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Vol. 93. Issue 3.
Pages 197-200 (01 September 2020)
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Vol. 93. Issue 3.
Pages 197-200 (01 September 2020)
Scientific Letter
DOI: 10.1016/j.anpede.2020.07.004
Open Access
Effect of urban vulnerability on the prevalence of infant obesity in Seville
Efecto de la vulnerabilidad urbana en la prevalencia de obesidad infantil en Sevilla
Sebastián Tornero Patricio
Corresponding author
, María Ángeles García Martín, Ana María Rueda de Castro, Rocío Muñoz Rebollo, Gema Conejo Gaspar
Observatorio de la Salud, Servicio de Salud del Excmo, Ayuntamiento de Sevilla, Sevilla, Spain
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Tables (2)
Table 1. Bivariate analysis of childhood obesity and/or overweight by age, sex and level of urban vulnerability.
Table 2. Multivariate analysis of childhood obesity and overweight by age, sex and level of urban vulnerability.
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To the editor:

The global increase in childhood obesity has become a public health problem that requires urgent intervention through the establishment of social welfare and health care policies.1 The onset of obesity during childhood entails an increase in the number of years that individuals are exposed to the effects of this risk factor for multiple comorbidities and could compromise the sustainability of public health care systems in the future.1

Multiple studies have evinced the association between childhood obesity and socioeconomic status (SES) in terms of professional category, unemployment, educational attainment or location of residence.2,3 The aim of our study was to assess the association and the effect of socioeconomic vulnerability of specific neighbourhoods on the prevalence of overweight and obesity in primary education students in Seville.

The main source of data was the database that we had access to through the Observatorio de la Salud (Health Observatory) of the City of Seville, used by the city to produce the report on childhood obesity in 2017.4 We conducted a cross-sectional study on the reference population of 45 377 schoolchildren enrolled in primary education in the 161 schools of the city of Seville (2015–2016 academic year). We stratified schools using a socioeconomic index calculated for the neighbourhoods where they were located, and selected schools by simple randomization (n=13). We also selected classrooms by simple randomization, taking into account the proportions of the total student body that corresponded to the students in each year. The final sample included 2320 schoolchildren aged 6–12 years, for who we obtained height and weight measurements and calculated the body mass index (BMI).

The dependent variable was the prevalence of childhood overweight and obesity, calculated using the child growth standards of the World Health Organization (WHO), which is the reference population that gives rise to the highest estimates of the prevalence of excess weight in children.4,5 The independent variables were age, sex and level of urban vulnerability of the neighbourhoods where schools were located. The source of the data used for the latter variable was the Catálogo de Barrios Vulnerables (Catalogue of Vulnerable Neighbourhoods),6 which classifies the neighbourhoods of Spanish cities according to their urban vulnerability, which is categorised in 4 levels based on unemployment, educational attainment and the state of preservation of residential buildings.

We made bivariate analyses comparing independent variables (age, sex, urban vulnerability) and dependent variables (obesity and/or overweight) by means of the χ2 test, considering results with a p-value of less than 0.05 statistically significant. We fitted logistic regression models with obesity and overweight as the dependent variable, calculating odds ratios, both crude and adjusted for the 3 independent variables, as well as the corresponding 95% confidence intervals (CIs). We performed the analysis with the software R version 3.5.1.

The report on which our study is based concluded that the prevalence of excess weight in primary school students in Seville was 41.6%, using the WHO child growth standards as reference (obesity, 15.3% and overweight, 26.3%).4 In our sample, 6 of the 13 schools were located in vulnerable neighbourhoods. The prevalence of childhood obesity increased with the vulnerability of the neighbourhood where the school was located: no vulnerability, 13.7%; medium vulnerability, 16.0%; high vulnerability, 26.6% (P= .004) (Table 1). We did not detect statistically significant differences in the prevalence of overweight or of excess weight (obesity+overweight) based on the level of vulnerability. The prevalence of childhood obesity was higher in boys than in girls (17.7% vs 12.9%; P= .001), and the analysis did not evince significant differences between age groups. The probability of having childhood obesity is 49% greater in boys and twice as high in schoolchildren in schools located in neighbourhoods with a high level of urban vulnerability (P= .001) (Table 2).

Table 1.

Bivariate analysis of childhood obesity and/or overweight by age, sex and level of urban vulnerability.

