Childhood overweight and obesity have significant short- and long-term negative impacts on children's health and well-being. These challenges are unequally distributed according to socioeconomic status (SES); however, previous studies have often lacked standardized and objectively measured data across national contexts to assess these differences. This study provides a cross-sectional picture of the association between SES and childhood overweight and obesity, based on data from 123,487 children aged 6-9 years in 24 countries in the World Health Organization (WHO) European region. Overall, associations were found between overweight/obesity and the three SES indicators used (parental education, parental employment status, and family-perceived wealth). Our results showed an inverse relationship between the prevalence of childhood overweight/obesity and parental education in high-income countries, whereas the opposite relationship was observed in most of the middle-income countries. The same applied to family-perceived wealth, although parental employment status appeared to be less associated with overweight and obesity or not associated at all. This paper highlights the need for close attention to context when designing interventions, as the association between SES and childhood overweight and obesity varies by country economic development. Population-based interventions have an important role to play, but policies that target specific SES groups are also needed to address inequalities.

Biomedical Sciences Department Faculty of Sport and Physical Education University of Novi Sad Novi Sad Serbia

Center for Health Ecology Institute of Public Health Podgorica Montenegro

College of Health and Agricultural Sciences University College Dublin Dublin Ireland

Croatian Institute of Public Health Zagreb Croatia

Departement of Non Communicable Diseases and Traumatisms Santé publique France the French Public Health Agency Saint Maurice France

Department Food and Nutrition National Centre of Public Health and Analyses Sofia Bulgaria

Department of Cardiology Institute of Mother and Child Warsaw Poland

Department of Epidemiology and Public Health Sciensano Brussels Belgium

Department of Health and Inequality Division of Mental and Physical Health Norwegian Institute of Public Health Oslo Norway

Department of Living Conditions and Lifestyle Public Health Agency of Sweden Solna Sweden

Department of Nutrition Research National Institute for Health Development Tallinn Estonia

Department of Pediatrics Paracelsus Medical University Salzburg Austria

Department of Preventive Medicine Lithuanian University of Health Sciences Kaunas Lithuania

Department of Research and Health Statistics Centre for Disease and Prevention Control Riga Latvia

Department of Science and Professional Development National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan Almaty Kazakhstan

Department of Social and Policy Sciences University of Bath Bath UK

Faculty of Mathematics and Computer Science University of Bremen Bremen Germany

Faculty of Medicine Hacettepe University Ankara Turkey

Faculty of Medicine SS Cyril and Methodius University Skopje North Macedonia

Faculty of Medicine University of Banja Luka Banja Luka Bosnia and Herzegovina

Faculty of Sport University of Ljubljana Ljubljana Slovenia

Health Authority Ministry of Health San Marino San Marino

Health Promotion and Inequality Danish Health Authority Copenhagen Denmark

Institute of Paediatric Endocrinology National Medical Research Centre for Endocrinology of the Ministry of Health of the Russian Federation Moscow Russian Federation

Institute of Public Health Skopje North Macedonia

Kazakhstan School of Public Health Kazakhstan's Medical University Almaty Kazakhstan

Leibniz Institute for Prevention Research and Epidemiology BIPS Bremen Germany

Maternal Child and Reproductive Health National Center for Disease Control and Public Health of Georgia Tbilisi Georgia

National Center for Health Assessment and Promotion National Institute of Public Health Bucharest Romania

National Centre for Disease Prevention and Health Promotion Italian National Institute of Health Rome Italy

Nutrition and Food Safety Sector Institute of Public Health Tirana Albania

Nutritional Surveillance and Epidemiology Team University Sorbonne Paris Nord Bobigny France

Obesity Management Centre Institute of Endocrinology Prague Czech Republic

Primary Child Health Unit Primary Health Care Floriana Malta

Public Health and Welfare Finnish Institute for Health and Welfare Helsinki Finland

Public Health Institute of Republic of Srpska Banja Luka Bosnia and Herzegovina

Republican Center for Health Promotion and Mass Communication Ministry of Health of the Kyrgyz Republic Bishkek Kyrgyzstan

Republican Centre for Nutrition Ministry of Health and Social Protection of Population Dushanbe Tajikistan

School of Medicine University of Zagreb Zagreb Croatia

Scientific Research Institute of Maternal and Child Health Ashgabat Turkmenistan

Spanish Agency for Food Safety and Nutrition Ministry of Consumer Affairs Madrid Spain

WHO Europe Collaborating Center for Nutrition and Childhood Obesity Food and Nutrition Department National Institute of Health Dr Ricardo Jorge Lisbon Portugal

World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases Division of Country Health Programmes WHO Regional Office for Europe Moscow Russian Federation

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