Regional Variations in Overweight and Obesity Among School-Aged Adolescents: Evidence From the Cross-Sectional Health...

Adolescent overweight and obesity (AdOO) represent a public health challenge across the European Union (EU). Rising AdOO prevalence contributes to early onset of chronic health conditions and long-term health inequalities. Dietary patterns, physical activity and socioeconomic and cultural environments differ across EU regions; identifying region-specific determinants is critical for shaping effective public health strategies.

Behavioural and demographic variables were drawn from the 2018 Health Behaviour in School-aged Children (HBSC) survey. Interaction and spatial plots were used to illustrate region-specific risk factors and estimate differences in AdOO prevalence. Among the 26 EU countries, stratified by regional zones, multivariable logistic regression analyses were performed to identify risk factors.

Interaction plots indicated zone-specific profiling supporting the need for stratified analysis. AdOO prevalence exceeded 17.0% in all regions, with variation between zones. Across all four regions, middle or higher family affluence, being a girl, moderate or higher physical activity and moderate or high sweets consumption were associated with lower odds of AdOO. In contrast, behavioural factors such as smoking, alcohol use and soft-drink consumption showed weaker or region-specific increases in odds. Age was not consistently associated with AdOO across regions: it showed no significant association in Western Europe, while alcohol use was linked to higher odds only in Southern Europe, and high soft-drink consumption increased odds only in the Eastern zone.

Region-specific risk profiles highlight opportunities for tailored interventions, including promoting physical activity, addressing socioeconomic inequalities and integrating sex-specific behavioural patterns into adolescent health policies for AdOO across the EU.