Capturing Modifiable Obesogenic Behaviors in Primary Pediatric Care Among Latino Adolescents

Background: Obesogenic behaviors are key contributors to chronic diseases, including type 2 diabetes and non-alcoholic fatty liver disease. Latino adolescents engage in more obesogenic behaviors and have a higher burden of chronic diseases than White adolescents. However, it is unclear if obesogenic behaviors identified in primary care are associated with specific individual- or neighborhood-level characteristics among Latino adolescents.

Methods: We used data from an observational cross-sectional study of 77,514 adolescents ages 13-17 years in Kaiser Permanente Northern California who self-identified as Latino and had a well-child visit during 2016-2019. Data from the first qualifying visit was used, and adolescents with BMIs in the underweight range were excluded. Adolescents self-reported four daily obesogenic behaviors: 1) consuming <5 servings of fruits/vegetables; 2) drinking ≥1 juice/soda; 3) exercising/playing sports for <60 minutes; and 4) >2 hours of screen time. We also created a composite variable for adolescents reporting ≥3 of these behaviors. We used multivariable logistic regression to examine associations between these obesogenic behaviors with age (13-15 vs. 16-17), gender, household language preference (English/Spanish), neighborhood deprivation index (NDI quartiles), and BMI (using CDC age- and sex-specific cut-points).

Results: Our sample had a mean age of 14.7 (SD 1.4), 23% lived in Spanish-speaking households, 43% lived in neighborhoods at the highest (most deprived) NDI quartile, and 45% had an overweight or obese BMI. Over one-fourth (27%) engaged in ≥3 obesogenic behaviors (Table 1). By individual behavior, older adolescents had higher odds of insufficient fruit/vegetable intake (OR 1.20; 95% CI: 1.17-1.24), being more sedentary (OR 1.51; 1.46-1.56), and reporting >2 hours of screen time (OR 1.07; 1.03-1.11) compared to younger adolescents, but juice/soda consumption was similar (OR 1.03; 0.99-1.06). Boys had higher odds of insufficient fruit/vegetable intake (OR 1.17; 1.13-1.20) and excess juice/soda consumption (OR 1.29; 1.25-1.33) than girls, but lower odds of being sedentary (OR 0.73; 0.70-0.75) and >2 hours of screen time (0.92; 0.89-0.95). Adolescents in Spanish-speaking households had lower odds of insufficient fruit/vegetable intake (OR 0.87; 0.84-0.90) and >2 hours of screen time (OR 0.93; 0.90-0.97), but higher odds of being more sedentary (OR 1.12; 1.08-1.16) than adolescents in English-speaking households. Adolescents in the fourth NDI quartile had higher odds of all obesogenic behaviors compared to adolescents in the first quartile. Adolescents with class 3 obesity had higher odds of reporting ≥3 obesogenic behaviors (OR 1.55; 1.42-1.70) than adolescents in the normal weight category (Table 2).

Conclusion: Among Latino adolescents, those who were older, had more severe obesity, or lived in more deprived neighborhoods were more likely to report daily obesogenic behaviors. This study underscores the need to target lifestyle interventions during childhood and in early adolescence. Our findings also support the value of assessing obesogenic behaviors in primary care to identify high-risk populations for intervention.