A Cross-Sectional Examination of Sleep and Obesity in Children and Adolescents Aged 10-17 Across the United States Open Access

Abstract

Background. Childhood and adolescent obesity is a primary health concern in the United States. Obesity has multiple health sequelae including diabetes, high blood pressure, sleep apnea, among others. Sleep has been suggested as lying on the pathway to obesity. Most of the research done to date has focused on adults, rather than children and adolescents. This paper will examine the relationship between sleep and obesity in a younger population, with a representative sample that allows for generalizability to children and adolescents within the United States between the ages of ten and seventeen who are not institutionalized.

 

Objectives. To examine the relationship between sleep and obesity in a cross-sectional manner in non-institutionalized children and adolescents between ten and seventeen years old in the United States.

 

Methods. Data are from the National Survey of Children’s Health (2016-2017) and were used to explore the relationship between hours of sleep children and adolescents get and BMI class. The sample size was 30,790. Descriptive statistics, ANOVA, chi-square, logistic regression, and multinomial regression were performed to explore this relationship.

 

Results. For each additional hour of sleep there is a 15.2% lower odds of obesity for children and adolescents between ten and seventeen years of age. Children and adolescents were 0.733x more likely to remain obese if they had one more hour of sleep compared to those who are of normal weight holding all other variables constant.

 

Conclusion. The results suggest that the amount of sleep children and adolescents get is associated with BMI category, and obesity. Further research in the area should look to establish the causal pathway between this relationship, and if there is a point where intervention could be useful.  

Table of Contents

Table of Contents

__________________________________________________________

Introduction………………………………………………………………………………………………………………………….1

Literature Review………………………………………………………………………………………………………………….3

Prevalence of Obesity in the United States………………………………………………………………………………..3

Sleep………………………………………………………………………………………………………………………………………….4

Sleep Guidelines and Recommendations for Children Aged 10-17…………………………………………….4

Sleep Patterns…………………………………………………………………………………………………………………………..5

Sleep and Obesity……………………………………………………………………………………………………………………..5

Potentially Confounding Variables………………………………………………………………………………………….…7

Nutrition…………………………………………………………………………………………………………………….….7

Activity Recommendations……………………………………………………………………………………….…..9

Activity and Obesity………………………………………………………………………………………………….……9

Activity and Sleep………………………………………………………………………………………………………..10

Socioeconomic Status………………………………………………………………………………………………..…10

Socioeconomic Status and Nutrition…………………………………………………………………….………10

Socioeconomic Status and Activity……………………………………………………………………………….11

Socioeconomic Status and Sleep…………………………………………………………………………….…….11

Socioeconomic Status and Obesity…………………………………………………………………………….…11

Environmental Factors and Obesity……………………………………………………………………………..12

Household-level Factors and Obesity and Sleep……………………………………………………………12

Neighborhood Level Factors and Obesity and Sleep…………………………………………….…….…12

Conceptual Framework…………………………………………………………………………………………………..……14

Data…………………………………………………………………………………………………………………………………….17

Eligibility………………………………………………………………………………………………………………………………….18

2016………………………………………………………………………………………………………………………………………..18

2017…………………………………………………………………………………………………………………………………..……19

Survey Questions……………………………………………………………………………………………………………..……..20

Methods……………………………………………………………………………………………………………………………..21

Variables………………………………………………………………………………………………………………………..……….21

BMI………………………………………………………………………………………………………………………………………...21

Sleep…………………………………………………………………………………………………………………………………….…21

Control Variables……………………………………………………………………………………………..………….22

Activity…………………………………………………………………………………………………………………….….22

Food and Socioeconomic Status………………………………………………………………………….….……22

Demographic……………………………………………………………………………………………………………………..……24

Missing…………………………………………………………………………………………………………………………..……….24

Statistical Analysis…………………………………………………………………………………………………….…….………24

Results………………………………………………………………………………………………………………….…….………26

Descriptive Results……………………………………………………………………………………………………..…….…….26

           BMI Category…………………………………………………………………………………………………..………….26

           Sleep……………………………………………………………………………………………………………………………26

           Confounding Variables…………………………………………………………………………………….………….26

           Demographic………………………………………………………………………………………………………..……..27

Analytic Results……………………………………………………………………………………………………………………….27

Logistic Regression…………………………………………………………………………………………….……………………28

Multinomial Regression…………………………………………………………………………………………….……………30

Discussion and Implications…………………………………………………………………………………..……………31

References………………………………………………………………………………………………………………………….34

Tables and Figures……………………………………………………………………………………………….……………..37

Figure One: Conceptual Framework for Sleep and Obesity in Children and Adolescents………...37

Figure Two: BMI Category Distribution for Children Aged 10-17………………………………………..……38

Figure Three: Hours of Sleep Distribution for Children Aged 10-17……………………………….………..39

Table One: Descriptive Statistics for the 2016-2017 National Survey of Children’s Health Sample…………………………………………………………………………………………………………………………………...40

Table Two: ANOVA Between BMI Categories……………………………………………………………….………….42

Table Three: Odds of Obesity from Logistic Regression…………………………………………………..………44

Table Four: Relative Risk of Remaining Underweight, Overweight, or Obese………………..………..45

Appendix…………………………………………………………………………………………………………………………...47

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, General
Keyword	Sleep Obesity Sleep Duration Adolescent Obesity Childhood Obesity
Committee Chair / Thesis Advisor	Solveig A. Cunningham, Emory University
Committee Members	Johnathan A. Edwards, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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