Inequalities In Overweight Research Articles

Socioeconomic - related inequalities in overweight and obesity: findings from the PERSIAN cohort study

BackgroundOverweight and obesity are major health concerns worldwide, with adverse health consequences during the life span. This study measured socioeconomic inequality in overweight and obesity among Iranian adults.MethodsData were extracted from 129,257 Iranian adults (aged 35 years and older) participated in the Prospective Epidemiologic Research Studies in IrAN (PERSIAN) in 14 provinces of Iran in 2014. Socioeconomic-related inequality in overweight and obesity was estimated using the Concentration Index (Cn). The Cn further decomposed to find factors explaining the variability within the Socioeconomic related inequality in overweight and obesity.ResultsOf the total number of participants, 1.98, 26.82, 40.76 and 30.43% had underweight, normal weight, overweight and obesity respectively. The age-and sex standardized prevalence of obesity was higher in females than males (39.85% vs 18.79%). People with high socioeconomic status (SES) had a 39 and 15% higher chance of being overweight and obese than low SES people, respectively. The positive value of Cn suggested a higher concentration of overweight (0.081, 95% confidence interval [CI]; 0.074–0.087) and obesity (0.027, 95% CI; 0.021–0.034) among groups with high SES. There was a wide variation in socioeconomic-related inequality in overweight and obesity rate across 14 provinces. The decomposition results suggested that SES factor itself explained 66.77 and 89.07% of the observed socioeconomic inequalities in overweight and obesity among Iranian adults respectively. Following SES, province of residence, physical activity, using hookah and smoking were the major contributors to the concentration of overweight and obesity among the rich.ConclusionsOverall, we found that overweight and obesity is concentrated among high SES people in the study population. . Accordingly, it seems that intersectional actions should be taken to control and prevent overweight and obesity among higher socioeconomic groups.

Inequalities in cardiovascular risks among Swedish adolescents (ABIS): a prospective cohort study

ObjectivesTo investigate if socioeconomic status (SES) is predictive of cardiovascular risk factors among Swedish adolescents. Identify the most important SES variable for the development of each cardiovascular risk factor. Investigate...

How does bridging social capital relate to health-behavior, overweight and obesity among low and high educated groups? A cross-sectional analysis of GLOBE-2014

BackgroundSocial capital is an important determinant of health, but how specific sub-dimensions of social capital affect health and health-related behaviors is still unknown. To better understand its role for health inequalities, it is important to distinguish between bonding social capital (connections between homogenous network members; e.g. similar educational level) and bridging social capital (connections between heterogeneous network members). In this study, we test the hypotheses that, 1) among low educational groups, bridging social capital is positively associated with health-behavior, and negatively associated with overweight and obesity, and 2) among high educational groups, bridging social capital is negatively associated with health-behavior, and positively with overweight and obesity.MethodsCross-sectional data on educational level, health-behavior, overweight and obesity from participants (25–75 years; Eindhoven, the Netherlands) of the 2014-survey of the GLOBE study were used (N = 2702). Social capital (“How many of your close friends have the same educational level as you have?”) was dichotomized as: bridging (‘about half’, ‘some’, or ‘none of my friends’), or bonding (‘all’ or ‘most of my friends’). Logistic regression models were used to study whether bridging social capital was related to health-related behaviors (e.g. smoking, food intake, physical activity), overweight and obesity, and whether these associations differed between low and high educational groups.ResultsAmong low educated, having bridging social capital (i.e. friends with a higher educational level) reduced the likelihood to report overweight (OR 0.73, 95% CI 0.52–1.03) and obesity (OR 0.58, 95% CI 0.38–0.88), compared to low educated with bonding social capital. In contrast, among high educated, having bridging social capital (i.e. friends with a lower educational level) increased the likelihood to report daily smoking (OR 2.11, 95% CI 1.37–3.27), no leisure time cycling (OR 1.55, 95% CI 1.17–2.04), not meeting recommendations for vegetable intake (OR 2.09, 95% CI 1.50–2.91), and high meat intake (OR 1.39, 95% CI 1.05–1.83), compared to high educated with bonding social capital.ConclusionsBridging social capital had differential relations with health-behavior among low and high educational groups. Policies aimed at reducing segregation between educational groups may reduce inequalities in overweight, obesity and unhealthy behaviors.

