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Background: Obesity remains a critical public health challenge driven by complex factors with education as a key determinant. While prevalence has risen in Germany, the burden is unequally distributed across educational groups. However, no study has systematically examined how educational inequalities in obesity vary across age groups and birth cohorts in Germany, limiting understanding of their development over the life course.

Aim/scientific question: This study examines the trend of educational inequalities in obesity in Germany (2003–2024) and analyses differences across age groups and birth cohorts.

Material & Methods: RKI health monitoring data (2003–2024; n=170,349) was used. Slope Index of Inequality and Relative Index of Inequality trends were estimated, complemented by age- and cohort-specific logistic regressions to assess associations between education and obesity.

Results: Absolute and relative educational inequalities in obesity remained high over time, especially among women, with only relative inequality among women decreasing significantly. Differences in predicted obesity prevalence by education were observed across most age groups without widening over age. In contrast, cohort analyses showed widening gradients, indicating that educational inequalities in obesity are stronger and obesity prevalence is higher in more recent birth cohorts, reaching 45–60% in low-educated groups born after 1980.

Discussion: Educational inequalities remained high for both sexes, with the observed decline in relative inequality among women likely reflecting rising overall prevalence rather than improved equity. Inequalities are already established by early adulthood and persist across the life course. Cohort analyses further suggest a shift towards earlier and more pronounced disparities in younger generations, indicating cumulative disadvantage over time and increasing long-term population burden. As these cohorts have not yet reached peak obesity levels, further increases in population-level inequalities are expected.

Take Home Message: Educational inequalities in obesity remain high and are likely to increase due to cohort effects. Younger cohorts, particularly those with low education, already show concerningly high prevalence levels, highlighting the need for early and targeted prevention strategies.

Competing interests: None