Geographic and ethnic inequalities in total and central obesity, and physical fitness among preschool children: Insights from the PREFIT project

Abstract

Background and objectives: Obesity and physical fitness are known to be influenced by various geographic factors and ethnicity in children. However, there is limited evidence on the level to which these factors can influence very early in life, at preschool age. This study aimed to describe and compare total and central obesity and physical fitness according to geographic factors and ethnicity in preschoolers. Methods: This cross-sectional study included 3179 preschoolers (4.6 ± 0.9y, 52.8% boys). Geographic factors (location and type of area: rural/urban) were assessed based on the school setting, while ethnicity was determined through parental self-report. Total and central obesity and physical fitness (cardiorespiratory fitness, muscular strength, speed-agility, balance) were assessed using the PREFIT battery. Results: Preschoolers from southern regions of Spain presented higher total obesity along with lower performance in cardiorespiratory fitness and lower-limb muscular strength compared to their northern peers (p ≤ 0.017). However, they demonstrated greater levels of upper-limb muscular strength and balance (p < 0.001). Preschoolers from rural areas of Spain showed higher central obesity but better fitness performance compared to those from urban areas (p ≤ 0.004). White and African preschoolers showed lower levels of total and central obesity than Latin preschoolers (p ≤ 0.003) and performed better in upper-limb muscular strength and speed–agility compared to Asian or Latin preschoolers (p ≤ 0.037). Conclusion: This study highlights significant physical health inequalities among preschoolers based on geographical factors and ethnic backgrounds. These findings underscore the need for targeted public health strategies to address socioeconomic and environmental determinants of early-life health disparities.