Regional and sociodemographic differences in average BMI among US children in the ECHO program

program collaborators for Environmental influences on Child Health Outcomes (ECHO)

Research output: Contribution to journalArticlepeer-review


Objective: The aim of this study was to describe the association of individual-level characteristics (sex, race/ethnicity, birth weight, maternal education) with child BMI within each US Census region and variation in child BMI by region. Methods: This study used pooled data from 25 prospective cohort studies. Region of residence (Northeast, Midwest, South, West) was based on residential zip codes. Age- and sex-specific BMI z scores were the outcome. Results: The final sample included 14,313 children with 85,428 BMI measurements, 49% female and 51% non-Hispanic White. Males had a lower average BMI z score compared with females in the Midwest (β = −0.12, 95% CI: −0.19 to −0.05) and West (β = −0.12, 95% CI: −0.20 to −0.04). Compared with non-Hispanic White children, BMI z score was generally higher among children who were Hispanic and Black but not across all regions. Compared with the Northeast, average BMI z score was significantly higher in the Midwest (β = 0.09, 95% CI: 0.05 to 0.14) and lower in the South (β = −0.12, 95% CI: −0.16 to −0.08) and West (β = −0.14, 95% CI: −0.19 to −0.09) after adjustment for age, sex, race/ethnicity, and birth weight. Conclusions: Region of residence was associated with child BMI z scores, even after adjustment for sociodemographic characteristics. Understanding regional influences can inform targeted efforts to mitigate BMI-related disparities among children.

Original languageEnglish (US)
Pages (from-to)2089-2099
Number of pages11
Issue number12
StatePublished - Dec 2021

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology
  • Nutrition and Dietetics


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