Mediators of socioeconomic differences in overweight and obesity among youth in Ireland and the UK (2011–2021): a systematic review

Abstract

Background By 2025, adult obesity prevalence is projected to increase in 44 of 53 of European-region countries. Childhood obesity tracks directly onto adult obesity, and children of low socioeconomic position families are at disproportionately higher risk of being obese compared with their more affluent peers. A previous review of research from developed countries identified factors mediating this relationship. This systematic review updates and extends those findings specifically within the context of Ireland and the United Kingdom. Objective The aim of this systematic review is to summarise peer-reviewed research completed in Ireland and the United Kingdom between 2011–2021 examining mediators of socioeconomic differentials in adiposity outcomes for youth. Design An electronic search of four databases, Ovid MEDLINE, Embase, Web of Science and EBSCOhost was conducted. Quantitative studies, published in the English language, examining mediators of socioeconomic differentials in adiposity outcomes in youth, and conducted in Ireland and the United Kingdom between 2011–2021 were included. An appraisal of study quality was completed. The systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Following screening, a total of 23 papers were eligible for inclusion. Results indicate socioeconomic differentials for Ireland and the United Kingdom follow similar patterns to other developed countries and have similar mediating factors including early life and parent-level factors. However, this review identified additional factors that mediate the relationship, namely access to green space and favorable neighborhood conditions. Identifying these factors present further opportunities for potential interventions and confirm the requirement for tailored and appropriate research and interventions for Ireland and the United Kingdom. Conclusion This review identified several modifiable factors that should be considered when planning interventions aimed at reducing socioeconomic differentials in adiposity among youth in Ireland and the United Kingdom. Support was found for interventions to be made as early as possible in an at-risk child’s life, with the prenatal and preschool periods considered the most efficacious. Results were equivocal about the role of physical activity in the risk of childhood overweight and obesity. While multi-country analyses provide excellent overviews, country- or area-specific research may produce more nuanced, and potentially more powerful findings, which can help better inform policy responses and interventions.

Ultraprocessed Food Consumption and Cardiometabolic Risk Factors in Children

“…These findings suggest that educational and socioeconomic factors may contribute to the purchase of low-cost and unhealthy foods, such as UPFs, increasing the risk of health disorders. 37,45,46 Several possible mechanisms could explain our results. First, UPFs contain higher amounts of sodium, energy, fat, and sugar and lower amounts of fiber, which are well recognized as contributors to cardiometabolic risk factors.…”

“…In addition, our results support the findings of other European studies that have shown that children of mothers with lower education or with lower socioeconomic status are more likely to consume UPFs. These findings suggest that educational and socioeconomic factors may contribute to the purchase of low-cost and unhealthy foods, such as UPFs, increasing the risk of health disorders …”

“…These findings suggest that educational and socioeconomic factors may contribute to the purchase of low-cost and unhealthy foods, such as UPFs, increasing the risk of health disorders. 37 , 45 , 46 …”

The relative roles of early life, physical activity, sedentarism and diet in social and economic inequalities in body mass index and obesity risk between 9 and 18

“…Summing the food types yields a scale which varies between -12 and 12+ at each wave and provides a time-varying dietary quality score. Given the importance of consumption of breakfast and sugar sweetened drinks in recent systematic reviews for SEP gradients in obesity ( Cronin et al, 2022 ; Gebremariam et al, 2017 ), measures of whether the participant consumed sweetened beverages in the last 24 h (no, once, 2+) and usually eats breakfast (yes, no) are included in the analysis.…”

“…To date, research has highlighted the role of variation in genotype, birth weight, breastfeeding, weaning practices, maternal smoking in pregnancy, maternal consumption of alcohol in pregnancy and child dietary quality and physical activity in overall obesity risk among children and young people ( Danielzik et al, 2004 ; Griffiths et al, 2009 ; Oken et al, 2007 ; Reilly et al, 2005 ; Von Kries et al, 2002 ) but less is known about the role of these factors for SEP variation in risk of obesity. Recent systematic reviews examining SEP differentials in childhood obesity have identified several modifiable risk factors in early life including infant birthweight, low breastfeeding initiation and duration, early age at weaning, maternal smoking during pregnancy, poor child dietary behaviours (particularly consumption of sugar-sweetened beverages, and not eating breakfast), high child sedentary behaviours and low physical activity and maternal BMI/pre-pregnancy weight ( Cameron AJ et al, 2015 ; Cronin et al, 2022 ; Gebremariam et al, 2017 ). However, systematic reviews cannot assess the relative contribution of these different factors to SEP differentials overall, that is, their importance at the population level in accounting for the mean differentials in BMI or risk of obesity between young people in different SEP groups.…”