Childhood obesity in England shows alarming rise in disparities over 24 years

In a recent study published in the Archives of Disease in Childhood, researchers analyzed increases in socioeconomic and racial disparities in childhood overweight and adiposity in England from 1995 to 2019, comparing survey data with administrative data.

Childhood obesity is a severe health issue, with the United Kingdom (UK) predicted to become the most obese nation in Europe by 2030.

Research indicates that the incidence of pediatric obesity has increased over time. Nevertheless, decreased response rates raise questions regarding representativeness and inherent biases in interpreting trends. Comprehensive comparative evaluations of childhood obesity are infrequent.

About the study

The researchers of the present study examined obesity trends and disparities in the prevalence of overweight and obese children in the 1995-2019 period.

The team used the National Child Measurement Programme (NCMP) and the Health Survey for England (HSE) data to examine trends and disparities in childhood obesity based on sex, ethnicity, parental education, and family structure. HSE and NCMP data were analyzed using International Obesity Task Force (IOTF) guidelines, deriving body mass index (BMI) cutoffs of 25 kg m^-2 for overweight and 30 kg m^-2 for obesity.

The study findings included sex- and age-specific overweight, adiposity, and overweight with adiposity. Inequalities were measured using parental educational attainment, family type, ethnicity (white or non-white), and region-wise Index of Multiple Deprivation (IMD).

The household of each child 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 prevalence throughout relevant years. They investigated non-response biases by assessing 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 the educational attainment of household members while accounting for yearly sample size variability. They performed Poisson regression modeling to calculate risk ratios (RR), adjusted for sex and age.

Results

Pediatric prevalence rates of overweight and adiposity rose from 26% (1995) to 32% by 2019. Region-wise deprivation, ethnicity, household configuration, and family educational attainment contributed to wider disparities, predominantly driven by increased frequency among socioeconomically deprived children.

Disparities between pediatric individuals from uneducated families and those with degree-level educated parents expanded from -1.1% to 13.2%. The gaps between one-parent and couple homes rose from 0.5% to 5.3%.

The HSE changes in the pediatric overweight and adiposity prevalence by socioeconomic deprivation quintiles were comparable with NCMP findings. From 2001 to 2019, disparities in the prevalence rates child due to deprivation increased, with RII growing from 1.2 to 2.0. From 1997 to 2014, children from degree-educated families showed lower adiposity prevalence than those from households lacking degree-level education.

In 1999-2000, education-associated RII was 0.8, demonstrating an inverse association between household educational attainment and overweight and adiposity prevalence, but it rose to 1.8 in 2014, indicating a trend reversal.

Since 2003, the RII seemed to increase due to the constant prevalence rates of overweight and adiposity in affluent children and rising rates in disadvantaged groups. From 1995-1996, the prevalence of overweight and adiposity was comparable among children residing in single-parent homes and couple homes (26%). In the 2015–2016 period, the rates increased to 34% in children living with a single parent, against 29% in couple households.

Initially, pediatric overweight or adiposity prevalence was more common among children of white ethnicity (26%) compared to those of non-white ethnicities (24%), but the trend reversed with time; in the 2015–2016 period, the prevalence rates were 26% and 35% among children of white and non-white ethnicities, respectively, a trend that continued over the study period.

The two datasets revealed similar patterns in pediatric overweight and adiposity despite HSE’s limitations. NCMP statistics consistently show that children in the poorest quintiles had higher prevalence rates than their less socioeconomically deprived counterparts, with the disparity widening over time.

Both datasets reveal progressive elevations in RII numbers, especially among those aged 10 to 11 years, indicating growing disparities in pediatric prevalence of overweight and adiposity, especially in older children.

Overall, the study findings showed increased pediatric prevalence rates of overweight and adiposity in England between 1995 and 2019. Increasing gaps in deprivation, gender, family structure, ethnicity, and parental education drove inequalities in the rates.

The cost-of-living crisis threatens to worsen these disparities, limiting access to nutritious meals, decent education, healthcare, safe surroundings, and secure work. Increased prevalence of overweight and adiposity was noted in adolescents and males, with probable decreases in younger ages and girls.