Urban environment and socio-economic inequalities in childhood excess weight: a cross-sectional study in Geneva, Switzerland

Background Childhood overweight and obesity represent major public health challenges, shaped by socio-economic and environmental factors. This study investigates the mediating and moderating role of urban environmental exposures in socio-economic disparities in childhood excess weight. Methods Data was drawn from a population-based sample of children (2-9 years) and adolescents (10-17 years) living in Geneva, Switzerland. Parents reported household financial situation and children's height and weight, from which excess weight (i.e. overweight or obesity) was derived. Residential exposures to air pollution (PM2.5, NO2), noise (daytime, nighttime), and neighborhood greenness (green areas, canopy coverage) were estimated based on geocoded residential addresses. The association between household financial situation and excess weight was evaluated, as well as the mediating and moderating roles of urban environmental exposures. Results The analysis included 1006 children and 1154 adolescents. Among children, an average-to-poor household financial situation was associated with higher odds of excess weight in children (adjusted odds ratio [aOR]: 1.79, 95% confidence interval [CI]: 1.13; 2.84). Higher noise exposure was associated with excess weight (daytime: aOR: 1.40, 95% CI: 1.10; 1.77, nighttime: aOR: 1.37, 95% CI: 1.08; 1.74), while the association with PM2.5 appeared stronger among socio-economically disadvantaged children, though the interaction did not reach statistical significance (financial situation x PM2.5 interaction: aOR: 1.59, 95% CI: 0.98; 2.59). No significant associations were observed among adolescents. Conclusion These findings highlight the joint influence of social and environmental inequalities on childhood excess weight and stress the need to address these interconnected determinants to design equitable, targeted public health interventions.