To examine the association between changes in contextual economic factors on childhood obesity in the US.
We combined data from 2003, 2007, and 2011/2012 National Surveys of Children’s Health for 129,781 children aged 10–17 with 27 state-level variables capturing general economic conditions, labor supply, and the monetary or time costs of calorie intake, physical activity, and cigarette smoking. We employed regression models controlling for demographic factors and state and year fixed effects. We also examined heterogeneity in economic effects by household income.
Obesity risk increased with workforce proportion in blue-collar occupations, urban sprawl, female labor force participation, and number of convenience stores but declined with median household income, smoking ban in restaurants, and full service restaurants per capita. Most effects were specific to low income households, except for density of supercenters/warehouse clubs which was significantly associated with higher overweight/obesity risk only in higher income households.
Conclusions for Practice
Changes in state-level economic factors related to labor supply and monetary or time cost of calorie intake may affect childhood obesity especially for children in low-income households. Policymakers should consider these effects when designing programs aimed at reducing childhood obesity.
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Anderson, P. M., Butcher, K. F., & Levine, P. B. (2003). Maternal employment and overweight children. Journal of Health Economics, 22(3), 477–504.
Auld, M. C., & Powell, L. M. (2009). Economics of food energy density and adolescent body weight. Economica, 76(304), 719–740. https://doi.org/10.1111/j.1468-0335.2008.00709.x.
Beydoun, M. A., Powell, L. M., Chen, X., & Wang, Y. (2011). Food prices are associated with dietary quality, fast food consumption, and body mass index among U.S. children and adolescents. Journal of Nutrition, 141(2), 304–311. https://doi.org/10.3945/jn.110.132613.
Cawley, J., & Liu, F. (2012). Maternal employment and childhood obesity: A search for mechanisms in time use data. Economics and Human Biology, 10(4), 352–364. https://doi.org/10.1016/j.ehb.2012.04.009.
Centers for Disease Control. (1989). The surgeon general’s 1989 report on reducing the health consequences of smoking: 25 years of progress. MMWR. Morbidity and Mortality Weekly Report, 38, 1.
Chou, S. Y., Grossman, M., & Saffer, H. (2004). An economic analysis of adult obesity: Results from the behavioral risk factor surveillance system. Journal of Health Economics, 23(3), 565–587. https://doi.org/10.1016/j.jhealeco.2003.10.003.
Courtemanche, C. (2009). Longer hours and larger waistlines? The relationship between work hours and obesity. Forum for Health Economics & Policy, 12, 2.
Courtemanche, C. (2011). A silver lining? The connection between gasoline prices and obesity. Economic Inquiry, 49(3), 935–957.
Courtemanche, C., & Carden, A. (2011). Supersizing supercenters? The impact of Walmart supercenters on body mass index and obesity. Journal of Urban Economics, 69(2), 165–181.
Courtemanche, C., Pinkston, J., Ruhm, C., & Wehby, G. (2016). Can changing economic factors explain the rise in obesity? Southern Economic Journal, 82(4), 1266–1310.
Courtemanche, C., Tchernis, R., & Zhou, X. (2017). Parental work hours and childhood obesity: Evidence using instrumental variables related to sibling school eligibility. Working paper no. 23376. Cambridge, MA: National Bureau of Economic Research.
Fertig, A., Glomm, G., & Tchernis, R. (2009). The connection between maternal employment and childhood obesity: Inspecting the mechanisms. Review of Economics of the Household, 7(3), 227.
Fletcher, J. M., Frisvold, D. E., & Tefft, N. (2010). The effects of soft drink taxes on child and adolescent consumption and weight outcomes. Journal of Public Economics, 94(11), 967–974. https://doi.org/10.1016/j.jpubeco.2010.09.005.
Freedman, D. S., Mei, Z., Srinivasan, S. R., Berenson, G. S., & Dietz, W. H. (2007). Cardiovascular risk factors and excess adiposity among overweight children and adolescents: The Bogalusa Heart Study. Journal of Pediatrics, 150(1), 12–17.e12. https://doi.org/10.1016/j.jpeds.2006.08.042.
