European Journal of Pediatrics

, Volume 177, Issue 5, pp 753–763 | Cite as

Migration background and childhood overweight in the Hannover Region in 2010–2014: a population-based secondary data analysis of school entry examinations

  • Yusheng ZhouEmail author
  • Thomas von Lengerke
  • Ulla Walter
  • Maren Dreier
Original Article


Overweight and obesity constitute a global epidemic with rates that are increasing rapidly in children. The aim of the present study was to examine ethnic differences in the prevalence of overweight in pre-school children in a multicultural context. Data were collected from a compulsory school entry examination in the Hannover Region, Germany (n = 50,716) from 2010 to 2014. The prevalence of overweight (including pre-obesity and obesity status) and obesity was estimated using a German national reference. The migration status of the children was based on the parent’s migration history. Multivariable logistic and hierarchical multinomial regression analyses were performed to identify factors associated with the overweight, pre-obesity, and obesity status. The prevalence of overweight was significantly higher among migrant children (12.7%) than among the non-migrant children (6.9%). After adjusting for socioeconomic and child development variables, migration background was strongly associated with weight status. The Turkish migrant children showed the highest odds of being pre-obesity (OR 2.05, 95%CI 1.7–2.56) and obesity (OR 2.09, 95%CI 1.67–2.77) compared to non-migrant children.

Conclusion: Ethnic and social inequalities exist in childhood overweight among pre-school children in the Hannover Region. Thus, appropriate interventions targeting high-risk migrant groups are needed.

What is Known:

• The current trend of prevalence rates in Germany for overweight and obesity of pre-school children is becoming stable.

• Prevalence of overweight and obesity is clearly higher among migrant children than among non-migrant children.

What is New:

• This article reveals ethnic variance among different migrant groups.

• Turkish migrant children have a higher rate of prevalence even compared to other migrant groups.

• Length of child day care attendance fails to exert a strong influence on overweight after adjusting for socio-economic and child development variables


Child Migration background Obesity Overweight Prevalence 



Body mass index


Odds ratio


Confidence interval


Large for gestational age


German Health Interview and Examination Survey for Children and Adolescents



The authors thank the team of the Hannover Region Social Pediatrics and Youth Medicine Office for providing the data.

Authors’ contributions

MD and UW conceived the study design. YZ performed the statistical analyses and wrote the manuscript. MD, TvL, and UW made substantial contributions, counseled YZ on statistical questions, reviewed data analyses and interpretations, and critically revised the subsequent versions of the manuscript. All authors have read and approved the final version.

Compliance with ethical statements

Conflict of interest

The authors declare that they have no conflict of interest.


