The distribution of risk groups varies between developing and developed countries. While in industrialized countries children from families with a poor socio-economic status are more often overweight, the opposite holds true for children in developing countries, where children of the upper middle class are more likely to be overweight. An example of the influence of the socio-economic status on obesity in developed countries is a study about prepubertal schoolchildren in northern Italy [22]: After adjustment for parents’ age and area of birth the relative risk of obesity was 1.6 for mother’s lowest educational level compared to the highest. For children whose father was unemployed the relative risk of obesity was 2.6. In developed countries, urban children tend to be less obese than rural children. A study performed in the USA revealed that BMI and skinfold thickness was greater for children living in rural than in urban settings (p 0.004) [23]. In contrast, in developing countries the urban upper class children are more likely to be obese than their peers living in rural areas [24, 25]. In Brazil, the increase of obesity prevalence in urban areas was more than twice as high as in rural areas [19]. In Thailand and in China, the prevalence of obesity was about three times higher in urban areas than in rural areas [26, 27]. In developing societies a strong direct relationship exists between socio-economic status and obesity in childhood [28]. This relation is particularly high in Latin American countries like Bolivia, Brazil, Colombia, Peru or El Salvador [24]. Interestingly, in Brazil the pattern of the prevalence of obesity is shifting to that in developed countries [29]. A substantial reduction (28%) in the prevalence of obesity among upper income urban women in Brazil was reported between 1989 and 1997. It was hypothesized that this may be already a result of an intense mass media work focused on combating a sedentary life style and promoting better food habits [30].
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