Addressing Obesity and Overweight Among Children Within the Child Welfare System
Childhood obesity is an epidemic in the United States — but research indicates that for adolescents of low economic status and those in the child welfare system, health outlooks may be especially bleak.
The precipitous rise of childhood obesity rates in the U.S. has been a significant cause for concern among health care providers in the past decade, and for good reason — being overweight significantly increases the risk of developing chronic health problems such as cardiovascular disease, diabetes and some types of cancer. The rate of childhood obesity in the U.S. is among the highest in the world: 18.5 percent of those between ages 2 and 19 are obese, according to the Centers for Disease Control and Prevention.
In recognition of National Childhood Obesity Awareness Month, we spoke with Janet Schneiderman, interim chair of the Department of Nursing and research associate professor in the Department of Children, Youth and Families at the USC Suzanne Dworak-Peck School of Social Work, about the social and economic factors associated with obesity and overweight among youth populations.
USC Suzanne Dworak-Peck School of Social Work: What initially sparked your interest in the study of overweight and obesity in children?
Janet Schneiderman: At the USC Suzanne Dworak-Peck School of Social Work, I conduct research focused on medical neglect and maltreatment of children in the child welfare system, as well as the obstacles inhibiting child welfare caregivers' access to pediatric health care.
My interest in childhood overweight and obesity arose in part due to my previous work in USC’s nursing department, where I taught public health, pediatrics and obstetrics nursing. As part of the public health program, I arranged for nursing students to visit the homes of new foster parents.
In these homes, I met some of the sickest children I’ve ever encountered, and realized that caregivers are often ill-equipped to offer foster children access to the health care and nutrition that they need. At the time, there was very little research on the physical health of children in the child welfare system, and I felt compelled to examine the issue further.
USC: What are some of the health issues commonly experienced by children in the child welfare system, and what factors contribute to the prevalence of these conditions?
JS: The majority of children in the welfare system come from or live with low-income families whose access to healthy foods is limited, both by geographic and financial barriers. This often leads families to feed their children food that is low-cost and easily accessible, but that is also low in nutrients and high in calories. As a result, those in child welfare are often overweight or obese.
Neglect or maltreatment may also increase a child’s likelihood to suffer from chronic conditions like overweight. This may seem counterintuitive, since we tend to think of neglected or maltreated children as underweight, but research indicates that these children are actually more likely to be overweight when compared with the national average.
Additionally, many children in the welfare system are born to mothers with addiction issues, leading to a prevalence of fetal alcohol syndrome. Other chronic health issues that may be exacerbated by stress — such as asthma — are also common, especially among children who have experienced maltreatment.
USC: How do the experiences of these children compare with those of children who are not in the child welfare system, but who come from similar economic backgrounds?
JS: Most children in the child welfare system remain at home or with a relative who acts as their guardian. For these children, the environmental factors and various stressors that contribute to childhood overweight are similar to those experienced by other low-income children outside of the foster care system.
However, those who enter the foster care system tend to experience higher rates of chronic illness than other children of similar economic status. The issue is complicated by the tumultuous nature of the foster care system — children’s placements change often, making it difficult to keep track of their health records or prescriptions and ensure that they have access to the care they need. This, in turn, creates more stress for foster children and their families, which can lead to a cycle of medical neglect and chronic illness.
USC: What studies have you been involved with recently on this subject? Have there been any particularly interesting or surprising findings that have emerged from your research?
JS: A few years ago, I conducted a study on obesity and overweight in children entering the child welfare system and those who stayed in long-term foster care, and found that those in long-term foster care were the most obese. Within the foster care system, obesity rates are highest among Latino children.
More recently, I’ve been using Penelope K. Trickett’s data on adolescent development to examine obesity and overweight among children in the child welfare system compared with children who live in the same communities and are exposed to similar environmental and economic factors, but are not part of the system. There is no significant difference between the rates of overweight for these two groups — except, interestingly, girls who have suffered neglect or sexual abuse experience a higher weight trajectory from age 16 onward than the comparison girls did.
USC: What can be done to combat these trends?
JS: My research has always focused on potential causes of obesity and overweight — but when it comes to solutions, I firmly believe that the later an intervention is implemented, the less likely it is to succeed. Research confirms the notion that adolescents who are already overweight are likely to remain chronically overweight into adulthood. The sooner childhood overweight is addressed, the more effective the effort will be. In addition, helping caregivers of children involved in child welfare understand the importance of healthy food choices and of the need for physical activity is imperative.