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We used a new conceptual framework that integrates tenets from health economics, social epidemiology, and health behavior to analyze the impact of socioeconomic forces on the temporal changes in the socioeconomic status (SES) gap in childhood overweight and obesity in China. In data from the China Health and Nutrition Survey for 1991 to 2006, we found increased prevalence of childhood overweight and obesity across all SES groups, but a greater increase among higher-SES children, especially after 1997, when income inequality dramatically increased. Our findings suggest that for China, the increasing SES gap in purchasing power for obesogenic goods, associated with rising income inequality, played a prominent role in the country's increasing SES gap in childhood obesity and overweight. (Am J Public Health. 2014;104:e14-e22. doi:10.2105/AJPH.2013.301669)
It is well documented tiiat family socioeco- nomic status (SES) is associated with childhood overweight and obesity1"3; however, Üie path- ways linking SES with overweight and obesity may be strongly conditioned by a country's stage of economic development. For example, an inverse relationship between SES and obe- sity is typically observed among children in developed countries,2,4 whereas in many de- veloping countries, overweight and obesity are more common among socioeconomic elites.1,5,6 Several questions are unanswered: What con- textual factors connect Üie stage of economic development with the sign and strength of Hie association between SES and childhood over- weight and obesity? What is Hie relative im- portance of these factors? What happens when these contextual factors exert contradictory effects on risk for childhood obesity and over- weight? The dramatic social and economic changes in Clima Üiat took place after 1997 provided a unique opportunity to explore these questions.
Until now, Üie only study of Üie change in Üie SES-overweight and obesity association among Chinese children focused on Üie annual change in overweight prevalence by income.7 This study found tiiat overweight prevalence increased fastest among high-income children between 1991 and 2004. To date, however, no study has thoroughly explored tlie contex- tual factors contributing to Üie changing relationship between SES and overweight and obesity in children and adolescents, in China or in any other developing country.
The direction of causality between SES and obesity for children is relatively easy to discern, because Üieir SES is predetermined by that of Üieir parents;...