In high-income countries, childhood obesity follows a clear socioeconomic gradient with greater prevalence in children with lower socioeconomic status (SES). The extent to which the trend of other social vulnerabilities over time and the accumulation of these vulnerabilities can affect children’s weight is still unknown.
In the IDEFICS study, 8624 children aged 2.0–9.9 years from eight European countries were examined at baseline and after 2 years. Sociodemographic variables, maternal body mass index (BMI), and lifestyle were reported by parents. Children were measured and classified as thin, normal weight, and overweight/obese using the extended IOTF criteria. Four vulnerable groups were defined: children whose parents were migrants, children whose parents lack a social network, children from non-traditional families (children not living with both biological parents), and children with unemployed parents. Logistic mixed-effects models were used to study the association between vulnerabilities and children’s weight at baseline and follow-up, temporal trends in vulnerabilities and children’s weight and accumulation of vulnerabilities and children’s weight. Models were adjusted for lifestyle, maternal BMI, parental education, and income.
Children whose parents lost their social support at follow-up were more likely to be thin than non-vulnerable children (OR = 1.69, 99% CI = 1.03–2.78). Children whose parents had a migrant background (OR = 1.30, 99% CI 1.04–1.62), children from non-traditional families at both time points (OR = 1.40, 99% CI 1.03–1.90) and whose parents were unemployed at baseline and follow-up (OR = 2.03, 99% CI 1.03–3.99) were more likely to be overweight/obese compared to non-vulnerable children. Cross-sectionally, we did not find an association between parental lack of network, non-traditional family structure, or employment and children’s weight status.
Policy actions are required to tackle inadequate weight loss and gain among vulnerable children (especially those exposed over the long term) since they are at a higher risk of thinness and overweight.
Subscribe to Journal
Get full journal access for 1 year
only $64.42 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
World Health Organization (WHO). Global strategy on diet, physical activity and health: childhood obesity and overweight. http://www.who.int/dietphysicalactivity/childhood/en/. 2017.
Biro FM, Wien M. Childhood obesity and adult morbidities. Am J Clin Nutr. 2010;91:1499S–1505S.
Rokholm B, Baker JL, Sorensen TI. The levelling off of the obesity epidemic since the year 1999—a review of evidence and perspectives. Obes Rev. 2010;11:835–46.
White J, Rehkopf D, Mortensen LH. Trends in socioeconomic inequalities in body mass index, underweight and obesity among English children, 2007–2008 to 2011–2012. PLoS ONE. 2016;11:e0147614.
Peeters A, Backholer K. Reducing socioeconomic inequalities in obesity: the role of population prevention. Lancet Diabetes Endocrinol. 2015;3:838–40.
Chung A, Backholer K, Wong E, Palermo C, Keating C, Peeters A. Trends in child and adolescent obesity prevalence in economically advanced countries according to socioeconomic position: a systematic review. Obes Rev. 2016;17:276–95.
Iguacel I, Fernandez-Alvira JM, Bammann K, De Clercq B, Eiben G, Gwozdz W, et al. Associations between social vulnerabilities and dietary patterns in European children: the Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study. Br J Nutr. 2016;116:1288–97.
Iguacel I, Michels N, Fernandez-Alvira JM, Bammann K, De Henauw S, Felso R, et al. Associations between social vulnerabilities and psychosocial problems in European children. Results from the IDEFICS study. Eur Child Adolesc Psychiatry. 2017;26:1105–17.
Iguacel I, Fernández-Alvira JM, Labayen I, Moreno LA, Samper MP, Rodríguez G. Social vulnerabilities as determinants of overweight in 2-, 4- and 6-year-old Spanish children. Eur J Public Health. 2017;27:788–96.
Harvey JR, Ogden D. Obesity treatment in disadvantaged population groups: where do we stand and what can we do? Prev Med. 2014;68:71–5.
Cutter SL, Carolina UoS, Boruff BJ, Carolina UoS, Shirley WL, Carolina UoS. Social vulnerability to environmental hazards. Soc Sci Q. 2003;84:242–61.
Labree W, van de Mheen D, Rutten F, Rodenburg G, Koopmans G, Foets M. Differences in overweight and obesity among children from migrant and native origin: the role of physical activity, dietary intake, and sleep duration. PLoS ONE. 2015;10:e0123672.
Chen AY, Escarce JJ. Family structure and childhood obesity, Early Childhood Longitudinal Study—Kindergarten Cohort. Prev Chronic Dis. 2010;7:A50.
