Socioeconomic inequalities in overweight and obesity among 6- to 9-year-old children in 24 countries from the World Health Organization European region

Marta Buoncristiano, Julianne Williams, Philippa Simmonds, Eha Nurk, Wolfgang Ahrens, Paola Nardone, Ana Isabel Rito, Harry Rutter, Ingunn Holden Bergh, Gregor Starc, Kenisha Russell Jonsson, Angela Spinelli, Stefanie Vandevijvere, Päivi Mäki, Sanja Musić Milanović, Benoît Salanave, Mahmut S. Yardim, Tatjana Hejgaard, Anna Fijałkowska, Shynar AbdrakhmanovaZulfiya Abdurrahmonova, Vesselka Duleva, Victoria Farrugia Sant'Angelo, Marta García-Solano, Andrea Gualtieri, Enrique Gutiérrez-González, Constanta Huidumac-Petrescu, Jolanda Hyska, Cecily C. Kelleher, Enisa Kujundžić, Valentina Peterkova, Ausra Petrauskiene, Iveta Pudule, Elena Sacchini, Lela Shengelia, Maya Tanrygulyyeva, Radka Taxová Braunerová, Zhamilya Usupova, Katharina Maruszczak, Sergej M. Ostojic, Igor Spiroski, Dragana Stojisavljević, Kremlin Wickramasinghe, João Breda

Research output: Contribution to journalArticlepeer-review

47 Citations (SciVal)


Childhood overweight and obesity have significant short- and long-term negative impacts on children's health and well-being. These challenges are unequally distributed according to socioeconomic status (SES); however, previous studies have often lacked standardized and objectively measured data across national contexts to assess these differences. This study provides a cross-sectional picture of the association between SES and childhood overweight and obesity, based on data from 123,487 children aged 6–9 years in 24 countries in the World Health Organization (WHO) European region. Overall, associations were found between overweight/obesity and the three SES indicators used (parental education, parental employment status, and family-perceived wealth). Our results showed an inverse relationship between the prevalence of childhood overweight/obesity and parental education in high-income countries, whereas the opposite relationship was observed in most of the middle-income countries. The same applied to family-perceived wealth, although parental employment status appeared to be less associated with overweight and obesity or not associated at all. This paper highlights the need for close attention to context when designing interventions, as the association between SES and childhood overweight and obesity varies by country economic development. Population-based interventions have an important role to play, but policies that target specific SES groups are also needed to address inequalities.

Original languageEnglish
Article numbere13213
JournalObesity Reviews
Issue numberS6
Early online date28 Jun 2021
Publication statusPublished - 30 Nov 2021

Bibliographical note

Funding Information:
The authors gratefully acknowledge support through a grant from the Russian Government in the context of the WHO European Office for the Prevention and Control of NCDs. The Ministries of health of Austria, Croatia, Greece, Italy, Malta, Norway, and the Russian Federation provided financial support for the meetings at which the protocol, data collection procedures, and analyses were discussed. Data collection in the countries was made possible through funding from: : World Health Organization (WHO) Country Office Albania and the WHO Regional Office for Europe. : WHO Regional Office for Europe. : Ministry of Health, Croatian Institute of Public Health and WHO Regional Office for Europe. : Ministry of Health of the Czech Republic, grant nr. 17‐31670A and MZCR—RVO EU 00023761. : The Danish Ministry of Health. : Santé publique France, the French Agency for Public Health. : WHO. : Health Service Executive. : Italian Ministry of Health; Italian National Institute of Health (Istituto Superiore di Sanità). : the Ministry of Health of the Republic of Kazakhstan within the scientific and technical program. : World Health Organization. : Centre for Disease Prevention and Control, Ministry of Health, Latvia. : Science Foundation of Lithuanian University of Health Sciences and Lithuanian Science Council and WHO. : Ministry of Health; : WHO and Institute of Public Health of Montenegro. , National Health Program, Ministry of Health. : Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates and the kind technical support from the Center for Studies and Research on Social Dynamics and Health (CEIDSS). : Ministry of Health; : WHO. : Health Ministry, Educational Ministry, Social Security Institute and Health Authority. : the Spanish Agency for Food Safety & Nutrition. : WHO Country Office in Tajikistan and Ministry of Health and Social Protection. : WHO Country Office in Turkmenistan and Ministry of Health. : Turkish Ministry of Health and World Bank. Albania Bulgaria Croatia Czechia Denmark France Georgia Ireland Italy Kazakhstan Kyrgyzstan Latvia Lithuania Malta Montenegro Poland Portugal Romania Russian Federation San Marino Spain Tajikistan Turkmenistan Turkey



  • children
  • obesity
  • overweight
  • socioeconomic status

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Public Health, Environmental and Occupational Health


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