Educational Inequalities In Obesity Research Articles

Widening Educational Inequalities in Physical Health Due to the Obesity Trend?—A Mediation Analysis Using the German Socio-Economic Panel Study

Objectives:This study examined the contribution of obesity to the development of educational inequalities in physical health.Methods:We used data from the German Socio-Economic Panel for the period 2002–2020. Physical health was measured with the modified SF12-questionnaire. Logistic regression analyses were applied to estimate time trends. The Relative Index of Inequality (RII) and the Slope Index of Inequality (SII) were calculated to examine educational inequalities. The role of obesity as a mediator was analyzed using the Karlson-Holm-Breen (KHB) method.Results:Over time, educational inequalities in obesity as well as impaired physical health widened in men and women, particularly among those aged 30–49 years. For individuals with a low level of education at this age, the probability of impaired physical health increased significantly by 7.7%-points in women and 9.4%-points in men. Of this increase, 25.9% for women and 14.8% for men could be attributed to the increase in obesity.Conclusion:Our findings suggest that the steeper rise in obesity among individuals with a low level of education partly explains the observed widening in educational inequalities in physical health.

Temporal trends and educational inequalities in obesity, overweight and underweight in pre-pregnant women and their male partners: a decade (2010-2019) with no progress in Sweden.

Trends in overweight and obesity among expectant parents can provide useful information about the family environment in which children will grow up and about possible social inequalities that may be passed on to them. Therefore, we aimed to assess whether the prevalence of underweight, overweight and obesity changed over time in pre-pregnant women and their male partners in northern Sweden, and if there were any educational inequalities. This study is based on cross-sectional data from a repeated survey of the population in Västerbotten, Sweden. The study population included 18,568 pregnant women and 18,110 male partners during the period 2010-2019. Multinomial logistic regression models were fitted separately for pregnant women and male partners to assess whether the prevalence of age-adjusted underweight, normal weight, overweight and obesity had evolved between 2010 and 2019, and whether trends differed by educational level. Among women, obesity prevalence increased from 9.4% in 2010 to 11.7% in 2019. Among men, it went from 8.9 to 12.8%. Educational inequalities were sustained across the study period. In 2019, the prevalence of obesity was 7.8 percentage points (pp) (CI = 4.4-11.3) higher among women with low compared to high education. The corresponding figure for men was 6.4 pp (CI = 3.3-9.6). It is not obvious that the prevalence of obesity among parents-to-be will decrease under current dispositions. Public health policies and practice should therefore be strengthened.

Educational inequalities, urbanicity and levels of non-communicable diseases risk factors: evaluating trends in Argentina (2005\u20132013)

BackgroundWe investigated a) whether urbanicity is associated with individual-level non-communicable diseases (NCD) risk factors and whether urbanicity modifies trends over time in risk factors; and (b) whether educational inequalities in NCD risk factors change over time or are modified by province urbanicity.MethodsWe used data from three large national surveys on NCD risk factors (Encuesta Nacional de Factores de Riesgo; ENFR2005–2009-2013) conducted in urban areas of Argentina (n = 108,489). We used gender-stratified logistic random-intercept models (individuals nested within provinces) to determine adjusted associations of self-reported individual NCD risk factors (hypertension, diabetes, obesity, and current smoking) with education and urbanicity.ResultsIn both men and women, the prevalence of obesity and diabetes increased over time but smoking decreased. Hypertension prevalence increased over time in men. Higher urbanicity was associated with higher odds of smoking and lower odds of hypertension in women but was not associated with NCD risk factors in men. Obesity increased more over time in more compared to less urbanized provinces (in men) while smoking decreased more over time in less urbanized provinces. All risk factors had a higher prevalence in persons with lower education (stronger in women than in men), except for diabetes in men and smoking in women. Educational inequalities in obesity (in men) and hypertension (in men and women) became stronger over time, while an initial inverse social gradient in smoking for women reverted and became similar to other risk factors over time. In general, the inverse associations of education with the risk factors became stronger with increasing levels of province urbanicity.ConclusionIncreasing prevalence of diabetes and obesity over time and growing inequities by education highlight the need for policies aimed at reducing NCD risk factors among lower socioeconomic populations in urban environments in Argentina.

