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• W2025660735 abstract "The growing obesity epidemic in the United States is threatening the health of millions of children nationwide. Current data indicate that since the National Health and Nutrition Examination Study (NHANES)11 Nonstandard abbreviations: NHANES, National Health and Nutrition Examination Study; NHLBI, National Heart, Lung, and Blood Institute; NGHS, National Growth and Health Study; GEMS, Girls Health Enrichment Multisite Studies. II (1976 to 1980), the prevalence of overweight in children has doubled from 7% to 15% in children 6 to 11 years old and nearly tripled from 5% to 15% in adolescents 12 to 19 years old ((1)). Although childhood obesity is present across all demographic and social classes, certain subgroups of the U.S. population are at increased risk. In particular, African-American preadolescent and adolescent girls show higher rates of overweight compared with their white counterparts. According to NHANES 1999 to 2000, African-American girls are twice as likely to be overweight as white girls at 6 to 11 years old (22.2% vs. 11.6%, respectively) and 12 to 19 years of age (26.6% vs. 12.4%, p ≤ 0.05) ((1)). Likewise, data from the National Heart, Lung, and Blood Institute (NHLBI) National Growth and Health Study (NGHS) (1987 to 1997) on 9- to 10-year-old African-American and white girls show that African-American girls have significantly higher mean BMI than white girls at 9 years of age (18.5 vs. 17.5, p = 0.0001) and 10 years of age (19.8 vs. 18.4, p = 0.0001) ((2)). Findings also indicate that by the age of 19, over one-half of the African-American girls in the NGHS cohort were overweight, and more than one-third were obese ((3)). Because childhood overweight has been increasingly recognized as a public health problem, a considerable amount of research exploring the correlates of childhood overweight has emerged. A large number of factors both proximal and distal to the individual have been identified as contributing to the increasing prevalence of overweight among youth, including genetic, familial, socioeconomic, psychosocial, behavioral, and environmental factors ((4)). Although this work has begun to shed light on the complexity of the obesity epidemic and has been informative with respect to targeting prevention and treatment efforts, considerably less information is available regarding determinants of overweight among African-American girls in particular. The NHLBI NGHS, a biracial observational cohort study, provided a wealth of information about the development of obesity among African-American and white girls ((5), (6)). However, many questions remain unanswered. Phase 1 of the Girls Health Enrichment Multisite Studies (GEMS) program, which had the goal of developing and pilot testing culturally appropriate interventions to prevent excessive weight gain in 8- to 10-year-old African-American girls, provides an additional important opportunity to better understand the correlates of obesity in this population. Phase 1 of GEMS was a 2.75-year development phase during which investigators from four field centers (University of Memphis, University of Minnesota, Baylor College of Medicine, and Stanford University) with the assistance of a coordinating center (George Washington University) and participation by the NHLBI conducted formative evaluation to develop their individual obesity prevention approaches. The field centers then independently developed and pilot tested their own interventions during a 12-week pilot study. Although the interventions were different at each field center, evaluation protocols with key commonalities were used, providing a rich data set to examine correlates of overweight among a geographically diverse group of preadolescent African-American girls. Although not including an exhaustive list of all possible correlates of overweight, the papers in this supplement are unique in their focus on a wide range of potential correlates of obesity, including psychosocial, diet, physical activity, biological, and maturational factors. Ethnic disparities in prevalence of overweight highlight the importance of examining the cultural differences among children from different racial/ethnic backgrounds and their varied effects on adiposity. For example, African-American girls and women experience less social pressure about their weight, tend to be more satisfied with their bodies, and have less negative attitudes about overweight compared with white girls and women ((7), (8), (9), (10), (11), (12), (13), (14), (15), (16), (17), (18)). These cultural differences have been hypothesized to account, in part, for the higher prevalence of obesity observed among African-American women ((8), (19)). Alternatively, the greater acceptance of a wider range of body sizes and the rejection of the ultrathin ideal for African-American women may be protective from problems with self-esteem and disordered eating. The first paper by Beech et al. explores possible relationships between the cultural perspectives of parents, including acculturation and ethnic identity, and eating behavior, physical activity, and body image. Dietary factors play a key role in the development and maintenance of overweight. Examination of NHANES III (1988 to 1994) data showed that mean energy intake was highest among African-American compared with nonHispanic white and Hispanic girls 6 to 11 (1873 vs. 1765 and 1414 kcal, respectively) and 12 to 19 (2060 vs. 1948 and 1901 kcal, respectively) years old ((20)). Differences were also observed for percentage of energy from fat, with black girls showing higher percentages of energy from total fat compared with white girls 6 to 11 years old (34.6% vs. 33.3%, respectively) and African-American and Hispanic girls 12 to 19 years old (36.5% vs. 33.6% and 33.8%, respectively). Additional studies reveal race/ethnicity differences in other aspects of eating behavior. Findings from NGHS show that African-American girls were more than twice as likely to engage in weight-related eating practices (i.e., eating in front of television, eating alone, snack food, skipping meals) compared with their white counterparts ((21)). For example, in both years 1 and 5, compared with white girls, African-American girls were significantly more likely to eat while watching television, eat big helpings, eat snack food and fast food, and eat while doing homework (p = 0.001). NGHS findings also show that African-American girls had lower intakes of calcium and potassium and higher intakes of vitamins, fat, and calories ((22)). In this study, not only race, but income and education, also explained variations in eating behaviors. These findings suggest that it is important to consider not only certain “unhealthy” eating behaviors as likely contributors to overweight status, but also race and socioeconomic status as factors that mediate these behaviors. Data from NGHS showed that racial differences in dietary behaviors even after controlling for socioeconomic status and overweight in African-American girls do not seem to be associated with parental income or education ((22), (23)). The paper by Cullen et al. identifies anthropometric, parental (e.g., low-fat cooking