Independent variable  ObesityOverweightOverweight+Obesity
  n  n    n  n    n  n   
Female  157  12.9  1063  87.1  .001  320  26.2  900  73.8  .824  477  39.1  743  6.9  .010 
Male  195  17.7  905  82.3    293  26.6  807  73.4    488  44.4  612  55.6   
Age (years)
6−9  229  16.0  1199  84.0  .146  373  26.1  1055  73.9  .676  602  42.2  826  57.8  .487 
10−12  123  13.8  769  86.2    240  26.9  652  73.1    363  4.7  529  59.3   
Level of urban vulnerabilitya
None  183  13.7  1154  86.3  .004  358  26.8  979  73.2  .852  541  4.5  796  59.5  .150 
Medium  132  16.0  694  84.0    216  26.2  610  73.8    348  42.1  478  57.9   
High  37  23.6  120  76.4    39  24.8  118  75.2    76  48.4  81  51.6   

Levels of vulnerability of neighbourhoods: none, low, medium, high and very high (there were no observations for low or very high vulnerability neighbourhoods).

Table 2.

Multivariate analysis of childhood obesity and overweight by age, sex and level of urban vulnerability.

Independent variables/Excess weight  OR  95% CI  P  aOR  95% CI  P 
Childhood obesity             
Female  —  —  —  —  —  — 
Male  1.46  1.16−1.83  .001  1.49  1.19−1.88  .001 
Age (years)             
10−12  —  —  —  —  —  — 
6−9  1.19  0.94−1.52  .143  1.23  0.97−1.57  .086 
Level of urban vulnerabilitya             
None  —  —  —  —  —  — 
Medium  1.20  0.94−1.53  .142  1.24  0.97−1.59  .084 
High  1.94  1.29−2.88  .001  2.03  1.34−3.01  .001 
Childhood overweight             
Female  —  —  —  —  —  — 
Male  1.02  0.85−1.23  .82  1.02  0.85−1.22  .854 
Age (years)             
10−12  —  —  —  —  —  — 
6−9  0.96  0.80−1.16  .676  0.96  0.79−1.16  .660 
Level of urban vulnerabilitya             
None  —  —  —  —  —  — 
Medium  0.97  0.79−1.18  .749  0.97  0.80−1.16  .767 
High  0.90  0.61−1.31  .604  0.90  0.61−1.31  .588 

aOR, adjusted odds ration; CI, confidence interval; OR, crude odds ratio.


Levels of vulnerability of neighbourhoods: none, low, medium, high and very high (there were no observations for low or very high vulnerability neighbourhoods).

There is a risk of selection bias in the study on account of a sampling method that, while appropriate for the initial report on obesity,4 may not have been ideal for our study. While no schools represented the highest level of urban vulnerability, we detected statistically significant differences in comparison with the reference group. We did not have access to the residential addresses of the schoolchildren that participated in the study, which may have resulted in classification bias. However, since children usually attend a school near the home, it is unlikely that the magnitude of this bias was sufficient to affect the results.

Our findings demonstrate the correlation and deleterious effect of residing in areas of lower SES on the prevalence of childhood obesity. Social welfare and public health policies are required to address socioeconomic inequalities.

Organización Mundial de la Salud.
Informe de la Comisión para acabar con la obesidad infantil [Internet].
L. Font-Ribera, X. García-Continente, M.C. Davó-Blanes, C. Ariza, E. Díez, M.M. García Calvente, et al.
The study of social inequalities in child and adolescent health in Spain.
L. Serra Majema, L. Ribas Barba, J. Aranceta Bartrina, C. Pérez Rodrigo, P. Saavedra Santana, L. Peña Quintana.
Obesidad infantil y juvenil en España.
M.A. García Martín, A.M. Rueda de Castro, R. Rebollo Muñoz, G. Conejo Gaspar, J.M. Capitán Gutiérrez.
Sobrepeso y Obesidad en Escolares de Educación Primaria de Sevilla, informe 2017. [Internet].
M.J. Ajejas Bazán, M.I. Jiménez Trujillo, J. Wärnberg, S. Domínguez Fernández, A. López de Andrés, N. Pérez Farinós.
Differences in the prevalence of diagnosis of overweight-obesity in Spanish children according to the diagnostic criteria set used.
Gac Sanit [Internet]., 32 (2018), pp. 477-480
Ministerio de Fomento del Gobierno de España. Visor del Catálogo de Barrios Vulnerables [Internet].

Please cite this article as: Patricio ST, Martín MÁG, de Castro AMR, Rebollo RM, Gaspar GC. Efecto de la vulnerabilidad urbana en la prevalencia de obesidad infantil en Sevilla. An Pediatr (Barc). 2020;93:197–200.

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