Understanding Disparities in Obesity and its Comorbidities in the US

Summary

Principal Investigator: Youfa Wang
Abstract: DESCRIPTION (provided by applicant): Understanding Disparities in Obesity and Its Comorbidities in the U.S. Obesity/overweight has become a public health crisis in the U.S., and currently affects 2/3 of adults and 1/3 of children. Obesity can serve as a good indicator of unhealthy lifestyles such as unhealthy diet and inadequate physical activity (PA), two key modifiable risk factors for many chronic diseases including Type 2 diabetes (T2D) and hypertension (HBP). National data show large ethnic/SES disparities in obesity, T2D, HBP and healthcare. Obesity is believed as the result of a large number of biological, behavioral, social, environmental and economic factors and the complex interactions between them that promote a positive energy balance. The determinants of these disparities are still poorly understood. Many speculations have been made regarding the major contributors based on a growing body of literature, which has focused largely on individual factors such as SES, body image, and lifestyle factors and in some recent studies regarding selected community characteristics. Our understanding of the relative contribution of these factors, the interplay between them, and the social, economic and environmental context on individual-level behaviors is limited. Our proposed 3-year study is a systematic investigation based on data collected from national surveys, large cohort studies and other sources and aims to understand the causes of ethnic/SES disparities in obesity and its co-morbidities (T2D and HBP) as well as the related health care in the U.S., both adults and children. We will use an interdisciplinary approach to study the determinants at the individual-, family-, and community- level using several sophisticated statistical methods: Aim 1: To study the modifiable determinants of ethnicity/SES disparities in obesity and main co-morbidities. We will study the contributions (in absolute and relative terms) of risk factors at the individual-, family-, and community-level, including psychosocial, behavioral, environmental, economic, and policy factors. Aim 1a: Study the contribution of individual-level (e.g., diet, PA, SES, social support, psychosocial factors), and family-level variables (e.g., SES, participation in food assistance programs, resemblance between parents and their children in diet, PA, and weight status);Aim 1b: Study the contribution of social context factors (e.g., food outlets, fitness facilities, food prices, community characteristics, school PE and recess policies, school food service). Aim 1c: Consider all related factors at multi-levels simultaneously to study their relative contributions. Aim 1d: Using similar approaches study T2D and HBP. Aim 1e: Conduct ecological/ aggregated analysis to study the underlying causes of the disparities at the state and metropolitan statistical area (MSA) levels. Aim 2: To study the influence of primary healthcare on the disparities of obesity and the causes of health care (related to obesity) disparities. Aim 3: To conduct simulation analyses using systems analysis approaches to examine the effects of potential interventions and scenarios for helping eliminate the ethnicity/SES disparities. Findings of this study will help achieve several of the objectives specified in the NIH PAR, and help direct future interventions to eliminate health disparities. PUBLIC HEALTH RELEVANCE: The proposed 3-year study is a systematic investigation based on data from national surveys and other sources to understand the individual-, family-, and community-level causes of ethnic/SES disparities in obesity and its co-morbidities including type 2 diabetes and hypertension as well as the related health care in the U.S. using an interdisciplinary approach.
Funding Period: ----------------2009 - ---------------2011-
more information: NIH RePORT

