Changes in social inequalities in excess body weight and body dissatisfaction among adolescents in a large Mediterranean city, 2016-2021

Purpose: We aimed to analyse the presence and changes of socioeconomic inequalities in excess weight and body dissatisfaction, stratified by sex, in 13- to 19-year-olds in a large Mediterranean city (Barcelona, Spain). Methods: We used data from the 2016 and 2021 editions of the FRESC survey, which is a representative citywide survey that captures various aspects of adolescent health. Excess weight was determined by objective body mass index measurements. Body dissatisfaction was defined as the discrepancy between perceived and desired body shape. Socioeconomic status was divided into five pseudo-quintiles by using the Family Affluence Scale. We calculated the corresponding prevalence estimates and fitted robust Poisson regression models to estimate both simple and complex measures of inequality, including relative and absolute differences between the two survey years. Results: During the study period, the overall prevalence of excess weight (25.3[23.9-26.6] vs. 29.8[28.2- 31.4]) and body dissatisfaction (44.2[42.6-45.8] vs. 60.4[58.7-62]) increased. Socioeconomic inequalities in excess weight significantly increased in girls (adjusted ratio of the relative index of inequalities = 1.72[1.08;2.74] but not in boys. Presence and persistence of socioeconomic inequalities were detected in body dissatisfaction in both girls and boys. Conclusions: Our findings highlight the presence of a sex-specific change in socioeconomic inequalities in adolescent well-being regarding excess weight and body dissatisfaction. These results underscore the need for local public policies to improve social equity in adolescent health.