title: Multi-level influences on childhood obesity in Sweden: societal factors, parental determinants and child's lifestyle.
abstract: BACKGROUND
  Swedish school children living in rural areas and in areas with low education are at excess risk of becoming overweight. This study examines influences of societal and individual characteristics (children and their parents) on prevalence of overweight and obesity, in a national sample of 7-9-year-old children.
  
  
  METHODS
  Anthropometric and lifestyle data were collected in a nationally representative sample of 3636 Swedish children. Overweight and obesity (International Obesity Task Force (IOTF)) data were analyzed in relation to lifestyle factors, parental weight, education and breast-feeding.
  
  
  RESULTS
  The prevalence of overweight was 15.6% including 2.6% obese. Urbanization level and parental characteristics (weight status and education) were related to risk of overweight. Overall less favorable lifestyle characteristics were observed in rural areas and for children of low/medium educated mothers. Boys had greater risk of obesity in semi-urban and rural areas but this was not true for girls. For children's overweight, the living area effect was attenuated in multivariate analysis, while there was an association with origin of parents, high parental weight and medium maternal education. For obesity, the living area effect remained in boys while having two non-Nordic parents predicted obesity in girls. Parental weight status was associated with obesity in both girls and boys.
  
  
  CONCLUSIONS
  Individual and societal factors influence children's weight status, and parental weight status is a strong determinant. Including overweight and obese parents in future health promoting interventions could be a strategy to prevent children from becoming overweight, but identifying those parents may prove difficult. To ensure reaching children with the greatest needs, targeting high risk areas might be a more effective approach.
authors.affiliation: Department of Public Health and Community Medicine, Public Health Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. lotta.moraeus@gu.se
authors.forename: L
authors.initials: L
authors.lastname: Moraeus
authors.forename: L
authors.initials: L
authors.lastname: Lissner
authors.forename: A
authors.initials: A
authors.lastname: Yngve
authors.forename: E
authors.initials: E
authors.lastname: Poortvliet
authors.forename: U
authors.initials: U
authors.lastname: Al-Ansari
authors.forename: A
authors.initials: A
authors.lastname: Sjöberg
mesh_terms: D015992:Body Mass Index; D002648:Child; D004522:Educational Status; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D009043:Motor Activity; D009765:Obesity / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D010290:Parents / Q000523:psychology; D015995:Prevalence; D012424:Rural Population; D057185:Sedentary Behavior; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology