International Journal of Behavioral Medicine

, Volume 25, Issue 1, pp 141–149 | Cite as

Child Overweight and Obesity in Shanghai, China: Contextualizing Chinese Socioeconomic and Gender Differences

  • Melissa L. MartinsonEmail author
  • Yu-Ling Chang
  • Wen-Jui Han
  • Jun Wen



Childhood overweight and obesity is on the rise in China and in Chinese cities in particular. The aim of this study is to explore the extent of income differences in childhood overweight in Shanghai, China, and examine demographic, social, and behavioral explanations for these differences.


Using the 2014 Child Well-Being Study of Shanghai, China—a survey that included extensive contextual information on children and their families in China’s most populous city, prevalence rates and adjusted odds ratios of child overweight and obesity at age 7 were calculated by income tercile controlling for a wide variety of sociodemographic variables.


District aggregate income increases the odds of child overweight/obesity, but only for boys. In contrast, rural hukou status was associated with lower odds of overweight/obesity for girls.


Boys at age 7 are more likely to be overweight and obese than girls. District income further increases this likelihood for boys, while rural hukou status decreases this likelihood for girls, suggesting that preferences for boys and thinness ideals for girls may play a role in the income patterning of childhood overweight and obesity.


Overweight and obesity Children China 


Compliance with Ethical Standards

Ethical Approval

This article uses secondary data and is exempt from human participant protocols. The original data collection was approved through the Institutional Review Board at New York University.

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

12529_2017_9688_MOESM1_ESM.pdf (11 kb)
ESM 1 (PDF 10 kb).


