Inequalities in childhood obesity: the impact of the socioeconomic crisis in Portugal from 2009 to 2015 

Portugal has one of the highest rates of childhood obesity among European countries, with 31.6% in 2002 and 30.5% in 2009 for children aged 7-10 years old. Portugal faces a deep economic crisis since 2008 leading to increased poverty and inequalities. Unemployment rate shifted from 9.4% (2009) to 16.2% (2013). In 2012, 18.7% of people were at risk of poverty, with children (0-17 years) being the most affected, reaching a value of 30.9% in 2012. Therefore, unemployment, social exclusion, decreasing mutual trust and social cohesion, and decreasing public and private investments are strong contributors for environmental vulnerability; all these factors hinder access to a healthy diet, health care and family’s healthy lifestyle. Moreover, several features in the environment shifted, such as closing of small restaurants, supermarkets, and other food stores. Data shows a consistent social gradient in childhood obesity, with lowest social classes exhibiting highest values of obesity. Childhood obesity has been our main focus of research over the last decade. We developed important and innovative studies in Portugal, namely the assessment, for the first time, of prevalence rates, predictors, sedentary behaviours, sleep duration, breastfeeding, urban-rural disparities, family socioeconomic status and behaviours, parental perceptions of neighbourhood environments and lately the effect of the build and social environment on obesity. Given the serious crisis that Portugal is facing, it is crucial to proceed with research on the health impacts that this crisis will likely have on childhood obesity.

 

A project – Inequalities in childhood obesity: the impact of the socioeconomic crisis in Portugal from 2009 to 2015 – started in 2016 with the following aims:

 

– To develop prospective and comparative studies about changes in families’ behaviour and in environmental infrastructures from 2009 to 2015-16 and to assess their impact in childhood obesity.

– What changed in families’ behaviours regarding nutrition, food insecurity, physical activity, and other lifestyle factors as well as neighbourhood’s resources availability, safety and social organization, as a consequence of the social and economic crisis? How it impacts in childhood obesity?

 

These questions highlight a major challenge faced by the scientific and policymaker community, which is to prevent that the economic crisis turns also into a health crisis.

Lisbon, Coimbra and Porto, three Portuguese cities with different characteristics were our cases studies. The same schools that we studied in 2009 were re-evaluated in 2015-16, sampling children aged 3-10 years old. Anthropometric measures to evaluate weight status and questionnaires to parents on: family sociodemographic characteristics, perceptions of their local neighborhoods, quality of life index (WHOQOL-BREF), depression anxiety stress scale for children and parents, diet patterns, food insecurity (Household Food Security Scale – HFSS), child sedentary behaviors as well as physical activity and sleep duration.

The social and built environment were studied in selected neighborhoods of these cities. A prior functional survey was made in 2009-2010 in which infrastructures and equipment’s related to the obesogenic environment were collected and geocoded (GIS) in buffers of 800 meters around child’s residence. Local availability of restaurants, food stores, gyms, green spaces, neighborhood socioeconomic deprivation and safety, were observed and registered. We intend to revisit these neighborhoods and assess the current availability of all resources that had been measured previously, and also assess changes on parental neighborhood perceptions, changes in socioeconomic environment and safety. The outcome of this project will provide clues for the policymakers and authorities of different arenas – health care, social security, education, transportation – and at different levels – local, regional and national – to overcome health risks and help the most vulnerable people. We plan outreach activities to engage target audiences with the project’s results and raise awareness about the topic. We want to engage mainly two audiences: the local communities involved in the project; and policymakers and stakeholders at local and national levels.

The field work was finished and all the collected data (anthropometric and questionnaires) are now in a SPSS database. Our data is now ready to be analysed. On total we observed 8572 children, aged 3.0-11.0 years in the Districts of Coimbra, Lisbon and Porto, in the same schools that we studied in 2002 and 2009.

We used a large questionnaire with the following topics:

  • Family characteristics, child sedentary behaviours (TV, Computer, Electronic Games, Smartphones, iPAD, etc), physical activity, frequency consumption of some foods
  • Parental perception of residential place from the “Environmental Module’ of the Standard questionnaire of the International Physical Activity Prevalence Study”
  • Questions regarding the economic crisis in Portugal, how families faced that, what did they change, how that impacted on family lifestyle (food, behaviours)
  • Children’s Eating Behaviour Questionnaire – CEBQ Questionnaire
  • SDQ-Strengths and Difficulties Questionnaire (Parents)
  • EADS -Strengths and Difficulties Questionnaire (Children)
  • Scale of Depression, Anxiety and Stress (Parents
  • Scale of Depression, Anxiety and Stress (children with > 8 years)
  • Kidscreen 27
  • Sleep questionnaire (child 8-10 years).
  • Food Insecurity questionnaire
  • We applied accelerometers in 671 children
  • We collected 730 buccal swabs for DNA analysis