title: Social inequality and age-specific gender differences in overweight and perception of overweight among Swedish children and adolescents: a cross-sectional study.
abstract: BACKGROUND
  Overweight among children and adolescents related to social inequality, as well as age and gender differences, may contribute to poor self-image, thereby raising important public health concerns. This study explores social inequality in relation to overweight and perception of overweight among 263 boys and girls, age 7 to 17, in Växjö, Sweden.
  
  
  METHODS
  Data were obtained through a questionnaire and from physical measurements of height, weight and waist circumference [WC]. To assess social, age and gender differences in relation to overweight, the independent sample t- and chi-square tests were used, while logistic regression modeling was used to study determinants for perception of overweight.
  
  
  RESULTS
  Social inequality and gender differences as they relate to high ISO-BMI [Body Mass Index for children] and WC were associated with low maternal socioeconomic status [SES] among boys < 13 years [mean age = 10.4; n = 65] and with low paternal education level among boys ≥ 13 years [mean age = 15.0; n = 39] [p < 0.05]. One suggested explanation for this finding is maternal impact on boys during childhood and the influence of the father as a role model for adolescent boys. The only association found among girls was between high ISO-BMI in girls ≥ 13 years [mean age = 15.0; n = 74] and low paternal occupational status. Concerning perception of overweight, age and gender differences were found, but social inequality was not the case. Among boys and girls < 13 years, perception of overweight increased only when overweight was actually present according to BMI or WC [p < 0.01]. Girls ≥ 13 years [mean age = 15.0] were more likely to unrealistically perceive themselves as overweight or "too fat," despite factual measurements to the contrary, than boys [p < 0.05] and girls < 13 years [mean age = 10.4; n = 83] [p < 0.001].
  
  
  CONCLUSIONS
  The association between social inequality and overweight in adolescence in this study is age- and gender-specific. Gender differences, especially in perception of overweight, tend to increase with age, indicating that adolescence is a crucial period. When planning interventions to prevent overweight and obesity among children and adolescents, parental SES as well as age and gender-specific differences in social norms and perception of body weight status should be taken into account.
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Pediatrics, Faculty of Health Sciences, Linköping University, Linköping, SE-58185, Sweden. jolanda.van.vliet@regionostergotland.se.
authors.forename: J S
authors.initials: JS
authors.lastname: van Vliet
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Child and Adolescent Psychiatry, Faculty of Health Sciences, Linköping University, Sweden and County Council of Östergötland, Linköping, SE-58185, Sweden. Per.A.Gustafsson@liu.sec.|Department of Pediatrics, University Hospital, County Council of Östergötland, Linköping, SE-58185, Sweden. Per.A.Gustafsson@liu.sec.
authors.forename: P A
authors.initials: PA
authors.lastname: Gustafsson
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Pediatrics, Faculty of Health Sciences, Linköping University, Linköping, SE-58185, Sweden. karel.duchen.munoz@regionostergotland.se.|Department of Pediatrics, University Hospital, County Council of Östergötland, Linköping, SE-58185, Sweden. karel.duchen.munoz@regionostergotland.se.
authors.forename: K
authors.initials: K
authors.lastname: Duchen
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Pediatrics, Faculty of Health Sciences, Linköping University, Linköping, SE-58185, Sweden. nina.nelson-follin@karolinska.se.|Quality and Patient Safety, Karolinska University Hospital, Stockholm, SE-17176, Sweden. nina.nelson-follin@karolinska.se.
authors.forename: N
authors.initials: N
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001294:Attitude to Health; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D003430:Cross-Sectional Studies; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D050177:Overweight / Q000453:epidemiology* / Q000523:psychology*; D010290:Parents / Q000523:psychology*; D015995:Prevalence; D012649:Self Concept; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D055105:Waist Circumference