What are the social determinants of health in adolescents with obesity and asthma?

From the Guidelines

Social determinants of health, including socioeconomic status, environmental conditions, food insecurity, educational disparities, and social support networks, play a crucial role in the management and exacerbation of obesity and asthma in adolescents, and addressing these factors is essential to improve health outcomes in this population. The relationship between obesity and asthma is complex, with studies indicating that obesity may be a predictor of the persistence of childhood asthma into adolescence, particularly in females 1. The relative risk of incident asthma increases with increasing obesity, and weight loss has been shown to decrease the severity and symptoms of asthma in morbidly obese asthmatics 1. Key factors to consider include:

• Low socioeconomic status, which limits access to quality healthcare, nutritious food options, and safe spaces for physical activity
• Environmental conditions, such as air pollution and substandard housing with allergens like mold and dust mites, which can trigger asthma attacks and limit outdoor exercise opportunities
• Food insecurity, which frequently leads to consumption of inexpensive, calorie-dense foods with poor nutritional value, contributing to obesity while providing inadequate nutrients for immune function
• Educational disparities, which affect health literacy, making it difficult for adolescents and their families to understand medication regimens or implement dietary changes
• Social support networks, which play a crucial role, as stigmatization of both obesity and asthma can lead to psychological distress, reduced treatment adherence, and social isolation. Addressing these determinants requires comprehensive approaches, including improved healthcare access, community-based exercise programs, school-based education, and policies that create healthier food environments and reduce environmental triggers 1.

From the Research

Social Determinants of Health in Obese, Asthmatic Adolescents

• The social determinants of health in obese, asthmatic adolescents are complex and multifaceted, involving factors such as socioeconomic status, education, and access to healthcare 2, 3.
• Studies have shown that weight loss in adolescents with obesity and asthma can lead to improvements in asthma-related outcomes, including quality of life and lung function 2.
• A comprehensive multidisciplinary management plan, including personalized advice on diet and exercise, can be effective in reducing the prevalence of overweight and obesity in childhood and adolescence 4.
• Clinical considerations in the management of obesity in children and adolescents include optimization of diagnosis and treatment approaches, as well as increased education and community-wide initiatives to promote early intervention 5.
• A staged-care approach for weight management, including prevention, structured weight management, comprehensive multidisciplinary intervention, and tertiary care intervention, can be an effective way to address obesity in children and adolescents 6.

Key Factors Influencing Health Outcomes

• Socioeconomic status and access to healthcare can have a significant impact on health outcomes for obese, asthmatic adolescents 2, 3.
• Education and awareness about healthy behaviors, such as diet and exercise, are crucial for preventing and managing obesity and asthma in adolescents 4, 6.
• Collaboration among healthcare providers, policymakers, and community leaders is essential for addressing the growing prevalence of obesity in children and adolescents 5.

Effective Interventions

• Multidisciplinary behavior-based obesity treatment programs can be effective in improving health outcomes for obese, asthmatic adolescents 2, 4.
• Personalized advice on diet and exercise, as well as cognitive behavioral therapy, can be useful components of a comprehensive management plan 2, 3.
• Bariatric surgery may be considered for adolescents with severe obesity, but should be undertaken by skilled bariatric surgeons affiliated with teams experienced in the medical and psychosocial management of adolescents 3.