Abstract
Background
There are significant cross-country differences in socio-economic gradients in later childhood and adulthood overweight/obesity; few studies assess whether this cross-national variation is evident from early childhood. Furthermore, the role of childcare in explaining overweight/obesity gradients might vary across countries, given differences in access, quality and heterogeneity within. Additionally, childcare is linked to parental characteristics such as maternal employment. The interplay between childcare and employment in producing early overweight/obesity gradients has received little attention, and might vary cross-nationally.
Methods
Using harmonized data from six high-quality, large datasets, we explore the variation in gradients in early overweight/obesity (at age 3–4 years old) by parental education across several high-income countries (USA, UK, France, the Netherlands, Germany and Japan). We then assess whether differential formal group care use attenuates some of these gradients, and whether this varies across maternal employment.
Results
Gradients in early childhood overweight/obesity by parental education are evident across several developed countries. Countries with higher overall prevalence of early overweight/obesity did not have the largest inequalities across education groups. The contribution of formal group care to producing these gradients varied across countries and across maternal employment status.
Conclusion
Early childhood inequalities in overweight/obesity are pervasive across developed countries, as noted for older children and adults. However, mechanisms producing these gradients vary across national contexts. Our study shows that, given the right context, quality childcare and maternal employment can successfully support healthy weight trajectories and not contribute (or even reduce) social inequalities in early overweight/obesity.
There are significant cross-country differences in socio-economic gradients in later childhood and adulthood overweight/obesity; few studies assess whether this cross-national variation is evident from early childhood. Furthermore, the role of childcare in explaining overweight/obesity gradients might vary across countries, given differences in access, quality and heterogeneity within. Additionally, childcare is linked to parental characteristics such as maternal employment. The interplay between childcare and employment in producing early overweight/obesity gradients has received little attention, and might vary cross-nationally.
Methods
Using harmonized data from six high-quality, large datasets, we explore the variation in gradients in early overweight/obesity (at age 3–4 years old) by parental education across several high-income countries (USA, UK, France, the Netherlands, Germany and Japan). We then assess whether differential formal group care use attenuates some of these gradients, and whether this varies across maternal employment.
Results
Gradients in early childhood overweight/obesity by parental education are evident across several developed countries. Countries with higher overall prevalence of early overweight/obesity did not have the largest inequalities across education groups. The contribution of formal group care to producing these gradients varied across countries and across maternal employment status.
Conclusion
Early childhood inequalities in overweight/obesity are pervasive across developed countries, as noted for older children and adults. However, mechanisms producing these gradients vary across national contexts. Our study shows that, given the right context, quality childcare and maternal employment can successfully support healthy weight trajectories and not contribute (or even reduce) social inequalities in early overweight/obesity.
| Original language | English |
|---|---|
| Article number | ckad058 |
| Pages (from-to) | 468–475 |
| Number of pages | 8 |
| Journal | European Journal of Public Health |
| Volume | 33 |
| Issue number | 3 |
| Early online date | 17 Apr 2023 |
| DOIs | |
| Publication status | E-pub ahead of print - 17 Apr 2023 |
Bibliographical note
Funding Information:This research was undertaken as part of the Development of Inequalities in Child Educational Achievement: A Six Country Study (DICE) project, funded under the Open Research Area (ORA) Round 5 Funding Scheme. We gratefully acknowledge funding support from the Economic and Social Research Council (ESRC Grant ES/S015191/1, UK); the Agence Nationale de la Recherche (ANR grant ANR-18-ORAR-0001, France), the Deutsche Forschungsgemeinschaft (DFG, Germany, SCHN 1116/1-1; WE 1478/12-1), the Nederlandse Organisatie voor Wetenschappelijk Onderzoek (NWO, Netherlands, grant number 464.18.102). Acknowledgements
Funding Information:
We also acknowledge the following data sources for this article. France: The Elfe survey is a joint project between the French Institute for Demographic Studies and the National Institute of Health and Medical Research, in partnership with the French blood transfusion service (Etablissement français du sang), Santé publique France, the National Institute for Statistics and Economic Studies, the Direction générale de la santé (Ministry of Health and Social Affairs), the Direction générale de la prévention des risques (Ministry for the Environment), the Direction de la recherche, des études, de l’évaluation et des statistiques (Ministry of Health and Social Affairs), the Département des études, de la prospective et des statistiques (Ministry of Culture), and the Caisse nationale des allocations familiales, with the support of the Ministry of Higher Education and Research and the Institut national de la jeunesse et de l’éducation populaire. Via the RECONAI platform, it receives a government grant managed by the National Research Agency under the “Investissements d'avenir” programme (ANR-11-EQPX-0038 and ANR-19-COHO-0001). Germany: This article uses data from the National Educational Panel Study (NEPS; see Blossfeld & Roßbach, 2019). The NEPS is carried out by the Leibniz Institute for Educational Trajectories (LIfBi, Germany) in cooperation with a nationwide network. The Netherlands: The Generation R Study is conducted by the Erasmus MC, University Medical Center Rotterdam in close collaboration with the Erasmus University Rotterdam and the city of Rotterdam. We gratefully acknowledge the contribution of children and parents. The general design of Generation R Study is made possible by long-term financial support from Erasmus MC, University Medical Center Rotterdam, Netherlands Organization for Health Research and Development (ZonMw) and the Ministry of Health, Welfare and Sport. USA: The US results are based on restricted-use data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B). The ECLS-B data are primarily sponsored by the National Center for Education Statistics (NCES) within the Institute of Education Sciences (IES) of the US Department of Education. UK: The UK results are based on data from the Millennium Cohort Study (MCS; doi: http://doi.org/10.5255/UKDA-SN-5795-5 ) conducted by the Centre for Longitudinal Studies. We would like to thank the MCS families for their time and cooperation as well as the MCS team at the Institute of Education, University College London. Japan: Japan's results are based on data from the Longitudinal Survey of Newborns in the 21st Century, 2010 birth cohort (LSN2010). The LSN2010 was collected and provided by the Japanese Ministry of Health, Labour and Welfare.
Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press on behalf of the European Public Health Association.