This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Achat HM, Stubbs JM (2014) Socio-economic and ethnic differences in the prevalence of overweight and obesity among school children. J Paediatr Child Health 50(10):E77–E84. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Adom T, Puoane T, de Villiers A, Kengne AP (2017) Prevalence of obesity and overweight in African learners: a protocol for systematic review and meta-analysis. BMJ Open 7(1):e013538. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Bhopal R (2014) Migration, ethnicity, race, and health in multicultural societies, 2nd edn. Oxford University Press, New YorkGoogle Scholar
  4. 4.
    Bingham DD, Varela-Silva MI, Ferrao MM, Augusta G, Mourao MI, Nogueira H, Marques VR, Padez C (2013) Socio-demographic and behavioral risk factors associated with the high prevalence of overweight and obesity in Portuguese children. Am J Hum Biol 25(6):733–742. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Bös K, Worth A, Opper E, Oberger J, Romagn N, Wagner M, Jekauc D, Mess F, Woll A (2009) Motorik-Modul: eine Studie zur motorischen Leistungsfähigkeit und körperlich-sportlichen Aktivität von Kindern und Jugendlichen in Deutschland. Abschlussbericht zum Forschungsprojekt. Nomos. ISBN, Baden-Baden. isbn:978-3-8329-4498-8Google Scholar
  6. 6.
    Brettschneider A, Schienkiewitz A, Schmidt S, Ellert U, Kurth B (2017) Updated prevalence rates of overweight and obesity in 4- to 10-year-old children in Germany. Results from the telephone-based KiGGS Wave 1 after correction for bias in parental reports. Eur J Pediatr 176(4):547–551. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Chen AY, Escarce JJ (2014) Family structure and childhood obesity: an analysis through 8th grade. Matern Child Health J 18(7):1772–1777. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Chung A, Backholer K, Wong E, Palermo C, Keating C, Peeters A (2014) Trends in child and adolescent obesity prevalence according to socioeconomic position: protocol for a systematic review. Syst Rev 3:52. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J (2007) Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 85(9):660–667CrossRefPubMedCentralGoogle Scholar
  10. 10.
    de Wilde JA, Verkerk PH, Middelkoop BJ (2014) Declining and stabilising trends in prevalence of overweight and obesity in Dutch, Turkish, Moroccan and South Asian children 3-16 years of age between 1999 and 2011 in the Netherlands. Arch Dis Child 99(1):46–51. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    de Wilde JA, Zandbergen-Harlaar S, van Buuren S, Middelkoop BJ (2013) Trends in body mass index distribution and prevalence of thinness, overweight and obesity in two cohorts of Surinamese South Asian children in The Netherlands. Arch Dis Child 98(4):280–285. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Djordjic V, Radisavljevic S, Milanovic I, Bozic P, Grbic M, Jorga J, Ostojic SM (2016) WHO European childhood obesity surveillance initiative in Serbia: a prevalence of overweight and obesity among 6-9-year-old school children. J Pediatr Endocrinol 29(9):1025–1030. CrossRefGoogle Scholar
  13. 13.
    El-Sayed AM, Scarborough P, Galea S (2011) Ethnic inequalities in obesity among children and adults in the UK: a systematic review of the literature. Obes Rev 12(5):e516–e534. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Gale CR, Batty GD, Cooper C, Deary IJ (2009) Psychomotor coordination and intelligence in childhood and health in adulthood—testing the system integrity hypothesis. Psychosom Med 71(6):675–681. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Gwozdz W, Sousa-Poza A, Reisch LA, Bammann K, Eiben G, Kourides Y, Kovacs E, Lauria F, Konstabel K, Santaliestra-Pasias AM, Vyncke K, Pigeot I (2015) Peer effects on obesity in a sample of European children. Econ Hum Biol 18:139–152. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Isong IA, Richmond T, Kawachi I, Avendaño M (2016) Childcare attendance and obesity risk. Pediatrics 138(5):e20161539. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Jouck S (2008) Dordel-Koch-Test (DKT)-Ein Test zur Erfassung der Motorischen Leistungsfähigkeit im Kindes- und Jugendalter. Dissertation, Deutsche Sporthochschule KölnGoogle Scholar
  18. 18.
    Khanolkar AR, Sovio U, Bartlett JW, Wallby T, Koupil I (2013) Socioeconomic and early-life factors and risk of being overweight or obese in children of Swedish- and foreign-born parents. Pediatr Res 74(3):356–363. CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kimbro RT, Brooks-Gunn J, McLanahan S (2006) Racial and ethnic differentials in overweight and obesity among 3-year-old children. Am J Public Health 97(2):298–305. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Koch B, Graf C, Hoffmeister U, Platschek A, Gruber W, Holl R (2016) Motorische Fitness extrem adipöser Kinder und Jugendlicher basierend auf der multizentrischen Adipositas-Patienten-Verlaufsdokumentation (APV). KlinischePadiatrie 228(2):84–90. CrossRefGoogle Scholar
  21. 21.
    Kocken PL, Schonbeck Y, Henneman L, Janssens A, Cecile JW, Detmar SB (2012) Ethnic differences and parental beliefs are important for overweight prevention and management in children: a cross-sectional study in the Netherlands. BMC Public Health 12:867. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Kohlhuber M, Rebhan B, Schwegler U, Koletzko B, Fromme H (2008) Breastfeeding rates and duration in Germany: a Bavarian cohort study. Br J Nutr 99(5):1127–1132. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kraus C (2017) Das SOPHIA- Programm. Available at: Accessed 12 Jun 2017
  24. 24.
    Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Gelß HC, Hesse V (2001) Perzentile für den Body-mass-Index für das Kinderund Jugendalter unter Heranziehung verschiedener deutscher Stichproben. MonatsschriftKinderheilkunde 149:807–818Google Scholar
  25. 25.