  1. 1.
    Dietz W. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics. 1998;101(3):518–25.PubMedGoogle Scholar
  2. 2.
    Nader PR, O’Brien M, Houts R, et al. Identifying risk for obesity in early childhood. Pediatrics. 2006;118(3):E594–601. Scholar
  3. 3.
    Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997;337(13):869–73. Scholar
  4. 4.
    OECD. Health at a glance, 2013. 2014;
  5. 5.
    Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes. 2006;1(1):11–25. Scholar
  6. 6.
    Cui Z, Huxley R, Wu Y, Dibley MJ. Temporal trends in overweight and obesity of children and adolescents from nine provinces in China from 1991–2006. Int J Pediatr Obes. 2010;5(5):365–74. Scholar
  7. 7.
    Seo D, Niu J. Trends in underweight and overweight/obesity prevalence in Chinese youth, 2004–2009. Int J Behav Med. 2014;21(4):682–90.CrossRefPubMedGoogle Scholar
  8. 8.
    Song Y, Wang H, Ma J, Wang Z. Secular trends of obesity prevalence in urban Chinese children from 1985 to 2010: gender disparity. PLoS One. 2013;8(1):e53069. Scholar
  9. 9.
    Song Y, Ma J, Wang H, et al. Secular trends of obesity prevalence in Chinese children from 1985 to 2010: urban-rural disparity. Obesity. 2015;23(2):448–53. Scholar
  10. 10.
    Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70(1):3–21.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    He W, James SA, Merli MG, Zheng H. An increasing socioeconomic gap in childhood overweight and obesity in China. Am J Public Health. 2014;104(1):e14–22.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Monteiro C, Moura E, Conde W, Popkin B. Socioeconomic status and obesity in adult populations of developing countries: a review. Bull World Health Organ. 2004;82(12):940–6.PubMedGoogle Scholar
  13. 13.
    Chen T, Modin B, Ji C, Hjern A. Regional, socioeconomic and urban-rural disparities in child and adolescent obesity in China: a multilevel analysis. Acta Paediatr. 2011;100(12):1583–9. Scholar
  14. 14.
    World Health Organization. China: health, poverty and economic development. Beijing: Office of the WHO Representative in China and Social Development Department of the China State Council Development Research Center; 2015.Google Scholar
  15. 15.
    Osnos E. Age of ambition: chasing fortune, truth, and faith in the new China. Macmillan. 2014;Google Scholar
  16. 16.
    Andegiorgish AK, Wang J, Zhang X, Liu X, Zhu H. Prevalence of overweight, obesity, and associated risk factors among school children and adolescents in Tianjin, China. Eur J Pediatr. 2012;171(4):697–703. Scholar
  17. 17.
    Liu J, Ye R, Li S, et al. Prevalence of overweight/obesity in Chinese children. Arch Med Res. 2007;38(8):882–6. Scholar
  18. 18.
    Wang Y. Cross-national comparison of childhood obesity: the epidemic and the relationship between obesity and socioeconomic status. Int J Epidemiol. 2001;30(5):1129–36. Scholar
  19. 19.
    Yu Z, Han S, Chu J, Xu Z, Zhu C, Guo X. Trends in overweight and obesity among children and adolescents in China from 1981 to 2010: a meta-analysis. PLoS One. 2012;7(12):e51949. Scholar
  20. 20.
    Zhang M, Guo F, Tu Y, et al. Further increase of obesity prevalence in Chinese children and adolescents—cross-sectional data of two consecutive samples from the city of shanghai from 2003 to 2008. Pediatr Diabetes. 2012;13(7):572–7. Scholar
  21. 21.
    Han W-J, Wen J. Child well-being study, Shanghai, China. NYU_ECNU Institute for Social Development at NYU Shanghai; 2014. Accessed 10 Mar 2015.
  22. 22.
    World Obesity Federation. Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity in children. 2015. Accessed 3 Jul 2015.
  23. 23.
    Wang Y, Lim H. The global childhood obesity epidemic and the association between socio-economic status and childhood obesity. Int Rev Psychiatry. 2012;24(3):176–88. Scholar
  24. 24.
    Ji C. Cooperative study on childhood obesity, working group on obesity in China. Report on childhood obesity in China (1)—body mass index reference for screening overweight and obesity in Chinese school-age children. Biomed Environ Sci. 2005;18(6):390–400.PubMedGoogle Scholar
  25. 25.
    Ji C. Cooperative study childhood obesity. The prevalence of childhood overweight/obesity and the epidemic changes in 1985–2000 for Chinese school-age children and adolescents. Obes Rev. 2008;9:78–81. Scholar
  26. 26.
    OECD. What are equivalence scales? 2011. Accessed 1 Sep 2015.
  27. 27.
    Wong K, Fu D, Li CY, Song HX. Rural migrant workers in urban China: living a marginalised life. Int J Soc Welf. 2007;16(1):32–40.CrossRefGoogle Scholar
  28. 28.
    Lan P. Segmented incorporation: the second generation of rural migrants in Shanghai. China Q. 2014;217:243–65.CrossRefGoogle Scholar
  29. 29.
    Yang S, Wang MYL, Wang C. Socio-spatial restructuring in Shanghai: sorting out where you live by affordability and social status. Cities. 2015;47:23–34. Scholar
  30. 30.
    White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30(4):377–99.CrossRefPubMedGoogle Scholar
  31. 31.
    Stata 12 Multiple-Imputation Reference Manual. College Station: Stata Press. 2011.Google Scholar
  32. 32.
    von Hippel PT. Regression with missing Ys: an improved strategy for analyzing multiply imputed data. Sociol Methodol. 2007;37:83–117.CrossRefGoogle Scholar
  33. 33.
    Cheah BC. Clustering standard errors or modeling multilevel data. 2009. Retrieved from
  34. 34.
    Moineddin R, Matheson FI, Glazier RH. A simulation study of sample size for multilevel logistic regression models. BMC Med Res Methodol. 2007;7:34. Scholar
  35. 35.
    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311(8):806–14.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Dearth-Wesley T, Wang H, Popkin BM. Under- and overnutrition dynamics in Chinese children and adults (1991–2004). Eur J Clin Nutr. 2008;62(11):1302–7. Scholar
  37. 37.
    Hesketh T, Lu L, Xing Z. The effect of China’s one-child family policy after 25 years. N Engl J Med. 2005;353(11):1171–6. Scholar
  38. 38.
    Luo Y, Parish WL, Laumann EO. A population-based study of body image concerns among urban Chinese adults. Body Image. 2005;2(4):333–45.CrossRefPubMedGoogle Scholar
  39. 39.
    Pampel FC, Denney JT, Krueger PM. Obesity, SES, and economic development: a test of the reversal hypothesis. Soc Sci Med. 2012;74(7):1073–81.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2017

Authors and Affiliations

  • Melissa L. Martinson
    • 1
    Email author
  • Yu-Ling Chang
    • 2
  • Wen-Jui Han
    • 3
  • Jun Wen
    • 4
  1. 1.University of WashingtonSeattleUSA
  2. 2.University of CaliforniaBerkeleyUSA
  3. 3.New York University Silver School of Social WorkNew YorkUSA
  4. 4.NYU-ECNU Institute for Social Development at NYU Shanghai, East China Normal UniversityShanghaiChina

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