Top Publications

  1. pmc Association between obesity and metabolic co-morbidities among children and adolescents in South Korea based on national data
    Hyunjung Lim
    Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
    BMC Public Health 14:279. 2014
  2. pmc Race, place, and obesity: the complex relationships among community racial/ethnic composition, individual race/ethnicity, and obesity in the United States
    James B Kirby
    Agency for Healthcare Research and Quality, Rockville, MD 20850, USA
    Am J Public Health 102:1572-8. 2012
  3. pmc Between-group differences in nutrition- and health-related psychosocial factors among US adults and their associations with diet, exercise, and weight status
    Youfa Wang
    Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N Wolfe St, Baltimore, MD 21205, USA
    J Acad Nutr Diet 112:486-498.e3. 2012
  4. ncbi The global childhood obesity epidemic and the association between socio-economic status and childhood obesity
    Youfa Wang
    Johns Hopkins Global Center for Childhood Obesity, Department of International Health, Human Nutrition Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
    Int Rev Psychiatry 24:176-88. 2012
  5. pmc Sociodemographic disparities in the composition of metabolic syndrome components among adults in South Korea
    Hyunjung Lim
    Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
    Diabetes Care 35:2028-35. 2012
  6. pmc Demographic and socioeconomic correlates of adiposity assessed with dual-energy X-ray absorptiometry in US children and adolescents
    Nguyen T Tuan
    Johns Hopkins Global Center on Childhood Obesity and Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
    Am J Clin Nutr 96:1104-12. 2012
  7. pmc Association between childhood obesity and metabolic syndrome: evidence from a large sample of Chinese children and adolescents
    Fangfang Chen
    Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
    PLoS ONE 7:e47380. 2012
  8. pmc Influence of school beverage environment on the association of beverage consumption with physical education participation among US adolescents
    Hsin Jen Chen
    Hsin Jen Chen and Youfa Wang are with the Department of International Health, Johns Hopkins Global Center on Childhood Obesity, and the Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
    Am J Public Health 103:e63-70. 2013
  9. pmc Multivariable analysis of the association between fathers' and youths' physical activity in the United States
    Zeynep Isgor
    Health Policy and Administration, School of Public Health and Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
    BMC Public Health 13:1075. 2013
  10. pmc Adiposity assessments: agreement between dual-energy X-ray absorptiometry and anthropometric measures in U.S. children
    Nguyen T Tuan
    Johns Hopkins Global Center on Childhood Obesity, Department of International Health Human Nutrition Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Alive and Thrive Project and Strategic Information, Family Health International FHI 360, Hanoi, Vietnam
    Obesity (Silver Spring) 22:1495-504. 2014

Scientific Experts

  • Youfa Wang
  • May A Beydoun
  • Xiaoli Chen
  • Hsin Jen Chen
  • Hyunjung Lim
  • Nguyen T Tuan
  • Lisa M Powell
  • Zeynep Isgor
  • Fangfang Chen
  • James B Kirby
  • X Chen
  • S Li
  • Hong Xue
  • Lan Liang
  • Dongqing Hou
  • Ryowon Choue
  • Roy Wada
  • Tianyou Wang
  • Xiaoyi Shan
  • Di Zhao
  • Jie Mi
  • Xiaoyuan Zhao
  • Tuan Nguyen
  • Hong Cheng
  • Nancy F Butte
  • Ramona C Krauss
  • Joel Gittelsohn
  • Lisa Jahns
  • Lawrence J Cheskin
  • Monal R Shroff
  • Alan B Zonderman
  • Leiyu Shi
  • Hind A Beydoun
  • M S Treuth

