Inequalities in body mass index, diet and physical activity in the UK: Longitudinal evidence across childhood and adolescence

Overweight and obesity trends and association with household wealth index among children aged 5 to 19 years in Ethiopia a multilevel analysis of 2016 EDHS data

Globally, an estimated 2.6 billion people, or 38%, are overweight or obese; the prevalence of obesity alone is anticipated to be 14%, or nearly 2 billion adults, children, and adolescents, by 2020. In addition, in 2035, the yearly worldwide economic cost of overweight and obesity will be $4.32 trillion if preventive and treatment strategies remain unchanged. This is equivalent to the impact of COVID-19 in 2020, about 3% of global gross domestic product (GDP). As a result, this study aimed to determine the association between the household wealth index and overweight and obesity in children over five in Ethiopia. A community-based cross-sectional study was conducted and data collection from a nationally representative sample of the 2016 Ethiopia Demographic and Health Survey (EDHS). The data collection was conducted from January to June 2016. The total sample of 20,584 children and adolescents aged 5 to 19 years old was utilized in the analysis. The overweight/obesity was measured by the weight-for-height (WFH) index, more than two standard deviations (+ 2 SD) above the median of the reference population based on the BMI Z-score. Multivariable logistic regression analysis was used to evaluate the predictors, and the findings were shown as an adjusted odds ratio (AOR) with a 95% confidence interval. At a p-value < 0.05, statistical significance was deemed to exist. Overall, out of 20,584 children aged 5 to 19 years, 2,336 (11.3%) were overweight or obese in Ethiopia. Factors such as maternal age greater than 40 years (AOR = 0.76, 95%CI: 0.67-0.89), mobile phone ownership (AOR = 1.36, 95%CI: 1.06-1.75), household use of solid fuel (AOR = 3.25, 95%1.66-6.37), middle wealth index (AOR = 1.47, 95% CI: 1.04-2.06), richest wealth index (AOR = 2.76, 95%CI: 1.59-4.81), regions lived in Afar (AOR = 0.28, 95%CI, 0.10-0.79), Gambela (AOR = 0.09, 95%CI, 0.03-0.24), Amhara (AOR = 3.27, 95%CI, 1.19-8.97), and Addis Ababa (AOR = 6.94, 95%CI, 1.36-12.68) were statistically significant with overweight and obesity among children older than five population in Ethiopia. This study pointed out factors such as maternal age, mobile phone ownership, household use of solid fuel, households having a middle and higher income, and living in Afar, Gambela, Amhara, and Addis Ababa are independent predictors of overweight and obesity among children older than five population in Ethiopia. As a result, a wide range of known contributing variables should be taken into account in programs aimed at reducing children's overweight and obesity.

The role of health literacy in intervention studies targeting children living with overweight or obesity and their parents-a systematic mixed methods review

Background

Excess weight and obesity are increasing among children. Health literacy has been suggested as a feasible concept for enabling informed health choices in weight management interventions for children and their parents. Knowledge of the skills necessary for a child to maintain new health behaviors is limited and the role of health literacy remains unclear. Thus, there is a need to summarize the effects of and experiences with interventions that include health literacy components to guide the development of effective, future weight-related interventions.

Aim

This review aims to identify how health literacy is integrated into studies of interventions targeting children with excess weight or obesity and/or their parents and to appraise the identified literature.

Methods

We conducted a systematic mixed methods review, with searches in Medline, CINAHL, Cochrane, EMBASE, ERIC, PsycINFO, and Web of Science. We included studies of interventions published after 2013 that targeted children under 19 years with excess weight or obesity and/or their parents, where health literacy played a role. Results from the included studies were integrated using qualitative data transformation techniques, followed by a narrative summary.

Results

We identified 7,910 citations. Four reports met our inclusion criteria and were included for review. These reports included a total of 402 children. Health literacy was assessed at baseline in two studies and measured as an outcome over time in one study. Methodological quality varied among the retained reports, with differences observed in study design, risk of bias and data collection methods. The reports highlight the need to adapt weight management treatments to the individual level of health literacy in children and their families to first ensure active participation in their treatment and second ensure long-term compliance with necessary lifestyle-related changes.

Discussion

Surprisingly, little attention has been paid to the importance of health literacy in weight management programs targeting children and their families. Seemingly, treatments tailored to the individual level of health literacy have not been prioritized in research. Addressing health literacy in children's weight management continues to be a multifaceted and ambitious mission. Future research should focus on integrating health literacy into weight management interventions in a systematic and theory-driven manner, ensuring that these interventions are tailored to the specific needs of children and their families and can sustain behavior change over time.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=478957, identifier: CRD42023478957.

