Area-level deprivation and adiposity in children: is the relationship linear?

Abstract

Objective: It has been suggested that childhood obesity is inversely associated with deprivation, such that the prevalence is higher in more deprived groups. However, comparatively few studies actually use an area level measure of deprivation limiting the scope to assess trends in the association with obesity for this indicator. Furthermore, most assume a linear relationship. Therefore, the aim of this study was to investigate associations between area level deprivation and three measures of adiposity: body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) in children.Design: Cross sectional study, data collected on 3 occasions a year apart (2005 -2007) Subjects: Data was available for 13333 children, typically aged 11-12 years from 37 schools and 542 Lower Super Output Areas (LSOAs).Measures: Stature, mass and WC. Obesity was defined as a BMI and WC exceeding the 95 th centile according to British reference data. WHtR exceeding 0.5 defined obesity. The Index of Multiple Deprivation affecting children (IDACI) was used to determine area level deprivation.Results: Considerable differences in the prevalence of obesity exist between the three different measures. However, for all measures of adiposity the highest probability of being classified obese is in the middle of the IDACI range. This relationship is more marked in girls, such that the probability of being obese for girls living in areas at the two extremes of deprivation is around half that at the peak, occurring in the middle. Conclusion:These data confirm the high prevalence of obesity in children and suggest that the relationship between obesity and residential area level deprivation is not linear. This is contrary to the 'deprivation theory' and questions the current understanding and interpretation of the relationship between obesity and deprivation in children. These results could help make informed decisions at the local level.

Response to ‘Area-level deprivation and adiposity in children: is the relationship linear?’

“…We also agree that the peaks in obesity prevalence occur in areas of above average deprivation not in 'middle affluent areas' as we described it in the paper (although it is the midpoint of the IDACI scale). However, the findings in our paper (2) and the evidence presented here remain consistent in that the relationship between obesity (measured by sBMI) and deprivation (measured by IDACI) for our data is not linear. These differences may be due to different measures of deprivation and the statistical techniques applied to the two data sets.…”

“…We are grateful to Rutter and colleagues (1) who raise some interesting discussion points in relation to our article investigating the relationship between adiposity and area level deprivation in children (2).…”

Is there a deprivation and maternal education gradient to child obesity and moderate‐to‐vigorous physical activity? Findings from the Millennium Cohort Study

“…The relationship between deprivation and child overweight and central obesity was linear, and the greatest disparities were observed between the least and most deprived children. A UK study conducted in Leeds found no evidence of a linear relationship between obesity and deprivation in 11‐year‐old children . However, the study was conducted at the local‐level and assessed school‐level deprivation rather than neighbourhood‐level deprivation that may not reflect the children's actual living environment.…”

“…Almost all previous studies in this area have defined SES using either an individual‐level (i.e. parental education ) or area‐level measure (IMD, deprivation; ). These studies have presumed that the strength and direction of the SES–child obesity association would be consistent across SES measures.…”

Deprivation indices and childhood BMI: a re-evaluation

“…A paper in this issue 1 challenges the conventional wisdom that body mass index (BMI) in children increases as deprivation index score increases. These results should lead us to consider both our assumptions about the data, but also our assumptions about the 'shape' of health inequalities.…”