounters.”
For more information:
Brisa N. Sánchez, PhD, can be reached at bns48@drexel.edu.
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