Greene, W. (2002). The bias of the fixed effects estimator in nonlinear models. New York: Stern School of Business, New York University.
Han, J. C., Lawlor, D. A., & Kimm, S. Y. (2010). Childhood obesity. The Lancet, 375(9727), 1737–1748. https://doi.org/10.1016/s0140-6736(10)60171-7.
Hannon, T. S., Rao, G., & Arslanian, S. A. (2005). Childhood obesity and type 2 diabetes mellitus. Pediatrics, 116(2), 473–480. https://doi.org/10.1542/peds.2004-2536.
Hawkes, C., Smith, T. G., Jewell, J., Wardle, J., Hammond, R. A., Friel, S., et al. (2015). Smart food policies for obesity prevention. The Lancet, 385(9985), 2410–2421. https://doi.org/10.1016/s0140-6736(14)61745-1.
Jacques-Tiura, A. J., & Greenwald, M. K. (2016). Behavioral economic factors related to pediatric obesity. Pediatric Clinics of North America, 63(3), 425–446. https://doi.org/10.1016/j.pcl.2016.02.001.
Karnik, S., & Kanekar, A. (2012). Childhood obesity: A global public health crisis. International Journal of Preventive Medicine, 3(1), 1–7.
Kutner, M., Greenburg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of america’s adults: Results from the 2003 national assessment of adult literacy. NCES 2006-483. Washington, DC: National Center for Education Statistics.
Larson, N., Wall, M., Story, M., & Neumark-Sztainer, D. (2013). Home/family, peer, school, and neighborhood correlates of obesity in adolescents. Obesity, 21(9), 1858–1869.
Liechty, J. M., Saltzman, J. A., & Musaad, S. M. (2015). Health literacy and parent attitudes about weight control for children. Appetite, 91, 200–208. https://doi.org/10.1016/j.appet.2015.04.010.
Lobstein, T., Jackson-Leach, R., Moodie, M. L., Hall, K. D., Gortmaker, S. L., Swinburn, B. A., et al. (2015). Child and adolescent obesity: Part of a bigger picture. The Lancet, 385(9986), 2510–2520. https://doi.org/10.1016/s0140-6736(14)61746-3.
Mellor, J. M. (2011). Do cigarette taxes affect children’s body mass index? The effect of household environment on health. Health Economics, 20(4), 417–431.
Morrissey, T. W. (2013). Trajectories of growth in body mass index across childhood: Associations with maternal and paternal employment. Social Science and Medicine, 95, 60–68. https://doi.org/10.1016/j.socscimed.2012.05.038.
Morrissey, T. W., Dunifon, R. E., & Kalil, A. (2011). Maternal employment, work schedules, and children’s body mass index. Child Development, 82(1), 66–81. https://doi.org/10.1111/j.1467-8624.2010.01541.x.
Ng, M., Fleming, T., Robinson, M., Thomson, B., Graetz, N., Margono, C., et al. (2014). Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: A systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 384(9945), 766–781. https://doi.org/10.1016/S0140-6736(14)60460-8.
Oddo, V. M., Nicholas, L. H., Bleich, S. N., & Jones-Smith, J. C. (2016). The impact of changing economic conditions on overweight risk among children in California from 2008 to 2012. Journal of Epidemiology and Community Health, 70(9), 874–880. https://doi.org/10.1136/jech-2015-207117.
Ogden, C. L., Carroll, M. D., Fryar, C. D., & Flegal, K. M. (2015). Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief, 219(219), 1–8.
Ogden, C. L., Carroll, M. D., Lawman, H. G., Fryar, C. D., Kruszon-Moran, D., Kit, B. K., et al. (2016). Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA, 315(21), 2292–2299. https://doi.org/10.1001/jama.2016.6361.
Orzechowski, W., & Walker, R. (2010). The tax burden on tobacco: Historical compilation (Vol. 45). Arlington, VA: Orzechowski and Walker.
Powell, L. M. (2009). Fast food costs and adolescent body mass index: Evidence from panel data. Journal of Health Economics, 28(5), 963–970. https://doi.org/10.1016/j.jhealeco.2009.06.009.
