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Economics and Human Biology 6 (2008) 204–211

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Obesity among male adolescent migrants in Vienna, Austria

Sylvia Kirchengast a,*, Edith Schober b
a
Institute for Anthropology, University of Vienna, Althanstrasse 14, A-1090 Vienna, Austria
b
University clinic for Paediatrics, Medical University Vienna, Austria
Received 13 November 2007; accepted 13 November 2007

Abstract
Childhood overweight and obesity – especially among migrant children – are health problems in several European countries.
The prevalence rates of overweight and obesity among 936 migrant boys of low socio-economic status from Turkey and former
Yugoslavia were compared with those of Austrian boys in Vienna. In the longitudinal study, children were measured at the ages of 6,
10 and 15 years. Weight status was estimated by means of the body mass index and percentile curves were used for weight status
classification. The prevalence of overweight and obesity was high among migrant boys as well as Austrian boys at all age groups.
Ten-year-old boys from Yugoslavia exhibited the highest percentage of overweight (nearly 38%). The lowest percentage of
overweight was among 6-year-old Austrian boys (17.2%). Being overweight or obese at the age of 6 years increased the risk of being
overweight at 10 and 15 years significantly ( p < 0.001). This was true of all groups independent of migrant status. The impact of
migrant status on weight status at the ages of 10 and 15 was not significant. Therefore, although migrant boys from former
Yugoslavia exhibited the highest rates of overweight and obesity, migrant status is not associated significantly with an increased
prevalence of obesity in this sample characterized by a generally low socio-economic status. Prevention should start as early as
possible for all children, since overweight tends to persist from childhood into adolescence independent of migrant status.
# 2007 Elsevier B.V. All rights reserved.

Keywords: Children; Childhood obesity; BMI; Socio-economic status; Migration; Ethnicity; Austria; Yugoslavia; Turkey

1. Introduction

The prevalence of childhood obesity is increasing rapidly worldwide (Cole et al., 2000; Livingstone, 2001), posing
a significant health problem in nearly all Industrialised countries. Childhood obesity results not only in social
stigmatisation of obese children and may have deleterious social and economic consequences (Kraig and Keel, 2001;
Latner and Stunkard, 2003), it has also dramatic health consequences. Childhood obesity is one of the most important
risk factors for hypertension, diabetes mellitus, or abnormal lipid profiles (Geiss et al., 2001; McGee, 2005) but also
for psychological and emotional morbidity during childhood and in later life (Latner and Stunkard, 2003). These risk
factors may operate through the association between child and adult obesity. Approximately one third of obese
children and adolescents become obese as adults (Guo et al., 2002). Therefore, the increasing prevalence of obesity
and overweight during childhood has also implications for long-term health and longevity. Being overweight during
adolescence yields an increased risk of coronary heart disease, colon cancer and arthritis among men and women who
had been overweight adolescents. Because of this public health importance, the monitoring of childhood obesity and

* Corresponding author. Tel.: +43 1 4255712; fax: +43 1 42779547.

E-mail address: sylvia.kirchengast@univie.ac.at (S. Kirchengast).

1570-677X/$ – see front matter # 2007 Elsevier B.V. All rights reserved.
doi:10.1016/j.ehb.2007.11.001
 S. Kirchengast, E. Schober / Economics and Human Biology 6 (2008) 204–211 205

the analyses of risk factors are necessary. Beside genetic factors (Kimm, 2003) obesity is largely caused by an
environment that promotes excessive food intake and discourages physical activity (Hill and Peters, 1998). In
Industrialized countries, this kind of environment seems to be typical of families with a low socio-economic status. In
addition several studies show, that children from families with low socio-economic status particularly suffer from
overweight and obesity (Gnavi et al., 2001; Haas et al., 2003; Langnäse et al., 2002). Apart from a low socio-economic
status, migrant status is an important risk factor to develop overweight or obesity during childhood (Popkin and Udry,
1998; Brussard et al., 2001; Smith et al., 2002). Immigrant children suffer to a significantly higher degree from excess
body weight and obesity than average (Popkin and Udry, 1998). However, longitudinal observations among migrant
children are rare. Therefore, the aim of the present longitudinal study was to analyse development of overweight and
obesity among migrant boys in Vienna, Austria, between the ages of 6 and 15 years.

2. Materials and methods

2.1. Sample

Data pertaining to 936 boys born in 1988 were included in the present analyses. In Austria, it is mandatory that
beginning at school entry special trained paediatricians of the medical school authority collect medical data and
measure standing height and body weight of all school children. Therefore, the authors cooperated closely with the
Viennese school medical authority. Viennese school authority randomly selected 46 public schools in Vienna (two
from each of the 23 districts) to participate in the present project.

