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Socioeconomic position, macroeconomic environment and overweight among adolescents in 35 countries

Abstract

Objective:

It is important to understand levels and social inequalities in childhood overweight within and between countries. This study examined prevalence and social inequality in adolescent overweight in 35 countries, and associations with macroeconomic factors.

Design:

International cross-sectional survey in national samples of schools.

Subjects:

A total of 11-, 13- and 15-year-olds from 35 countries in Europe and North America in 2001–2002 (N=162 305).

Measurements:

The main outcome measure was overweight based on self-reported height and weight (body mass index cut-points corresponding to body mass index of 25 kg/m2 at the age of 18 years). Measures included family and school affluence (within countries), and average country income and economic inequality (between countries).

Results:

There were large variations in adolescent overweight, from 3.5% in Lithuanian girls to 31.7% in boys from Malta. Prevalence of overweight was higher among children from less affluent families in 21 of 24 Western and 5 of 10 Central European countries. However, children from more affluent families were at higher risk of overweight in Croatia, Estonia and Latvia. In Poland, Lithuania, Macedonia and Finland, girls from less affluent families were more overweight whereas the opposite was found for boys. Average country income was associated with prevalence and inequality in overweight when considering all countries together. However, economic inequality as measured by the Gini coefficient was differentially associated with prevalence and socioeconomic inequality in overweight among the 23-high income and 10-middle income countries, with a positive relationship among the high income countries and a negative association among the middle income countries.

Conclusion:

The direction and magnitude of social inequality in adolescent overweight shows large international variation, with negative social gradients in most countries, but positive social gradients, especially for boys, in some Central European countries. Macroeconomic factors are associated with the heterogeneity in prevalence and social inequality of adolescent overweight.

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Acknowledgements

HBSC is a WHO collaborative study. We thank International Coordinator of the 2001–2002 study: Candace Currie, University of Edinburgh, Scotland, and the Data bank manager: Oddrun Samdal, University of Bergen, Norway. We also thank all our international colleagues mentioned in Table 1 for thorough data sampling; we would also like to thank Lene Theil Skovgaard, Section of Biostatistic, Department of Public Health, Faculty of Health Sciences, University of Copenhagen for her technical advice and support in discussions on the multilevel statistics; and Birgit Pallesen and Karen Steenhard for their help with language. We owe our gratitude to The Health Insurance Foundation (Helsefonden), Denmark and the Nordea Denmark foundation for their support for our research.

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Correspondence to P Due.

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No parts of the article have been published elsewhere, and the article has not been sent to any other journals. The study complies with the Helsinki Declaration on ethics in science. All of the authors have approved the final version of the article.

Appendix

Appendix

Members of the HBSC Obesity Writing Group: A Borraccino, Department of Public Health and Microbiology, University of Turin, Turin, Italy; I Borup, Nordic School of Public Health, Göteborg, Sweden; W Boyce, Social Program Evaluation Group, Queens University, Kingston, Ontario, Canada; F Elgar, Department of Psychology, Carleton University, Ottawa, Ontario, Canada; SN Gabhainn, Department of Health Promotion, National University of Ireland, Galway, Ireland; R Krølner and C Svastisalee, Department of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark, MC Matos, Faculdade de Mortricidade Humana, Universidade Tecnica de Lisboa, Lisbon, Portugal; T Nansel, National Institute of Child Health and Human Development, Bethesda, MD, USA; H Al Sabbah and C Vereecken, Department of Public Health, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium; R Valimaa, Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland

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Due, P., Damsgaard, M., Rasmussen, M. et al. Socioeconomic position, macroeconomic environment and overweight among adolescents in 35 countries. Int J Obes 33, 1084–1093 (2009). https://doi.org/10.1038/ijo.2009.128

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