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

Sosiale forskjeller i helse er en velkjent utfordring i folkehelsearbeidet - også blant barn og unge - hvor dette gjenspeiles i sunnere helsevaner og lavere forekomst av overvekt/fedme blant de som har foreldre med høy sosial status. Det har imidlertid vist seg vanskelig å redusere disse forskjellene. Dette kan skyldes dårlig forståelse av årsaksfaktorene bak forskjellene og/eller hvilke tiltak som er mest effektive. I dette prosjektet er det første målet å undersøke sosiale forskjeller i vektutvikling fra fødsel til 14-års alder og finne faktorer som kan forklare disse forskjellene. Det andre målet er å tilpasse en målemetode for å kartlegge mat- og fysisk aktivitetsmiljøet i nabolag med ulik sosial status. Det tredje målet er å bruke målemetoden for undersøke hvordan miljøene påvirker helsevanene og vekten til ungdommer og undersøke mulige forskjeller avhengig av sosioøkonomisk status for individet eller for nabolaget. Sist, men ikke minst vil vi utforske hvilke intervensjoner som har størst sannsynlighet for å redusere ulikhet i overvekt og fedme blant ungdommer. For å imøtekomme disse målene, har det blitt gjennomført intervjuer med ungdommer og deres foreldre fra ulike nabolag i Oslo. Et virtuelt revisjonsverktøy for å kartlegge mat- og aktivitetsmiljø har blitt validert i ulike nabolag i Oslo. For å kartlegge forskjeller i vektutvikling fra fødsel til barndom, har det blitt utført analyse av data fra en fødselskohortstudie. Prosjektet har fullført/gjennomført en tverrsnittstudie, hvor rundt 900 elever fra 28 skoler i ulike nabolag i Oslo deltok. Våre resultater indikerer viktige trender over tid i utviklingen av ulikhet i kroppsvekt, samt faktorer som må bli intervenert på for å motvirke disse ulikhetene. Videre har vi identifisert faktorer som påvirker ungdoms mat- og aktivitetsvaner og som forklarer sosial ulikhet i disse vanene. Resultatene fra dette prosjektet danner et viktig grunnlag for målrettede folkehelseintervensjoner for å redusere sosial ulikhet i disse helseatferdene og kroppsvekt blant ungdom. Verktøyet som ble videreutviklet og validert med den hensikt å undersøke nabolagets mat- og aktivitetsutforming vil også være en viktig resurs for videre forskning. Funnene våre har blitt kommunisert gjennom ulike kanaler og vi planlegger å fortsette med det i fremtiden.

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.