Overweight and obesity in a representative sample of schoolchildren – exploring the urban–rural gradient in Sweden

To present the prevalence and urban‐rural differences of overweight and obesity in 7–9‐year‐old Swedish schoolchildren, we used anthropometric data from a nationally representative survey performed in 2008. Trained staff weighed and measured 4538 children in grades 1 and 2 in 94 primary schools. Weight classification was performed using the IOTF reference and school areas were classified based on level of urbanization and area‐level education. Overweight was found in 17% of the children including 3% obese. For overweight, odds‐ratios were 1.33 and 1.61 (significant) in semi‐urban and rural areas, relative to urban areas. After adjusting for area‐level education, differences by degree of urbanisation were greatly attenuated and non‐significant. For obesity urban‐rural differences were observed in boys only and remained after adjustment for area‐level education. For area‐level education, risk estimates were significantly elevated and unaffected by urbanization and gender, odds‐ratios 1.75 and 2.21 for overweight and 2.62 and 3.69 for obesity, in medium‐ and low‐education areas compared to high‐education areas. This supports earlier reports identifying areas with low socioeconomic status as high‐risk areas for overweight and obesity. However, this study also suggests that gender should be considered when targeting children in urban as well as rural communities for health promoting interventions.