Pathways of Parental Education on Children's and Adolescent's Body Mass Index: The Mediating Roles of Behavioral and Psychological Factors

Abstract

AimThe increasing body mass index (BMI) often followed by overweight and obesity is a global health problem of the 21st century. Children and adolescents with lower socioeconomic status are more affected than their counterparts. The mechanisms behind these differences must be well understood to develop effective prevention strategies. This analysis aims at examining the association of parental education as an indicator of the socioeconomic status on children's and adolescent's body mass index and the role of behavioral and psychological risk factors for a higher BMI longitudinally.MethodsThe analysis was based on a nationwide sample of N = 460 children and adolescents, aged 11 to 17 at baseline (2009–2012), who took part in the representative BELLA study, the mental health module of the German National Health Interview and Examination Survey among Children and Adolescents (KiGGS). A follow-up was conducted 5 years later. Using mediation analyses, the mediating effects of breakfast consumption, consumption of sugar-sweetened beverages, screen time, physical activity, mental health problems (Strengths and Difficulties Questionnaire), and health-related quality of life (KIDSCREEN-10) on the association of parent's years of education on their children's BMI were investigated.ResultsA lower level of parental education was significantly associated with a higher BMI in children and adolescents 5 years later. The association was partially mediated by breakfast consumption and total screen time, with breakfast consumption mediating 16.7% and total screen time 27.8% of the association. After controlling for age, gender, and migration status, only breakfast consumption remained a partial mediator (8.5%). Other included variables had no mediating effects.ConclusionsPreventive measures should be mainly targeted at children and adolescents of parents with lower educational levels. Tailored strategies to prevent the development of overweight and obesity in this population among children and adolescents should promote daily breakfast consumption at home and reducing screen time.

Adolescent overweight and obesity in Ireland—Trends and sociodemographic associations between 1990 and 2020

“…These findings are consistent with recent results from Germany, which found that a lower level of parental educational attainment was associated with a significantly higher BMI in children and adolescents and displayed a significant effect on various mediators of obesity, including a less healthful dietary pattern and increased screen time. 43 This study indicated that a lower level of parental educational attainment was the strongest predictor of increased risk of adolescent overweight/obesity in 2006, with the effect of social class only becoming apparent in 2020. Ireland experienced rapid economic growth during the early 2000s and had the second highest rate of employment and gross domestic product per capita in 2005/2006.…”

Do maternal socioeconomic status influence child overweight?

“…Families with higher incomes tend to adopt healthier behaviors such as; making healthier food choices, allocating more time for physical activity and having greater access to better healthcare, all of which contribute to lower BMI in children [ 36 , 37 ]. Within this familial context, mothers as the primary caregivers in a family setting tend to exert a direct influence on their children's dietary choices, physical activity, screen time, sleep patterns, and other health-related habits that contribute to the risk of childhood obesity [ [40] , [41] , [42] , [43] , [44] ]. It is reported that in majority countries, mothers predominantly assume the key role of establishing a conducive family dietary environment and shaping behaviors which exerts a certain influence over their children's food preferences and consumption practice [ 44 ].…”

“…Within this familial context, mothers as the primary caregivers in a family setting tend to exert a direct influence on their children's dietary choices, physical activity, screen time, sleep patterns, and other health-related habits that contribute to the risk of childhood obesity [ [40] , [41] , [42] , [43] , [44] ]. It is reported that in majority countries, mothers predominantly assume the key role of establishing a conducive family dietary environment and shaping behaviors which exerts a certain influence over their children's food preferences and consumption practice [ 44 ]. Thus, maternal education has a crucial impact in caregiving because mothers with higher education levels tend to have better health knowledge and possess greater access to healthcare services [ 45 ].…”

The role of energy balance related behaviors in socioeconomic inequalities in childhood body mass index: A comparative analysis of Germany, the Netherlands, the United Kingdom, and the United States

“…Another indication for the expectation that there are cross-national differences in the relative contribution of factors that explain inequalities in childhood BMI is that there is some inconsistency in the findings of single-country studies on the importance of specific EBRBs. A study conducted in the UK showed that SES-related disparities in physical activity explain inequalities in child weight status (Goisis et al, 2016), whereas others-based in the US (Hanson and Chen, 2007), the Netherlands (Bouthoorn et al, 2014), and Germany (Seum et al, 2022)-reported no significant role of physical activity in explaining inequalities in child BMI. Socioeconomic inequalities in sedentary behaviours-such as screen time-and certain dietary factors (e.g., breakfast consumption) quite consistently explain inequalities in BMI and weight status across studies.…”

“…Regarding breakfast consumption, a Netherlands based study showed that socioeconomic inequalities in overweight/obesity were already present at elementary school entry, and that the children's breakfast consumption contributed to these inequalities (Veldhuis et al, 2013). A study amongst German children also showed that a lower level of parental education was linked to skipping breakfast, and that breakfast consumption partially mediated the association between parental education and BMI (Seum et al, 2022). UK (Libuy et al, 2021) and US (Miech et al, 2006) based studies showed socioeconomic inequalities in breakfast consumption and BMI and weight status.…”