Social disparities determine the success of child obesity treatment. Why are they rarely examined?
Socio-economic status and ethnic background are key risk factors for developing obesity in childhood. Such disparities act through differential exposure to obesogenic environments, along with access to health-creating resources, and the education and skills to use them.
It follows that effectiveness of obesity treatment will follow a similar pattern. Yet, despite over 20,000 peer-reviewed papers on treating obesity in children, including over 500 systematic reviews, the issue of social disparities is rarely addressed.
This month Obesity Reviews publishes a systematic review of the influence of social disparities on the success of child obesity treatment for children between three and ten years old. The paper’s authors examined 64 previous systematic reviews in which measures of social disparity were discussed, and then expanded their search to examine a further 82 primary studies of paediatric obesity treatment.
The results confirm the extraordinary lack of evidence on the social and economic influences on treatment outcomes. A total of 44 reports of paediatric treatment for obesity were identified in which social disparity measures were taken at baseline, but 39 of these reports did not analyse obesity-related outcomes in relation to the disparity measures taken.
While the collection of social disparity information at baseline is clearly important, the information is frequently used as a control measure, in order to adjust the outcome data by removing the potential influence of these disparities. Valuable evidence of the differential effects on different population groups is lost. Only a small number of papers report relevant findings, and they show the principle issues affecting treatment to be:
- Families’ perceptions and attitudes to overweight in children.
- The influence of pre-existing social, commercial, financial and physical environments.
- Inability to continue attending treatment due to scheduling conflicts, treatment disappointment, and communication issues between health professionals and families.
- Financial and time costs associated with treatment.
The authors also highlight the following concerns:
- When collected, baseline data on social disparities are mixed in nature and may include ethnicity or racial descriptors, deprivation indices, educational status, or indirect indicators such as health insurance status.
- In addition to a lack of analysis of the influence of social disparities on the effectiveness of paediatric obesity treatment there is also little consideration of how disparities affect recruitment, drop-out and follow-up phases of interventions.
The authors urge researchers to collect and analyse their results with social disparities in mind, and to re-analyse already-collected data where disparity differentials can be examined. They also urge research funding bodies to require the analysis of social disparities to be part of any study they fund.
In a recent policy brief, World Obesity recommended strengthening equitable access to paediatric weight management services including the need to ensure services are child-friendly and staff well-trained to encourage attendance, designing interventions in consultation with families and young people, adopting a holistic approach, and ensuring actions to prevent weight re-gain are in place.
COVID-19: an opportunity for child obesity services
The evidence is clear: obesity increases the likelihood of worst outcomes in case of COVID-19 illness, both for children and adults. The measures taken to help curb COVID-19 are likely to have substantial repercussions on children’s health services, with new opportunities to ensure equitable care for all children with overweight and obesity.
This blog has been written to highlight the findings of the STOP project, run by a consortium including the World Obesity Federation and headed by Imperial College London. The STOP project aims to generate scientifically sound, novel and policy-relevant evidence on the factors that contribute to the spread of childhood obesity in European countries.
The STOP project has received funding from the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No. 774548. The content of this blog reflects only the authors’ views, and the European Commission is not liable for any use that may be made of the information it contains.