Abstract
It is unclear whether the socioeconomic inequality in prevalence of overweight and obesity is already present among very young children. This study investigates the association between overweight and socioeconomic status (SES, with maternal educational level as an indicator of SES) among 5-year-old children. This cross-sectional study uses baseline data from 5-year-olds of Dutch ethnicity (n = 5,582) and their mothers collected for the “Be active, eat right” study. Compared to children of mothers with the highest educational level, for children of mothers with the lowest educational level the odds ratio (adjusted for demographic characteristics) for having overweight was 2.10 (95% confidence interval: 1.57–2.82), and for having obesity was 4.18 (95% confidence interval: 2.32–7.55). Addition of maternal and child lifestyle-related characteristics decreased the odds ratios for overweight and obesity by 26.4% and 42.1%, respectively. The results show that an inverse SES-overweight/obesity association is already present at elementary school entry, and that watching TV by mother and child, the child consuming breakfast and, especially maternal weight status, are contributing factors in this association. These results should be taken into account when developing policies to reduce inequalities in (childhood) health.
Highlights
Childhood overweight and obesity have increased at a dramatic rate worldwide and are a major burden on public health [1,2]
The changes in Odds ratios (ORs) >5% are indicated in bold numbers. b High educational level = academic higher education, higher professional education; mid educational level = pre-university education, senior general secondary education, and senior secondary vocational education; low educational level = preparatory secondary vocational education, lower secondary vocational education, primary education, and no education.c Overweight = Body mass index (BMI) 25–30; obesity =
Age of the mother and the child were included as categorical variables to reduce the number of cells with zero frequencies. a Change 1 and change 2 represent the change in OR relative to Model 1 for mid and low education, after adjustment for the mediating characteristics of the mother (Model 2) and the child (Model 3) ([ORModel 2/3 − ORModel 1]/[ORModel 1 − 1] × 100). b High educational level = academic higher education, higher professional education; mid educational level = pre-university education, senior general secondary education, and senior secondary vocational education; low educational level = preparatory secondary vocational education, lower secondary vocational education, primary education, and no education
Summary
Childhood overweight and obesity have increased at a dramatic rate worldwide and are a major burden on public health [1,2]. Differences in the prevalence of childhood overweight across SES groups are likely to be explained by differences in characteristics of the children and their parents related to material circumstances, behavior and/or knowledge, all of which influence energy balance [6,9]. Few studies evaluated to what extent parental overweight and lifestyle-related behaviors of the child, i.e., playing outside, sedentary behavior, consuming breakfast and drinking sweet beverages, contribute to the association between SES and early childhood overweight [6,7]; these lifestyle-related behaviors have been shown to be associated with both childhood overweight and indicators of SES [16,17,18,19,20]. Understanding the influence of SES on patterns of eating and physical activity that lead to early childhood overweight and obesity is critical for the development of effective prevention programs
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