Fatter Wallets = Skinnier Kids: Casinos Associated With Lower Obesity Rates

Tanya H. Lee

New research shows that opening a new or expanding an existing tribal casino is associated with a reduction in childhood obesity. The finding is extremely important, according to researchers, because overweight/obesity is a significant problem among American Indian children and adults and because being overweight or obese in childhood has impacts that can eventually become life-threatening.

The research does not prove a causal relationship between casino development and fewer overweight/obese kids, but it does strongly suggest that such a relationship exists. Johns Hopkins' Department of International Health's Jessica C. Jones-Smith, lead investigator for the project, says, "This is a strong study that is not as methodologically rigorous as a randomized control trial but that offers better evidence towards causality than most other observational designs."

The research also shows that the reduction in overweight/obese children associated with casino development appears to be long-lasting. Jones-Smith says, "In this time period of 2001 to 2012 different tribes opened their casinos at different times, and we did look at whether the time that you opened the casino had any impact on our estimate of the casino's impact on obesity. It didn't, so it looks like throughout this time whenever you opened the casino you still experienced a decrease in the risk for obesity." Thus, a tribe that opened a casino in the early 2000s showed the same reduction in overweight/obese children as one that opened a casino five or six years later.

Researchers looked at a total of 117 California school districts that encompassed tribal lands, based on information from the U.S. Census Bureau. Of those school districts, "57 gained or expanded a casino, 24 had a preexisting casino but did not expand, and 36 never had a casino." Then they looked at BMI (body-mass index) for the children in those districts based on information supplied by the California Department of Education. Forty-eight percent of the BMI measurements for children whose parents identified the child's race as American Indian or Alaska Native were classified as overweight/obese.

In school districts that encompassed tribal lands where a new casino had been built or an existing casino expanded between the years 2001 and 2012, the risk of being an overweight/obese AI/AN child dropped 0.19 percent per new slot machine. Since there were on average 13 new slots per capita, the total reduction in the risk of being overweight or obese averaged 2.47 percent. Each new slot represented a per capita increase in annual income of $541 and a decrease in the number of people living in poverty. For the average of 13 new slots per capita, this would mean a 7.8-percent reduction in the number of people living in poverty.

The investigators concluded that the most plausible explanation for their findings is that opening a new or expanding an existing casino increased families' and communities' economic resources and that in turn led to a decrease in the risk of children being overweight or obese.

Jones-Smith is an assistant professor at the Johns Hopkins Bloomberg School of Public Health. The other investigators on the project were William H. Dow from the School of Public Health at the University of California, Berkeley, and Kristal Chichlowska, an independent consultant in Sacramento. The paper, "Association Between Casino Opening or Expansion and Risk of Childhood Overweight and Obesity," was published in the Journal of the American Medical Association in early March. The project was funded by the National Institute of Child Health and Human Development.

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