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Social class, parental education, and obesity prevalence in a study of six-year-old children in Germany

Abstract

OBJECTIVE:

To assess the association between socioeconomic status (SES) and childhood obesity, and which factor in particular stands out in relation to obesity.

METHODS:

When 2020 children attended their obligatory health exam prior to school entry in the City of Aachen, Germany, 1979 parents (97.9%) filled out a questionnaire on their child's weight development and on indicators of their family's SES in a cross-sectional survey. In addition, standardized measures of weight and height were taken. More detailed information on several different SES variables, such as parental education, occupation, income, family constellation, single parenthood, and the location and size of the family residence was obtained by personal interviews in a subsample of all native German speaking children with a BMI≥85th percentile, defined as cases (n=146), and with a BMI between the 40th and 60th percentile, defined as controls (n=221).

RESULTS:

The indicators of parental education were most strongly associated with children's obesity. There was a strong dose–response relationship between a composed index of social class and obesity. Children of the lowest social status had a more than three-fold risk to be obese than children of the highest social status in the screening population (OR: 3.29, CI: 1.92–5.63).

CONCLUSIONS:

The findings established a strong relationship between parental years of education and childhood obesity. Prevention and treatment programs should endeavor to better target undereducated parents and their young children at high risk.

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References

  1. World Health Organization. Prevention and managing the global epidemic. Report of a WHO Consultation on Obesity, Geneva, 3–5 June, 1998.

  2. Fredriks AM, van Buuren S, Wit JM, Verloove-Vanhorick SP . Body index measurements in 1996–7 compared with 1980. Arch Dis Child 2000; 82: 107–112.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Herpertz-Dahlmann B, Geller F, Bohle C, Khalil C, Trost-Brinkhues G, Ziegler A, Hebebrand J . Secular trends in body mass index measurements in preschool children from the City of Aachen, Germany. Eur J Pediatr 2003; 162: 104–109.

    PubMed  Google Scholar 

  4. Kromeyer-Hauschild K, Zellner K, Jaeger U, Hoyer H . Prevalence of overweight and obesity among school children in Jena (Germany). Int J Obes Relat Metab Disord 1999; 23: 1143–1150.

    Article  CAS  PubMed  Google Scholar 

  5. Lazarus R, Wake M, Hesketh K, Waters E . Change in body mass index in Australian primary school children, 1985–1997. Int J Obes Relat Metab Disord 2000; 24: 679–684.

    Article  CAS  PubMed  Google Scholar 

  6. Lobstein T, Frelut ML . Prevalence of overweight among children in Europe. Obes Rev 2003; 4: 195–200.

    Article  CAS  PubMed  Google Scholar 

  7. Ogden CL, Flegal KM, Carroll MD, Johnson CL . Prevalence and trends in overweight among US children and adolescents, 1999–2000. JAMA 2002; 288: 1728–1732.

    Article  PubMed  Google Scholar 

  8. Birch LL, Davison KK . Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight. Pediatr Clin N Am 2001; 48: 893–907.

    Article  CAS  Google Scholar 

  9. Langnase K, Mast M, Muller MJ . Social class differences in overweight of prepubertal children in northwest Germany. Int J Obes Relat Metab Disord 2002; 26: 566–572.

    Article  CAS  PubMed  Google Scholar 

  10. Mei Z, Scanlon KS, Grummer-Strawn LM, Freedman DS, Yip R, Trowbridge FL . Increasing prevalence of overweight among US low-income preschool children: the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance, 1983 to 1995. Pediatrics 1998; 101: E12.

    Article  CAS  PubMed  Google Scholar 

  11. Parsons TJ, Power C, Logan S, Summerbell CD . Childhood predictors of adult obesity: a systematic review. Int J Obes Relat Metab Disord 1999; 23 (Suppl 8): S1–S107.

    PubMed  Google Scholar 

  12. Reidpath DD, Burns C, Garrard J, Mahoney M, Townsend M . An ecological study of the relationship between social and environmental determinants of obesity. Health Place 2002; 8: 141–145.

    Article  PubMed  Google Scholar 

  13. De Spiegelaere M, Dramaix M, Hennart P . The influence of socioeconomic status on the incidence and evolution of obesity during early adolescence. Int J Obes Relat Metab Disord 1998; 22: 268–274.

    Article  CAS  PubMed  Google Scholar 

  14. Braddon FE, Rodgers B, Wadsworth ME, Davies JM . Onset of obesity in a 36 year birth cohort study. Br Med J (Clin Res Edn) 1986; 293: 299–303.

    Article  CAS  Google Scholar 

  15. Gortmaker SL, Must A, Perrin JM, Sobol AM, Dietz WH . Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med 1993; 329: 1008–1012.

    Article  CAS  PubMed  Google Scholar 

  16. Sobal J, Stunkard AJ . Socioeconomic status and obesity: a review of the literature. Psychol Bull 1989; 105: 260–275.

    Article  CAS  PubMed  Google Scholar 

  17. Lamerz A, Kuepper-Nybelen J, Bruning N, Wehle C, Trost-Brinkhues G, Brenner H, Hebebrand J, Herpertz-Dahlmann B . Prevalence of obesity, binge eating, and night eating in a cross-sectional field survey of 6-year-old children and their parents in a German urban population. J Child Psychol. Psychiatry 2005; 46: 4.

    Article  Google Scholar 

  18. Zametkin AJ, Zoon CK, Klein HW, Munson S . Psychiatric aspects of child and adolescent obesity: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 2004; 43: 134–150.