Lissner L, Wijnhoven TM, Mehlig K, Sjoberg A, Kunesova M, Yngve A, et al. Socioeconomic inequalities in childhood overweight: heterogeneity across five countries in the WHO European Childhood Obesity Surveillance Initiative (COSI-2008). Int J Obes. 2016;40:796–802.
Gerald LB, Anderson A, Johnson GD, Hoff C, Trimm RF. Social class, social support and obesity risk in children. Child Care Health Dev. 1994;20:145–63.
Braveman P, Gottlieb L. The social determinants of health: it’s time to consider the causes of the causes. Public Health Rep. 2014;129:19–31.
Parks EP, Kumanyika S, Moore RH, Stettler N, Wrotniak BH, Kazak A. Influence of stress in parents on child obesity and related behaviors. Pediatrics. 2012;130:e1096–104.
De Henauw S, Verbestel V, Marild S, Barba G, Bammann K, Eiben G, et al. The IDEFICS community-oriented intervention programme: a new model for childhood obesity prevention in Europe? Int J Obes. 2011;35:S16–23.
Ahrens W, Bammann K, Siani A, Buchecker K, De Henauw S, Iacoviello L, et al. The IDEFICS cohort: design, characteristics and participation in the baseline survey. Int J Obes. 2011;35:S3–15.
Bammann K, Gwozdz W, Lanfer A, Barba G, De Henauw S, Eiben G, et al. Socioeconomic factors and childhood overweight in Europe: results from the multi-centre IDEFICS study. Pediatr Obes. 2013;8:1–12.
Meesters PD, Comijs HC, de Haan L, Smit JH, Eikelenboom P, Beekman AT, et al. Subjective quality of life and its determinants in a catchment area based population of elderly schizophrenia patients. Schizophr Res. 2013;147:275–80.
Waldfogel J, Craigie TA, Brooks-Gunn J. Fragile families and child wellbeing. Future Child. 2010;20:87–112.
Agnafors S, Sydsjo G, Comasco E, Bladh M, Oreland L, Svedin CG. Early predictors of behavioural problems in pre-schoolers—a longitudinal study of constitutional and environmental main and interaction effects. BMC Pediatr. 2016;16:76.
Huybrechts I, Bornhorst C, Pala V, Moreno LA, Barba G, Lissner L, et al. Evaluation of the children’s eating habits questionnaire used in the IDEFICS study by relating urinary calcium and potassium to milk consumption frequencies among European children. Int J Obes. 2011;35:S69–78.
Stomfai S, Ahrens W, Bammann K, Kovács É, Mårild S, Michels N, et al. Intra- and inter-observer reliability in anthropometric measurements in children. Int J Obes. 2011;35:S45–51.
Cole TJ, Lobstein T. Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes. 2012;7:284–94.
UNESCO. Statistics. Montreal, QC: International Standard Classification of Education (ISCED); 2006.
Kim S, Egerter S, Cubbin C, Takahashi ER, Braveman P. Potential implications of missing income data in population-based surveys: an example from a postpartum survey in California. Public Health Rep. 2007;122:753–63.
Grow HM, Cook AJ, Arterburn DE, Saelens BE, Drewnowski A, Lozano P. Child obesity associated with social disadvantage of children’s neighborhoods. Soc Sci Med. 2010;71:584–91.
Shrewsbury V, Wardle J. Socioeconomic status and adiposity in childhood: a systematic review of cross-sectional studies 1990-2005. Obesity. 2008;16:275–84.
Wang Y, Lim H. The global childhood obesity epidemic and the association between socio-economic status and childhood obesity. Int Rev Psychiatry. 2012;24:176–88.
Nyberg G, Norman Å, Sundblom E, Zeebari Z, Elinder LS. Effectiveness of a universal parental support programme to promote health behaviours and prevent overweight and obesity in 6-year-old children in disadvantaged areas, the Healthy School Start Study II, a cluster-randomised controlled trial. Int J Behav Nutr Phys Act. 2016;21:13.
Heredia NI, Ranjit N, Warren JL, Evans AE. Association of parental social support with energy balance-related behaviors in low-income and ethnically diverse children: a cross-sectional study. BMC Public Health. 2016;16:1182.
Tate EB, Wood W, Liao Y, Dunton GF. Do stressed mothers have heavier children?: a meta-analysis on the relationship between maternal stress and child body mass index. Obes Rev. 2015;16:351–61.
Stenhammar C.Department of Women’s and Children’s Health UU, Uppsala, Sweden, Olsson G, Department of Neuroscience and Department of Public Health and Caring Sciences UU, Uppsala, Sweden, Bahmanyar S, Clinical Epidemiology Unit KH, Karolinska Institutet, Stockholm, Sweden, et al. Family stress and BMI in young children. Acta Paediatr. 2010;99:1205–12.