Social inequalities in the use of online food delivery services and associations with weight status: cross-sectional analysis of survey and consumer data

ABSTRACT

Background

Little is known about who uses online food delivery services and how use of these services is associated with social inequalities in food purchasing and diet-related health. This study explored associations between social position and use of online takeaway food and grocery delivery services, and its association with weight status.

Methods

Data were obtained from households in a consumer research panel living in London and the north of England (n=1521) in February 2019. Use of online grocery delivery services was determined via recorded purchases, and takeaway food delivery app use via survey responses. Social position was approximated through occupation-based social grade and household income. We used logistic regression to estimate the association between social position and use of online delivery services, and the relationship between online delivery service use and weight status.

Results

Overall, 13.2% of respondents used takeaway food delivery apps over a 7-day period and 15.6% of households used online grocery delivery services over a 4-week period. High-income households were more likely to use online grocery delivery services than low-income households (OR 2.01, 95% CI 1.22 to 3.34). In contrast, households with lower social grade were more likely to use takeaway food delivery apps compared with households in the highest grade (OR 2.31, 95% CI 1.38 to 3.87). While takeaway food delivery app use was positively associated with living with obesity (relative risk ratio 1.84, 95% CI 1.20 to 2.82), use of online grocery delivery services was not.

Discussion

Findings indicate that use of online food delivery services is patterned by markers of social position and weight status, which may lead to dietary inequalities. The potential impact of increased and differential usage of online delivery services on diet and dietary inequalities warrants further research.

The association between caesarean section delivery and obesity at age 17 years. Evidence from a longitudinal cohort study in the United Kingdom

BACKGROUND

Childhood and adolescent obesity are major, preventable public health concerns. Studies to date are inconclusive regarding an association between caesarean section (CS) delivery and offspring obesity, with fewer studies conducted in late adolescence. This study examined the association between CS delivery, with a specific focus on planned CS, and induction of labour and adolescent body mass index (BMI) and body fat percentage (BF%) at age 17 years.

METHODS

Data on 8,880 mother-child pairs from the United Kingdom Millennium Cohort Study were analysed. The exposures were mode of delivery (normal vaginal delivery (VD) (reference), assisted VD, planned CS and emergency CS) and mode of delivery by induction of labour status. Crude and adjusted binary logistic regression and linear regression models were fitted examining BMI and BF% at age 17 years respectively, adjusting for several potential confounders.

RESULTS

Adolescents born by CS did not have an elevated BMI or BF% compared to those born by normal VD. The fully adjusted results for overweight and obesity in children born by planned CS, compared to VD, were 1.05 (95% CI: 0.86-1.28) and 0.94 (95% CI: 0.72-1.23), respectively. The results were similar for the associations between CS and BF%, and between induction of labour and BMI.

CONCLUSION

Overall, this large longitudinal study did not support an association between CS or induction of labour and overweight, obesity or BF%. It is possible that previously reported associations are due to residual or unmeasured confounding and/or underlying indications for CS delivery.

Beyond correlates: the social gradient in childhood overweight

BACKGROUND

Health (in)equity has a high priority on research and policy agendas. Even though it is known that inequalities in overweight prevalence accumulate with age and are already existent among children below the age of six, research on this topic is scarce. In this young age group, parents play an important role in preventing overweight and associated adverse consequences. This study examines the magnitude of parental misclassification of child weight status and its correlates, focussing on the factors that determine social status and equity.

METHODS

Preschool children's weight and height was measured objectively. Parents gave information on their socioeconomic background. Family education was dichotomised into tertiary and non-tertiary educational level, according to CASMIN. Binary logistic regression, adjusted for parental BMI, was applied to detect odds of childhood overweight.

RESULTS

Data on family educational level and anthropometrics were available from 643 children (4.5 ± 0.82 years, 52.7% male) and their parents of which 46.5% (n = 299) had a tertiary educational background. The groups (tertiary vs. non-tertiary educational level) differ significantly in overweight prevalence (3.7% vs. 11.9%, p ≤ 0.001). Odds of overweight were two times higher in children with non-tertiary educational background (OR: 2.123, CI: 1.010-4.461, p < 0.05), adjusted for parental BMI.

CONCLUSION

Children from families with low educational background have an elevated risk of overweight, already at a very young age. Education in general (not explicitly health education) seems to play a tremendous role in the prevention of overweight and obesity and should therefore be implied in policies enhancing health equity.

TRIAL REGISTRATION

DRKS-ID: DRKS00010089.

Trends in the effects of socioeconomic position on physical activity levels and sedentary behavior among Korean adolescents

OBJECTIVES

We examined trends in physical activity and sedentary behavior in Korean adolescents, and their association with socioeconomic position (SEP).

