Obesity found to be higher in preschoolers suspected of being maltreated

Obesity rates among preschoolers who have been investigated by child protective services for alleged maltreatment are nearly three times as high as children in the general population, a new study by researchers at the University of Illinois suggests.

The researchers found that obesity rates among CPS-investigated preschoolers ages 2 through 5 were 28 percent, versus 10 percent for their peers, and obesity was prevalent among other youth at risk of abuse/neglect as well.

"We looked at standardized weight-for-age measurements of obesity and found that more than one in four of the children investigated for abuse or neglect by CPS were what would be considered obese – at or above the 95th percentile" on the Centers for Disease Control and Prevention's growth charts, said study co-author Jesse Helton. "That compares to about one in six kids nationally and about one in five children on public aid."

Helton, who is a faculty member in the Children and Family Research Center, and co-author Janet Liechty estimated the prevalence of obesity using children's weight as reported by their caregivers and the CDC's sex-adjusted weight-for-age growth charts.

Prior research has shown that weight-for-age is an acceptable alternative to body mass index data for estimating obesity in population-level studies when data on both height and weight are not available, said Liechty, who is a professor of social work and of medicine at Illinois.

The prevalence of obesity among preschoolers and elementary school-aged children is of particular concern because it predisposes them to obesity as adults and the social stigma and lifelong health problems associated with it, including diabetes, cardiovascular disease, asthma, orthopedic problems and metabolic syndrome, Helton and Liechty wrote.

Participants for the study were drawn from the National Survey of Child and Adolescent Well-Being II, a nationwide survey that included more than 5,800 children, ages birth to 17 years, who were investigated for maltreatment during 2008.

"The survey is the only nationally representative data set that exists of children who were investigated for maltreatment, so it's an important data set to use," Liechty said. "Even though we didn't have all the measures of adiposity that we wanted, we had an acceptable proxy for it. If anything, research suggests that using weight-for-age may underestimate the prevalence of obesity, so it's a more conservative estimate than the BMI would give. It's unlikely that this measure would inflate the prevalence."

The problem of obesity among CPS-involved children points to a need for greater emphasis on proper nutrition, exercise and other behaviors that promote healthy weight during social services interventions, the researchers said.

While nutrition and exercise are on the list of things that caseworkers are supposed to address with parents and other caregivers, concerns about children's safety, education and stability take precedence, and nutrition is often so far down the list that it is not addressed, Helton said.

Children at risk of abuse/neglect are already predisposed to a host of physical and psychological problems, and obesity may add to those burdens.

"These kids face a lot of potential health challenges due to maltreatment, and there needs to be better monitoring so we can get a clearer picture of just how big the problem is and where targeted interventions need to be done," Helton said. "Oftentimes these kids are not only poor, but they're also at risk of being abused or neglected. They are different from children who are living in poverty, but in nurturing homes, and they need a monitoring system that reflects that."

Consistent with the majority of CPS cases, most of the children in the study were living with their biological parents following an abuse/neglect investigation, often in impoverished neighborhoods that were bereft of safe places for children to play outdoors and of grocery stores with fresh fruits and vegetables and other nutritious food.

Other research has shown that even when children are removed from their homes and placed in foster care or kinship care, frequently these homes also are in neighborhoods with similar barriers to healthy lifestyles, Helton said.

Boys were more likely to be obese than girls, the researchers found. About one in 2.4 (42 percent) of Latino boys ages 6 through 11 were obese, as were more than one-third (36 percent) of white boys ages 2 through 5.

Across all categories except for white girls, obesity rates were higher among children ages 2 through 11 than among older children (ages 12 and above).

Hispanic girls and African-American boys ages 12 through 17 had the lowest rates of obesity (9 percent and 14 percent, respectively).

Chronic maltreatment may have a greater impact on girls' weight status than on boys' weight status, however. A family history of CPS investigation quadrupled adolescent girls' odds of obesity, but did not have the same effect on boys, the researchers found.

The study, which is available online, is to be published in the journal Child Abuse and Neglect.