Detail Information

Publications27

  1. pmc Association between obesity and metabolic co-morbidities among children and adolescents in South Korea based on national data
    Hyunjung Lim
    Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
    BMC Public Health 14:279. 2014
    ..We assessed the association between weight status and metabolic co-morbidities among South Korean children using nationally representative data...
  2. pmc Race, place, and obesity: the complex relationships among community racial/ethnic composition, individual race/ethnicity, and obesity in the United States
    James B Kirby
    Agency for Healthcare Research and Quality, Rockville, MD 20850, USA
    Am J Public Health 102:1572-8. 2012
    ..We explored the association between community racial/ethnic composition and obesity risk...
  3. pmc Between-group differences in nutrition- and health-related psychosocial factors among US adults and their associations with diet, exercise, and weight status
    Youfa Wang
    Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N Wolfe St, Baltimore, MD 21205, USA
    J Acad Nutr Diet 112:486-498.e3. 2012
    ..Large disparities exist across ethnic and socioeconomic status groups regarding obesity and other chronic diseases. Eliminating health disparities is a national priority in the United States...
  4. ncbi The global childhood obesity epidemic and the association between socio-economic status and childhood obesity
    Youfa Wang
    Johns Hopkins Global Center for Childhood Obesity, Department of International Health, Human Nutrition Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
    Int Rev Psychiatry 24:176-88. 2012
    ..In general, SES groups with greater access to energy-dense diets (low-SES in industrialized countries and high-SES in developing countries) are at increased risk of being obese than their counterparts...
  5. pmc Sociodemographic disparities in the composition of metabolic syndrome components among adults in South Korea
    Hyunjung Lim
    Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
    Diabetes Care 35:2028-35. 2012
    ..The SES-MetS association was not found in men. Central obesity + low HDL-C + hypertriglyceridemia was the most common MetS pattern regardless of the SES...
  6. pmc Demographic and socioeconomic correlates of adiposity assessed with dual-energy X-ray absorptiometry in US children and adolescents
    Nguyen T Tuan
    Johns Hopkins Global Center on Childhood Obesity and Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
    Am J Clin Nutr 96:1104-12. 2012
    ..Associations between demographic-socioeconomic characteristics and childhood obesity are complex in the United States...
  7. pmc Association between childhood obesity and metabolic syndrome: evidence from a large sample of Chinese children and adolescents
    Fangfang Chen
    Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
    PLoS ONE 7:e47380. 2012
    ..32-212.61; obesity: OR=249.99, 95% CI=79.51-785.98). Prevalence of MetS related components has reached high level among Beijing children who were overweight or obese. The association between metabolic disorders and obesity was strong...
  8. pmc Influence of school beverage environment on the association of beverage consumption with physical education participation among US adolescents
    Hsin Jen Chen
    Hsin Jen Chen and Youfa Wang are with the Department of International Health, Johns Hopkins Global Center on Childhood Obesity, and the Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
    Am J Public Health 103:e63-70. 2013
    ..We examined the association of adolescents' beverage consumption with physical activity and studied how their school beverage environment influences the association...
  9. pmc Multivariable analysis of the association between fathers' and youths' physical activity in the United States
    Zeynep Isgor
    Health Policy and Administration, School of Public Health and Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
    BMC Public Health 13:1075. 2013
    ..S. do not meet the recommended levels of daily physical activity. Parental influences such as parents' physical activity participation may play an important role in affecting youths' physical activity...
  10. pmc Adiposity assessments: agreement between dual-energy X-ray absorptiometry and anthropometric measures in U.S. children
    Nguyen T Tuan
    Johns Hopkins Global Center on Childhood Obesity, Department of International Health Human Nutrition Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Alive and Thrive Project and Strategic Information, Family Health International FHI 360, Hanoi, Vietnam
    Obesity (Silver Spring) 22:1495-504. 2014
    ..To evaluate performance of anthropometric measures relative to percentage body fat (%BF) measured by dual-energy X-ray absorptiometry in children...
  11. pmc The changing food outlet distributions and local contextual factors in the United States
    Hsin Jen Chen
    Johns Hopkins Global Center on Childhood Obesity, Department of International Health, Human Nutrition Program, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
    BMC Public Health 14:42. 2014
    ..S. This study examines the changes in food stores/services at the 5-digit Zip Code Tabulated Area (ZCTA5) level in the U.S., and assesses contextual factors associated with the changes...
  12. pmc Ethnic disparities in adolescent body mass index in the United States: the role of parental socioeconomic status and economic contextual factors
    Lisa M Powell