practices), and psychosocial characteristics, and meal practices (e.g., breakfast skipping and number of meals and snacks consumed) associated with dietary intake among the GEMS girls. Correlates of key dietary intake variables thought to be related to weight status are explored, including consumption of total energy, percentage energy from fat, fruit, 100% fruit juice, vegetables, sweetened beverages, and water. Children's activity level, including time spent in sedentary activities such as television viewing and time spent engaged in physical activity, have been implicated as important correlates of overweight. In the last several years, there has been a rapid decline in physical activity levels among girls. Several studies have reported physical activity levels dropping as much as 50% during adolescence ((24), (25)). Although decreases in physical activity levels are persistent across several social and demographic conditions, declines are greatest among African-American girls. For example, in NGHS longitudinal analysis, Kimm et al. ((26)) found that median leisure time activity levels in black girls declined significantly more than white girls from the ages of 9 to 10 to 17 to 18 (100% vs. 64% decline, respectively, p < 0.001). Television viewing has been consistently associated with childhood obesity. Results from NHANES III (1988 to 1994) showed that BMI was positively related to television in children ((27)). NHANES III (1988 to 1994) also showed that children who watched more television were less likely to participate in vigorous activity and tended to have higher BMIs ((28)). Similarly, Eisenmann et al. ((29)) found that television viewing was positively related to BMI in girls (p < 0.05). Dowda et al. ((30)) found that girls who watched >4 hours per day were twice as likely to be overweight than those who watched <4 hours per day. The positive relationship between television viewing and obesity is particularly relevant to African-American girls because they tend to spend more time viewing than their white counterparts. For example, in NHANES III (1988 to 1994), 43.1% of black compared with 15.6% of white girls 8 to 16 years old watched >4 hours of television per day ((27)). Similarly, Eisenmann et al. ((29)) found that 53.7% of black compared with 12.9% of white girls watch >4 hours of television per day. Findings thus far indicate that African Americans not only spend more time in front of the television compared with their white counterparts, but their obesity status is also at least partially explained by their viewing status. NGHS data showed that at baseline, television viewing was positively associated with obesity in 9- to 10-year-old African-American girls ((23)). Despite the well-documented link between television viewing and overweight status, the mechanisms that link television viewing to higher BMI have not been established. In this supplement, Matheson et al. describe the amount and types of foods that African-American girls in GEMS consume while watching television and examine associations between girls’ BMI and the types of food they consume while watching television. Children who are more physically active tend to be less likely to be overweight ((31)), and many factors contribute to physical activity among African-American girls. The home environment is one factor that is understudied. The paper by Adkins et al. explores the relationship of GEMS girls’ physical activity levels with parental self-efficacy and support and with home and family environmental factors. Another key question of interest is the extent to which eating and physical activity behaviors are associated. The paper by Jago et al. examines cross-sectional relationships between physical activity and dietary behaviors among GEMS girls. The paper by Thompson et al. also explores this theme and examines the extent to which diet and physical activity changes covaried among 8- to 10-year-old African-American girls over the 12-week intervention period and the extent to which changes in diet and physical activity predicted 12-week changes in BMI. Early sexual maturation is a biological consideration in the development of pediatric obesity. Several studies examining maturation and adiposity have found that girls who experience menarche before 12 years of age are heavier and have a greater percentage of body fat compared with late-maturing girls ((32)). The prevalence of early maturation is particularly high among African-American girls ((33), (34)). In this supplement, Himes et al. describe associations between sexual maturation and body composition in the GEMS participants and reinforces the importance of considering sexual maturation in the classification of overweight and the development of obesity during adolescence. Finally, the increase in the prevalence of type 2 diabetes diagnosed among youth has been alarming ((35), (36)). Hyperinsulinemia/insulin resistance is a risk factor for future type 2 diabetes. Fasting insulin and blood lipids serve as direct indicators of subsequent risk and as biochemical markers of metabolically significant adiposity. The paper by Wilson et al. examines correlates of these biochemical markers in this understudied population of African-American girls. To summarize, this supplement provides informative data on a wide range of behavioral, psychosocial, and biological correlates of overweight among a geographically diverse group of young African-American girls. It should be noted that the papers are limited by the relatively small sample size of the GEMS Phase 1 trial, particularly papers that used data that were collected at fewer than the four field centers. In some cases, the lack of significant findings may be due to low power to detect statistically significant associations. Despite this limitation, several interesting themes with potential implications for intervention emerge throughout the supplement. For example, the papers by Adkins et al. and Cullen et al., in particular, show interesting associations between parental factors and girls’ dietary and physical activity behavior, highlighting the importance of parental involvement in obesity prevention and treatment interventions. Additionally, papers by Matheson et al., Jago et al., and Thompson et al. highlight the importance of linkages between diet and activity behaviors and, thus, the importance of addressing both diet and activity in the context of obesity-related interventions. Finally, the papers by Himes et al. and Wilson et al. highlight the importance of assessing maturational and biochemical factors associated with obesity. Although these papers do not provide definitive answers, this collection of papers raises important questions that need to be answered to help understand and ultimately address the problem of obesity among African-American girls and women. We thank Sara Solomon for her contributions to this overview. This research was funded by Grants UO1-HL62662, UO1-HL62663, UO1-HL62668, UO1-HL62732, and UO1-HL65160 from NHLBI, NIH." @default.
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• W2025660735 title "Correlates of Obesity in African‐American Girls: An Overview" @default.
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