2.2. Procedure

Stature was measured with an anthropometer to the nearest millimetre. Weight was recorded with a scale precise to
100 g. During measurement, the children and adolescents were without shoes and wore only underwear. In Austria,
three examinations are mandatory: The first examination takes place at the age of 6 years before school entry. The
second examination takes place 4 years later, when primary school is finished at the age of 10. The third and last
examination takes place at the age of 15 years, shortly before the end of mandatory school attendance. The data files
including all information concerning stature and body weight as well as some socio-economic data belong to the
administration of the Viennese school medical office1. All probands started school in Vienna in September 1994.

2.3. Migrant status and ethnicity

In the present study, only children of the first or second-generation immigrants were included. Both parents had to
be born in their country of origin. All subjects started school in Austria, although some of them had immigrated to
Austria after their birth. The data set comprised three subsets according to the ethnicity of the subjects. Group one
comprised 227 boys from Turkey. Although the majority of them was born in Austria, all of them lived in traditional
Turkish immigrant families of the first or second generation. The second group comprised 270 boys who originated
from countries of former Yugoslavia (Serbia, Bosnia-Herzegovina, Croatia and Macedonia). More than the half of
these children were born in Austria, however all families had still immigrant status. Only migrant boys from Turkey
and former Yugoslavia were included in the analyses, because the great majority of migrants in Austria originated from
these countries. These two groups were compared with 439 boys from Austria. All of them were born in Austria and
were Austrian citizens. This was also true of their parents.

2.4. Socio-economic status of the probands

Social status was estimated by educational level of the boys, parental employment status and family size. Social
data were collected at each examination. Only boys visiting attending public secondary schools in Vienna were

1
Gesundheitsdienst der Stadt Wien (MA15), Schulärztlicher Dienst, MR Dr.Christa Lucius, 1020 Vienna, Obere Augartenstrasse 16; tel. +1
5311487631.
206 S. Kirchengast, E. Schober / Economics and Human Biology 6 (2008) 204–211

included in the present analyses. The records of these students also had retrospective information on their
anthropometric measurements at the age 6. At the age of 10 children can take one of two educational paths for
secondary school based on their performance at the elementary level: a lower level called ‘‘Hauptschule’’ or a higher
level called ‘‘Gymnasium’’ (Entorf and Lauk, 2006). In Vienna, the attendance at a Hauptschule is a main indicator for
a low skill and educational level of the school children as well as that of their parents (Entorf and Lauk, 2006). The
present data corroborated this information. Household size varied between 2 and 12 persons. It was not possible to
collect data on family income. Furthermore, it was not possible to get comparable data from Austrian and immigrant
children with a higher socio-economic status.

2.5. Classification of the weight status

Weight status was determined by using the body mass index (BMI) kg/m2. For optimal monitoring of weight status,
up-to-date reference data on representative samples from the population are necessary. Appropriate BMI reference
data exist neither for the Austrian population of Vienna, nor for immigrant one. Since all three subsamples of the
present study comprised only Caucasians living in Central Europe, the authors decided to use BMI percentiles
published by Kromeyer-Hausschild et al. (2001) for central Europe.

2.6. Statistical analyses

Statistical analyses were carried out by means of SPSS (program version 11.0). The Kolmogoroff-Smirnov test
indicated a normal distribution of body height and body weight but not of the BMI values. Therefore, non-parametric
tests (Kruskall–Wallis tests) for group comparisons were used. The weight status (normal weight BMI < Percentile
90, overweight BMI = Percentile 90–97, and obese BMI > Percentile 97) was compared according ethnic group and
socio-economic parameters by x2 (crosstabs). Additionally binary logistic regression analyses were performed. For
the analyses of the longitudinal observations, x2 were used. In the longitudinal analyses overweight and obese children
were grouped together (BMI > Percentile 90).

3. Results

3.1. Anthropometrics

Statistically significant group differences in stature and body weight between Austrian boys and migrant boys were
documented for all age classes ( p < 0.01). Boys from the former Yugoslavia were significantly taller and heavier in all
age groups than their counterparts from Austria and Turkey (Table 1). Statistically significant group differences in
weight status were observable only for the 10-year-olds ( p < 0.01) (Table 1).

3.2. Weight status

Regarding the weight status, only minor ethnic differences were observable. All groups exhibited high percentages
of overweight and obesity. At the age of 6 years 17.2% of the Austrian boys and 23.7% of the Yugoslavian boys were
overweight or obese, these differences were statistically insignificant (Fig. 1). At the age of 10 years the group
differences were of statistically significant (x2 = 14.15, p < 0.05). While only 20% of the Turkish boys corresponded
to the definitions of overweight or obesity this was true of 28.7% of the Austrian and 38% of the Yugoslavian boys. At
the age of 15 no statistically significant group differences were found, 23% of the Austrian boys, 25% of the Turkish
and nearly 30% of the Yugoslavian boys were classified as overweight or obese.

