Healthy habits regress in childhood compared to 2019, especially among children in vulnerable situations

The state of health of children, and therefore of society, has worsened in the last three years, according to the PASOS 2022-2023 study by the Gasol Foundation -the foundation of the Pau and Marc Gasol brothers to prevent childhood obesity. While the level of obesity and overweight is maintained in the population aged 8 to 16 years in Spain, the variables of quality of life, use of screens, hours of sleep, diet and physical activity worsen compared to the first edition of the study, which was presented in 2019.

"We are facing an extremely worrying situation, with serious consequences in the short, medium and long term," said Cristina Ribes, executive director of the Gasol Foundation. "We are experiencing an accelerated deterioration of children's living habits, especially among those living in a situation of socioeconomic vulnerability."

The main results of the second edition of PASOS were presented at an event attended by Dr. Anna Veiga, director of the Probitas Foundation; Dr. Marta Segú, director of the FCBarcelona Foundation -both main collaborators of the study-; as well as Cristina Ribes, executive director of the Gasol Foundation; Dr. Helmut Schröder, senior researcher at the Hospital del Mar Research Institute and coordinator of group 30 of CIBERESP; and Dr. Santi F. Gómez, principal investigator of the study.

Growing social inequalities in health

The main PASOS results, which expand on the preliminary conclusions presented in January, reconfirm that the childhood obesity pandemic affects to a greater extent those children and adolescents who live in a situation of socioeconomic vulnerability. Specifically, 6.7% more children and adolescents enrolled in schools located in a census tract with a lower average income per person per year are obese.

This worrying trend is also seen in the case of severe obesity, which increases slightly in environments with a higher percentage of child poverty, while it decreases in those areas with less child poverty. Thus, it is confirmed that in the short period evaluated there is a trend towards an increase in social inequalities in relation to the most extreme conditions of childhood obesity.

"Childhood obesity is a complex challenge that affects society as a whole: we must make a determined, forceful and multi-sectoral effort to curb this social problem that goes far beyond public health," said Dr. Santi F. Gómez, Global Director of Research and Programs at the Gasol Foundation and principal investigator of the PASOS study. "Preventing and reducing childhood obesity means providing opportunities for children to grow up healthy, and thus making progress on 14 of the 17 Sustainable Development Goals that are impacted by obesity."

In this regard, Dr. Helmut Schröder noted that "of particular concern is the disproportionate increase in severe obesity, compared to general obesity, when comparing the data from the PASOS study with those from the EnKid study in 2000. This disproportionate increase was more pronounced in girls".

Main results of the PASOS 2022-2023 study

The main results of the study indicate that 32.2 % of children and adolescents report having problems in relation to emotional well-being. This percentage has grown substantially since 2019, when it stood at 19.8 %. Moreover, this growth is much more accentuated for the female gender (reaching 40 % in 2022-2023), in the adolescent population (42.4 %) and in the population with the highest child poverty (30.1 %). At the same time, in the last 3 years, children's perception of their own state of health has deteriorated considerably, decreasing by more than 6 points (on a scale of 0 to 100). This decrease reaches almost 9 points for the population of lower socioeconomic level, both according to the level of average income per year and according to the level of child poverty.

Regarding the use of screens, the average is very high both during the week (193.9 minutes on average per day) and on weekends (288.4 minutes), figures that exceed the 2019-2020 data, where the situation was already worrying. A similar situation occurs when we analyze the hours of sleep, since almost half of the children and adolescents in Spain do not comply with the recommendations of hours of daily sleep both on weekdays and weekends. The percentage of non-compliance is higher among female participants (47.6%) from Monday to Friday.

In terms of nutrition, the level of adherence to the Mediterranean diet has decreased compared to 2019 to 6.48 points on a scale of -4 to 12 points. Only 37% of the infant-juvenile population reaches a high level of adherence to the Mediterranean diet, a reduction of more than 3 points compared to 2019-2020; while 12% already present a low level, an increase of almost 2 points compared to 2019-2020. The deterioration in eating habits is also greater in the population of lower socioeconomic level.

In the case of physical activity, the average number of minutes dedicated to the practice of moderate or vigorous physical activity has decreased by 7.4 minutes for the female gender and by 7.1 for the male gender with respect to 2019-2020, which means a reduction of about 50 minutes per week. Such deterioration is higher in environments with a higher percentage of child poverty, as it implies an average decrease of almost 14 minutes per day less of moderate or vigorous physical activity. This means almost 100 minutes per week.

Faced with this reality, the Gasol Foundation insists on the importance of continuing to promote the 200 measures of the National Strategic Plan for the Reduction of Childhood Obesity, which should take a holistic approach, including the promotion of physical activity, nutrition, sleep, reduction of the use of screens and the promotion of emotional well-being and quality of life. At the same time, it is important to halt the increase in social inequalities in health that this PASOS 2022-2023 report highlights.

Image: From left to right: Dr. Santiago Gómez, Dr. Helmut Schröder and Dr. Marta Segú.