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BEDREHELSE-Bedre helse og livskvalitet

Tackling socioeconomic differences in weight development among youth: assessing trends, mechanisms and potential interventions

Alternative title: Hvordan takle sosiale forskjeller i vektutvikling blant unge: trender, mekanismer og mulige tiltak

Awarded: NOK 15.9 mill.

Project Number:

273823

Application Type:

Project Period:

2018 - 2022

Partner countries:

Social inequalities in health are a well-known public health challenge. Among children and adolescents, these inequalities are reflected by more favorable health behaviors and a lower incidence of overweight/obesity among those with parents with high socioeconomic status. Reducing these differences has proven to be difficult, due namely to a poor understanding of the causal factors behind the differences and the interventions that are most effective. In this project, the first aim is to study socioeconomic differences in the development of body weight between birth and 14 years and assess factors explaining these differences. The second aim is to validate an environmental mapping tool and to map the neighborhood physical activity and food environments in areas with different levels of affluence. The third aim is to assess how these environments affect the health behaviors and body weight of adolescents and explore possible differences by individual and neighborhood socioeconomic status. We will also explore the interventions that are most likely to reduce inequalities in overweight and obesity among youth. To address these objectives, interviews with adolescents from different neighborhoods in Oslo and their parents have been conducted. A virtual audit tool to map the food and activity environments has been validated in different neighborhoods in Oslo. Analysis of data from a birth cohort study has been conducted to map inequalities in weight development from birth to childhood. A cross-sectional survey of students in Oslo has been completed. Around 900 students from 28 schools in different neighborhoods of Oslo have participated in this survey. Our results have indicated important trends over time in the development of inequalities in weight and factors that need to be targeted to combat these inequalities. Factors influencing adolescent eating and activity behaviors and explaining related social inequalities were also identified. The results of the project will be important for public health efforts aimed at reducing social differences in lifestyle behaviors and body weight among young people. The mapping tool validated in this study also constitutes an important resource for future studies. We have disseminated our findings using different channels, and plan to continue to do so.

The results of the project indicate clear socioeconomic differences in body weight, dietary behaviors and physical activity among youth, irrespective of the indicator of socioeconomic position used. Differences in behaviors were due to interacting factors at the home (such as accessibility of unhealthy food, parental modelling of health behaviors), but also at the neighborhood level (e.g. social norms related to food and activity, different opportunities for participation in leisure-time activity, use of fast food places as meeting place). Neighborhoods in Oslo with lower income had a tendency to have a higher availability of fast food places and a lower availability of indoor recreational facilities. Our results also showed an important impact of prenatal and early postnatal factors for inequalities in obesity among 5-, 8-and 14-year-olds based on data from the Norwegian Mother, Father and Child Cohort Study. Unhealthy behaviors and overweight/obesity among youth have several short- and long-term adverse health impacts. Thus, social inequalities in these behaviors and body weight represent an important societal problem. The results of this study have important implications for combating such inequalities, as they indicate entry points for interventions at the family, community and physical neighborhood level. Our results indicate that combating inequalities in dietary behaviors, physical activity and body weight among youth in Norway will require contributions from different sectors. These include antenatal care services/health stations and schools, in combination with interventions at the municipal level, supported by policies at the national level aiming to promote healthy diets and physical activity for all irrespective of socioeconomic background. The translation of our results into practice can thus contribute to ongoing efforts aimed at reducing social inequalities in Norway and beyond. Such efforts, if successful, can lead to significant health-related impacts, but also economic impacts. The project involved international interdisciplinary collaboration between project members with complementary skills and expertise, allowing multiple perspectives to be incorporated, and opening opportunities for future collaborative work among project members.

Overweight and obesity are a significant public health challenge globally, and disproportionately affect those with a low socioeconomic position in developed countries. Despite an increasing commitment at national and international levels, reducing these inequalities has proved challenging, even in settings considered as egalitarian such as Norway. Such inequalities are particularly problematic during childhood as their consequences can be both short term but also carry over into adulthood, contributing to a vicious circle of inequality in health. To address this challenge, there is a need to understand when, how and why these inequalities occur and develop throughout childhood. It is also of utmost importance to explore the understudied modifiable factors that contribute to unfavorable health behaviors leading to overweight and obesity and associated inequalities. Against this background, the present project aims to explore the longitudinal development of inequalities in body weight between birth and 14 years of age and identify important mediators of these inequalities. Using advanced modeling applied to high quality longitudinal data, the effects of hypothetical interventions on body weight and inequalities of body weight will be assessed. To explore the understudied effects of neighborhood physical characteristics on health behaviors and body weight among youth, a combination of approaches (qualitative and quantitative)will be used. Reducing social inequalities in health is a priority health agenda in Norway and globally. Results of this research will contribute to the development of interventions aimed at achieving this goal. An understanding of users' needs is key to the development of effective interventions. By involving relevant user groups in different phases of the project and by disseminating our findings, we aim to support the development of effective interventions aimed at reducing inequalities in health behaviors and body weight among youth.

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Funding scheme:

BEDREHELSE-Bedre helse og livskvalitet