Body Mass Index Trajectory-Specific Changes in Economic Circumstances: A Person-Oriented Approach Among Midlife and Ageing Finns.

Jatta Salmela,Tea Lallukka,Ossi Rahkonen,Noora Kanerva,Elina Mauramo

doi:10.3390/ijerph17103668

Abstract

Economic disadvantage is related to a higher risk of adulthood obesity, but few studies have considered whether changes in economic circumstances depend on a person’s body mass index (BMI) trajectory. We identified latent BMI trajectories among midlife and ageing Finns and captured individual-level changes in economic circumstances within the BMI trajectories utilizing sequence analysis. We used the Helsinki Health Study cohort data of initially 40–60-year-old Finnish municipal employees, with four survey questionnaire phases (2000–2017). Each survey included identical questions on height and weight, and on economic circumstances incorporating household income and current economic difficulties. Based on computed BMI, we identified participants’ (n = 7105; 82% women) BMI trajectories over the follow-up using group-based trajectory modeling. Four BMI trajectories were identified: stable healthy weight (34% of the participants), stable overweight (42%), overweight to class I obesity (20%), and stable class II obesity (5%). Lower household income level and having economic difficulties became more common and persistent when moving from lower- to higher-level BMI trajectories. Differences in household income widened over the follow-up between the trajectory groups, whereas economic difficulties decreased equally in all trajectory groups over time. Our study provides novel information on the dynamic interplay between long-term BMI changes and economic circumstances.

Highlights

People with economic disadvantage, such as those having low income or wealth or living in poverty, have an increased risk of unhealthy weight gain and obesity in high-income countries [1,2,3].Economic disadvantage is assumed to contribute to obesity, for instance, through food insecurity and limited possibilities of exercise activities
Lower household income level became more common during the follow-up among the whole study population, whereas the proportion of participants with economic difficulties decreased over time (Supplementary Table S3)
Performing sequence analyses for economic circumstances within the body mass index (BMI) trajectory groups is a step further in trying to understand how varying economic circumstances are associated with weight changes in the long-term. This person-oriented cohort study showed that prolonged and volatile economic disadvantage was more likely to occur among midlife and ageing Finns with developing obesity

Summary

Introduction

People with economic disadvantage, such as those having low income or wealth or living in poverty, have an increased risk of unhealthy weight gain and obesity in high-income countries [1,2,3]. Economic disadvantage is assumed to contribute to obesity, for instance, through food insecurity and limited possibilities of exercise activities. Adverse economic circumstances tend to be long-lasting and accumulate over time, even over generations [6], which further increases the risk of developing obesity [7,8]. Whereas some aspects of socioeconomic circumstances (e.g., education) are mostly constant, material aspects (e.g., income and economic difficulties) may vary more over time [10,11], which potentially has an impact on changes in health behavior and in body weight

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