Childhood obesity is a major public health challenge and its prevalence continues to increase in many, but not all, countries worldwide. International data indicate that the prevalence of obesity is greater among boys than girls 5–19 years of age in the majority of high and upper middle-income countries worldwide. Despite this observed sex difference, relatively few studies have investigated sex-based and gender-based differences in childhood obesity. We propose several hypotheses that may shape the research agenda on childhood obesity. Differences in obesity prevalence may be driven by gender-related influences, such as societal ideals about body weight and parental feeding practices, as well as sex-related influences, such as body composition and hormones. There is an urgent need to understand the observed sex differences in the prevalence of childhood obesity; incorporation of sex-based and gender-based analysis in all childhood obesity studies may ultimately contribute to improved prevention and treatment.
BackgroundChildhood obesity is a major public health concern. This study evaluated the independent and joint associations of family-level income, neighbourhood-level income and neighbourhood deprivation, in relation to child obesity.MethodsA cross-sectional study was conducted in children ≤12 years of age from TARGet Kids! primary care network (Greater Toronto Area, 2013–2019). Parent-reported family income was compared with median neighbourhood income and neighbourhood deprivation measured using the Ontario Marginalization Index. Children’s height and weight were measured and body mass index (BMI) z-scores (zBMI) were calculated. ORs and 95% CIs were estimated for the three exposure variables separately using multilevel multinomial logistic regression models with zBMI categories as the outcome, adjusting in model 1 for age, sex, ethnicity and number of family members and in model 2 adding family income. A joint measure was derived combining income and deprivation measures.ResultsA total of 5962 children were included. Low family income (Q1 vs Q5: OR=4.69, 95% CI 2.65 to 8.29), low neighbourhood income (Q1 vs Q5: OR=2.18, 95% CI 1.33 to 3.58) and high neighbourhood deprivation (Q1 vs Q5: OR=2.45, 95% CI 1.52 to 3.95) were each associated with increased OR of child obesity. However, after adjustment for family income, the association for both neighbourhood income (OR=1.39, 95% CI 0.82 to 2.34) and deprivation (OR=1.56, 95% CI 0.94 to 2.58) and obesity was attenuated. Children from low-income families living in low-income or high deprivation neighbourhoods had higher OR of obesity.ConclusionChild obesity was independently associated with low family-level income and a joint measure suggests that neighbourhood also matters. Socioeconomic inequalities at both individual and neighbourhood levels should be addressed in childhood obesity interventions.
In a health care system with finite resources, we need appropriateness guidelines to facilitate access and planning and to prevent abuse. Cataract surgery is one of the most commonly performed procedures worldwide, with overall high patient satisfaction and societal impact. In contrast to other elective procedures, such as knee arthroscopy, where evidence is limited, there is clear visual and functional benefit for patients suffering from cataract symptoms. 1 While in principle it makes sense to have rules in place to guide appropriateness, misguided or overly simplistic rules actually could cause harm. Herein, we present some considerations in developing appropriateness guidelines.
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