The association of socioeconomic status and response to pediatric health behavior and lifestyle obesity treatment in Germany and Sweden: A multiyear, two-cohort observational study

Background: Whether socioeconomic status (SES) influences obesity treatment response among children remains unclear. This study aimed to examine the association between SES and response to health behavior and lifestyle pediatric obesity treatment over 3 years in two European countries. Methods and findings: In this two-cohort study, data were obtained from the Swedish Childhood Obesity Treatment Register (BORIS) and the German/Austrian/Swiss Adiposity Patients Register (APV). SES was divided into quintiles, using individual-level indicators as a composite index in Sweden and an area-level index in Germany. Treatment response was assessed as change in body mass index standard deviation score (BMI SDS) using linear mixed-effects models, obesity remission using Cox regression, and treatment discontinuation within six months using mixed-effects logistic regression. Analyses were stratified by country and adjusted for sex, baseline obesity class, age group, and migration background. Conclusions: SES was associated with pediatric obesity treatment outcomes, but patterns differed between countries. While socioeconomic gradients in remission were observed in both settings, inequalities in BMI SDS reduction and treatment discontinuation were evident only in Germany, pointing to potential roles of both measurement differences and contextual factors. Why was this study done?: What did the researchers do and find?: What do these findings mean?: