In a recently published study in the Archiv für Krankheiten im Kindesalter, researchers analyzed the increase in socio-economic and racial differences in overweight and obesity in children in England from 1995 to 2019, comparing survey data with administrative data.
Childhood obesity is a serious health problem, with the United Kingdom (UK) projected to be the country with the highest obesity rates in Europe by 2030.
Studies show that the prevalence of childhood obesity has increased over time, but decreased response rates raise questions about the representativeness and inherent biases in interpreting trends. Comprehensive comparative assessments of childhood obesity are rare.
About the Study
The researchers of the present study examined obesity trends and differences in the prevalence of overweight and obese children from 1995 to 2019.
The team used data from the National Child Measurement Program (NCMP) and the Health Survey for England (HSE) to analyze trends and differences in childhood obesity based on gender, ethnic background, parental education, and family structure. HSE and NCMP data were analyzed based on the International Obesity Task Force (IOTF) guidelines, deriving thresholds for body mass index (BMI) of 25 kg m-2 for overweight and 30 kg m-2 for obesity.
The study results included gender- and age-specific overweight, obesity, and overweight with obesity. Inequalities were measured based on parents‘ education level, family type, ethnic background (white or non-white), and the Index of Multiple Deprivation (IMD) region.
Each child’s household was classified according to their education level (from 1998 to 2014): no formal education, completion level, Advanced General Certificate of Education (GCE), General Certificate of Secondary Education (GCSE), or equivalent.
The researchers examined trends in overweight and obese children by calculating the prevalence over the relevant years. They assessed non-response bias by evaluating age changes and IMD values in HSE and NCMP data between 2006 and 2019.
They used the Relative Index of Inequality (RII) to examine long-term changes in IMD values and household members‘ education level, taking into account the annual variability of the sample size. They conducted Poisson regression modeling to calculate risk ratios (RR) adjusted for gender and age.
The pediatric prevalence rate of overweight and obesity increased from 26% (1995) to 32% in 2019. Regional deprivation, ethnic background, household configuration, and family education level contributed to greater inequalities, primarily due to the increased frequency of socioeconomically disadvantaged children.
The differences between pediatric individuals from low-educated families and those with parents with a higher education degree increased from -1.1% to 13.2%. The differences between single-parent and couple households increased from 0.5% to 5.3%.
The HSE changes in the prevalence of childhood overweight and obesity due to socioeconomic deprivation quintiles were comparable to the NCMP results. From 2001 to 2019, the differences in prevalence rates of children due to deprivation increased, with the RII rising from 1.2 to 2.0. From 1997 to 2014, children from families with a higher education degree had lower obesity prevalence than children from households without a higher education degree.
In the 1999-2000 period, the education-related RII was 0.8, showing a reverse association between household education level and overweight and obesity prevalence. However, in 2014, it increased to 1.8, indicating a reversal trend.
Since 2003, the RII seemed to increase due to constant prevalence rates of overweight and obesity in affluent children and increasing rates in disadvantaged groups. From 1995 to 1996, the prevalence of overweight and obesity in children living in single-parent and couple homes was comparable (26%). In the 2015-2016 period, the rates rose to 34% for children living with a single parent, compared to 29% in couple households.
Initially, the prevalence of overweight or obesity in white ethnic children (26%) was higher than in non-white ethnic children (24%), but over time, the trend reversed. In the 2015-2016 period, the prevalence rates in white and non-white ethnic children were 26% and 35%, respectively, a trend that continued throughout the study period.
Both datasets showed similar patterns in overweight and obesity in children, despite the limitations of HSE. NCMP statistics consistently showed that children in the poorest quintiles had higher prevalence rates than their less socioeconomically disadvantaged peers, with inequality increasing over time.
Both datasets indicated a progressive increase in RII numbers, especially in individuals aged 10 to 11, suggesting growing differences in pediatric overweight and obesity prevalence, especially in older children.
Overall, the study results in England between 1995 and 2019 showed an increased pediatric prevalence rate of overweight and obesity. Increasing differences in terms of deprivation, gender, family structure, ethnic background, and parental education led to disparities in the rates.
The cost of living crisis threatens to exacerbate these differences and restrict access to nutritious meals, proper education, healthcare, a safe environment, and secure employment. An increased prevalence of overweight and obesity was observed in adolescents and males, with a likely decrease in younger age groups and females.