A Scoping Review of the Social Determinants of Pediatric and Adolescent Obesity

Abstract

Context: Social determinants of health (SDOH) play a large role in pediatric and adolescent metabolic health worldwide. Objective: The study is aimed at exploring key SDOH related to childhood obesity, worldwide. Methods: Primary research articles from PubMed, Embase, and Medline databases published between 2013 and 2023, had a study population of 0-19-year-olds, and examined the association between WHO-defined SDOH and childhood obesity were included. Non-English papers and those outside WHO-defined SDOHs were excluded. Two reviewers independently performed a blinded screening of titles and abstracts, followed by a full-text assessment of selected articles. Results: Of the 703 initial articles, 22 duplicates were excluded, leaving 681 unique articles from PubMed (N = 274), Medline (N = 43), and Embase (N = 364). Initial screening excluded 579 articles, and full-text screening excluded 61 more, resulting in 41 final articles. Reasons for exclusion primarily involve missing SDOH exposure or weight-related outcomes and articles being reviews, editorial/opinion pieces, or interventional studies. Most included studies were cross-sectional (N = 25) and conducted in North America (N = 22). The average study sample size was 43,640 participants. These studies focus on socioeconomic determinants, neighborhood characteristics, food environment, healthcare access, educational determinants, and immigration-related factors. Obesity-related outcomes included general obesity, severe obesity, abdominal obesity, weight gain, BMI/weight categories, and continuous BMI measures. Conclusion: Key SDOHs of childhood obesity include socioeconomic status, neighborhood characteristics, food environment, healthcare access, immigration, and culture. Despite diverse regional studies, there is a notable gap in US-specific data on SDOH of childhood obesity, especially by race and ethnicity. Further research is needed to better understand these determinants and their impact on pediatric metabolic health.

Figure 1

Inclusion and exclusion process of articles collected from PubMed, Medline, and Embase (N = 703).