Document Type : Original Article



INTRODUCTION: Overweight and obesity as a major public health issue can lead to adverse
health consequences during the life span. This study aimed to measure socioeconomic inequality
in unhealthy weight among school students in Kermanshah, west of Iran.
METHODS: The cross‑sectional study measured the socioeconomic‑related inequalities in unhealthy
weight among 1404 secondary school students aged 11–16 years in Kermanshah in 2018. Unhealthy
weight is defined as body mass index of >25 kg/m2
 in the study. Socioeconomic‑related inequality
in unhealthy weight was calculated using the concentration index (Cn
). A logistic regression model
was used to estimate the marginal effect of independent variables.
RESULTS: The prevalence of unhealthy weight for the total sample was 0.13 (95% confidence
interval [CI]: 0.11–0.14). Of these, the prevalence of unhealthy weight for girls and boys was
0.11 (95% CI: 0.09–0.14) and 0.15 (95% CI: 0.12–0.18), respectively. The value of Cn
 for the
total sample was 0.12 (95% CI: 0.03–0.2), which indicates a higher concentration of unhealthy
weight among the high socioeconomic status (SES) students. Two factors of SES (49.11%) and
gender (40.08%) had the largest contribution to socioeconomic inequality in unhealthy weight among
the study students.
CONCLUSIONS: Socioeconomic‑related inequality in unhealthy weight was concentered among
high‑SES students in the study. Thus, public health policies need to be formulated to change sedentary
lifestyles and unhealthy dietary patterns among students with higher SES.


1. Khazaei S, Nooraliey P, Gholamaliee B, Delavar MK, Khazaei S,
Jamorpour S, et al. The prevalence of obesity among Iranian
adolescents: A meta‑analysis study. J Qom Univ Med Sci J
2. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M.
Body‑mass index and incidence of cancer: A systematic review
and meta‑analysis of prospective observational studies. Lancet
3. van Baal PH, PolderJJ, de Wit GA, Hoogenveen RT, Feenstra TL,
Boshuizen HC, et al. Lifetime medical costs of obesity: Prevention
no cure for increasing health expenditure. PLoS Med 2008;5:e29.
4. Kelishadi R, Qorbani M, Heshmat R, Djalalinia S, Sheidaei A,
Safiri S, et al. Socioeconomic inequality in childhood obesity
and its determinants: A blinder‑oaxaca decomposition.
J Pediatr (Rio J) 2018;94:131‑9.
5. Moradi G, Mostafavi F, Azadi N, Esmaeilnasab N, Ghaderi E.
Socioeconomic inequality in childhood obesity. J Res Health Sci
6. Angoorani P, Heshmat R, Ejtahed HS, Motlagh ME, Ziaodini H,
Taheri M, et al. The association of parental obesity with
physical activity and sedentary behaviors of their children: The
CASPIAN‑V study. J Pediatr (Rio J) 2018;94:410‑8.
7. Walsh B, Cullinan J. Decomposing socioeconomic inequalities
in childhood obesity: Evidence from Ireland. Econ Hum Biol
8. NCD Risk Factor Collaboration (NCD‑RisC). Worldwide trends
in body‑mass index, underweight, overweight, and obesity
from 1975 to 2016: A pooled analysis of 2416 population‑based
measurement studies in 128·9 million children, adolescents, and
adults. Lancet 2017;390:2627‑42.
9. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of
obesity and trends in body mass index among US children and
adolescents, 1999‑2010. JAMA 2012;307:483‑90.
10. HallDM, ColeTJ. What use is the BMI? Arch Dis Child 2006;91:283‑6.
11. Centers for Disease Control and Prevention. About Child
and Teen BMI; 2019. Available from:
bmi.html. [Last accessed on 2019 Jan 20].
12. Wagstaff A. The bounds of the concentration index when the
variable of interest is binary, with an application to immunization
inequality. Health Econ 2005;14:429‑32.
13. Wagstaff A, Van Doorslaer E, Watanabe N. On decomposing
the causes of health sector inequalities with an application to
malnutrition inequalities in Vietnam. J Econ 2003;112:207‑23.
14. Izadi N, Hashemi‑Nazari SS, Rafiee E, Malekifar A, Najafi F.
Socioeconomic inequality in overweight/obesity and related
factors in adolescents in Kermanshah‑Iran. Iran Red Crescent
Med J 2017;19 (11); e55588.
15. Veghari GR, Rahmati R. The prevalence of obesity in primary
schools of Golestan Province of Iran. Payavard Salamat
16. Matin BK, Jalilian F, Alavije MM, Ashtarian H, Mahboubi M,
Afsar A, et al. Using the PRECEDE model in understanding
determinants of quality of life among Iranian male addicts. Glob
J Health Sci 2014;6:19‑27.
17. Kelishadi R, Alikhani S, Delavari A, Alaedini F, Safaie A,
Hojatzadeh E, et al. Obesity and associated lifestyle behaviours in
Iran: Findings from the first national non‑communicable disease
risk factor surveillance survey. Public Health Nutr 2008;11:246‑51.
18. Hajian‑Tilaki KO, Heidari B. Prevalence of obesity, central obesity
and the associated factors in urban population aged 20‑70 years,
in the North of Iran: A population‑based study and regression
approach. Obes Rev 2007;8:3‑10.
19. Bakhshi E, Eshraghian MR, Mohammad K, Foroushani AR,
Zeraati H, Fotouhi A, et al. Sociodemographic and smoking
associated with obesity in adult women in Iran: Results from the
national health survey. J Public Health (Oxf) 2008;30:429‑35.
20. Mirsolimany H, Mokhtari N, Mirhadiyan L, Leili EK. Survey
predictors of overweight and obesity in children beginning.
J Holist Nurs Midwifery 2015;25:55‑62.
21. Rezaei OM, Moodi M, Tiyuri A, Zar Shenas F, Sharifi M.
Prevalence of obesity and its relationship with food habits among
10‑14 years old school boys in Birjand, 2014: A short report.
J Rafsanjan Univ Med Sci 2016;14:1085‑94.
22. Jafari‑Adli S, Jouyandeh Z, Qorbani M, Soroush A, Larijani B,
Hasani‑Ranjbar S, et al. Prevalence of obesity and overweight in
adults and children in Iran; a systematic review. J Diabetes Metab
Disord 2014;13:121.
23. Jalilvand M, Kimiagar M, Hosseini S, Rajabzadeh R, Sodmand M,
Alavinia S. Obesity prevalence and Related factors in north
Khorasan high school students. J North Khorasan Univ Med Sci
24. Akhavan‑Karbasi S, Fallah R, Golestan M, Sadr‑Bafghi M.
Prevalence and risk factors of obesity and overweight among
primary school children in Yazd. J Shahid Sadoughi Univ Med
Sci 2009;16:8‑13.
25. Quintal C, Oliveira J. Socioeconomic inequalities in child obesity
and overweight in Portugal. Int J Soc Econ 2017;44:1377‑89.
26. OgdenCL, CarrollMD, LawmanHG, FryarCD, Kruszon‑MoranD,
Kit BK, et al. Trends in obesity prevalence among children and
adolescents in the United States, 1988‑1994 through 2013‑2014US
trends in obesity prevalence in children and adolescents,
1988‑2014US trends in obesity prevalence in children and
adolescents, 1988‑2014. JAMA 2016;315:2292‑9.
27. Shakeri M, Mojtahedi Y, Naserian J, Moradkhani M. Obesity
among female adolescents of Tehran schools. J Payavard Salamat