Abstract
This study investigated the contribution of psychosocial stress to mediating inequities in weight gain by educational status in a large cohort of young Australian women over a 9-year follow-up. This observational cohort study used survey data drawn from 4,806 women, aged 22 to 27 years at baseline (2000), participating in the Australian Longitudinal Study on Women's Health, who reported their education level (2000), perceived stress (2003), and weight (2003 and 2012). Using a causal inference framework based on counterfactuals for mediation analysis, we fitted linear or logistic regression models to examine the total effect, decomposed into natural direct and indirect effects via perceived stress, of education level (highest qualification completed: up to year 12/trade or diploma vs. university) on weight change. Women with lower education gained more weight over 9 years (6.1 kg, standard deviation [SD] 9.5) than women with higher education (3.8 kg, SD 7.7; P < 0.0001) and were more likely to be very or extremely stressed. The higher weight gain associated with low education was not mediated through perceived stress (per SD increase, percent mediated: 1.0%). Education-based inequities in weight gain over time were not attributable to greater psychosocial stress among women with lower education levels.
Highlights
In high-income countries, women of low socioeconomic position (SEP) are at increased risk of unhealthy weight gain and the development of obesity compared with those of higher SEP [1, 2]
Individuals of lower SEP may experience stress associated with their lower social standing, or because they are subjected to financial strain or other comparatively harsher living conditions associated with their disadvantage [13], and this may contribute to weight gain over time
We found the hypothesised associations between lower education and greater perceived stress over three years; and between stress and greater weight gain over nine years, with women reporting the most stress gaining an additional 2.3kg relative to those reporting less stress
Summary
In high-income countries, women of low socioeconomic position (SEP) (for example, those with a low education level, low income, or working in a low status occupation) are at increased risk of unhealthy weight gain and the development of obesity compared with those of higher SEP [1, 2]. The reasons for this increased risk are not well understood.
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