3.3. Socio-economic parameters and weight status

The great majority of parents worked as unskilled workers (80.2%). The percentage of unemployed fathers
depending on social welfare aid/or financial income support was extraordinarily high with 15.6%. Austrian and
migrant fathers did not differ significantly insofar as unemployment was concerned. More than 34% of Austrian and
Yugoslavian mothers were unemployed. This was true of 74.1% of the Turkish mothers. Neither parental employment
 S. Kirchengast, E. Schober / Economics and Human Biology 6 (2008) 204–211 207

Table 1
Stature, body weight and body mass index (BMI) according to age, and ethnicity (male) Kruskall–Wallis tests
Austria (n = 439) Turkey (n = 227) Former Yugoslavia (n = 270) Sig.
x (S.D.) x (S.D.) x (S.D.)
Stature (cm)
6 years 121.4 (6.7)c 121.7 (6.8)c 123.7 (6.6)a,b p < 0.001
10 years 141.4 (7.0)c 141.2 (7.4)c 144.5 (7.6)a,b p < 0.001
15 years 167.9 (8.3)b,c 165.9 (7.9)a,c 170.1 (7.3)a,b p < 0.001
Body weight (kg)
6 years 24.5 (5.7)c 24.7 (5.8) 25.7 (5.9)a p < 0.05
10 years 38.4 (9.8)c 37.2 (9.2)c 41.7 (10.8)a,b p < 0.001
15 years 62.5 (14.9)c 60.3 (12.7) 64.9 (13.1) a p < 0.001
BMI (kg/m2)
6 years 16.45 (2.51) 16.48 (2.47) 16.66 (2.73) n.s
10 years 19.03 (3.72)c 18.44 (3.35)c 19.76 (3.94)a,b p < 0.01
15 years 22.04 (4.42) 21.80 (3.74) 22.37 (3.88) n.s.
a
Significantly different from Austrian boys.
b
Significantly different from Turkish boys.
c
Significantly different from Yugoslavian boys.

Fig. 1. Weight status by age and ethnicity (%).

status nor household size had a significant impact on the weight status of the boys in the present sample. This was true
of migrant as well as Austrian boys. These results are not shown here.

3.4. Longitudinal observations

For the following analyses obese and overweight children were grouped together (BMI > Percentile 90). Weight
status at age 6 years had a marked impact on subsequent weight status ( p < 0.001) (Figs. 2–4). 56.1% of Austrian
boys, who were overweight or obese at the age of 6 years, were still classified as overweight at the age of 15 years,
while this was true of 18.1% of those boys who had a normal weight at age 6 years (Fig. 2). Among migrant boys, who
208 S. Kirchengast, E. Schober / Economics and Human Biology 6 (2008) 204–211

Fig. 2. Weight status changes in the Austrian sample.

Fig. 3. Weight status changes in the Turkish sample.

Fig. 4. Weight status changes in the Yugoslavian sample.

 S. Kirchengast, E. Schober / Economics and Human Biology 6 (2008) 204–211 209

Table 2
Binary logistic regression analyses (0 = normal weight, 1 = overweight)
Regression coefficient B Significance 95% confidence interval
Weight status at the age of 10 years
Weight status at the age of 6 years 2.78 p < 0.001 9.849–26.140
Migrant status 0.14 n.s. 0.890–1.431
Weight status at the age of 15 years
Weight status at the age of 10 years 2.82 p < 0.001 10.927–25.947
Migrant status 0.18 n.s. 0.905–1.485

were overweight at the age of 6 years 53.8% (Turkish boys) and 65.9% (Yugoslavian boys) remained overweight until
the age of 15 (Figs. 3 and 4). In contrast, only 14.8% of the boys from Turkey, who were normal weight at the age of 6
years, were overweight at the age of 15. Of those boys from former Yugoslavia who had normal weight at the age of 6
years, 23.1% were overweight at the age of 15. The logistic regression analyses corroborated these results. Weight
status at the age of 10 years was influenced significantly ( p < 0.001) by the weight status at the age of 6 years but not
by migrant status. At 15 years weight status was significantly influenced by the weight status at 10 years ( p < 0.001),
but not by migrant status (Table 2).

