Childhood Obesity Among Hispanic Children in Florida

Introduction and PICOT Question

Latinos are among the fastest-growing populations in the United States. The community currently constitutes over 22% of all children below 18 years of age in the country. Of the total population of Latino children, over 45% are overweight or obese, compared to 25% of overweight children of white descent. Childhood obesity is a complex condition: when a child's weight exceeds the normal range for children of the same age and height, it is flagged as a health concern. The triggers of excess weight gain are broadly similar across age groups, but one's community background significantly influences obesity risk because it shapes the choices individuals make (CDC, 2016).

The United States faces a serious challenge with childhood obesity. Both children and adolescents are at significant risk of poor health outcomes as a result of obesity, and prevalence remains alarmingly high across these age groups. Obesity prevalence among children aged 2–19 years was estimated at 13.7 million. Specifically, prevalence stood at 13.9% among children aged 2 to 5 years, 18.4% among children aged 6 to 11 years, and 20.6% among those aged 12 to 19 years. Disparities exist across racial and ethnic groups: Hispanics report a prevalence rate of 25.8%, and non-Hispanic Black children report 22%, both considerably higher than non-Hispanic whites at 14.1%. Non-Hispanic Asians, at 11.0%, demonstrated the lowest prevalence among these groups (Hales et al., 2017).

PICOT Question: How do weight and other health-related outcomes (O) for children aged 2–19 years (P) participating in a dietary, physical education, and exercise program (I) compare to non-participants (C) over three years (T)?

Culture and Childhood Obesity

Obesity among Hispanic children is elevated in part because healthcare is not easily accessible to this population. Food swamps and high poverty levels are widespread, and the incidence of related health ailments is correspondingly high. Nevertheless, the Latino population has demonstrated the capacity to overcome these health challenges when adequate support is provided (Gonzalez, 2016). The continuing growth of the Latino community means that the elevated risk of developing obesity translates into a greater overall burden of diabetes, cancer, and other chronic conditions.

It is also notable that the incidence of diabetes is inversely proportional to the educational level of the head of household among children and adolescents aged 2 to 19 years. Obesity prevalence stands at 18.9% among children and adolescent youth in the lowest economic group and at 19.9% for those in the middle-income class. Those in the highest income groups show a prevalence rate of just 10.9%. Obesity prevalence is lowest among the highest-income groups of non-Hispanic Asian youth and Hispanic boys. Conversely, obesity prevalence is notably elevated among the highest-income group of non-Hispanic white children, Hispanic girls, and non-Hispanic Asian youth (Ogden et al., 2018). Among non-Hispanic Black girls, obesity prevalence does not differ significantly across income levels.

Consequences of Childhood Obesity

Obesity carries serious health consequences in adolescence and childhood, increasing morbidity and raising the likelihood of developing diabetes and cardiovascular disease. When cardiovascular risk factors linked to obesity in children are clustered — particularly dyslipidemia, hyperglycemia, hypertension, and inflammation — they strongly predict the onset of cardiovascular disease in adulthood. Furthermore, childhood obesity is associated with fatty liver disease, orthopedic complications, asthma, chronic kidney disease, ovarian hyperandrogenism, and obstructive sleep apnea (Caprio et al., 2008). From the child's perspective, a significant effect of obesity may be psychosocial, including social isolation, declining academic performance, and a diminished self-image.

Obesity in childhood is also a reliable predictor of obesity in adulthood. The Bogalusa Heart Study tracked a sample of 2,400 children aged 5 to 14 for an average of 17 years and found that Black children who were obese had an 83% likelihood of remaining obese in adulthood, compared to 68% for white children (Freedman et al., 2005). The relationship between obesity and the development of type 2 diabetes is particularly disproportionate among Native American, African American, and Hispanic adolescents. The SEARCH for Diabetes in Youth Study found that the proportion of all diabetes cases classified as type 2 varied significantly by ethnicity among individuals aged 10 to 19: 6% among non-Hispanic whites, 22% among Hispanics, 33% among African Americans, 40% among Asian/Pacific Islanders, and 76% among Native Americans (SEARCH for Diabetes in Youth Study Group et al., 2006).

Although type 2 diabetes among adolescents remains relatively uncommon overall, it is rising in specific ethnic and racial groups. Among Pima Indians, 2.2% of those aged 10 to 14 and 5% of those aged 15 to 19 were diagnosed with type 2 diabetes in the 1990s — increases from zero and 1%, respectively, recorded twenty years earlier. Impaired fasting glucose, a precursor to type 2 diabetes, was identified in 13% of Mexican American adolescents, 7% of non-Hispanic white adolescents, and 4% of non-Hispanic Black adolescents in the NHANES 1999–2002 data (Kelsey et al., 2014). Obese youth also exhibit higher rates of hypertension, with no clear ethnic disparities once data are controlled for obesity levels. The occurrence of dyslipidemia similarly increases with obesity; triglyceride levels are notably elevated in Mexican Americans with obesity, while they are lowest among African American children. HDL cholesterol levels are inversely proportional to triglyceride levels.

Liver disorders in obese youth range from steatosis and steatohepatitis to cirrhosis. Obese boys are more likely to present with fatty liver than obese girls, and this difference varies significantly by race and ethnicity. In one study of obese children aged 2 to 19, fatty liver disease was found in 50% of Hispanic children, 35% of white children, and only 10% of Black children. Obesity in children is also associated with a poor quality of life, and this negative impact is observed broadly across racial and ethnic groups. At the population level, national healthcare spending is estimated to increase by $149 million every year due to obesity, and premature deaths in the United States are largely attributable to unhealthy eating habits.

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