International differences in gradients in early childhood overweight and obesity: the role of maternal employment and formal childcare attendance

Lidia Panico*, Cesarine Boinet, Hideo Akabayashi, Sanneke De La Rie, Sarah Jiyoon Kwon, Yuriko Kameyama, Renske Keizer, Kayo Nozaki, Valentina Perinetti Casoni, Anna Volodina, Jane Waldfogel, Sabine Weinert, Elizabeth Washbrook

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
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There are significant cross-country differences in socio-economic gradients in later childhood and adulthood overweight/obesity; few studies assess whether this cross-national variation is evident from early childhood. Furthermore, the role of childcare in explaining overweight/obesity gradients might vary across countries, given differences in access, quality and heterogeneity within. Additionally, childcare is linked to parental characteristics such as maternal employment. The interplay between childcare and employment in producing early overweight/obesity gradients has received little attention, and might vary cross-nationally. 


Using harmonized data from six high-quality, large datasets, we explore the variation in gradients in early overweight/obesity (at age 3-4 years old) by parental education across several high-income countries (USA, UK, France, the Netherlands, Germany and Japan). We then assess whether differential formal group care use attenuates some of these gradients, and whether this varies across maternal employment. 


Gradients in early childhood overweight/obesity by parental education are evident across several developed countries. Countries with higher overall prevalence of early overweight/obesity did not have the largest inequalities across education groups. The contribution of formal group care to producing these gradients varied across countries and across maternal employment status. 


Early childhood inequalities in overweight/obesity are pervasive across developed countries, as noted for older children and adults. However, mechanisms producing these gradients vary across national contexts. Our study shows that, given the right context, quality childcare and maternal employment can successfully support healthy weight trajectories and not contribute (or even reduce) social inequalities in early overweight/obesity.

Original languageEnglish
Pages (from-to)468-475
Number of pages8
JournalEuropean Journal of Public Health
Issue number3
Publication statusPublished - 1 Jun 2023

Bibliographical note

Funding Information:
This research was undertaken as part of the Development of Inequalities in Child Educational Achievement: A Six Country Study (DICE) project, funded under the Open Research Area (ORA) Round 5 Funding Scheme. We gratefully acknowledge funding support from the Economic and Social Research Council (ESRC Grant ES/S015191/1, UK); the Agence Nationale de la Recherche (ANR grant ANR-18-ORAR-0001, France), the Deutsche Forschungsgemeinschaft (DFG, Germany, SCHN 1116/1-1; WE 1478/12-1), the Nederlandse Organisatie voor Wetenschappelijk Onderzoek (NWO, Netherlands, grant number 464.18.102). Acknowledgements

Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press on behalf of the European Public Health Association.

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