Abstract
The mission of the National Collaborative on Childhood Obesity Research (NCCOR) is to accelerate progress in reducing childhood obesity, with an emphasis on populations experiencing disparities in obesity prevalence. 1 NCCOR has identified gaps and opportunities in available childhood obesity measures, highlighting the need to address both socioecological and individual factors that influence childhood obesity.2,3
To build on this, NCCOR commissioned an exploratory landscape analysis and expert interviews with NCCOR steering committee-identified government and academic researchers (n = 5) to better understand social determinants of health (SDOH) and structural racism (SR) as influences on childhood obesity, particularly in relationship to measurement and data needs. 4 The purpose of this editorial is to share insights gained from this exploratory pilot project and inform future research directions (full report available on NCCOR's website). 4
The interviews explored multiple linkages between SDOH, environmental impacts, and childhood obesity, and the pervasive role of SR in increasing exposures to obesogenic aspects of the environment. The landscape analysis, informed by the experts, NCCOR members, and online searches, identified 47 measures for SDOH and SR, addressing multilevel factors that influence childhood obesity such as access to health care services, environmental justice, and residential segregation. 4
Experts identified challenges in use of these measures, notably that measures of race and racism have been conflated. They recommended that researchers be cautious when interpreting results stratified by race, as they likely capture “not just the individual's race…but racism.” They also acknowledged that much current literature concerning SDOH or SR uses readily accessible data rather than robust measures. One expert pointed to problematic studies that oversimplify and “measure individual level characteristics at a population level and then call it a social determinant of health.” Experts highlighted a need for more comprehensive measures of SR and SDOH, such as emerging maps of redlining, 5 and the Child Opportunity Index. 6
The experts underscored the shortage of frameworks to support appropriate use of existing SDOH and SR measures. One expert reported “we need more pathways versus more tools.” They added that increased awareness, proper implementation, and operationalization of these measures within a public health context are needed, with one stating “you should be able to articulate how you think [the measure]'s going to affect individual or family behavior and outcomes.”
Measures of SDOH and SR were found from several disciplines, though their application to childhood obesity research is limited. Since 1996, 117 articles in Pubmed addressed redlining; only one explores redlining and childhood obesity. 7 Utilizing health equity frameworks and tools when examining childhood obesity, for example, the Getting to Equity in Obesity Prevention Framework 8 and the Practitioner's Guide for Advancing Health Equity, 9 is critical in harmonizing SDOH and SR measures for childhood obesity research and increasing comparability of results.
The recommendations highlighted in this editorial could be expanded to further specify training, framework development, and measurement needs concerning SDOH and childhood obesity. Such efforts could inform multisector research to better understand the complex interconnectedness of SDOH, SR, environments, and childhood obesity and accelerate progress toward more equitable health outcomes.
Footnotes
Authors' Contributions
D.V. contributed to conceptualization, methodology, investigation, visualization, and writing—original draft. E.A.S. was involved in conceptualization, methodology, investigation, visualization, and writing—original draft. D.B., A.S., and A.L.Y. carried out supervision and writing—reviewing and editing. K.N. was in charge of project administration and writing—reviewing and editing.