Socio-economic inequalities in body mass index among preschool children: do sports programs in early childhood education and care centers make a difference?

Alena Mayer; Raphael M Herr; Thomas Klein; Eva Wiedemann; Katharina Diehl; Stephanie Hoffmann; Miriam Blume; Dennis Jepsen; Leonie Sundmacher; Marike Andreas; Sven Schneider

doi:10.3389/fpubh.2023.1079871

Socio-economic inequalities in body mass index among preschool children: do sports programs in early childhood education and care centers make a difference?

Front Public Health. 2023 Jun 22:11:1079871. doi: 10.3389/fpubh.2023.1079871. eCollection 2023.

Authors

Affiliations

¹ Center for Preventive Medicine and Digital Health (CPD), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
² Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
³ Max-Weber-Institute of Sociology, Faculty of Economics and Social Sciences, Heidelberg University, Heidelberg, Germany.
⁴ Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Cottbus, Senftenberg, Germany.
⁵ Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
⁶ Institute of Medical Sociology, Medical Faculty, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany.
⁷ Chair of Health Economics, Technical University of Munich, München, Germany.

^# Contributed equally.

Abstract

Background: Overweight in childhood is considered to be one of the most serious public health challenges. Many studies have investigated individual-level determinants of children's body mass index (BMI), yet studies exploring determinants at the meso-level are sparse. The aim of our study was to examine how a sports focus at early childhood education and care (ECEC) centers moderates the effect of parental socio-economic position (SEP) on children's BMI.

Methods: We used data from the German National Educational Panel Study and included 1,891 children (955 boys and 936 girls) from 224 ECEC centers in our analysis. Linear multilevel regressions were used to estimate the main effects of family SEP and the ECEC center sports focus, as well as their interaction, on children's BMI. All analyses were stratified by sex and adjusted for age, migration background, number of siblings, and employment status of parents.

Results: Our analysis confirmed the wellknown health inequalities in childhood overweight with a social gradient toward a higher BMI for children from lower SEP families. An interactive effect between family SEP and ECEC center sports focus was found. Boys with low family SEP not attending a sports-focused ECEC center had the highest BMI among all boys. In contrast, boys with low family SEP attending a sports-focused ECEC center had the lowest BMI. For girls, no association regarding ECEC center focus or interactive effects emerged. Girls with a high SEP had the lowest BMI, independent of the ECEC center focus.

Conclusion: We provided evidence for the gender-specific relevance of sports-focused ECEC centers for the prevention of overweight. Especially boys from low SEP families benefited from a sports focus, whereas for girls the family's SEP was more relevant. As a consequence, gender differences in determinants for BMI at different levels and their interaction should be considered in further research and preventive measures. Our research indicates that ECEC centers may decrease health inequalities by providing opportunities for physical activity.

Keywords: BMI; children; early childhood education and care center; health equalities; meso-level; pre-school; sport.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Body Mass Index
Child, Preschool
Exercise
Female
Humans
Male
Overweight* / epidemiology
Socioeconomic Factors
Sports*

Grants and funding

This study was funded by the German Research Foundation (DFG) grant number FOR2723 (Project Number 384210238). The individual grant number for the subproject is SCHN727/9-1. The funding organization had no role in the design, analysis and interpretation of the data, in the writing of the manuscript, or submission of the manuscript for publication. For the publication fee, we acknowledge financial support by the Deutsche Forschungsgemeinschaft within the funding program “Open Access Publikationskosten” as well as by Heidelberg University.