Strauss RS, Knight J. Influence of the home environment on the development of obesity in children. Pediatrics. 1999;103:e85.
Gibson LY, Byrne SM, Davis EA, Blair E, Jacoby P, Zubrick SR. The role of family and maternal factors in childhood obesity. Med J Aust. 2007;186:591–5.
Yannakoulia M, Papanikolaou K, Hatzopoulou I, Efstathiou E, Papoutsakis C, Dedoussis GV, et al. Association between family divorce and children’s BMI and meal patterns: the GENDAI study. Obesity. 2008;16:1382–7.
Vanaelst B, De Vriendt T, Ahrens W, Bammann K, Hadjigeorgiou C, Konstabel K, et al. Prevalence of psychosomatic and emotional symptoms in European school-aged children and its relationship with childhood adversities: results from the IDEFICS study. Eur Child Adolesc Psychiatry. 2012;21:253–65.
Vanaelst B, Huybrechts I, De Bourdeaudhuij I, Bammann K, Hadjigeorgiou C, Eiben G, et al. Prevalence of negative life events and chronic adversities in European pre- and primary-school children: results from the IDEFICS study. Arch Public Health. 2012;22:70.
Labree LJ, van de Mheen H, Rutten FF, Foets M. Differences in overweight and obesity among children from migrant and native origin: a systematic review of the European literature. Obes Rev. 2011;12:e535–47.
Delavari M, Sønderlund AL, Swinburn B, Mellor D, Renzaho A. Acculturation and obesity among migrant populations in high income countries—a systematic review. BMC Public Health. 2013;13:458.
Gordon-Larsen P, Harris KM, Ward DS, Popkin BM. Acculturation and overweight-related behaviors among Hispanic immigrants to the US: the National Longitudinal Study of Adolescent Health. Soc Sci Med. 2003;57:2023–34.
Hope S, Pearce A, Whitehead M, Law C. Parental employment during early childhood and overweight at 7-years: findings from the UK Millennium Cohort Study. BMC Obes. 2015;2:33.
Cawley J, Liu F. Maternal employment and childhood obesity: a search for mechanisms in time use data. Econ Hum Biol. 2012;10:352–64.
Bauer KW, Hearst MO, Escoto K, Berge JM, Neumark-Sztainer D. Parental employment and work-family stress: associations with family food environments. Soc Sci Med. 2012;75:496–504.
Voss M, Nylen L, Floderus B, Diderichsen F, Terry PD. Unemployment and early cause-specific mortality: a study based on the Swedish twin registry. Am J Public Health. 2004;94:2155–61.
Iguacel I, Fernandez-Alvira JM, Bammann K, Chadjigeorgiou C, De Henauw S, Heidinger-Felso R, et al. Social vulnerability as a predictor of physical activity and screen time in European children. Int J Public Health. 2018;63:283–95.
Hense S, Pohlabeln H, Nathalie M, Mårild S, Lissner L, Kovacs E, et al. Determinants of attrition to follow-up in a multicentre cohort study in children-results from the IDEFICS Study. Epidemiol Res Int. 2013;2013:1.
This work has been done as part of the IDEFICS Study (http://www.idefics.eu). The authors gratefully acknowledge the financial support of the European Community within the Sixth RTD Framework Programme Contract No. 016181 (FOOD). II has been financed by the FPU (grant reference FPU014/00922) Predoctoral Programmes (Spanish Ministry of Education and Science). We thank the IDEFICS children and their parents who generously volunteered and participated in this project.
II carried out the statistical analysis and drafted the manuscript along with LAM. NM and CB designed the statistical analyses. KB, JMF-A, WG, AS, and PR developed the measurement instruments; WA, LL, LR, MT, LAM, and TV supervised the national data collection. Authors read and critically reviewed the manuscript.
Conflict of interest
The authors declare that they have no conflict of interest.
Electronic supplementary material
About this article
Cite this article
Iguacel, I., Fernández-Alvira, J.M., Ahrens, W. et al. Prospective associations between social vulnerabilities and children’s weight status. Results from the IDEFICS study. Int J Obes 42, 1691–1703 (2018). https://doi.org/10.1038/s41366-018-0199-6
International Journal of Obesity (2020)
Socioeconomically Disadvantaged Groups and Metabolic Syndrome in European Adolescents: The HELENA Study
Journal of Adolescent Health (2020)
A randomized controlled trial for overweight and obesity in preschoolers: the More and Less Europe study - an intervention within the STOP project
BMC Public Health (2019)