# Association Between Sub-National Regional Socioeconomic Status and Childhood Obesity in Five South-East European Countries: The WHO European Childhood Obesity Surveillance Initiative—COSI (2019)

## TL;DR

This study explores how regional socioeconomic differences in five South-East European countries relate to childhood obesity rates.

## Contribution

The study introduces a sub-national regional analysis of childhood obesity in South-East Europe, linking it to socioeconomic status.

## Key findings

- Childhood obesity prevalence varied significantly across regions in Croatia, Slovenia, and Serbia.
- A moderate clustering of obesity rates was observed (Moran’s I = 0.337).
- Higher sub-national human development index was negatively associated with childhood obesity (β = −66.63, p < 0.001).

## Abstract

Background/Objectives: This study focused on the sub-national regional heterogeneity in childhood obesity prevalence across five countries in south-east Europe and the correlation between this heterogeneity and socioeconomic differences. Previous studies have mainly observed national or cross-national data but this study used a sub-national regional approach that may be beneficial in the further investigation of childhood obesity. Methods: Nationally representative samples of children from Croatia, Montenegro, North Macedonia, Serbia and Slovenia were selected using the COSI methodology and used to estimate regional childhood obesity prevalence values. The Sub-national Human Development Database provided data on the Sub-national Human Development Index (SHDI). The spatial autocorrelation analysis of childhood obesity prevalence in sub-national regions was performed and its association with sub-national human development was tested with an ordinary least squares regression model. Results: This study found statistically significant differences in childhood obesity prevalence across sub-national regions in Croatia, Slovenia and Serbia, while no such differences were observed in North Macedonia and Montenegro. There was moderate clustering in childhood obesity rates (Moran’s I = 0.337). The results indicated a significant negative association between SHDI and childhood obesity prevalence across the 48 regions (β = −66.63, p < 0.001). Conclusions: Future public health efforts should take into consideration regional differences in childhood obesity prevalence, and more targeted research is essential for understanding the mechanisms of resilience and vulnerability on a sub-national level.