Gender-specific mediators of the association between parental education and adiposity among adolescents: the HEIA study

Identifying the mechanisms behind socioeconomic inequalities in adiposity among youth is vital for efforts aimed at combating these inequalities. The study explored whether a broad range of behavioral and familial factors mediated the associations between parental education and indicators of adiposity among adolescents. Baseline data from a school-based intervention study conducted in 2007 among 11-year-old adolescents were used. Anthropometric outcomes, physical activity and sedentary time among adolescents were objectively measured. Other behavioral variables and parental waist circumference were self-reported. Mediation analyses were conducted. Among boys, maternal waist circumference (WC), paternal WC and TV viewing mediated 16%, 11.5% and 13% of the association between parental education and adolescent WC. The respective proportions when body fat percentage was used as the outcome variable were 22.5%, 16% and 21%. Among girls, maternal and paternal WC mediated 20% and 14% of the association between parental education and WC. The respective proportions when body fat percentage was used as the outcome variable were 14% and 10%. Other included variables did not play any mediating role. Parental WC was found to be a mediator of socioeconomic differences in adiposity in both genders; underlying mechanisms were however not investigated. Among boys, reducing TV time could contribute to the reduction of social inequalities in adiposity.

Socio-Economic, Psychosocial, Lifestyle and Community Factors do not Explain Ethnic Inequalities in Obesity in Disadvantaged Israeli Mothers

AbstractGuided by the psycho-social environment approach to explaining health inequalities, this cross-sectional study aimed to assess the contribution of individual and community factors to explaining ethnic inequalities in overweight and obesity between Arab and Jewish mothers of young children in Israel. Data (N = 946, 371 Jewish, 575 Arab mothers) were collected by self-report questionnaire in mid-2015 as part of a special ‘Preparation for School’ project for children aged 5–6 years from twenty Mother and Child Health clinics in towns and villages of lowest socio-economic ranking in northern Israel. Multinomial logistic regression models were conducted to assess the effect of socio-economic status (SES), psychological, lifestyle behaviour and community food-related practices on mediating the association of ethnicity with overweight and obesity. Overweight and obesity were significantly higher among Arab mothers. The strength of the association of ethnicity with overweight [(odds ratio) OR = 1.80, 95 per cent confidence interval (CI) = 1.31, 2.47] or obesity (OR = 2.14. 95 per cent CI = 1.44, 3.18) remained constant after SES, and other variables were included in two steps. The persistence of ethnic inequalities suggests that the variables included in the analysis did not explain inequalities in this disadvantaged population. Social work may contribute to understanding additional explanatory variables that have the potential to be amenable to change by multidisciplinary and social work interventions.

Growing ethnic disparities in prevalence of overweight and obesity in children 2-15 years in the Netherlands.

Overweight and obesity rates stabilized or declined in the largest ethnic groups in the Netherlands, while reports on thinness are conflicting. Ethnic inequalities in time trends are unknown. The aim of this study was to examine (differences in) trends in overweight (including obesity), obesity, severe obesity and thinness in children of Dutch, Turkish, Moroccan and South Asian descent. A retrospective cross-sectional study based on 135 150 height and weight measurements, taken between 2007 and 2015 in 77 058 children, aged 2-15 years, living in the city of The Hague (the Netherlands). Trends were determined with logistic regression. An interaction term was added to the model to test for effects of ethnicity on time trends. In Dutch children, overweight, obesity and severe obesity rates declined between 2007 and 2015, while overweight remained stable in Turkish, Moroccan and South Asian children. Turkish children showed a decrease in obesity (OR 0.981; 95% confidence interval 0.965-0.998), and Moroccan children in severe obesity (OR 0.918; 95% CI 0.877-0.962). South Asian children had the highest overweight and obesity rates of all ethnic groups (32.7 and 21.5% in 2015, respectively). Thinness rates were generally low and only decreased in South Asian children (0.940; 95% CI 0.886-0.997). Ethnic inequalities in overweight and obesity rates widened since 2007, despite a decline in overweight and/or obesity in most ethnic groups. Ethnic specific interventions are highly needed, especially for South Asian children.

Socioeconomic Inequalities in Overweight and Obesity in Serbia: Data from 2013 National Health Survey.

Socioeconomic Inequalities in Overweight and Obesity in Serbia: Data from 2013 National Health Survey.