4. Discussion

Over the last few decades, Austria has undergone a change, from a more or less homogeneous society to a
multicultural one, characterized by an increasing number of migrants—especially from former Yugoslavia and Turkey
(Kilaf, 2004). Of the Austrian population, 9.6% have foreign citizenship and the proportion of the migrant population
is highest in Vienna, 18.0% (Baldaszti, 2006). About 40% of migrants in Vienna originate from former Yugoslavia,
about 15% from Turkey (Baldaszti, 2006). The increasing number of immigrants has brought the health status of
different ethnic groups into focus. As has been reported for several others countries (Brussard et al., 2001; Elkeles and
Seifert, 1996; Bongard et al., 2002; Daryani, 2006), immigrants in Austria constitute a vulnerable group in terms of
health. Changes in lifestyle – especially nutritional patterns – due to migration with its economic, social and
environmental consequences have a major impact on health and disease patterns among migrants (Kilaf, 2004). Their
low socio-economic position and minority group status are frequently associated with increased chronic distress, a
higher morbidity and an increased mortality rate (Brussard et al., 2001; Elkeles and Seifert, 1996; Bongard et al., 2002;
Daryani, 2006). Many authors (Popkin and Udry, 1998; Brussard et al., 2001; Kilaf, 2004; Hoppichler and Lechleitner,
2001) suggested that the high prevalence rate of overweight and obesity is, a special health problem of migrants,
especially among women, children and adolescents. Migrant children were consistently found to be more frequently
overweight or obese compared to children of the host population (Brussard et al., 2001; Fredriks et al., 2003; Gordon-
Larsen et al., 2003; Erb and Winkler, 2003; Kuepper-Nybelen et al., 2005; Will et al., 2005). The results of the present
study corroborate these observations only partly: The percentages of overweight and/or obesity were generally high, as
expected, for a sample consisting of adolescents of low socio-economic status. Comparing migrant boys with their
Austrian counterparts, however, indicated that only migrant boys from former Yugoslavia surpassed their Austrian
counterparts in the prevalence of overweight and obesity at all age groups, statistically significant differences however,
were found for the age of 10 years only. Boys from Turkey and Austrian boys showed a very similar prevalence of
overweight and/or obesity. The relatively low rate of obesity among the Turkish subsample corresponds with the
results of Will et al. (2005) and Öner et al. (2004), however it is in a sharp contrast to the findings of Delekat (2003) and
Kalies et al. (2002) who declared overweight and obesity a special problem of children of Turkish origin. According to
Özer (2007) 22.4% of Turkish boys in Ankara are overweight and 5.6% are obese. This is a higher prevalence of
overweight, however a lower prevalence of obesity in comparison to the present sample. Obesity and overweight is
extraordinarily high about Turkish girls (Kirchengast and Schober, 2006). Nearly 13% of the Turkish girls were
classified as obese and more than 15% were classified as overweight.
In the present sample, in contrast to previous studies, only slight differences in the prevalence of overweight or
obesity between Austrian boys and migrant boys were observable. This minor effect of ethnicity or migrant status on
the prevalence of overweight may be due to the fact, that no marked differences in the socio-economic status were
210 S. Kirchengast, E. Schober / Economics and Human Biology 6 (2008) 204–211

observable between the three ethnic groups considered in the present paper, as the educational level of all children and
parents in the present study was rather low. The three ethnic groups did not differ significantly in paternal employment
status. Household size and paternal employment status had no impact on weight status. This may be due to the fact,
that socio-economic differences within the whole sample were minimal. The observed association between low socio-
economic status and overweight and/or obesity has been generally explained by reduced physical activity and adverse
nutritional habits among people with lower socio-economic status (Manios et al., 2005). Speakman et al. (2005)
reported an underestimation of food energy contents by many people of lower socio-economic strata. Nutritional
habits as well as activity patterns are also influenced by culture and religious components (Gordon-Larsen et al., 2003;
Shatenstein and Ghadirian, 1998; Dowler, 2001; Green et al., 2003; Daryani, 2006). Migration often induces a
profound change in food habits and physical activity patterns. This kind of food acculturation experienced by migrants
to Western Industrialized countries such as Austria often includes a changing from a diet with a high content of
vegetables and fruits towards more meat, fat, sugar and so-called junk food (Kilaf, 2004). This kind of food is typically
consumed by people of the lower social strata (Shahar et al., 2005; Rathmanner et al., 2006). With reference to the
longitudinal development, we found that migrant status has only a minor impact on weight at ages 10 or 15 years.
Weight at age 6 influenced weight status at age 10, while weight at age 10 influenced weight at age 15, but migrant
status did not play a role. In part the results of the present study corroborate the findings of several previous studies,
which indicate that childhood overweight or obesity are strong predictors of adolescent and adult obesity or
overweight (Serdula et al., 1993; Whitaker et al., 1997; Williams, 2001; Guo et al., 2002; Field et al., 2005). On the
other hand, the results of the present study suggest that a more differential interpretation of the impact of migrant status
on weight status is warranted (Cornelisse-Vermaat and Maassen van den Brink, 2007). The high prevalence of
overweight and obesity among boys during childhood and adolescents in the present sample seems not to be
exclusively an effect of migration, rather it seems to be due to the low socio-economic status of these boys.

Acknowledgements

The authors are gratefully indebted to the Viennese school medical authority (Dr. Lucius and her team) for their
kind co-operations and help. Special thanks go to four anonymous reviewers for their valuable and constructive
criticisms.

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