Socioeconomic position and cardiometabolic risk factors in children and adolescents with obesity: findings from the Bern Obesity in Childhood and Adolescence Biorepository (BOCAB)

Purpose: In high-income countries, lower socioeconomic position (SEP) is linked to higher childhood obesity prevalence but its association with cardiometabolic risk in those presenting in pediatric weight management services remain underexplored. Methods: In the Bern Obesity in Childhood and Adolescence Biorepository (BOCAB), we used the Swiss neighborhood index of SEP (0-100, 100=highest SEP) to assess cross-sectional associations with obesity severity and cardiometabolic risk factors, mediation by behavioral lifestyle factors and longitudinal associations between SEP and percentage of the 95th BMI percentile (%BMIp95) and waist circumference-to-height ratio (WHtR), adjusted for age and sex. Results: Among 886 participants (52% male, mean age 11.2 years [SD 3.1]), mean %BMIp95 was 124% (SD 17%). A 10-unit higher SEP was associated with lower %BMIp95 ({beta} -2.57; 95% CI -3.84 to -1.31) and lower WHtR ({beta} -0.006; -0.010 to -0.001), both partially mediated by weekly physical activity and screen time. Higher SEP was also associated with lower odds of insulin resistance (OR 0.80; 0.65 to 0.98), low HDL-cholesterol (OR 0.81; 0.67 to 0.98), elevated non-HDL-cholesterol (OR 0.74; 0.59 to 0.92) and elevated triglycerides (OR 0.83; 0.70 to 0.98). Among 419 participants with longitudinal data, annual reduction in %BMIp95 and WHtR did not differ by SEP. Conclusion: Lower SEP is associated with greater obesity severity and cardiometabolic risk among children and adolescents with obesity presenting at specialized tertiary care. Screening and early referral of lower-SEP children and adolescents with obesity should be encouraged, before cardiometabolic risk accumulates, particularly since treatment response did not differ once enrolled.