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- Family wealth inequalities in Portuguese children's health-related quality of life according to weight status - findings from COSI/WHO Europe studyPublication . Rito, Ana Isabel; Martins, Maria de Fátima; Gaspar, Marta; Bento, Alexandra; Abreu Santos, CristinaIntrodution: Health-Related Quality of Life (HRQoL) is a multidimensional concept encompassing aspects of quality of life that directly or indirectly relate to health, such as physical, psychological, and social well-being. The interplay between socioeconomic factors, like family earnings and weight status impacts children’s HRQoL, highlighting the importance of addressing these factors to promote health equity from an early age. Methods: This observational cross-sectional study analyzed data from the 6th WHO European Childhood Obesity Surveillance Initiative, the COVID study in Portugal, targeting primary school-age children. BMI was calculated using WHO reference growth charts for children, and data on children's HRQoL and family perceived wealth was obtained through a family form, reporting data during the COVID-19 pandemic (March 2020-June 2022). HRQoL was assessed using the KIDSCREEN-10 parent report, with Rasch scores calculated and transformed into T-scores. Higher values indicate higher levels of HRQoL. Family perceived wealth reflects how easily a family meets monthly expenses using their earnings. It is categorized as “low” (combining the answers “we have trouble meeting the end of the month with our earnings” and “we barely meet the end of the month with our earnings”), “medium” (“we meet the end of the month with their own earnings without serious problems”), and “high” (“we easily met the end of the month with their own earnings”). Results: Among the 3279 children analysed, 12.0% were classified as having obesity, with a higher proportion of boys (51.8%) than girls (48.2%). After adjusting for sex and age, the linear regression coefficients showed that family perceived wealth was positively associated with HRQoL in both groups (without obesity: medium compared with low 2.548, 95% CI: 1.398;3.699, p<0.001 and high compared with low perceived health 4.240, 95% CI: 2.953;5.527, p<0.001; with obesity: medium compared with low 3.671, 95% CI: 0.810;6.532, p=0.012 and high compared with low perceived health 3.850, 95% CI: 0.516;7.184, p=0.024). General linear regression also showed that family perceived wealth demonstrates a clear gradient effect in both groups. The differences in age and sex-adjusted mean scores between the lowest and the medium and higher perceived wealth levels were statistically significant for HRQoL scores (47.64 for high, p<0.001, 45.93 for medium, p=0.003, and 43.38, p<0.001, for low in children without obesity; 48.04, 47.85, and 44.19 respectively in children with obesity, with p=0.038 for the lowest category). Conclusion: Findings suggest that family perceived family wealth significantly influences children's HRQoL, regardless of BMI. The relationships between this factor and HRQoL emphasize the need for multifaceted interventions that address both family socioeconomic circumstances and weight status to improve children's health and well-being.
- Understanding the intergenerational impact of obesity in Portugal: data from COSI to support BETTER4U – an innovative European projectPublication . Rito, Ana; Gaspar, Marta; Martins, Maria de Fátima; Dedoussis, GeorgeIntroduction: Both childhood and adult obesity have been rising worldwide, as a global health challenge, with parental obesity identified as a key determinant of childhood obesity through genetic predisposition and shared obesogenic environments. This intergenerational link underscores the potential of interventions targeting adult obesity to disrupt the family cycle of obesity, such as the BETTER4U project (2023–2027), a personalized lifestyle intervention that aims to reduce obesity prevalence in adults, using artificial intelligence and evidence-based strategies. In this context, the WHO Childhood Obesity Surveillance Initiative (COSI) provides critical data on the nutritional status of children across Europe, including valuable insights into parental factors. These data form a vital foundation for interventions like BETTER4U, guiding their design and focus. Methods: COSI systematically collects comparable data every 2–3 years on the nutritional status of children aged 6 to 9 years across Europe. This data includes anthropometric measurements of children (weight and height), which are classified using the WHO Growth Reference Charts (5–19 years). Additionally, information on family and parental characteristics is gathered through self-reported data, including parental nutritional status (calculated BMI, classified according to the WHO reference) and socioeconomic factors. For this analysis, a cross-sectional observational study was carried out based on data from the 6th round of COSI (2021/2022) in Portugal to explore the association between parental and childhood obesity. The aim was to support the potential of the BETTER4U project, which involves 7 countries, including Portugal, to address obesity not only at the individual level but also within families by disrupting intergenerational patterns of obesity. Results: The sample included 4215 children and their parents. The prevalence of obesity was 12.9% among children and 13.7% among parents. A binary logistic regression was performed, considering a significance level of p<0.05. After adjusting for potential confounding factors, including sex and age of both children and parents, parental education level, and perceived family wealth, parental obesity was found to be significantly associated with childhood obesity. Children with parents with obesity were 2.65 times more likely to have obesity than children of parents without obesity (adjusted Odds Ratio [aOR]: 2.65; 95% Confidence Interval [CI]: 2.133–3.292; p<0.001). Conclusions: Parental obesity is a critical determinant of childhood obesity, underlining the importance of targeting parental factors in health interventions. By focusing on adult obesity, the BETTER4U project has the potential to not only reduce obesity prevalence in adults but also create positive effects within families.
- Obesity and socioeconomic vulnerabilities: evidence from COSI Portugal supporting BETTER4U - a tailored approach to weight managementPublication . Rito, Ana; Martins, Maria de Fátima; Gaspar, Marta; Dedoussis, GeorgeIntroduction: Obesity remains a critical global health challenge, contributing to the rising prevalence of non-communicable diseases and imposing substantial burdens on public health systems worldwide. Understanding the determinants of obesity is essential for designing effective and inclusive interventions. The BETTER4U project (2023–2027) aims to develop and implement a personalized lifestyle intervention, by addressing the multifaceted determinants of adult obesity. Data such as those provided by the Childhood Obesity Surveillance Initiative (COSI) offer critical insights into these determinants, supporting the design of tailored interventions. Socioeconomic vulnerabilities, in particular, have been consistently identified as key determinants of obesity, requiring targeted strategies to address their impact. Methods: COSI, conducted by WHO, not only collects data on the nutritional status of children aged 6–8 years, but also gathers family-level information self-reported by parents, including parental nutritional status (calculated BMI, classified according to the WHO reference) and socioeconomic factors. This study utilized data from the 5th (2018/2019) and 6th (2021/2022) rounds of COSI in Portugal to perform a cross-sectional observational analysis exploring the association between adult obesity and vulnerability factors. Participants were categorized into groups based on sex (female vs. male) and the following socioeconomic variables: educational level (lower vs. higher education), perceived family wealth (experiencing financial difficulties vs. not experiencing financial difficulties), occupation (employed/student vs. unemployed/sick/disabled), and residential setting (urban vs. rural). The aim was to identify the determinants of adult obesity to support the design of BETTER4U’s personalized intervention strategies, which will be implemented in seven European countries, including Portugal. Results: Of the 9169 adults included in this analysis, 12.2% had obesity and 21.6% reported financial difficulties. A binary logistic regression was conducted, considering a significance level of p<0.05. After adjusting for confounding factors (age, sex, education level, occupation and residential setting), financial difficulties emerged as a significant predictor of obesity. Adults facing financial challenges were nearly twice as likely to have obesity compared to those without such difficulties (adjusted Odds Ratio [aOR]: 1.88, 95% Confidence Interval [CI]: 1.639–2.162; p<0.001). Conclusions: This analysis demonstrates the critical role of financial difficulties in shaping obesity outcomes among adults, emphasizing the need for inclusive, tailored interventions to address the needs of at-risk populations and providing a robust foundation for BETTER4U’s innovative and evidence-based strategies for weight management