Objective To explore trends in prevalence and socioeconomic inequalities in underweight and obesity in 5-year-old schoolchildren in Scotland between 2011/2012 and 2017/2018.
Design A population-based, repeated cross-sectional study.
Setting Local authority primary schools in Scotland.
Participants 373 189 5-year-old schoolchildren in Scotland between 2011/2012 and 2017/2018.
Methodology Trends in prevalence and inequalities in underweight and obesity were examined across seven school years (2011/2012–2017/2018) for 373 189 5-year-old schoolchildren in Scotland. Body mass index SD scores were calculated, and epidemiological cut-offs relative to the UK 1990 references categorised underweight and obesity. Slope/relative indices of inequality (SII/RII) were calculated for underweight and obesity by school year using the area-based Scottish Index of Multiple Deprivation.
Results The prevalence of obesity rose slightly overall during the study period (9.8% in 2011/2012; 10.1% in 2017/2018). However, this masked a widening of inequalities, with children from the most deprived areas experiencing a greater risk of obesity in 2017/2018 than in 2011/2012 (risk ratio=1.14, 95% CI 1.04 to 1.25) compared with an unchanged risk in children from the least deprived areas (risk ratio=0.95, 95% CI 0.82 to 1.11). SII and RII indicate widening inequalities for obesity, with RII rising from 1.95 (95% CI 1.71 to 2.22) in 2011/2012 to 2.22 (95% CI 1.93 to 2.56) in 2017/2018. The prevalence of underweight was consistently low (compared with the UK 1990 references) and remained unchanged over the study period (1.2% in 2011/2012; 1.1% in 2017/2018), with no consistent evidence of social patterning over time.
Conclusions Inequalities in obesity in schoolchildren in Scotland are large and have widened from 2011, despite only a slight rise in overall prevalence. In contrast there has been little change in underweight prevalence or inequalities during the study period. Extra resources for policy implementation and measures which do not widen inequalities and focus on reaching the most deprived children are required to tackle the high prevalence and growing inequalities in childhood obesity in Scotland.
- community child health
- public health
- health policy
- nutrition & dietetics
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Contributors RS designed the study, developed the statistical design, wrote the statistical analysis plan, performed the statistical analysis, collated all reviewer comments and updated accordingly, and wrote the manuscript. JJR designed the study, provided critical review of the findings and wrote the manuscript. AH designed the study, provided critical review of the findings and wrote the manuscript. LAK developed the statistical design, provided critical review of the statistical analysis and wrote the manuscript. DC wrote the grant for the overall project, designed the study, provided critical review of the findings and wrote the manuscript. DY developed the statistical design, provided critical review of the statistical analysis and wrote the manuscript. AS wrote the grant for the overall project, designed the study, developed the statistical design, provided critical review of the findings and wrote the manuscript. All authors reviewed and approved the final manuscript.
Funding This work was supported by Glasgow Children’s Hospital Charity St Andrew’s PhD Studentship Grant Number GCHCRF/PHD/2018/01. Data were provided under the Scottish Government funding of the evaluation of Childsmile.
Disclaimer The Glasgow Children’s Hospital Charity and the Scottish Government did not influence the writing of this report in any way.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Information governance approval was granted by the National Health Service (NHS) Scotland Public Benefit and Privacy Panel for Health and Social Care. Ethical approval was obtained from the University of Glasgow Ethics Committee (project no. MVLS200150076/FM04908).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. The original data for the Child Health Systems Programme School 2011/2012–2017/2018 are available from eDRIS (https://www.isdscotland.org/Products-and-Services/EDRIS/). The data are owned by Public Health Scotland (formerly Information Services Division) of NHS Scotland and project registration is required to access these data and conditions of use apply (https://www.isdscotland.org/Products-and-Services/eDRIS/Research-Proposal/index.asp). We are unable to provide direct access to the data as these are not owned by the authors.
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