    Kuepper-Nybelen J, Lamerz A, Bruning N, Hebebrand J, Herpertz-Dahlmann B, Brenner H (2005) Major differences in prevalence of overweight according to nationality in preschool children living in Germany: determinants and public health implications. Arch Dis Child 90(4):359–363. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Lee I, Bang K, Moon H, Kim J (2016) Comparison of obesity rates in early childhood (4 to 80 months) by parental socioeconomic status using National Cohort Dataset in Korea. Asian Nurs Res (Korean SocNursSci) 10(4):305–311. CrossRefGoogle Scholar
  27. 27.
    Lumeng JC, Gannon K, Appugliese D, Cabral HJ, Zuckerman B (2005) Preschool child care and risk of overweight in 6- to 12-year-old children. Int J Obes 29(1):60–66. CrossRefGoogle Scholar
  28. 28.
    Macbeth H, Shetty P (2004) Health and ethnicity, [Repr.]. Taylor and Francis, London and New YorkGoogle Scholar
  29. 29.
    Martin L, Oepen J, Reinehr T, Wabitsch M, Claussnitzer G, Waldeck E, Ingrisch S, Stachow R, Oelert M, Wiegand S, Holl R (2015) Ethnicity and cardiovascular risk factors: evaluation of 40,921 normal-weight, overweight or obese children and adolescents living in Central Europe. Int J Obes 39(1):45–51. CrossRefGoogle Scholar
  30. 30.
    Menigoz K, Nathan A, Turrell G (2016) Ethnic differences in overweight and obesity and the influence of acculturation on immigrant bodyweight: evidence from a national sample of Australian adults. BMC Public Health 16:932. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Mitchell EA, Stewart AW, Braithwaite I, Hancox RJ, Murphy R, Wall C, Beasley R (2016) Birth weight and subsequent body mass index in children: an international cross-sectional study. Pediatr Obes 12(4):280–285. CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Moss A, Klenk J, Simon K, Thaiss H, Reinehr T, Wabitsch M (2012) Declining prevalence rates for overweight and obesity in German children starting school. Eur J Pediatr 171(2):289–299. CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    O’Brien M, Nader PR, Houts RM, Bradley R, Friedman SL, Belsky J, Susman E, the NICHD Early Child Care Research Network (2007) The ecology of childhood overweight: a 12-year longitudinal analysis. Int J Obes 31(9):1469–1478. CrossRefGoogle Scholar
  34. 34.
    Parikka S, Mäki P, Levälahti E, Lehtinen-Jacks S, Martelin T, Laatikainen T (2015) Associations between parental BMI, socioeconomic factors, family structure and overweight in Finnish children: a path model approach. BMC publichealth 15:271. CrossRefGoogle Scholar
  35. 35.
    Plachta-Danielzik S, Landsberg B, Seiberl J, Gehrke MI, Gose M, Kehden B, Muller MJ (2012) Langsschnittdaten der Kieler Adipositas-Praventionsstudie (KOPS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 55(6–7):885–891. CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Qiao Y, Ma J, Wang Y, Li W, Katzmarzyk PT, Chaput J, Fogelholm M, Johnson WD, Kuriyan R, Kurpad A, Lambert EV, Maher C, Maia J, Matsudo V, Olds T, Onywera V, Sarmiento OL, Standage M, Tremblay MS, Tudor-Locke C, Church TS, Zhao P, Hu G (2015) Birthweightandchildhoodobesity: a 12-country study. Int J ObesSuppl 5(Suppl 2):S74–S79. CrossRefGoogle Scholar
  37. 37.
    Schenk L, Ellert U, Neuhauser H (2007) Kinder und Jugendliche mit Migrationshintergrund in Deutschland. Methodische Aspekte im Kinder- und Jugendgesundheitssurveys (KiGGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 50(5–6):590–599CrossRefPubMedCentralGoogle Scholar
  38. 38.
    van Rossem L, Hafkamp-de Groen E, Jaddoe VW, Hofman A, Mackenbach JP, Raat H (2014) The role of early life factors in the development of ethnic differences in growth and overweight in preschool children: a prospective birth cohort. BMC publichealth 14:722. CrossRefGoogle Scholar
  39. 39.
    Voigt M, Rochow N, Hesse V, Olbertz D, Schneider KT, Jorch G (2010) Kurzmitteilung zu den Perzentilwerten für die Körpermaße der Neugeborenen. Z GeburtshilfeNeonatol 214:24–29. CrossRefGoogle Scholar
  40. 40.
    Wang L, Southerland J, Wang K, Bailey BA, Alamian A, Stevens MA, Wang Y (2017) Ethnic differences in risk factors for obesity among adults in California, the United States. J Obes 2017:2427483. CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Waters E, Ashbolt R, Gibbs L, Booth M, Magarey A, Gold L, Kai Lo S, Gibbons K, Green J, O'Connor T, Garrard J, Swinburn B (2008) Double disadvantage: the influence of ethnicity over socioeconomic position on childhood overweight and obesity: findings from an inner urban population of primary school children. Int J PediatrObes 3(4):196–204. CrossRefGoogle Scholar
  42. 42.
    Will B, Zeeb H, Baune BT (2005) Overweight and obesity at school entry among migrant and German children: a cross-sectional study. BMC Public Health 5:45. CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Yu ZB, Han SP, Zhu GZ, Zhu C, Wang XJ, Cao XG, Guo XR (2011) Birth weight and subsequent risk of obesity: a systematic review and meta-analysis. Obes Rev 12(7):525–542. CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    European Commission (2014) EU Action plan on childhood obesity 2014–2020:1–68Google Scholar
  45. 45.
    World Health Organization (2016) Report of the commission on ending childhood obesity. In: Geneva: World Health Organization. Available at Accessed 06 Dec 2017
  46. 46.
    Reiss K, Breckenkamp J, Borde T, Brenne S, David M, Razum O (2014) Smoking during pregnancy among Turkish immigrants in Germany—are there associations with acculturation? Nicotine Tob Res 17(6):643–652CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Yusheng Zhou
    • 1
    Email author
  • Thomas von Lengerke
    • 2
  • Ulla Walter
    • 1
  • Maren Dreier
    • 1
  1. 1.Institute of Epidemiology, Social Medicine and Health Systems ResearchHannover Medical SchoolHannoverGermany
  2. 2.Medical Psychology UnitHannover Medical SchoolHannoverGermany

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