Impact of objective and subjective social status on obesity in a biracial cohort of adolescents

Objective: To characterize the associations between socioeconomic status (SES), two levels of subjective social status (SSS), and adolescent obesity. Research Methods and Procedures: Cross-sectional study of 1491 black and white adolescents attending public school in a suburban school district in Greater Cincinnati, Ohio. BMI greater than or equal to95th percentile derived from measured height and weight defined overweight. Students rated SSS on separate 10-point scales for society and school. A parent provided information on parent education and household income for SES. Results: Although there were no sex differences in SES, black students were more likely to come from families with less well-educated parents and lower incomes (p < 0.001). Black girls had the lowest societal SSS (p = 0.003), lowest school SSS (p = 0.046), and highest BMI (p < 0.001). Prevalence of overweight was highest among black girls (26.0%) and boys (26.2%), intermediate for white boys (17.2%), and least for white girls (11.6%). Logistic regression modeling revealed that parent education, household income, and school SSS were each associated with overweight. In a fully adjusted model, school SSS retained its association to overweight (odds ratio, 1.16; 95% CI, 1.06, 1.26) independent of SES. The association of school SSS was strongest among white girls, intermediate for white and black boys, and absent for black girls. Discussion: Perceptions of social stratification are independently associated with overweight. There were important racial and sex differences in the social status-overweight association. SSS in the more immediate, local reference group, the school, had the strongest association to overweight.