Major Finding: Most children – 89% – drank sugar-sweetened beverages, and half of the children snacked “often” or “very often” on chips, cheese puffs, and similar items.

Data Source: A survey of 136 parents or guardians of children aged 2-11 years with a body mass index at the 95th percentile or greater for age and sex. The families were all low income.

Disclosures: Dr. Cluss said she had no relevant financial disclosures.

DENVER – Drinking sugar-sweetened beverages, not eating breakfast, and eating too many low-nutrient, high-fat snacks were among the modifiable risk factors for obesity found in a cross-sectional survey of obese, low-income children.

Remind parents and guardians of the importance of eating breakfast every day, particularly if they have an older, obese child, Patricia Cluss, Ph.D., said at the meeting.

In addition, younger children were significantly less likely to eat enough vegetables, according to the survey of 136 parents or guardians of children aged 2-11 years with a body mass index at the 95th percentile or greater for age and sex.

“I'm not sure we would have predicted this: As children got older, they ate more vegetables,” Dr. Cluss said.

Most children – 89% – drank sugar-sweetened beverages. “This is probably not a surprise to this audience,” Dr. Cluss said.

Counsel all your families with obese children to eliminate or significantly reduce their consumption of sugar-sweetened beverages, Dr. Cluss said.

The total number of meals and snacks eaten per day was another modifiable factor identified in the study. A total of 28% of parents reported their obese child ate five or more meals and snacks per day.

Intake of low-nutrient, high-fat snacks was another modifiable risk factor, according to the study. Half the children snacked “often” or “very often” on chips, cheese puffs, and similar items. “It's horrifying to see how much of their daily calorie consumption – these are kids in the 99th percentile for BMI – can come from high-calorie snacks with almost no nutrition,” said Dr. Cluss, a psychiatrist at the University of Pittsburgh.

Dr. Cluss, lead researcher Linda J. Ewing, Ph.D., and their associates assessed this population because, although approximately 30% of children and adolescents are overweight or obese, minorities and low-income groups are at higher risk.

The cohort of children skewed older (half were aged 9-11 years). In addition, 39% had a BMI in the 99th or greater percentile, “so this is a very obese sample.” The majority of caregivers were women (96%) and parents (94%); most of the 6% who were guardians were close relatives. The mean age of the adults was 35 years (range, 22-71 years). A majority were black (75%), 20% were white, and 5% were other race/ethnicities. About 93% of adults had at least a high school diploma.

More than two-thirds (71%) of parents and guardians were obese themselves, “but that was not a requirement for participation,” Dr. Cluss said.

However, having an obese caregiver significantly increased the chances the child was eating five or more meals/snacks per day.

A meeting attendee asked Dr. Cluss if she recommends no snacks or healthy snacks. “On the surface, eating three meals and two snacks may not be all that bad, depending on how healthy the snack is,” she replied.

All families in the study were insured by Medicaid. The majority (79%) lived in households with annual incomes of &dollar;25,000 or less, which included 49% with household incomes of &dollar;15,000 or less. The relatively lower-income caregivers were significantly more likely to shop for food at a convenience store as compared with a supermarket, according to Dr. Cluss said.

“This could reflect their preference, but the lower-income sample may be living in areas where a convenience store is the only place they can buy food if they don't have transportation,” she explained.

The majority of surveys were completed in a pediatric primary care clinic setting, but a few were done in the child's home when transportation was an issue, she said.

Overall, 37% of adults in the study said they “almost never” ate together with the child without the television on. However, caregivers and children from households with annual incomes of &dollar;15,000 or less were more likely to eat without the television on, which Dr. Cluss called an intriguing finding that warrants further research.

Dr. Cluss said they plan to validate these initial results using food recall data. She said, “I think future food recall data will give us a better picture versus the initial survey data.”

To view a video interview with Dr. Cluss, scan this QR code with a smart phone.

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'It's horrifying to see how much of their daily calorie consumption … [is] from snacks with almost no nutrition.'

Source DR. CLUSS

Modifiable Factors Found in Obese Children