Abstract
Obesity is socioeconomically, geographically and ethnically patterned. Understanding these elements of disadvantage is vital in understanding population obesity trends and the development of effective and equitable interventions. This study examined the relationship between neighbourhood socioeconomic disadvantage and geographic remoteness with prospective trends in mean body mass index (BMI) among immigrants to Australia. Longitudinal data (2006–2014) from a national panel survey of Australian adults was divided into an immigrant-only sample (n = 4,293, 52.6% women and 19,404 person-year observations). The data were analysed using multi-level random effects linear regression modelling that controlled for individual socioeconomic and demographic factors. Male immigrants living in the most disadvantaged neighbourhoods had significantly higher mean BMI compared with those living in the least disadvantaged. Over time, mean BMI increased for all groups except for men living in the least disadvantaged neighbourhoods, for whom mean BMI remained almost static (0.1 kg/m2 increase from 2006 to 2014), effectively widening neighbourhood inequalities. Among women, mean BMI was also significantly higher in the most compared with the least, disadvantaged neighbourhoods (β = 2.08 kg/m2; 95%CI: 1.48, 2.68). Neighbourhood inequalities were maintained over time as mean BMI increased for all groups at a similar rate. Male and female immigrants residing in outer regional areas had significantly higher mean BMI compared with those living in major cities; however, differences were attenuated and no longer significant following adjustment for ethnicity, individual socioeconomic position and neighbourhood disadvantage. Over time, mean BMI increased in all male and female groups with no differences based on geographic remoteness. Obesity prevention policy targeted at immigrant cohorts needs to include area-level interventions that address inequalities in BMI arising from neighbourhood disadvantage, and be inclusive of immigrants living outside Australia’s major cities.
Highlights
Worldwide, adult overweight and obesity rose by 27.5% between 1980 and 2013, with an estimated 2.1 billion people overweight or obese in 2013 [1]
This study examined the relationship between neighbourhood socioeconomic disadvantage and geographic remoteness with prospective trends in mean body mass index (BMI) among immigrants to Australia
Women in the sample were evenly distributed across quintiles of neighbourhood disadvantage and women in the most disadvantaged neighbourhood (Quintile 1) had the highest BMI in 2014 (27.2 kg/m2 (SD 6.0))
Summary
Adult overweight and obesity rose by 27.5% between 1980 and 2013, with an estimated 2.1 billion people overweight or obese in 2013 [1]. Contextual factors associated with obesity and body mass index (BMI) in ethnic minority groups include attributes of the built environment [16,17,18,19,20] and of the social environment [5,19,20], ethnic density [21,22,23,24,25], racial or residential segregation [26,27,28], neighbourhood socioeconomic disadvantage [28,29,30,31,32] and geographic remoteness (urban vs rural) [33] The majority of these studies have been from the US, and wider research examining the role of contextual factors on immigrant obesity trends in other developed countries is needed to advance the field and guide policy development [12,21]
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