Educational inequalities in obesity: a multilevel analysis of survey data from cities in Latin America.

ObjectiveUsing newly harmonised individual-level data on health and socioeconomic environments in Latin American cities (from the Salud Urbana en América Latina (SALURBAL) study), we assessed the association between obesity and education levels and explored potential effect modification of this association by city-level socio-economic development.DesignThis cross-sectional study used survey data collected between 2002 and 2017. Absolute and relative educational inequalities in obesity (BMI ≥ 30 kg/m2, derived from measured weight and height) were calculated first. Then, a two-level mixed-effects logistic regression was run to test for effect modification of the education–obesity association by city-level socio-economic development. All analyses were stratified by sex.SettingOne hundred seventy-six Latin American cities within eight countries (Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico and Peru).Participants53 186 adults aged >18 years old.ResultsAmong women, 25 % were living with obesity and obesity was negatively associated with educational level (higher education–lower obesity) and this pattern was consistent across city-level socio-economic development. Among men, 18 % were living with obesity and there was a positive association between education and obesity (higher education–higher obesity) for men living in cities with lower levels of development, whereas for those living in cities with higher levels of development, the pattern was inverted and university education was protective of obesity.ConclusionsAmong women, education was protective of obesity regardless, whereas among men, it was only protective in cities with higher levels of development. These divergent results suggest the need for sex- and city-specific interventions to reduce obesity prevalence and inequalities.

Socioeconomic inequalities in obesity among Korean women aged 19-79 years: the 2016 Korean Study of Women's Health-Related Issues.

OBJECTIVESWhile the prevalence of obesity in Asian women has remained stagnant, studies of socioeconomic inequalities in obesity among Asian women are scarce. This study aimed to examine the recent prevalence of obesity in Korean women aged between 19 years and 79 years and to analyze socioeconomic inequalities in obesity.METHODSData were derived from the 2016 Korean Study of Women’s Health-Related Issues. The chi-square test and logistic regression analysis were used to analyze the associations between socioeconomic factors and obesity using Asian standard body mass index (BMI) categories: low (<18.5 kg/m2 ), normal (18.5-22.9 kg/m2 ), overweight (23.0-24.9 kg/m2 ), and obese (≥25.0 kg/ m2 ). As inequality-specific indicators, the slope index of inequality (SII) and relative index of inequality (RII) were calculated, with adjustment for age and self-reported health status.RESULTSKorean women were classified into the following BMI categories: underweight (5.3%), normal weight (59.1%), overweight (21.2%), and obese (14.4%). The SII and RII revealed substantial inequalities in obesity in favor of more urbanized women (SII, 4.5; RII, 1.4) and against of women who were highly educated (SII, -16.7; RII, 0.3). Subgroup analysis revealed inequalities in obesity according to household income among younger women and according to urbanization among women aged 65-79 years.CONCLUSIONSClear educational inequalities in obesity existed in Korean women. Reverse inequalities in urbanization were also apparent in older women. Developing strategies to address the multiple observed inequalities in obesity among Korean women may prove essential for effectively reducing the burden of this disease.

Inequalities in smoking and obesity in Europe predicted to 2050: Findings from the EConDA project.

The aim of this study was to project educational inequalities in obesity and smoking prevalence to 2050 based on past obesity and smoking trends by education level. Data on obesity (body mass index ≥ 30) and smoking prevalence (current smokers) by education level (tertiary education and less than tertiary) from nationally representative cross-sectional surveys were collected for the following six countries participating in the Economics of Chronic Diseases project (EConDA): England, Finland, Lithuania, the Netherlands, Poland (obesity only) and Portugal (obesity only). A nonlinear multivariate regression model was fitted to the data to create longitudinal projections to 2050. Inequalities were measured with a prevalence ratio and a prevalence difference using projected obesity/smoking prevalence. Educational inequalities in obesity prevalence are projected to increase in Finland, Lithuania and England for men, and in Lithuania and Poland for women, by 2050. Obesity prevalence is projected to increase faster among the more advantaged groups in England, Portugal, Finland and the Netherlands among women, and Portugal and the Netherlands among men, narrowing inequalities. In contrast to obesity, smoking prevalence is projected to continue declining in most of the countries studied. The decline is projected to be faster in relative terms among more advantaged groups; therefore, relative educational inequalities in smoking prevalence are projected to increase in all countries. Widening educational inequalities in obesity and smoking prevalence are expected in several European countries if current trends in obesity and smoking prevalence are unaltered. This will impact on inequalities in morbidity and mortality of associated diseases such as diabetes, coronary heart disease and chronic obstructive pulmonary disease.