    Institute for Health Research and Policy, University of Illinois at Chicago, 1747 W Roosevelt Road, Chicago, IL 60608, USA
    Soc Sci Med 75:469-76. 2012
    ..A significantly large portion of the ethnic BMI gap, however, remained unexplained between black and white female adolescents...
  13. pmc Disparities in pediatric obesity in the United States
    Youfa Wang
    Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
    Adv Nutr 2:23-31. 2011
    ..g. white children and adolescents. Vigorous, effective interventions are needed to promote healthy lifestyles among U.S. young people and to reduce disparities in obesity...
  14. pmc How much of racial/ethnic disparities in dietary intakes, exercise, and weight status can be explained by nutrition- and health-related psychosocial factors and socioeconomic status among US adults?
    Youfa Wang
    Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
    J Am Diet Assoc 111:1904-11. 2011
    ..5%) in the racial/ethnic differences when controlling for SES. In conclusion, NHRPF may explain very few, but SES may contribute some of the racial/ethnic disparities in diet, exercise, and weight status in the United States...
  15. ncbi How active are American adolescents and have they become less active?
    S Li
    Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
    Obes Rev 11:847-62. 2010
    ..These national data show no clear evidence of declining PA among US adolescents in recent years. Reduced PA is not likely the major explanation of the recent increase in obesity among US adolescents...
  16. pmc Trends and correlates in meat consumption patterns in the US adult population
    Youfa Wang
    Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
    Public Health Nutr 13:1333-45. 2010
    ..Few studies have examined recent shifts in meat consumption (MC), differences among US population groups, and the influence of psychosocial-behavioural factors...
  17. pmc Socio-demographic disparities in distribution shifts over time in various adiposity measures among American children and adolescents: What changes in prevalence rates could not reveal
    May A Beydoun
    Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore
    Int J Pediatr Obes 6:21-35. 2011
    ..Overweight groups gained more adiposity over time, especially WC. Solely examining prevalence shifts masks pattern complexity...
  18. pmc Dietary intake patterns of low-income urban african-american adolescents
    Youfa Wang
    Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
    J Am Diet Assoc 110:1340-5. 2010
    ....
  19. pmc Do children and their parents eat a similar diet? Resemblance in child and parental dietary intake: systematic review and meta-analysis
    Y Wang
    Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
    J Epidemiol Community Health 65:177-89. 2011
    ..However, previous findings on child-parent resemblance in dietary intakes are mixed. We systematically reviewed and meta-analysed the association (correlations) based on published studies...
  20. pmc Food prices are associated with dietary quality, fast food consumption, and body mass index among U.S. children and adolescents
    May A Beydoun
    Center for Human Nutrition, Department of International Health, Johns Hopkins, Bloomberg School of Public Health, Baltimore, MD 21205, USA
    J Nutr 141:304-11. 2011
    ..S. children aged 2-9 y, higher FF-PI is associated with better dietary quality, whereas higher FV-PI is linked to higher BMI and lower fiber intake. Associations varied by family income in children for many dietary intake variables...
  21. pmc Is ideal body image related to obesity and lifestyle behaviours in African American adolescents?
    X Chen
    Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
    Child Care Health Dev 38:219-28. 2012
    ..Research on the association between ideal body image (IBI) and obesity and related lifestyle factors among African American children and adolescents is limited...
  22. pmc Serum antioxidant status is associated with metabolic syndrome among U.S. adults in recent national surveys
    May A Beydoun
    National Institute on Aging, National Institute of Health, Intramural Research Program, Baltimore, MD 21224, USA
    J Nutr 141:903-13. 2011
    ..S. adults with MetS, for the prevention of type 2 diabetes and various cardiovascular endpoints...
  23. pmc Americans with diet-related chronic diseases report higher diet quality than those without these diseases
    Xiaoli Chen
    Center for Human Nutrition, Department of International Health, Behavior and Society, Baltimore, MD 21205, USA
    J Nutr 141:1543-51. 2011
    ..Efforts are needed to promote healthy eating among Americans with diet-related chronic diseases; nutrition education and promotion of FL use may help...
  24. ncbi Who is missing the message? Targeting strategies to increase food label use among US adults
    Xiaoli Chen
    Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
    Public Health Nutr 15:760-72. 2012
    ..To evaluate the associations between sociodemographic and psychosocial characteristics and food label (FL) use in US adults...
  25. pmc Pathways linking socioeconomic status to obesity through depression and lifestyle factors among young US adults
    May A Beydoun
    National Institute on Aging, NIA NIH IRP, Baltimore, MD, USA
    J Affect Disord 123:52-63. 2010
    ..Future prospective studies are needed to examine potential mechanisms using physiological markers of depression, lifestyle and obesity...