Powell, L. M., Auld, M. C., Chaloupka, F. J., O’Malley, P. M., & Johnston, L. D. (2007a). Associations between access to food stores and adolescent body mass index. American Journal of Preventive Medicine, 33(4, Supplement), S301–S307. https://doi.org/10.1016/j.amepre.2007.07.007.
Powell, L. M., & Bao, Y. (2009). Food prices, access to food outlets and child weight. Economics and Human Biology, 7(1), 64–72. https://doi.org/10.1016/j.ehb.2009.01.004.
Powell, L. M., & Chaloupka, F. J. (2009). Food prices and obesity: Evidence and policy implications for taxes and subsidies. Milbank Quarterly, 87(1), 229–257. https://doi.org/10.1111/j.1468-0009.2009.00554.x.
Powell, L. M., Chriqui, J., & Chaloupka, F. J. (2009). Associations between state-level soda taxes and adolescent body mass index. Journal of Adolescent Health, 45(3 Suppl), S57–63. https://doi.org/10.1016/j.jadohealth.2009.03.003.
Powell, L. M., Han, E., & Chaloupka, F. J. (2010). Economic contextual factors, food consumption, and obesity among US adolescents. The Journal of Nutrition, 140(6), 1175–1180. https://doi.org/10.3945/jn.109.111526.
Powell, L. M., Johnston, L. D., Auld, M. C., O’Malley, P. M., & Chaloupka, F. J. (2007b). Access to fast food and food prices: Relationship with fruit and vegetable consumption and overweight among adolescents. In K. Bolin & J. Cawley (Eds.), The economics of obesity (Vol. 17, pp. 23–48). Bingley: Emerald Group Publishing Limited. https://doi.org/10.1016/s0731-2199(06)17002-8.
Ruhm, C. J. (2008). Maternal employment and adolescent development. Labour Economics, 15(5), 958–983. https://doi.org/10.1016/j.labcco.2007.07.008.
Sen, B. (2012). Is there an association between gasoline prices and physical activity? Evidence from American time use data. Journal of Policy Analysis and Management, 31(2), 338–366.
Simmonds, M., Llewellyn, A., Owen, C., & Woolacott, N. (2016). Predicting adult obesity from childhood obesity: A systematic review and meta-analysis. Obesity Reviews, 17(2), 95–107.
Sturm, R., & Datar, A. (2005). Body mass index in elementary school children, metropolitan area food prices and food outlet density. Public Health, 119(12), 1059–1068.
Sturm, R., Powell, L. M., Chriqui, J. F., & Chaloupka, F. J. (2010). Soda taxes, soft drink consumption, and children’s body mass index. Health Affairs, 29(5), 1052–1058.
Wang, Y. C., McPherson, K., Marsh, T., Gortmaker, S. L., & Brown, M. (2011). Health and economic burden of the projected obesity trends in the USA and the UK. The Lancet, 378(9793), 815–825. https://doi.org/10.1016/s0140-6736(11)60814-3.
Yin, H. S., Sanders, L. M., Rothman, R. L., Shustak, R., Eden, S. K., Shintani, A., et al. (2014). Parent health literacy and “obesogenic” feeding and physical activity-related infant care behaviors. Journal of Pediatrics, 164(3), 577–583.e571. https://doi.org/10.1016/j.jpeds.2013.11.014.
Zhao, Z., & Kaestner, R. (2010). Effects of urban sprawl on obesity. Journal of Health Economics, 29(6), 779–787.
Ziol-Guest, K. M., Dunifon, R. E., & Kalil, A. (2013). Parental employment and children’s body weight: Mothers, others, and mechanisms. Social Science and Medicine, 95, 52–59. https://doi.org/10.1016/j.socscimed.2012.09.004.
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Guarnizo-Herreño, C.C., Courtemanche, C. & Wehby, G.L. Effects of Contextual Economic Factors on Childhood Obesity. Matern Child Health J 23, 1317–1326 (2019). https://doi.org/10.1007/s10995-019-02777-6
- Body Mass Index
- Economic factors