• A new study led by the Harvard Pilgrim Health Care Institute examined whether neighborhood food access in early life is associated with trajectories of child body mass index and obesity risk.

• Study results show that neighborhood food access matters. Residing in low-income, low-food-access neighborhoods during pregnancy or early childhood is linked to a higher body mass index (BMI) z-score and a more than 50% increased risk of obesity and severe obesity from childhood to adolescence.

• Investing in neighborhood resources to improve food access during pregnancy and early childhood may play a crucial role in preventing child obesity.

Boston, MA - Limited access to healthy foods, resulting from residence in under-resourced neighborhoods, is a critical public health concern. A new study suggests that residing in these areas during pregnancy or early childhood significantly raises the risk of obesity and severe obesity from childhood to adolescence. 

The findings are published September 16 in JAMA Pediatrics.

While previous research has established a connection between food insecurity and obesity in adults, critical early life stages, such as pregnancy and early childhood are often overlooked, despite offering greater potential for intervention and influence on long-term health outcomes. 

The prevalence of food insecurity in U.S. households with children under 18 years remains alarmingly high. Recent data indicates an increase from 12.5% in 2021 to 17.3% in 2022. At the same time, childhood obesity rates have been steadily rising. This dual burden is particularly worrying, as both conditions are strongly linked with long-term health consequences, including cardiovascular disease and diabetes.

The new findings, led by investigators from the Harvard Pilgrim Health Care Institute, underscores the importance of early-life neighborhood environments in shaping child health outcomes.  

By unraveling the mechanisms and identifying risk factors linking neighborhood food access and obesity in children, we can develop targeted preventive strategies that may mitigate chronic conditions in the future.
-Izzuddin Aris, PhD

“Understanding how experiencing food insecurity during these formative years impacts subsequent child obesity is essential. By unraveling the mechanisms and identifying risk factors linking neighborhood food access and obesity in children, we can develop targeted preventive strategies that may mitigate chronic conditions in the future,” said lead author Izzuddin Aris, Harvard Medical School assistant professor of population medicine at the Harvard Pilgrim Health Care Institute. 

In this nationwide multi-cohort study, researchers examined data from over 28,000 children across the U.S., drawn from 55 birth cohorts participating in the NIH Environmental influences on Child Health Outcomes (ECHO) program. The team focused on neighborhoods classified as low-income-low-food-access, where the nearest supermarket is more than 0.5 miles away in urban areas or over 10 miles away in rural regions. These neighborhoods, pose a significant challenge in accessing and purchasing healthier food options. 

After adjusting for individual sociodemographic factors, study results found that residence in these neighborhoods during pregnancy was associated with >50% higher risk of obesity and severe obesity from childhood to adolescence and higher BMI z-scores at ages 5, 10, and 15 years. Similar associations were observed for children who lived in low-income-low-food-access neighborhoods during early childhood. 

The study adds to the growing body of literature supporting the link between food insecurity and subsequent childhood obesity. In a previous study of ECHO participants, Dr. Aris and team found that residence in the lowest opportunity neighborhoods in early life was associated with ~80% higher obesity risk at similar life stages.

Adds Dr. Aris, “Our findings support a focus on investments or strategies to improve healthful food access in early life. This includes incentivizing new supermarkets in existing low-income-low-food-access neighborhoods, providing healthy-choice pantries, and improving access to healthier food choices in small retail corner and convenience stores. Such investments could play a crucial role in preventing child obesity and promoting healthier communities.” 

About the Harvard Pilgrim Health Care Institute’s Department of Population Medicine
The Harvard Pilgrim Health Care Institute's Department of Population Medicine is a unique collaboration between Harvard Pilgrim Health Care and Harvard Medical School. Created in 1992, it is the first appointing medical school department in the United States based in a health plan. The Institute focuses on improving health care delivery and population health through innovative research and education, in partnership with health plans, delivery systems, and public health agencies. Point32Health is the parent company of Harvard Pilgrim Health Care and Tufts Health Plan. Follow us on X and LinkedIn.

About the NIH Environmental influences on Child Health Outcomes Program (ECHO) 
Launched in 2016, the Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.