Social class, parental education, and obesity prevalence in a study of six-year-old children in Germany

OBJECTIVE: To assess the association between socioeconomic status (SES) and childhood obesity, and which factor in particular stands out in relation to obesity. METHODS: When 2020 children attended their obligatory health exam prior to school entry in the City of Aachen, Germany, 1979 parents (97.9%) filled out a questionnaire on their child's weight development and on indicators of their family's SES in a cross-sectional survey. In addition, standardized measures of weight and height were taken. More detailed information on several different SES variables, such as parental education, occupation, income, family constellation, single parenthood, and the location and size of the family residence was obtained by personal interviews in a subsample of all native German speaking children with a BMI >= 85th percentile, defined as cases (n = 146), and with a BMI between the 40th and 60th percentile, defined as controls (n = 221). RESULTS: The indicators of parental education were most strongly associated with children's obesity. There was a strong dose response relationship between a composed index of social class and obesity. Children of the lowest social status had a more than three-fold risk to be obese than children of the highest social status in the screening population (OR: 3.29, CI: 1.92-5.63). CONCLUSIONS: The findings established a strong relationship between parental years of education and childhood obesity. Prevention and treatment programs should endeavor to better target undereducated parents and their young children at high risk.