Abstract
BACKGROUND: In Sweden, schoolwork pressure and adolescent overweight/obesity prevalence have increased in recent decades. This study investigates the relationship between schoolwork pressure and weight status, considering the moderating role of socioeconomic background. METHODS: We analysed pooled cross-sectional data from 12 154 adolescents in the nationally representative Swedish Health Behaviour in School-aged Children surveys (2013/14, 2017/18, 2021/22). Logistic regression models examined the association between schoolwork pressure and self-reported overweight/obesity status (standardised by IOTF cut-offs) across socioeconomic backgrounds assessed by the Family Affluence Scale (FAS) and perceived family wealth (PFW). We calculated population attributable fractions to quantify schoolwork pressure's contribution to overweight/obesity. RESULTS: 37% of students reported high schoolwork pressure, and 14% had overweight or obesity. High schoolwork pressure was associated with increased odds of overweight/obesity (OR 1.17, 95% CI 1.03-1.32). Adolescents experiencing high pressure from low socioeconomic backgrounds FAS (OR 2.10, 95% CI 1.60-2.76) or PFW (OR 1.82, 95% CI 1.22-2.71) had the highest odds of overweight/obesity. Approximately 5% of overweight/obesity cases were attributable to high schoolwork pressure. CONCLUSIONS: High schoolwork pressure increases the likelihood of adolescent overweight/obesity, particularly for disadvantaged socioeconomic groups. Implementing policies to reduce academic stress and providing targeted support are essential for promoting healthier outcomes.