Deprivation and childhood obesity: a cross sectional study of 20 973 children in Plymouth, United Kingdom

OBJECTIVE—To study the association between socioeconomic deprivation and childhood obesity.
DESIGN—Cross sectional study.
SETTING—All state primary schools in Plymouth. Plymouth is a relatively deprived city in the United Kingdom, ranking 338th of 366( )local authorities on the Department of the Environment Index of Local Conditions.
SUBJECTS—20 973 children between the ages of 5 and 14 years, 1994-96.
MAIN OUTCOME MEASURE—Numbers of obese children (body mass index (BMI) above the 98th centile) by quarters of Townsend score.
RESULTS—Plymouth had a rate of childhood obesity two and half times that expected nationally (5% v 2%). The obesity prevalence increased with age, being almost double in the oldest age quarter (boys 6.2%; girls 7.0%), compared with the youngest age quarter. Within Plymouth, there was a significant trend for higher rates of obesity related to increasing deprivation in both boys (p=0.017) and girls (p=0.018). The odds ratio (OR) for childhood obesity (highest-lowest quarter of Townsend scores) had borderline significance in boys (OR 1.29, 95% confidence intervals (CI) 1.00 to 1.65, p=0.049) but was larger and more significant in the girls (OR 1.39, 95% CI 1.08 to 1.80, p=0.011). Unlike boys, the association between obesity in girls and Townsend scores became stronger with age such that in the oldest age quarter (over 11.7 years), girls in the highest quarter of Townsend scores were nearly twice as likely be obese, as compared with the lowest quarter (OR 1.95, 95% CI 1.23 to 3.08, p=0.005). State of pubertal development could not be accounted for as this information was not available.
CONCLUSIONS—This study provides evidence for an association between deprivation and childhood obesity in this English population. The health of children from deprived households is affected by a number of adverse influences. The high prevalence of obesity in these children is yet another factor that could predispose to greater morbidity in adult life.


Keywords: childhood obesity; socioeconomic deprivation; body mass index; Townsend material deprivation scor

Modern Human Physiology with Respect to Evolutionary Adaptations that Relate to Diet in the Past

This paper reviews evidence from human physiology as to which foods may have been typically consumed by the hominin ancestral lineage up to the advent of anatomically modern humans. Considerable evidence suggests that many common diseases can be prevented by hunter-gatherer diets. Apparently, human nutritional metabolism is not perfectly fine-tuned for recently introduced staple foods, such as cereals, dairy products, added salt, and refined fats and sugar. It is much more uncertain if human physiology can provide direct evidence of which animal and plant foods were regularly consumed during human evolution, and in what proportions. The requirements of ascorbic acid can easily be met by organ meats from large animals, as well as by plant foods. Vitamin B 12 is absent in plant foods and must be supplied from meat, fish, shellfish, or insects, but the required amounts are apparently small. Since iodized salt and dairy products were not available before the advent of agriculture, only those ancestors with highly regular access to fish or shellfish would be expected to have reached the currently recommended intake of iodine. However, there is insufficient data to suggest that humans, by way of natural selection, would have become completely dependent on marine food sources. Therefore, it is highly possible that human requirements for iodine are currently increased by some dietary factors. These theoretically include goitrogens in certain roots, vegetables, beans, and seeds. The notion that humans are strictly dependent on marine foods to meet requirements of long-chain omega-3 fatty acids still awaits solid evidence. Shifting the focus from general human characteristics to ethnic differences, persistent lactase activity in adulthood is obviously not the only characteristic to have emerged under nutritional selection pressure. Other examples are a relative resistance against diseases of affluence in northern Europeans and a relatively low prevalence of gluten intolerance in populations with a long history of wheat consumption. In conclusion, humans are well adapted for lean meat, fish, insects and highly diverse plant foods without being clearly dependent on any particular proportions of plants versus meat