Prevalence of Overweight and Income Gaps in 245 Districts of Korea: Comparison Using the National Health Screening Database and the Community Health Survey, 2009-2014.

BackgroundWe compared age-standardized overweight prevalence and their income gaps at the level of district in Korea using the National Health Screening Database (NHSD) and the Community Health Survey (CHS).MethodsWe analyzed 39,093,653 subjects in the NHSD and 926,580 individuals in the CHS between 2009 and 2014. For the comparison of body mass index (BMI) distributions, data from 26,100 subjects in the Korea National Health and Nutrition Examination Survey (KNHANES) were also analyzed. We calculated the age-standardized overweight prevalence and its interquintile income gap at the district level. We examined the magnitudes of the between-period correlation for age-standardized overweight prevalence. The differences in overweight prevalence and its income gap between the NHSD and the CHS were also investigated.ResultsThe age-adjusted mean BMI from the CHS was lower than those from the NHSD and the KNHANES. The magnitudes of the between-period correlation for overweight prevalence were greater in the NHSD compared to the CHS. We found that the district-level overweight prevalence in the NHSD were higher in all districts of Korea than in the CHS. The correlation coefficients for income gaps in overweight prevalence between the two databases were relatively low. In addition, when using the NHSD, the district-level income inequalities in overweight were clearer especially among women than the inequalities using the CHS.ConclusionThe relatively large sample size for each district and measured anthropometric data in the NHSD are more likely to contribute to valid and reliable measurement of overweight inequality at the district level in Korea.

Have health inequalities changed during childhood in the New Labour generation? Findings from the UK Millennium Cohort Study

ObjectivesTo examine how population-level socioeconomic health inequalities developed during childhood, for children born at the turn of the 21st century and who grew up with major initiatives to tackle health...

Alternative measures to BMI: Exploring income-related inequalities in adiposity in Great Britain

Socio-economic inequalities in adiposity are of particular interest themselves but also because they may be associated with inequalities in overall health status. Using cross-sectional representative data from Great Britain (1/2010-3/2012) for 13,138 adults (5652 males and 7486 females) over age 20, we aimed to explore the presence of income-related inequalities in alternative adiposity measures by gender and to identify the underlying factors contributing to these inequalities. For this reason, we employed concentration indexes and regression-based decomposition techniques. To control for non-homogeneity in body composition, we employed a variety of adiposity measures including body fat (absolute and percentage) and central adiposity (waist circumference) in addition to the conventional body mass index (BMI). The body fat measures allowed us to distinguish between the fat- and lean-mass components of BMI. We found that the absence of income-related obesity inequalities for males in the existing literature may be attributed to their focus on BMI-based measures. Pro-rich inequalities were evident for the fat-mass and central adiposity measures for males, while this was not the case for BMI. Irrespective of the adiposity measure applied, pro-rich inequalities were evident for females. The decomposition analysis showed that these inequalities were mainly attributable to subjective financial well-being measures (perceptions of financial strain and material deprivation) and education, with the relative contribution of the former being more evident in females. Our findings have important implications for the measurement of socio-economic inequalities in adiposity and indicate that central adiposity and body composition measures should be included health policy agendas. Psycho-social mechanisms, linked to subjective financial well-being, and education -rather than income itself-are more relevant for tackling inequalities.

Gender inequalities in excess adiposity and anaemia combine in a large double burden of malnutrition gap detrimental to women in an urban area in North Africa.

