Associations Between Ecological Determinants and Weight Status Changes Among Children from Vulnerable Populations: Empirical Findings from a National Panel Survey in South Korea
Restricted accessResearch articleFirst published online April, 2025
Associations Between Ecological Determinants and Weight Status Changes Among Children from Vulnerable Populations: Empirical Findings from a National Panel Survey in South Korea
Pandemic-related weight gain disproportionately has affected children from socioeconomically disadvantaged backgrounds. However, key determinants of childhood obesity among these vulnerable children remain relatively underexplored.
Methods:
In a secondary data analysis using a longitudinal dataset, the relationships between child weight status and its individual and environmental influences among vulnerable children were examined based on an ecological model. We analyzed three-point time-series data for 1308 participants from a Korean national panel survey of vulnerable children. Adiposity estimates were calculated using body mass index (BMI) z-scores.
Results:
The panel regression analysis revealed that 2 factors, namely “lack of adequate sleep time” at the individual level and “suboptimal relationships with childcare teachers” at the interpersonal level, had a significant impact on the BMI z-scores of vulnerable children.
Conclusions:
It is crucial to develop strategies that ensure sufficient sleep time and to actively involve childcare centers in implementing place-based interventions and initiatives to prevent obesity among vulnerable children. Moreover, it is essential to continue efforts in identifying the significant determinants of childhood obesity among vulnerable populations by considering the major environments in which these children live and grow.
HauerslevMNarangTGrayNSamuelsTABhuttaZA.Childhood obesity on the rise during COVID-19: a request for global leaders to change the trajectory. Obesity. 2022;30(2):288-291. doi:10.1002/oby.23307
2.
Ayala-MarínAMIguacelIMiguel-EtayoPDMorenoLA.Consideration of social disadvantages for understanding and preventing obesity in children. Front Public Health. 2020;8:423. doi:10.3389/fpubh.2020.00423
3.
AyalaGXMonge-RojasRKingACHunterRBergeJM.The social environment and childhood obesity: implications for research and practice in the United States and countries in Latin America. Obes Rev. 2021;22:e13246. doi:10.1111/obr.13246
4.
LeeJParkJKimHSKimWSHwangG.Barriers to promoting physical activity among overweight and obese children from low-income families using community child care centers. J Korean Public Health Nurs. 2017;31(2):327-340. doi:10.5932/JKPHN.2017.31.2.327
5.
HoelscherDMButteNFBarlowS, et alIncorporating primary and secondary prevention approaches to address childhood obesity prevention and treatment in a low-income, ethnically diverse population: Study design and demographic data from the Texas Childhood Obesity Research Demonstration (TX CORD) study. Childhood Obes. 2015;11(1):71-91. doi:10.1089/chi.2014.0084
6.
La FauciGMontaltiMDi ValerioZ, et alObesity and COVID-19 in children and adolescents: reciprocal detrimental influence—systematic literature review and meta-analysis. Int J Environ Res Public Health. 2022;19(13):7603. doi:10.3390/ijerph19137603
7.
ParkJ.Predictors of health-promoting behaviors in children from low-income families: an ecological approach. Nurs Health Sci. 2018;20(1):60-68. doi:10.1111/nhs.12388
8.
AppelhansBMFitzpatrickSLLiH, et alThe home environment and childhood obesity in low-income households: indirect effects via sleep duration and screen time. BMC Public Health. 2014;14(1):1-9. doi:10.1186/1471-2458-14-1160
9.
McLeroyKBibeauDStecklerAGlanzK.An ecological perspective on health promotion programs. Health Educ Q. 1988;15(4):351-337. doi:10.1177/109019818801500401
10.
HarrisJLPomerantzJLLobsteinTBrownellKD.A crisis in the marketplace: how food marketing contributes to childhood obesity and what can be done. Annu Rev Public Health. 2009;30:211-225. doi:10.1146/annurev.publhealth.031308.100304
11.
LuppinoFSde WitLMBouvyPF, et alOverweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67(3):220-229. doi:10.1001/archgenpsychiatry.2010.2
12.
JakobsenDDBraderLBruunJM.Association between food, beverages and overweight/obesity in children and adolescents—a systematic review and meta-analysis of observational studies. Nutrients. 2023;15(3):764. doi:10.3390/nu15030764
13.
LiberaliRKupekEAssisMAAD. Dietary patterns and childhood obesity risk: a systematic review. Childhood Obes. 2020;16(2):70-85. doi:10.1089/chi.2019.0059
14.
MorrisseyBTaverasEAllenderSStrugnellC.Sleep and obesity among children: a systematic review of multiple sleep dimensions. Pediatr Obes. 2020;15(4):e12619. doi;10.1111/ijpo.12619
15.
AdachiMTakahashiMShinkawaHMoriHNishimuraTNakamuraK.Longitudinal association between smartphone ownership and depression among schoolchildren under COVID-19 pandemic. Soc Psychiatry Psychiatr Epidemiol. 2022;57(2):239-243. doi:10.1007/s00127-021-02196-5
16.
SunXHaydelKFMathesonDDesaiMRobinsonTN.Are mobile phone ownership and age of acquisition associated with child adjustment? A 5-year prospective study among low-income Latinx children. Child Dev. 2023;94(1):303-314. doi:10.1111/cdev.13851
17.
