A small but telling study from the Johns Hopkins Children's Center reveals an ominous trend: more than expected, obesity shadows Baltimore's homeless children and their caregivers, putting them at high risk for heart disease, stroke and type 2 diabetes, among other conditions.
"Not long ago, homeless people were undernourished. Our study shows the pendulum has swung the other way: Obesity might be the new form of malnutrition among the homeless," says lead author Kathleen Schwarz, M.D., a gastroenterologist at the Children's Center. "More disturbing, it appears that being both poor and homeless may increase one's obesity risk."
The study, published in the March issue of the online journal Medscape General Medicine, looked at 60 children, ages 2 to 18, and 31 caregivers recruited from eight homeless shelters in Baltimore. Nearly half of the children (25 out of 60) were either overweight or at risk for becoming overweight. Children with weight in the 85th to 95th percentile for their age are considered "at risk," while those with weight above the 95th percentile are classified as overweight. The U.S. Centers for Disease Control does not use the term "obese" for children. Compared with children nationally, Baltimore's homeless poor had a higher percentage of at-risk or overweight children, pointing to homelessness as an added risk.
Researchers didn't monitor food intake or physical activity, but say low-cost, calorie-dense meals and fear of spending time outdoors in high-crime areas are the likely culprits.
None of the children younger than 7 years were overweight, but their body mass indexes (BMIs) increased with age, suggesting that obesity risk creeps up as children grow older.
Exploring the link between the weights of adults and those of children in their care, researchers found that 77 percent of the caregivers were overweight or obese, compared to 42 percent of children. "Scientists have long known that the children of overweight parents are likely to grow into overweight adults," Schwarz says. "We saw this dynamic playing out in our study."
These early findings from the Baltimore group may warn of a national obesity epidemic among America's more than 14.5 million homeless, researchers note, and spell financial and medical trouble.
"If what we saw in Baltimore's homeless turns out to be a national trend, we're headed for a crisis that would cost us hundreds of millions of dollars," Schwarz says. "That's before we even try to measure the toll in terms of human suffering and loss of life."
Prevention efforts should focus on ensuring healthier meals at homeless shelters, educating parents and caregivers, and providing space for indoor physical activities in high-crime areas, the researchers say.
Nine million children in the United States are considered overweight, according to the Institute of Medicine. If the current obesity trends continue, America's children could become the first generation in more than a century to have shorter life spans than their parents, experts warn.
The study was funded by the National Institutes of Health. Co-authors are Beth Garrett, R.N.; Jenifer Hampsey, R.D., both of the Johns Hopkins Children's Center; and Douglas Thompson, Ph.D., of the Maryland Medical Research Institute, Baltimore.
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