In a recently published study, Dr Archives of Childhood DiseasesResearchers analyzed the rise in socioeconomic and racial disparities in childhood overweight and obesity in England from 1995 to 2019, comparing survey data with administrative data.
Childhood obesity is a serious health problem, with the United Kingdom (UK) predicted to become the most obese nation in Europe by 2030.
Research indicates that the incidence of childhood obesity has increased over time. Nevertheless, response rates have declined and have raised questions about representativeness and inherent bias in interpreting trends. Comprehensive comparative assessments of childhood obesity are rare.
About the study
The researchers of the current study examined obesity trends and disparities in the prevalence of overweight and obese children during the period 1995-2019.
The team used data from the National Child Measurement Program (NCMP) and the Health Survey for England (HSE) to examine trends and disparities in childhood obesity based on gender, ethnicity, parental education and family structure. HSE and NCMP data were analyzed using International Obesity Task Force (IOTF) guidelines, creating a body mass index (BMI) cutoff of 25 kg m.-2 Excess weight and 30 kg m-2 for obesity.
Study outcomes included sex- and age-specific overweight, adiposity, and overweight with adiposity. Inequality was measured using parental educational attainment, family type, ethnicity (white or non-white), and the regional Index of Multiple Deprivation (IMD).
Each child’s family was classified based on their educational attainment (from 1998 to 2014): no formal education, degree level, General Certificate of Education (GCE) advanced level, General Certificate of Secondary Education (GCSE), or equivalent.
The researchers investigated trends in overweight and obese children by calculating contextually relevant data throughout the year. They investigated non-response bias by assessing changes in age and IMD values in HSE and NCMP data between 2006 and 2019.
They used the relative index of inequality (RII) to examine the educational attainment of family members while accounting for long-term changes in IMD values and annual sample size variability. They performed Poisson regression modeling to calculate risk ratios (RRs) adjusted for gender and age.
By 2019, the prevalence of overweight and obesity in children has increased from 26% (1995) to 32%. Regional deprivation, ethnicity, family composition and family educational attainment have contributed to wide disparities, mainly due to increased frequency among socioeconomically disadvantaged children.
The disparity between children in uneducated families and degree-level educated parents widened from -1.1% to 13.2%. The gap between single-parent and couple households increased from 0.5% to 5.3%.
HSE changes in childhood overweight and adiposity stratified by socioeconomic deprivation quintile were comparable to NCMP findings. From 2001 to 2019, inequality in the prevalence rate of children due to deprivation increased, with the RII rising from 1.2 to 2.0. From 1997 to 2014, children in degree-educated families showed lower longevity than those in families lacking a degree-level education.
In 1999–2000, the education-related RII was 0.8, demonstrating an inverse relationship between family educational attainment and overweight and obesity prevalence, but in 2014 it increased to 1.8, indicating an inverse trend.
Since 2003, the RII appears to have risen due to continued trends in overweight and obesity rates among affluent children and rising rates among disadvantaged groups. From 1995–1996, the prevalence of overweight and adiposity was comparable among children living in single-parent households and in couple households (26%). During 2015-2016, the rate among children living with single parents increased to 34%, compared to 29% in couple families.
Initially, childhood overweight or adiposity was more common among children of white ethnicity (26%) than non-white ethnicity (24%), but the trend reversed over time; During the 2015–2016 period, prevalence rates among children of white and non-white ethnicity were 26% and 35%, respectively, a trend that continued throughout the study period.
The two datasets revealed similar patterns of pediatric overweight and adiposity despite the limitations of HSE. NCMP statistics consistently show that children in the poorest quintiles had higher prevalence rates than their less socioeconomically deprived peers, with disparities widening over time.
Both datasets revealed a progressive elevation of RII numbers, particularly among 10- to 11-year-olds, indicating a growing disparity in the pediatric prevalence of overweight and adiposity, especially among older children.
Overall, the study results showed that the prevalence of overweight and obesity in England increased between 1995 and 2019. Increasing gaps in deprivation, gender, family structure, ethnicity, and parental education have contributed to disparities in these rates.
The cost-of-living crisis threatens to worsen these inequalities, limiting access to nutritious food, decent education, health care, a safe environment and secure work. An increased prevalence of overweight and adiposity has been observed in adolescents and males, with a possible decrease in adolescents and females.