Breaking the Cycle: A Case-Control Study on Social and Familial Influences in Childhood Obesity

Abstract

Objective. Childhood obesity is a growing public health concern influenced by social and familial determinants. This study examines the associations between caregiver education, family structure, social risk factors, and familial obesity with childhood obesity in a Portuguese pediatric population to inform targeted interventions.

Materials and Methods. A retrospective case-control study was conducted at a Portuguese secondary hospital, including 78 children with obesity and 326 controls. Controls were selected using a time-matched, hospital-based approach from the same ward and calendar years as the cases. Socioeconomic data were extracted from the hospital records. Social risk was defined based on documented indicators of socioeconomic vulnerability, such as financial hardship, suspicion of neglect, and housing instability, identified through multidisciplinary records. Logistic regression models were used to assess the risk of obesity while adjusting for age and sex.

Results. Caregiver education and familial obesity were the strongest predictors of childhood obesity. Children whose caregivers had not completed compulsory education had a significantly higher risk of obesity, whereas familial obesity showed an even stronger association. Social risk factors were linked to obesity in univariate analyses but lost significance in adjusted models. An exploratory interaction between caregiver education and social risk suggested higher odds when both disadvantages co-occurred. Family structure did not independently predict obesity.

Conclusion. This study highlights the need for targeted public health interventions addressing caregiver education, economic support for at-risk families, and family-wide lifestyle changes. A multi-sectoral approach integrating healthcare, education, and community programs is crucial for reducing childhood obesity and promoting long-term health equity.