LajunenHRKeski-RahkonenAPulkkinenLRoseRJRissanenAKaprioJ.Are computer and cell phone use associated with body mass index and overweight? A population study among twin adolescents. BMC Public Health. 2007;26(7):24. doi:10.1186/1471-2458-7-24
18.
OnayTBeyazıtUUçarABütün AyhanA.Obesity in childhood: associations with parental neglect, nutritional habits, and obesity awareness. Front Nutr. 2024;2(11):1430418. doi:10.3389/fnut.2024.1430418
19.
LiPLyuJZhouS, et alAssociation of peer network with childhood obesity in DECIDE-Children Program. Nutrients. 2023;15(19):4154. doi:10.3390/nu15194154
20.
BjertnaesAAFossumINOmaIBakkenKSArneTHolten-AndersenMN.A cross-sectional study of the relationship between mental health problems and overweight and obesity in adolescents. Front Public Health. 2020;8:334. doi:10.3389/fpubh.2020.00334.
21.
SnellingAHawkinsMMcClaveRIrvine BelsonS.The role of teachers in addressing childhood obesity: a school-based approach. Nutrients. 2023;15(18):3981. doi:10.3390/nu15183981
22.
ArisIMPerngWDabeleaD, et alAssociations of neighborhood opportunity and social vulnerability with trajectories of childhood body mass index and obesity among US children. JAMA Netw Open. 2022;5(12):e2247957. doi:10.1001/jamanetworkopen.2022.47957
23.
DanielsKMSchinasiLHAuchinclossAHForrestCBDiez RouxAV.The built and social neighborhood environment and child obesity: a systematic review of longitudinal studies. Prev Med. 2021;153:106790. doi:10.1016/j.ypmed.2021.106790
ParkJBaekSImM.Trends in health-related interventions on children attending community child care centers in South Korea. Child Health Nurs Res. 2018;24(2):241-251. doi:10.4094/chnr.2018.24.2.241
27.
ParkJBaekSHwangGParkCHwangS.Diet-related disparities and childcare food environments for vulnerable children in South Korea: a mixed-methods study. Nutrients. 2023;15(8):1940. doi:10.3390/nu15081940
28.
Korean Centers for Disease Control & Korean Journal of Pediatrics. 2017 Child and adolescent growth chart: Commentary. Published 2017. Accessed January 19, 2023. https://knhanes.kdca.go.kr/knhanes/sub08/sub08_01.do
29.
HalesCMFreedmanDSAkinbamiLWeiROgdenCL.Evaluation of alternative body mass index (BMI) metrics to monitor weight status in children and adolescents with extremely high BMI using CDC BMI-for-age growth charts. Vital Health Stat 1. 2022;2(197):1-42. doi:10.15620/cdc:121711
30.
WeaverRGHuntETArmstrongB, et alCOVID-19 leads to accelerated increases in children’s BMI z-score gain: an interrupted time-series study. Am J Prev Med. 2021;61(4):e161-e169. doi:10.1016/j.amepre.2021.04.007
31.
WooldridgeJM.Econometric Analysis of Cross Section and Panel Data. MIT Press; 2010.
32.
HsiaoC.Panel data analysis—advantages and challenges. Test. 2007;16(1):1-22. doi:10.1007/s11749-007-0046-x
33.
StavridouAKapsaliEPanagouliE, et alObesity in children and adolescents during COVID-19 pandemic. Children (Basel, Switzerland). 2021;8(2):135. doi:10.3390/children8020135
34.
McIntyreRLAdamsonAJNelsonMWoodsideJBeattieSSpenceS.Changes and differences in school food standards (2010-2021) and free school meal provision during COVID-19 across the UK: potential implications for children’s diets. Nutr Bull. 2022;47(2):230-245. doi:10.1111/nbu.12556
35.
JensenMGeorgeMJRussellMROdgersCL.Young adolescents’ digital technology use and mental health symptoms: little evidence of longitudinal or daily linkages. Clin Psychol Sci. 2019;7(6):1416-1433. doi:10.1177/2167702619859336
36.
BalajMYorkHWSripadaK, et alParental education and inequalities in child mortality: a global systematic review and meta-analysis. Lancet. 2021;398(10300):608-620. doi:10.1016/S0140-6736(21)00534-1
37.
PinillaJLopez-ValcarcelBGUrbanos-GarridoRM.Estimating direct effects of parental occupation on Spaniards’ health by birth cohort. BMC Public Health. 2017;17(1):26. doi:10.1186/s12889-016-3997-6
38.
BatoolSHSafdarMEmanS.Relationship between parents’ health literacy and child health: a systematic review. Libr Hi Tech. 2022;42(1):131-148. doi:10.1108/LHT-11-2021-0398
39.
JonesELeeHChoK.Exploring parents’ participation decisions on school-based health screenings in mountainous regions. Korean J Fam Med. 2019;40(4):220-226. doi:10.4082/kjfm.18.0201
MillerMAKruisbrinkMWallaceJJiCCappuccioFP.Sleep duration and incidence of obesity in infants, children, and adolescents: a systematic review and meta-analysis of prospective studies. Sleep. 2018;41(4):zsy018. doi:10.1093/sleep/zsy018
43.
ZellerMHReiter-PurtillJRameyC.Negative peer perceptions of obese children in the classroom environment. Obesity. 2008;16(4):755-762. doi:10.1038/oby.2008.4
44.
ChungIJLeeKLeeJ.The effect of workers’ burnout on children’s psychosocial adjustment in community child centers. Korean Soc Child Welf. 2010;31:205-234.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
