New research has revealed that the percentage of children who are overweight or obese surprisingly decreases in areas where casinos are opened or expanded in American-Indian societies.
The study, which was published in the Journal of the American Medical Association (JAMA), links the expansion or opening of a casino in a community to decreased risk of childhood obesity, reduced poverty rates, and higher family income. It found that American Indians’ incomes increased and their children’s obesity rates decreased after they built casinos on tribal lands in California. This is advantageous to native Americans when compared to states like Utah and Hawaii where gambling has been banned.
Most communities are concerned about the negative effects of gambling, such as an increase in crime rate. However, according to Augusta Free Press, the wealth which casinos provide enhances social mobility.
There is an inverse relationship between economic resources and the risk of childhood obesity. Studies have assessed whether the correlation is a direct result of economic resources or other causes. In the United States, it is known that lower incomes are often linked to higher rates of obesity.
A short review: finding the link between casinos and obesity
For families with limited financial power, obesity could be a deadly health challenge. In the US, it is a public health concern. As of 2017, 41.9% of American adults were obese. American Indian children were also 1.5 times more likely to become overweight than other American adolescents, with 31.5% of boys and 27.9% of girls being overweight or obese.
The Centers for Disease Control and Prevention (CDC) states that 14.7 million American children and adolescents are obese, noting that socio-economic status is an underlying factor. “Obesity prevalence was 18.9% among children and adolescents aged 2-19 years in the lowest income group, 19.9% among those in the middle-income group, and 10.9% among those in the highest income group,” CDC said.
In November 2011, James A. Levine of the Mayo Clinic wrote in the Diabetes journal that “in contrast to international trends, people in America who live in the most poverty-dense counties are those most prone to obesity.”
People in America who live in the most poverty-dense counties are those most prone to obesity.James A. Levine, Division of Endocrinology, Mayo Clinic in Arizona
One of the measures to counter the effect of poverty in Indian-American communities has been the legalisation of casinos on tribal lands, with the core aim of promoting “tribal economic development, tribal self-sufficiency, and strong tribal government,” according to the Indian Gaming Act of 1988. It stipulates that profits are to be ploughed back into tribal welfare or the community, or donated to charity.
Expectedly, the presence of casinos has been associated with increases in employment and per capita income, as well as a decline in the number of working poor on tribal lands.
To properly establish the connection between casinos and economic status and health of Indian-Americans, several studies have been performed. However, their results have been contradictory.
Five of such studies examined the effect of casinos on health outcomes. Three of the studies, which were derived from longitudinal research that involved one large tribe, suggested a negative impact of casinos on native tribes: an increase in psychiatric disorders, higher numbers of accidental deaths among adults, and a rise in obesity among youths from low-income areas. In contrast, two additional studies utilising national data discovered that casinos were associated with positive outcomes: a reduction in hypertension, diabetes and total deaths, and obesity among American-Indian adults.
Jessica C. Jones-Smith, an associate professor at the University of Washington Department of Epidemiology (UW Epi) and the Johns Hopkins Bloomberg School of Public Health in Baltimore, along with co-authors William H. Dow and Kristal Chichlowska, longitudinally examined whether the establishment or expansions of casinos owned by American Indians were connected to the risk of childhood obesity.
The researchers studied children between the ages of 7 and 18 in 117 school districts in California, including tribal lands. The data for the study was collected from 2001 to 2012. The researchers then compared children in districts to children in tribal lands where a new casino was opened or an existing one expanded, versus those that did not.
They hypothesised that casinos had the potential of altering community, family, and individual resources, thereby reducing barriers to physical activity and healthy eating, and essentially lowering the risk of obesity and overweight.
“These resources could include increased income, either via employment or per capita payments, and health-promoting community resources, such as housing, recreation and community centres, and health clinics,” the study’s authors wrote.
Essentially, these factors would make children become thinner.
The research was performed by recording the body mass index (BMI) of the American-Indian students who lived on tribal lands and those who did not, the percentage of the population living in poverty, annual per capita income, and annual median household income.
57 out of the 117 districts expanded or opened a casino during the research period. 24 districts expanded their casinos while 36 of them never opened a casino. 48 percent of the children were categorised as either overweight or obese. Interestingly, the study found that each additional casino slot per capita was linked to a reduction in the proportion of the population living in poverty, an increase in average per capita annual income, and a drop in the proportion of overweight and obese children.
Although the researchers outlined the need for additional studies for corroboration, they said the link between casinos and childhood obesity could be ascribed to the increase in individual, family, and community economic resources.
“Every slot machine per capita gained was associated with a 0.19 percentage point decrease in the likelihood of overweight/obesity (95% CI, 0.26 to 0.11 percentage points) and a decrease in BMI z score ( = 0.003; 95% CI, 0.005 to 0.0002) among American Indian children,” the researchers said.
According to Dr Neal Halfon, Professor of Paediatrics at the University of California, Los Angeles, the correlation between lower incomes or poverty and higher obesity rates is well established.
A casino in every neighbourhood is not the answer, but increasing family income and removing other pressures that reduce the capacity of families to invest in their children should be part of the solution.Dr Neal Halfon, Professor of Paediatrics at the University of California, Los Angeles
“A casino in every neighbourhood is not the answer, but increasing family income and removing other pressures that reduce the capacity of families to invest in their children should be part of the solution” to problems with child health that are associated with poverty, wrote Dr Neal Halfo, in an op-ed published alongside the study in JAMA. Halfon was not a part of the study’s research team.
Jones-Smith, J. C., Dow, W. H., & Chichlowska, K. (2014). Association between casino opening or expansion and risk of childhood overweight and obesity. JAMA, 311(9), 929. https://doi.org/10.1001/jama.2014.604