    Article  PubMed  Google Scholar 

  19. Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Geiß HC, Hesse V, von Hippel A, Jaeger U, Johnson D, Korte W, Menner K, Müller G, Müller JM, Niemann-Pilatus A, Remer T, Schaefer F, Wittchen HU, Zabransky S, Zellner K, Ziegler A, Hebebrand J . Perzentile für den Body-mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben [Percentiles of body mass index in children and adolescents evaluated from different regional German studies]. Monatsschr Kinderheilkd 2001; 149: 807–818.

    Article  Google Scholar 

  20. Peng CJ, Chang CM, Kuo SE, Liu YJ, Kuo HC, Lin SJ . Analysis of anthropometric growth trends and prevalence of abnormal body status in Tainan elementary-school children. Acta Paediatr Taiwan 1999; 40: 406–413.

    CAS  PubMed  Google Scholar 

  21. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL . 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 2002; 11: 1–190.

    Google Scholar 

  22. Dietz WH, Bellizzi MC . Introduction: the use of body mass index to assess obesity in children. Am J Clin Nutr 1999; 70: 123S–125S.

    Article  CAS  PubMed  Google Scholar 

  23. Statistik Regional 1999 [Regional Statistics 1999]. Düsseldorf: Landesamt für Datenverarbeitung und Statistik 2000.

  24. Statistisches Jahrbuch der Stadt Aachen 2001 [Statistical Yearbook of the City of Aachen 2001]. Aachen: Statistisches- und Meldeamt der Stadt Aachen 2002.

  25. Rasmussen F, Johansson M, Hansen HO . Trends in overweight and obesity among 18-year-old males in Sweden between 1971 and 1995. Acta Paediatr 1999; 88: 431–437.

    Article  CAS  PubMed  Google Scholar 

  26. Stam-Moraga MC, Kolanowski J, Dramaix M, De Backer G, Kornitzer MD . Sociodemographic and nutritional determinants of obesity in Belgium. Int J Obes Relat Metab Disord 1999; 23 (Suppl 1): 1–9.

    Article  PubMed  Google Scholar 

  27. Power C, Parsons T . Nutritional and other influences in childhood as predictors of adult obesity. Proc Nutr Soc 2000; 59: 267–272.

    Article  CAS  PubMed  Google Scholar 

  28. Power C, Matthews S . Origins of health inequalities in a national population sample. Lancet 1997; 350: 1584–1589.

    Article  CAS  PubMed  Google Scholar 

  29. Lamb M, Pleck J, Charnov E, Levine J . A biosocial perspective on parental behavior and involvement. In: Lancaster J, Alterman J, Rossi A, Sherrod L (eds) Parenting across the lifespan: biosocial dimensions. Aldine de Gruyter: New York; 1987. pp 111–142.

    Google Scholar 

  30. Jacobi C, Agras WS, Hammer L . Predicting children's reported eating disturbances at 8 years of age. J Am Acad Child Adolesc Psychiatry 2001; 40: 364–372.

    Article  CAS  PubMed  Google Scholar 

  31. Laessle RG, Uhl H, Lindel B . Parental influences on eating behavior in obese and nonobese preadolescents. Int J Eat Disord 2001; 40: 447–453.

    Article  Google Scholar 

  32. Anderson PM, Butcher KF, Levine PB . Maternal employment and overweight children. J Health Econ 2003; 22: 477–504.

    Article  PubMed  Google Scholar 

  33. Lowry R, Kann L, Collins JL, Kolbe LJ . The effect of socioeconomic status on chronic disease risk behaviors among US adolescents. JAMA 1996; 276: 792–797.

    Article  CAS  PubMed  Google Scholar 

  34. Ward M, Sheridan A, Howell F, Hegarty I, O'Farrell A . Infant feeding: factors affecting initiation, exclusivity and duration. Irish Med J 2004; 97: 197–199.

    CAS  Google Scholar 

  35. Jeffery RW, French SA . Socioeconomic status and weight control practices among 20- to 45-year-old women. Am J Public Health 1996; 86: 1005–1010.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Wardle J, Volz C, Golding C . Social variation in attitudes to obesity in children. Int J Obes Relat Metab Disord 1995; 19: 562–569.

    CAS  PubMed  Google Scholar 

  37. Lissau I, Sorensen TI . Parental neglect during childhood and increased risk of obesity in young adulthood. Lancet 1994; 343: 324–327.

    Article  CAS  PubMed  Google Scholar 

  38. Shaffer DR . Developmental Psychology, 5th edn. Brooks/Cole: Pacific Grove, CA; 1999.

    Google Scholar 

  39. Power C, Manor O, Matthews S . Child to adult socioeconomic conditions and obesity in a national cohort. Int J Obes Relat Metab Disord 2003; 27: 1081–1086.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We would like to thank the entire staff of the Aachen Public Health Service and the medical students Sandra Schäfer, Christine Schell and Martina Selzner for their support and cooperation. This study was funded by the German Society for the Advancement of Scientific Research (DFG Grants HE 1809/5-1 and BR 1704/4-1) and by the START-Program of the Medical Faculty, RWTH Aachen, Germany.

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Correspondence to A Lamerz.

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Lamerz, A., Kuepper-Nybelen, J., Wehle, C. et al. Social class, parental education, and obesity prevalence in a study of six-year-old children in Germany. Int J Obes 29, 373–380 (2005). https://doi.org/10.1038/sj.ijo.0802914

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