Affluence Protects Children From Obesity Even In Areas With Lots Of Unhealthy Food Outlets

University College London

Family affluence shields children from the risks of obesity and unhealthy eating habits, even when they're surrounded by unhealthy food options, according to a study co-led by researchers at UCL.

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The research, conducted in four London boroughs and funded by the National Institute for Health & Care Research (NIHR), highlights the urgent need to address structural inequalities, such as household deprivation, if local and national policies aimed at improving children's diets are to be effective.

As the Government extends free school meals and faces pressure to remove the two-child benefit cap, the study's findings suggest that reforms to welfare policies, including benefit caps and targeted subsidies for healthy food, may be just as important for children's health as changes to the neighbourhood food environment.

The study team - led by researchers at UCL, the University of Cambridge, the University of Leeds and City St George's, University of London - say such interventions are especially critical now, given the rise in the cost of living and increasing rates of food insecurity across the UK.

Childhood obesity inequalities in England persist despite targeted interventions and national policies focused on promoting healthy diets and food environments. Family-level deprivation is one of the most important determinants of childhood obesity in the UK. Family-level deprivation was assessed in the study based on a range of indicators including education level, family income, and home ownership status. Children from deprived backgrounds face overlapping challenges, such as limited access to healthy food, financial stress, and targeted marketing, that make healthy eating harder and contribute to higher obesity rates.

To find out more about the impact of deprivation and other factors on family food culture, the researchers recruited 728 families with primary school-aged children from four socioeconomically diverse London boroughs in 2022. Data was collected through computer-assisted interviews (30.8% in-person, 69.2% telephone) on the home food environment, parental feeding practices, and children's eating behaviours, food preferences and child weight.

Their analysis, published in the International Journal of Behavioral Nutrition and Physical Activity, revealed that:

  • Greater family deprivation was strongly linked to home food environments that promote excessive weight gain ('obesogenic' environments).
  • Children living in more deprived households displayed more unhealthy eating behaviours, such as eating in response to negative emotions and external food cues rather than because of hunger, and a stronger desire for soft drinks.
  • Parents facing higher deprivation were more likely to use emotional and pressuring feeding practices, and to provide less structured meals.
  • Although neighbourhood exposure to unhealthy food outlets (such as fast-food shops between home and school) was also associated with obesogenic home food environments, it had less impact than family-level deprivation.

These findings confirm national trends showing that primary school-aged children from disadvantaged backgrounds have higher BMIs than their peers from more affluent families. However, the study goes further by identifying the mechanisms through which deprivation shapes food practices and behaviours within the home, and these insights can inform future public health interventions.

Joint lead author Dr Andrea Smith of the MRC Epidemiology Unit at the University of Cambridge, who was a Senior Research Fellow at UCL when this research was completed, said: "Our study shows that deprivation has a deep and wide-ranging impact on children's eating habits, family feeding practices, and ultimately children's weight. While improving neighbourhood food environments remains important, we cannot ignore the broader social and economic conditions families are facing. Tackling deprivation must be central to any strategy aiming to reduce health inequalities in childhood obesity."

The study forms part of the Family Food Experience Study - London, which investigates how socioeconomic and environmental factors shape food practices within families. It provides new evidence for local authorities and policymakers, emphasising the need to tailor interventions to the realities of family deprivation and household stress. The findings highlight the need for stronger action to address structural inequalities, not just improvements to local food environments, as family affluence appears to buffer children from obesity risk, even in unhealthy food surroundings.

Senior author Professor Clare Llewellyn, based at the UCL Institute of Epidemiology & Health Care, said: "Our findings suggest that family deprivation - not just the local food environment - is a key driver of unhealthy eating habits and obesity in children. Tackling childhood obesity means addressing the root causes, including economic hardship and food insecurity. Without policy action on these broader structural issues, efforts to promote healthy eating are unlikely to succeed."

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