Circumstances Versus Efforts: Dissecting the Drivers of Adolescent Obesity Inequality.

Background: Previous studies have focused predominantly on socioeconomic disparities in adolescent obesity, but the sources of inequality may be more extensive.

Objectives: We aim to quantify and decompose the inequality of opportunity (IOp) in adolescent obesity caused by circumstances and examine the indirect effects of these circumstances on obesity through key effort factors.

Methods: Based on the IOp framework and previous evidence, we categorised age, gender, socioeconomic status, and family-school environments of adolescents (N = 9117) as circumstances and obesity-related behaviours as efforts. The IOp was quantified and decomposed to determine the contribution of each circumstance. We also analysed the association between sleep debt and the circumstances to calculate the magnitude of indirect effects.

Results: Of the obesity-related behaviours, only sleep debt showed a significant association with obesity (OR = 1.21, p < 0.05). Age and gender contributed 45.97% to the IOp, whereas socioeconomic status contributed 10.43% and family-school environments contributed 43.59%. Older and female adolescents whose fathers held high-status occupations tended to suffer from obesity due to sleep debt, while the opposite was true for adolescents whose mothers exercised, only children, boarders, high school students, and those from wealthier families.

Conclusions: Family-school environments contribute much greater to the IOp in adolescent obesity than socioeconomic status, and sleep debt plays an essential mediating role. The government bears the responsibility to undertake corresponding prioritised actions.