Associations of Longitudinal BMI-Percentile Classification Patterns in Early Childhood with Neighborhood-Level Social Determinants of Health
Open accessAbstract
Background: Understanding social determinants of health (SDOH) that may be risk factors for childhood obesity is important to developing targeted interventions to prevent obesity. Prior studies have examined these risk factors, mostly examining obesity as a static outcome variable. Methods: We extracted electronic health record data from 2012 to 2019 for a children’s health system that includes two hospitals and wide network of outpatient clinics spanning five East Coast states in the United States. Using data-driven and algorithmic clustering, we have identified distinct BMI-percentile classification groups in children from 0 to 7 years of age. We used two separate algorithmic clustering methods to confirm the robustness of the identified clusters. We used multinomial logistic regression to examine the associations between clusters and 27 neighborhood SDOHs and compared positive and negative SDOH characteristics separately. Results: From the cohort of 36,910 children, five BMI-percentile classification groups emerged: always having obesity ( n = 429; 1.16%), overweight most of the time ( n = 15,006; 40.65%), increasing BMI percentile ( n = 9,060; 24.54%), decreasing BMI percentile ( n = 5,058; 13.70%), and always normal weight ( n = 7,357; 19.89%). Compared to children in the decreasing BMI percentile and always normal weight groups, children in the other three groups were more likely to live in neighborhoods with higher poverty, unemployment, crowded households, single-parent households, and lower preschool enrollment. Conclusions: Neighborhood-level SDOH factors have significant associations with children’s BMI-percentile classification and changes in classification. This highlights the need to develop tailored obesity interventions for different groups to address the barriers faced by communities that can impact the weight and health of children living within them.
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Neighborhood SDOH shapes childhood obesity trajectories.
“Five BMI trajectories identified; children in higher‐risk groups significantly more likely in high‐poverty, high‐unemployment neighborhoods; neighborhood SDOH shapes childhood obesity trajectories”
From Artificial Intelligence and Machine Learning for Identifying Social Determinants of Health in Low‐Income Populations Within United States Health Systems: A Scoping Review (2026) · cites this paper as [24]
The Conclusion reports five distinct early-childhood BMI-percentile subgroups, and the Discussion says all three higher-risk groups were more likely to live in neighborhoods with higher poverty and unemployment. The paper studies associations, however, so the statement that neighborhood SDOH “shapes” trajectories goes beyond its evidence if read as a causal claim. (LLM, conf=0.85)
Experimental — accuracy not yet measuredFive BMI trajectories were identified.
“Five BMI trajectories identified; children in higher‐risk groups significantly more likely in high‐poverty, high‐unemployment neighborhoods; neighborhood SDOH shapes childhood obesity trajectories”
Children in higher-risk BMI trajectory groups were significantly more likely to be in high-poverty, high-unemployment neighborhoods.
“Five BMI trajectories identified; children in higher‐risk groups significantly more likely in high‐poverty, high‐unemployment neighborhoods; neighborhood SDOH shapes childhood obesity trajectories”
Unsupervised clustering identified patient subphenotypes linked to SDOH exposure.
“Unsupervised clustering, including hierarchical clustering [20] and trajectory‐based algorithmic grouping [24], identified patient subphenotypes linked to SDOH exposure.”
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Percentages, sums and reported differences re-computed from the paper’s own numbers.
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Fyfe‐Johnson, A. L., Reid, M. M., Jiang, L., Chang, J. J., Huyser, K. R., Hiratsuka, V. Y., Johnson-Jennings, M., Conway, C., Goins, R. T., Sinclair, K., et al. (2022) · Childhood Obesity · doi:10.1089/chi.2022.0012 · Cited by 10 · see citing works
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Subtyping patients with chronic disease using longitudinal BMI patterns
Mottalib, M. M., Jones‐Smith, J. C., Sheridan, B., & Beheshti, R. (2023) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2023.3237753 · Cited by 9 · see citing works
Self-citationEarly childhood growth trajectories in a Medicaid population
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Reliable prediction of childhood obesity using only routinely collected EHRs may be possible
Gupta, M., Eckrich, D., Bunnell, H. T., Phan, T.-L. T., & Beheshti, R. (2024) · Obesity Pillars · doi:10.1016/j.obpill.2024.100128 · Cited by 10 · see citing works
Self-citationA Scoping Review of the Social Determinants of Pediatric and Adolescent Obesity
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Children’s perceptions of the neighbourhood as a social determinant of health – a qualitative study
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- Authors
- Gupta, M., Phan, T.-L. T., Lê-Scherban, F., Eckrich, D., Bunnell, H. T., & Beheshti, R.
- Affiliations
- Southern Methodist University (US)
- Nemours Children's Health System (US)
- Epidemiology & Biostatistics, and Urban Health Collaborative Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
- University of Delaware (US)
- Venue
- Childhood Obesity
- Publisher
- SAGE Publications
- Published
- 2025-01-01
- Volume
- 21
- Issue
- 1
- Pages
- 65-75
- ISSN
- 2153-2168 (ISSN-L)
- 2153-2176
- PMC
- PMC11807911
- OpenAlex
- W4401871369
- Cited by
- 9
- References
- 97
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 2
- FWCI
- 3.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Childhood Obesity (publishedVersion)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (submittedVersion, cc-by-nc-nd)
- Funders
- National Institutes of Health
- National Institute of General Medical Sciences (P20GM103446, U54GM104941, P20GM113125)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Keywords
- body mass index percentiles, early childhood, neighborhood poverty, household crowding, single-parent families, preschool enrollment, obesity prevention
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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