Trends in educational inequalities in obesity in 15 European countries between 1990 and 2010

BackgroundThe prevalence of obesity increased dramatically in many European countries in the past decades. Whether the increase occurred to the same extent in all socioeconomic groups is less known. We systematically assessed and compared the trends in educational inequalities in obesity in 15 different European countries between 1990 and 2010.MethodsNationally representative survey data from 15 European countries were harmonized and used in a meta-regression of trends in prevalence and educational inequalities in obesity between 1990 and 2010. Educational inequalities were estimated by means of absolute rate differences and relative rate ratios in men and women aged 30–64 years.ResultsA statistically significant increase in the prevalence of obesity was found for all countries, except for Ireland (among men) and for France, Hungary, Italy and Poland (among women). Meta-regressions showed a statistically significant overall increase in absolute inequalities of 0.11% points [95% CI 0.03, 0.20] per year among men and 0.12% points [95% CI 0.04, 0.20] per year among women. Relative inequalities did not significantly change over time in most countries. A significant reduction of relative inequalities was found among Austrian and Italian women.ConclusionThe increase in the overall prevalence aligned with a widening of absolute but not of relative inequalities in obesity in many European countries over the past two decades. Our findings urge for a further understanding of the drivers of the increase in obesity in lower education groups particularly, and an equity perspective in population-based obesity prevention strategies.

Causation or selection - examining the relation between education and overweight/obesity in prospective observational studies: a meta-analysis.

Numerous studies have investigated the association between education and overweight/obesity. Yet less is known about the relative importance of causation (i.e. the influence of education on risks of overweight/obesity) and selection (i.e. the influence of overweight/obesity on the likelihood to attain education) hypotheses. A systematic review was performed to assess the linkage between education and overweight/obesity in prospective studies in general populations. Studies were searched within five databases, and study quality was appraised with the Newcastle-Ottawa scale. In total, 31 studies were considered for meta-analysis. Regarding causation (24 studies), the lower educated had a higher likelihood (odds ratio: 1.33, 1.21-1.47) and greater risk (risk ratio: 1.34, 1.08-1.66) for overweight/obesity, when compared with the higher educated. However, these associations were no longer statistically significant when accounting for publication bias. Concerning selection (seven studies), overweight/obese individuals had a greater likelihood of lower education (odds ratio: 1.57, 1.10-2.25), when contrasted with the non-overweight or non-obese. Subgroup analyses were performed by stratifying meta-analyses upon different factors. Relationships between education and overweight/obesity were affected by study region, age groups, gender and observation period. In conclusion, it is necessary to consider both causation and selection processes in order to tackle educational inequalities in obesity appropriately.

Four Decades of Obesity Trends among Non-Hispanic Whites and Blacks in the United States: Analyzing the Influences of Educational Inequalities in Obesity and Population Improvements in Education.

Both obesity (body mass index ≥ 30) and educational attainment have increased dramatically in the United States since the 1970s. This study analyzed the influences of educational inequalities in obesity and population improvements in education on national obesity trends between 1970 and 2010. For non-Hispanic white and black males and females aged 25–74 years, educational differences in the probability of being obese were estimated from the 1971–2012 National Health and Nutrition Examination Surveys, and population distributions of age and educational groups, from the 1970 Census and 2010 American Community Survey. In the total population, obesity increased from 15.7% to 38.8%, and there were increases in the greater obese probabilities of non-college graduates relative to four-year college graduates. The increase in obesity would have been lower by 10% (2.2 percentage points) if educational inequalities in obesity had stayed at their 1970 values and lower by one third (7.9 points) if obesity inequalities had been eliminated. Obesity inequalities were larger for females than males and for whites than blacks, and obesity did not differ by education among black males. As a result, the impact of obesity inequalities on the obesity trend was largest among white females (a 47% reduction in the obesity increase if obesity inequalities had been eliminated), and virtually zero among black males. On the other hand, without educational improvements, the obesity increase would have been 9% more in the total population, 23% more among white females and not different in the other three subpopulations. Results indicate that obesity inequalities made sizable contributions to the obesity trends, and the obesity reductions associated with educational improvements were more limited.