METHODS

We used data from the Korea Youth Risk Behavior Survey, a nationwide study involving students aged 12-19 conducted between 2009 and 2021. SEP was assessed based on economic status, parental education attainment, and urbanization. Physical activity was categorized into vigorous physical activity, moderate physical activity, and muscle training, and sedentary time was also measured. We conducted the log-binomial regression to calculate prevalence ratios (PRs) and prevalence differences.

RESULTS

Our analysis included a total of 593,896 students. We observed an increasing trend in physical activity, but a worsening trend in sedentary behavior. A positive association was found between an adolescent's physical activity and SEP indicators, except for urbanization. Adolescents with higher economic status engaged in more vigorous physical activity (high: PR, 1.26; 95% confidence interval [CI], 1.25 to 1.28; middle: PR, 1.03; 95% CI, 1.02 to 1.04). Similar associations were observed for father's education (tertiary or above: PR, 1.11; 95% CI, 1.09 to 1.13; upper secondary: PR, 1.05; 95% CI, 1.03 to 1.07) and mother's education (tertiary or above: PR, 1.17; 95% CI, 1.15 to 1.20; upper secondary: PR, 1.06; 95% CI, 1.04 to 1.08). Adolescents with higher economic status also showed a higher compliance rate with the guideline restricting sedentary time to 2 hours per day (high: PR, 1.28; 95% CI, 1.25 to 1.30; middle: PR, 1.03; 95% CI, 1.01 to 1.05).

CONCLUSIONS

Adolescents with higher SEP exhibited more physical activity and less sedentary time than those with lower SEP.

Adolescents' experiences of a school-based health promotion intervention in socioeconomically advantaged and disadvantaged areas in Sweden: a qualitative process evaluation study

BACKGROUND

Adolescence is a transition period in which positive experiences of physical activity have the potential to last into later adulthood. These experiences are influenced by socioeconomic determinants, leading to health inequalities. This study aims to explore adolescents' experiences and participation in a multi-component school-based intervention in schools located in socioeconomically advantaged and disadvantaged areas in Sweden.

METHODS

A qualitative design was used to evaluate how participants experienced the intervention. The intervention was a multi-component school-based intervention. It was conducted in six schools (four control and two intervention schools) with a total of 193 students and lasted one school year. It was teacher-led and consisted of three 60-minute group sessions per week: varied physical activities, homework support with activity breaks, and walks while listening to audiobooks. In total, 23 participant observations were conducted over eight months and 27 students participated in focus groups. A content analysis was conducted.

RESULTS

The results describe a main category 'Engaging in activities depending on socioeconomic status' and three generic categories: 1. Variations in participation in PA together with classmates and teachers; 2. Variations in engagement in PA after school; and 3. Differences in time and place allocated to do homework and listen to audiobooks. These categories illustrate how participants looked forward to the physical activities but used the time spent during the walks and homework support differently depending on how busy they were after school. Frequently, those who were busiest after school were also those from the advantaged area, and those who had little to do after school were from the disadvantaged area.

CONCLUSION

Socioeconomic factors influence participants' possibilities to engage in the intervention activities as well as how they use their time in the activities. This study showed that it is crucial to support adolescents' participation in physical activities by providing structure and engaging well-known teachers in the activities, especially in schools located in disadvantaged areas.

Polygenic and socioeconomic risk for high body mass index: 69 years of follow-up across life

Genetic influences on body mass index (BMI) appear to markedly differ across life, yet existing research is equivocal and limited by a paucity of life course data. We thus used a birth cohort study to investigate differences in association and explained variance in polygenic risk for high BMI across infancy to old age (2-69 years). A secondary aim was to investigate how the association between BMI and a key purported environmental determinant (childhood socioeconomic position) differed across life, and whether this operated independently and/or multiplicatively of genetic influences. Data were from up to 2677 participants in the MRC National Survey of Health and Development, with measured BMI at 12 timepoints from 2-69 years. We used multiple polygenic indices from GWAS of adult and childhood BMI, and investigated their associations with BMI at each age. For polygenic liability to higher adult BMI, the trajectories of effect size (β) and explained variance (R2) diverged: explained variance peaked in early adulthood and plateaued thereafter, while absolute effect sizes increased throughout adulthood. For polygenic liability to higher childhood BMI, explained variance was largest in adolescence and early adulthood; effect sizes were marginally smaller in absolute terms from adolescence to adulthood. All polygenic indices were related to higher variation in BMI; quantile regression analyses showed that effect sizes were sizably larger at the upper end of the BMI distribution. Socioeconomic and polygenic risk for higher BMI across life appear to operate additively; we found little evidence of interaction. Our findings highlight the likely independent influences of polygenic and socioeconomic factors on BMI across life. Despite sizable associations, the BMI variance explained by each plateaued or declined across adulthood while BMI variance itself increased. This is suggestive of the increasing importance of chance ('non-shared') environmental influences on BMI across life.