Social Determinants of Child Obesity in Shanghai, China: Comparing Chinese and US Disparity Patterns

Background and Purpose: In the past several decades, cities in China have experienced unprecedented levels of economic and social development—generating interest in the impact on the well-being of young people. Research suggests that increases in chronic health conditions have increased commensurate with levels of development. In particular, studies document the dramatic rise in childhood overweight/obesity in East Coast Chinese cities. Research into childhood overweight/obesity in China has largely relied on public health data that lacks detailed information on the social determinants of increased obesity. Our study takes advantage of a new dataset focused on the wellbeing of children in Shanghai that includes comprehensive contextual information on these children. We examine the extent to which childhood overweight/obesity at school entry may be associated with family sociodemographic factors in Shanghai in 2014. We then contextualize these associations with well-documented patterns of child obesity in developed countries such as the US.

Method: We use the 2014 Child Well-Being Study of Shanghai, China—a study modeled on child cohort studies in the United States. The sample of approximately 2,000 children is 7 years of age on average at the time of survey in 2014. We use logistic regression to estimate odds ratios and adjusted proportions of overweight and obesity by income tercile, parental education, and hukou status (rural vs. urban). Results use the CDC overweight and obesity cutpoints for comparison to the US, but we also conduct sensitivity analyses using other established international and Chinese overweight and obesity standards. All results are stratified by gender due to established gender differences in childhood obesity. We also include a number of sociodemographic factors, health insurance status, and health behaviors in our models. For the US, we estimate similar results using the National Health and Nutrition Examination Survey—data that are publicly available and regularly used to monitor US rates of child obesity/overweight.

Results: Preliminary results find a very high rate of childhood overweight and obesity (36% and 21%, respectively) in Shanghai, China—rates that are higher than in the US. 42% of boys and 30% of girls in our sample are overweight or obese. The multivariate analysis also indicates that like many developing countries, our sample has a reverse income and education gradient in childhood overweight/obesity—but only for girls. High income and high education are associated with higher rates of childhood overweight/obesity for girls, but no pattern by SES exists for boys. Girls from urban families are also more likely to be overweight or obese than girls from rural-status families.

Conclusions and Implications: Social determinants of childhood overweight/obesity are an increasing concern to social workers focused on the wellbeing of children—particularly those working in health and school settings. Our results shed light on the importance of social welfare programs, healthcare reform, and school settings in Shanghai to address this issue from a multi-faceted perspective, and the optimal roles and functions of social workers to improve overall child wellbeing in rapidly changing China.