Trends in educational inequalities in obesity in 15 European countries between 1990 and 2010

Trends in educational inequalities in obesity in 15 European countries between 1990 and 2010

Educational inequalities in obesity and gross domestic product: evidence from 70 countries

BackgroundWe test the reversal hypothesis, which suggests that the relationship between obesity and education depends on the economic development in the country; in poor countries, obesity is more prevalent in...

Temporal trends in socioeconomic inequalities in obesity prevalence among economically-active working-age adults in Scotland between 1995 and 2011: a population-based repeated cross-sectional study.

ObjectivesObesity has been an alarming public health issue in the UK. Socioeconomic inequalities in obesity have been well-studied, however limited studies addressed inequality trends over time and none of them in Scotland.MethodsWe used nationally-representative data from the Scottish Health Survey (SHeS) across four time points between 1995 and 2010/2011. Respondents were economically active adults aged 16–65 years (N=27 059, 12 218 men). Socioeconomic position (SEP) was assessed by highest educational qualification, occupational social class and household income (2003 and 2010/2011 only) as well as a composite SEP score. We carried out sex-stratified logistic regression analyses (adjusted for age, smoking status, alcohol consumption, self-rated general health and physical activity) and we computed the relative index of inequality (RII).ResultsBetween 1995 and 2010/2011, obesity prevalence increased in both men (from 17% in 1995 to 30.2% in 2010/2011, 2010/2011 OR of obesity compared with 1995=2.07; 95% CI 1.83 to 2.34) and women (from 18.4% to 30.2%; OR=1.85; 95% CI 1.66 to 2.07). Increase in obesity prevalence was observed across all socioeconomic strata, within which the most rapid increase was among males from the highest socioeconomic groups. RII showed that educational inequalities in obesity narrowed for both men (p=0.007) and women (p=0.008). Income inequalities in obesity between 2003 and 2010/2011 in women were also reduced (p=0.046) on the relative scale.ConclusionsObesity prevalence in Scotland increased substantially between 1995 and 2010/2011, although socioeconomic inequalities have decreased due to the more rapid increase in the higher socioeconomic strata.

Absolute and relative educational inequalities in obesity among adults in Tehran: Findings from the Urban HEART study-2

The prevalence of obesity is increasing in Iran. Previous studies showed mixed results in relation to association between socioeconomic status and obesity in the country. The current study aimed to examine educational inequalities among adults in Tehran in 2011. Data on 90,435 persons 18 years and older from Urban Health Equity Assessment and Response Tool (Urban HEART-2) were analyzed. The Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were used for assessing educational inequalities in obesity. These measures were quantified using generalized linear models for the binomial family adjusted for sex and age. Subgroup analysis was conducted across sex, age groups and the 22 districts of Tehran. Both SII and RII showed substantial educational inequalities in obesity in favour of more educated adults [RII and SII (95% CI were equal to 2.91 (2.71-3.11) and 0.12 (0.12-0.13)), respectively]. These educational inequalities were persistent even after adjusting for employment, marital status and smoking. Subgroup analysis revealed that educational inequalities were more profound among women. While among men educational inequalities were generally increasing with age, an inverse trend was observed among women. Educational inequalities were observed within all 22 districts of Tehran and generally there were no statistically significant differences between districts. An inverse association between education and obesity was observed in the current study. To decrease educational inequalities in Tehran, priority should be given to younger women and older men. Further analyses are needed to explain these inequalities.

Correction: Educational Inequalities in Obesity among Mexican Women: Time-Trends from 1988 to 2012

Correction: Educational Inequalities in Obesity among Mexican Women: Time-Trends from 1988 to 2012

Educational inequalities in obesity among Mexican women: time-trends from 1988 to 2012.

