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Socioeconomic inequalities in childhood Body Mass Index (BMI) are becoming increasingly more pronounced across the world. Although countries differ in the direction and strength of these inequalities, cross-national comparative research on this topic is rare. This paper draws on harmonized longitudinal cohort data from four wealthy countries—Germany, the Netherlands, the United Kingdom (UK), and the United States (US)—to 1) map cross-country differences in the magnitude of socioeconomic inequalities in childhood BMI, and 2) to examine cross-country differences in the role of three energy-balance-related behaviors—physical activity, screen time, and breakfast consumption—in explaining these inequalities. Children were aged 5–7 at our first timepoint and were followed up at age 8–11. We used data from the German National Educational Panel Study, the Dutch Generation R study, the UK Millennium Cohort Study and the US Early Childhood Longitudinal-Kindergarten Study. All countries revealed significant inequalities in childhood BMI. The US stood out in having the largest inequalities. Overall, inequalities between children with low versus medium educated parents were smaller than those between children with high versus medium educated parents. The role of energy-balance-related behaviors in explaining inequalities in BMI was surprisingly consistent. Across countries, physical activity did not, while screen time and breakfast consumption did play a role. The only exception was that breakfast consumption did not play a role in the US. Cross-country differences emerged in the relative contribution of each behavior in explaining inequalities in BMI: Breakfast consumption was most important in the UK, screen time explained most in Germany and the US, and breakfast consumption and screen time were equally important in the Netherlands. Our findings suggest that what constitutes the most effective policy intervention differs across countries and that these should target both children from medium as well as low educated families. • All countries showed substantial socioeconomic inequalities in childhood BMI. • In all countries, inequalities in BMI steepen over course of primary school. • Protective factors among the most advantaged seem to mainly drive inequalities. • Across most countries, underlying mechanisms for inequalities in BMI are similar. • The relative contribution of each mechanism to BMI inequalities differs per country. [ABSTRACT FROM AUTHOR]

Overweight and obese people appear to be at greater risk of suboptimal vitamin and mineral status compared with people of a healthy weight. Nutrients most affected include vitamin D, vitamin B, carotenoids, folate, vitamin C and iron. The reasons are unknown but may be caused by poor diets, increased requirements or obesity-related changes to nutrient absorption, excretion or metabolism, or a combination of these. Sequestration of fat-soluble vitamins by adipose tissues is also a major factor. Although dietary assessment in obese populations is hampered by under-reporting, there is evidence that dietary patterns characterised by energy-dense, processed foods are more common in groups with a higher body mass index. Dieting practices, bariatric surgery and the use of anti-obesity drugs may compound the risk of nutrient inadequacy, although sustained weight loss helps to improve vitamin D status. A poor nutrient status could accentuate the risk of chronic diseases already experienced by overweight people on account of their excessive fat mass. There is evidence that the use of dietary supplements can improve nutrient status and have a favourable impact on disease risk markers such as lipid profiles and insulin resistance. Whether currently dieting or not, overweight people may benefit from safeguarding vitamin and mineral adequacy by taking a multi-nutrient supplement alongside an increased intake of nutrient-rich foods. [ABSTRACT FROM AUTHOR]