Abstract
BackgroundSocioeconomic inequalities in longitudinal patterning of childhood overweight could cause marked differentials in total burden by adulthood. This study aims to determine timing and strength of the association between socioeconomic status (SES) and children’s body mass index (BMI) in the pre- and primary school years, and to examine socioeconomic differences in overweight trajectories across childhood.MethodsParticipants were 4949 children from the Longitudinal Study of Australian Children. BMI was measured at four biennial waves starting at age 4–5 years in 2004. Developmental trajectories of childhood overweight were identified with latent class analyses. Composite variables of family and neighbourhood SES were used.ResultsSocioeconomic differences in mean BMI z-scores already present at age 4–5 more than doubled by age 10–11 years, reflecting decreasing mean BMI among advantaged rather than increasing means among disadvantaged children. Latent class analysis identified children with ‘stable normal weight’ (68%), and with ‘persistent’ (15%), ‘late-onset’ (14%), and ‘resolving’ overweight (3%). Risks of persistent and late-onset childhood overweight were highest among low SES families (e.g. most disadvantaged quintile: ORpersistent = 2.51, 95%CI: 1.83–3.43), and only partly explained by birth weight and parental overweight. Relationships with neighbourhood SES were weaker and attenuated fully on adjustment for family SES. No socioeconomic gradient was observed for resolving overweight.ConclusionsChildhood has become the critical period when socioeconomic inequalities in overweight emerge and strengthen. Although targeting disadvantaged children with early overweight must be a top priority, the presence of childhood overweight even among less-disadvantaged families suggests only whole-society approaches will eliminate overweight-associated morbidity.
Highlights
Overweight is a worldwide public health concern [1] given its adverse immediate and long-term consequences [2,3]
Data on body mass index (BMI) were more often missing among children of families or neighbourhoods with a low socioeconomic status (P-values in all waves,0.05, except in Wave 1 P-value = 0.14)
Noteworthy is the lack of a socioeconomic gradient in childhood trajectories of stable low BMI. In this contemporary population-based cohort of Australian children, we showed that socioeconomic differences in high BMI already present at age 4–5 years persisted but had more than doubled by age 10–11 years, confirming and extending findings from other countries [14,15]
Summary
Overweight is a worldwide public health concern [1] given its adverse immediate and long-term consequences [2,3]. Large socioeconomic inequalities are observed in prevalence of the morbidities associated with overweight and obesity, such as cardiovascular disease and diabetes [6,7]. Tackling overweight effectively is likely to require a ‘proportionate universalism’ approach whereby interventions are implemented at a level according to their need across the social gradient [13]. To do this requires a much clearer understanding of patterns of disproportionate need across the SES gradient, showing when in life socioeconomic inequalities in overweight emerge, and how and why they persist during childhood. This study aims to determine timing and strength of the association between socioeconomic status (SES) and children’s body mass index (BMI) in the pre- and primary school years, and to examine socioeconomic differences in overweight trajectories across childhood
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