Association Between Casino Opening or Expansion and Risk of Childhood Overweight and Obesity

Study Questions:

Does the opening or expansion of American Indian–owned casinos increase the risk for childhood overweight or obesity?


Data on anthropometric measurement collected through fitness testing from 117 school districts, which encompassed tribal lands in California from 2001 to 2012, were included. Children in school districts encompassing American Indian tribal lands that either gained or expanded a casino were compared with children in districts with tribal lands that did not gain or expand a casino. The primary outcomes of interest included number of children who met criteria for being overweight or obese and body mass index (BMI) z score. Additional factors included data on per capita annual income, median annual household income, percentage of population in poverty, and total population.


Of the 117 school districts included in this analysis, 57 gained or expanded a casino, 24 had a pre-existing casino but did not expand, and 36 never had a casino. Forty-eight percent of the anthropometric measurements were classified as overweight/obese (11,048/22,863). Every casino slot machine per capita gained was associated with an increase in per capita annual income (β = $541; 95% confidence interval [CI], $245-$836) and a decrease in percentage in poverty (β = −0.6%; 95% CI, −1.1% to −0.20%) among American Indians living on tribal lands. Among American Indian children, every slot machine per capita gained was associated with a decreased probability of overweight/obesity by 0.19 percentage points (95% CI, −0.26 to −0.11 percentage points) and a decrease in BMI z score (β = −0.003; 95% CI, −0.005 to −0.0002).


The investigators concluded that opening or expanding a casino was associated with increased economic resources and decreased risk of childhood overweight/obesity.


These data support the hypothesis that lower income status places children at risk for being overweight or obese.

Keywords: Body Mass Index, California, Schools, Indians, North American, Obesity, Poverty

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