The home environment and childhood obesity in low-income households: indirect effects via sleep duration and screen time

Abstract

BackgroundChildhood obesity disproportionally affects children from low-income households. With the aim of informing interventions, this study examined pathways through which the physical and social home environment may promote childhood overweight/obesity in low-income households.MethodsData on health behaviors and the home environment were collected at home visits in low-income, urban households with either only normal weight (n = 48) or predominantly overweight/obese (n = 55) children aged 6–13 years. Research staff conducted comprehensive, in-person audits of the foods, media, and sports equipment in each household. Anthropometric measurements were collected, and children’s physical activity was assessed through accelerometry. Caregivers and children jointly reported on child sleep duration, screen time, and dietary intake of foods previously implicated in childhood obesity risk. Path analysis was used to test direct and indirect associations between the home environment and child weight status via the health behaviors assessed.ResultsSleep duration was the only health behavior associated with child weight status (OR = 0.45, 95% CI: 0.27, 0.77), with normal weight children sleeping 33.3 minutes/day longer on average than overweight/obese children. The best-fitting path model explained 26% of variance in child weight status, and included paths linking chaos in the home environment, lower caregiver screen time monitoring, inconsistent implementation of bedtime routines, and the presence of a television in children’s bedrooms to childhood overweight/obesity through effects on screen time and sleep duration.ConclusionsThis study adds to the existing literature by identifying aspects of the home environment that influence childhood weight status via indirect effects on screen time and sleep duration in children from low-income households. Pediatric weight management interventions for low-income households may be improved by targeting aspects of the physical and social home environment associated with sleep.

Family Chaos and Child Functioning in Relation to Sleep Problems Among Children at Risk for Obesity

“…A socioecological framework conceptualizes a child within a family and the causal arrows of child and family factors may be bi-directional, though empirical evidence supports family chaos as a mediating variable for child problem behaviors (Bronfenbrenner, 1986; Evans, Gonnella, Marcynyszyn, Gentile, & Salpekar, 2005). Regarding risk for obesity, Appelhans and colleagues recruited low-income families (18% Hispanic) and found a significant positive relationship between family chaos and child weight status that was mediated by short sleep duration and higher screen time (Appelhans et al, 2014). While the study provided initial evidence linking family chaos with sleep duration, other important factors were not assessed, including child emotional and behavioral problems.…”

Obesity and Altered Sleep: A Pathway to Metabolic Derangements in Children?

“…Such evidence would support that inadequate amounts of sleep will lead to endoplasmic reticulum stress in hypothalamic neurons, to alterations in some of the neuropeptides that regulate appetite, such as increased levels of ghrelin, reduced levels of leptin, and reduced central biological activity of orexin, all of which would then converge to increase food intake and reduce satiety [27-29] [30]. Under particular circumstances, the correlation of insufficient sleep with food desire and screen time emerges as being particularly prominent, especially among children and adolescents [23, 31-33]. Despite aforementioned comments, we should also note that although the overall data are supportive of an association between short sleep duration and increased risk for obesity, some studies have been somewhat conflictive for any of the age groups examined.…”

Early Childhood Screen Time and Parental Attitudes Toward Child Television Viewing in a Low-Income Latino Population Attending the Special Supplemental Nutrition Program for Women, Infants, and Children

“…1 The association between media exposure and childhood obesity has been supported by research over the past several decades, [1][2][3] with both media exposure and obesity more prevalent among minorities and lower socioeconomic groups. [4][5][6][7] In addition, increased media exposure is associated with higher risk of multiple medical problems, including hypertension, 8 high cholesterol, 8 diabetes, 9 psychological and social issues, 9,10 and sleep disorders.…”