Area-based socioeconomic environment, obesity risk behaviours, area facilities and childhood overweight and obesity: Socioeconomic environment and childhood overweight
Highlights
► The less affluent areas showed the highest prevalence of childhood obesity in Spain. ► This finding was not explained by risk behaviours or by socioeconomic position. ► No relation was found between the price of fruits/vegetables and consumption. ► There was association between number of sports facilities and physical inactivity. ► Availability of sport facilities might influence prevalence of childhood obesity.
Introduction
Obesity has a complex aetiology due to the multitude of factors involved: genetic, environmental, metabolic, and lifestyle. One of the factors whose relation with childhood obesity has begun to be studied is socioeconomic environment of the area of residence. Several studies have found a relation between indicators of area-based socioeconomic environment and the prevalence of obesity (Shrewsbury and Wardle, 2008).
Adverse household socioeconomic circumstances are associated with a higher prevalence of obesity in childhood (Shrewsbury and Wardle, 2008), and the proportion of families in low socioeconomic position is higher in poor areas. However, less than half of the studies reporting a relation between area socioeconomic environment and obesity have investigated the extent to which this relation can be explained by household socioeconomic circumstances (Gross et al., 2009, Janssen et al., 2006, Oliver and Hayes, 2005, Veugelers and Fitzgerald, 2005, Voorhees et al., 2009). In three of these studies the relation could not be explained by household socioeconomic circumstances given that, after adjusting for those circumstances, the magnitude of the association decreased but did not disappear (Gross et al., 2009, Oliver and Hayes, 2005, Veugelers and Fitzgerald, 2005).
Likewise, the frequency of lifestyles conducive to obesity, such as unhealthy dietary patterns and physical inactivity, has been described as higher in children and adolescents who live in poor areas (Craig et al., 2010, Nelson and Woods, 2009), but only one of the mentioned studies (Veugelers and Fitzgerald, 2005) has investigated whether this difference in lifestyles helps explain the variability in the prevalence of obesity by area socioeconomic environment.
It has also been noted that differences in area facilities – such as the availability and price of healthy food and the absence of parks and sports and recreational facilities – may give rise to area differences in dietary intake and physical inactivity (Lovasi et al., 2009). However, to date no study has evaluated the extent to which differences in area facilities can explain the relation between socioeconomic environment and childhood obesity.
In light of the foregoing, the objectives of this work were to investigate the relation between socioeconomic environment of the area of residence and the prevalence of obesity and overweight in Spanish children and adolescents, and to evaluate whether the possible relation is explained by household socioeconomic circumstances, by obesity risk behaviours, and by area facilities.
Section snippets
Methods
Data were taken from the Spanish National Survey of Child Health conducted in 2006–07. Subjects were selected by multi-stage stratified sampling in each of the 50 provinces. Census sections were the first-stage units and primary households were the second-stage units. If children under 16 were living in the household, one of them was selected. The questionnaires were filled out by one of the parents or, if this was not possible, by the person's guardian. The median sample size per province was
Results
The relation of characteristics of study subjects and area of residence with the two indicators of socioeconomic environment was significant, except for their distribution by age and sex (Table 1). Age, sex, household socioeconomic position and risk behaviours were significantly related with the prevalence of both overweight and obesity except for fruit and vegetable consumption and type of breakfast (Table 2).
Table 3 shows the association of socioeconomic environment with overweight and
Discussion
Our results show a graded association between socioeconomic environment based on indicators reflecting wealth or deprivation and overweight and obesity. Adjusting for the variables that reflect family socioeconomic position and obesity risk behaviours reduced but did not eliminate the association, except for the relation between wealth and overweight, which disappeared.
Various studies in wealthy countries have also found that the prevalence of overweight and obesity in children and adolescents
Conflicts of interest statement
The authors declare no conflicts of interest.
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