BackgroundObesity is one of the leading causes of global morbidity and mortality. Trends in educational inequalities in obesity prevalence among Mexican women have not been analysed systematically to date.MethodsData came from four nationally representative surveys (1988, 1999, 2006, and 2012) of a total of 51 220 non-pregnant women aged 20 to 49. Weight and height were measured during home visits. Education level (higher education, high school, secondary, primary or less) was self-reported. We analysed trends in relative and absolute educational inequalities in obesity prevalence separately for urban and rural areas.ResultsNationally, age-standardised obesity prevalence increased from 9.3% to 33.7% over 25 years to 2012. Obesity prevalence was inversely associated with education level in urban areas at all survey waves. In rural areas, obesity prevalence increased markedly but there was no gradient with education level at any survey. The relative index of inequality in urban areas declined over the period (2.87 (95%CI: 1.94, 4.25) in 1988, 1.55 (95%CI: 1.33, 1.80) in 2012, trend p<0.001). Obesity increased 5.92 fold (95%CI: 4.03, 8.70) among urban women with higher education in the period 1988–2012 compared to 3.23 fold (95%CI: 2.88, 3.63) for urban women with primary or no education. The slope index of inequality increased in urban areas from 1988 to 2012. Over 0.5 M cases would be avoided if the obesity prevalence of women with primary or less education was the same as for women with higher education.ConclusionsThe expected inverse association between education and obesity was observed in urban areas of Mexico. The declining trend in relative educational inequalities in obesity was due to a greater increase in obesity prevalence among higher educated women. In rural areas there was no social gradient in the association between education level and obesity across the four surveys.

Educational inequalities in obesity, abdominal obesity, and metabolic syndrome in seven Latin American cities: the CARMELA Study

Earlier reviews have found that the proportion of inverse associations between socioeconomic status and obesity increased according to the level of development of the studied country. Based on this finding, it has been hypothesized that in low- to middle- income countries the burden of obesity shifts to disadvantaged groups as a country develops. CARMELA is a cross-sectional, population-based observational study that sampled 11,550 women and men age 25-64 from seven major Latin American cities. We analyzed by gender the association of educational attainments (as proxy of socioeconomic status) with body mass index, waist circumference and metabolic syndrome. Participating cities were divided by country Human Development Index (HDI). An inverse gradient between socioeconomic status and body mass index in women was uniformly present in High HDI cities (Buenos Aires, Santiago, Mexico) but not in Medium HDI group (Barquisimeto, Bogota, Lima, Quito), where two cities showed an inverse gradient and two cities did not. In men, no clear socioeconomic gradients were found. Findings regarding waist circumference and metabolic syndrome closely mirrored those about body mass index. In women but not men, these results give support to the hypothesis of obesity shifting to the poor and extend it to the related concepts of abdominal obesity and metabolic syndrome. Obesity should be considered as a socially-generated disease and an indicator of socioeconomic disadvantage, to be approached by comprehensive strategies that bear in mind this perspective.

Prevalence of educational inequalities in obesity between 1970 and 2003 in France

This paper examines trends in obesity rates and education-related absolute and relative inequalities in obesity over the last 40 years in France. Data are drawn from the French Decennial Health Surveys of 1970, 1980, 1991 and 2003. The difference in obesity rates between the least- and most-educated, the Slope Index of Inequality, is used to estimate absolute inequalities in obesity. The ratio of the corresponding rates, the Relative Index of Inequality, reveals the relative inequalities in obesity. Obesity rates were similar in men and women, but educational inequalities were greater in women. Obesity rates were similar over the first three surveys but increased for all in the 2003 survey. This increase was accompanied by increases in absolute inequalities in men (P = 0.04) from a Slope Index of Inequality of 4.80% (95% confidence interval [CI] = 2.27, 7.32) to 8.64% (95% CI = 5.97, 11.32) and women (P = 0.004) from 8.90% (95% CI = 6.18, 11.63) to 14.57% (95% CI = 11.83, 17.32). Relative inequalities in obesity remained stable over the 40 years. Recent increase in obesity rates in France is accompanied by increases in absolute education-related inequalities, while relative inequalities have remained stable; this suggests that obesity rates have increased at a much faster rate in the low-education groups.