The nutrition transition has exacerbated the gender gap in health in the Middle East and North Africa region as the increase in excess adiposity has been much higher among women than men. This is not exclusive of the persistence of anaemia, generally also more prevalent among women. We assessed the magnitude and sociodemographic factors associated with gender inequality vis-à-vis the double burden of excess adiposity and anaemia. Cross-sectional study, stratified two-stage cluster sample. BMI (=weight/height2) ≥25·0 kg/m2 defined overweight and BMI≥30·0 kg/m2 obesity. Anaemia was defined as Hb <120 g/l for women, <130 g/l for men. Gender inequalities vis-à-vis the within-subject coexistence of excess adiposity and anaemia were assessed by women v. men relative prevalence ratios (RPR). Their variation with sociodemographic characteristics used models including gender × covariate interactions. Greater Tunis area in 2009-2010. Adults aged 20-49 years (women, n 1689; men, n 930). Gender inequalities in excess adiposity were high (e.g. overweight: women 64·9 % v. men 48·4 %; RPR=2·1; 95 % CI 1·6, 2·7) and much higher for anaemia (women 38·0 % v. men 7·2 %; RPR=8·2; 95 % CI 5·5, 12·4). They were striking for overweight and anaemia (women 24·1 % v. men 3·4 %; RPR=16·2; 95 % CI 10·3, 25·4). Gender inequalities in overweight adjusted for covariates increased with age but decreased with professional activity and household wealth score; gender inequality in anaemia or overweight and anaemia was more uniformly distributed. Women were much more at risk than men, from both over- and undernutrition perspectives. Both the underlying gender-related and sex-linked biological determinants of this remarkable double burden of malnutrition inequality must be addressed to promote gender equity in health.

Socio-demographic inequalities in overweight and obesity among Lithuanian adults: time trends from 1994 to 2014.

The aim was to examine trends in socio-demographic differences in the prevalence of overweight and obesity among the Lithuanian adult population from 1994 to 2014. The data from 11 postal surveys were analysed. For every survey, a nationally representative random sample aged 20-64 was drawn from the National Population Register. The sample consisted of 3000 individuals in each of the 1994-2008 surveys and 4000 in the last three surveys. Altogether, 8738 men and 11,822 women participated in the surveys. Self-reported weight and height were used to calculate BMI. From 1994 to 2014, the prevalence of overweight and obesity increased in all socio-demographic groups of men, reaching 58.6% and 19.5% respectively. Highly educated men and those living in cities had higher BMI values than lower educated and non-urban inhabitants without substantial changes in the differences in BMI over the study period. In women, the prevalence of overweight decreased from 51.7% to 46%, whereas the prevalence of obesity did not change being 19.2% in 2014. Overweight and obesity were more common among lower educated women and those living in non-urban areas than in the others. Educational inequalities in weight status of women increased due to the decrease of BMI only in women with university education. CONCLUSIONS TIME TRENDS IN BMI WERE MORE PRONOUNCED AMONG LITHUANIAN MEN THAN WOMEN, WHEREAS SOCIO-DEMOGRAPHIC INEQUALITIES WERE GREATER AMONG WOMEN THE STRATEGIES FOR PREVENTION AND CONTROL OF OBESITY SHOULD TARGET ALL MEN AND WOMEN WITH LOWER EDUCATION AND LIVING IN NON-URBAN AREAS OF LITHUANIA.

Ethnic Inequalities in Overweight and Obesity Prevalence among Copenhagen Schoolchildren from 2002 to 2007

Background: The stabilization in levels of childhood overweight has masked increasing gaps among different ethnic and socioeconomic groups in several countries. Objective: To examine if levels and trends in childhood overweight and obesity differed by ethnicity and socioeconomic areas in Copenhagen schoolchildren. Methods: From measured heights and weights of 32,951 children 5-8 and 14-16 years of age, the prevalence of overweight (including obesity) and obesity were estimated using International Obesity Task Force criteria. Differences in prevalence levels and trends across six school years by ethnicity and socioeconomic areas were examined using logistic regression. Results: The prevalence of overweight significantly decreased from 2002 to 2007 among the youngest Western girls and boys, showed no significant changes among the oldest non-Western girls and increased among the oldest non-Western boys. In all years, the youngest non-Western children had significantly higher levels of overweight than Western children. Although the prevalence of overweight tended to be higher in low socioeconomic areas as compared with high socioeconomic areas, few differences were statistically significant. Consistent trends in overweight across the years by socioeconomic area were not observed. Conclusion: Ethnic and social inequalities exist in childhood overweight among Copenhagen schoolchildren; thus appropriate interventions targeting high-risk groups are needed

Trends in child and adolescent obesity prevalence in economically advanced countries according to socioeconomic position: a systematic review.

Recent obesity trends in children and adolescents suggest a plateau. However, it is unclear whether such trends have been experienced across socioeconomic groups. We analysed whether recent trends in child and adolescent overweight and obesity differ by socioeconomic position (SEP) across economically advanced countries. Eligible studies reported overweight and obesity prevalence in children and/or adolescents (2-18 years), for at least two time points since 1990, stratified by SEP. Socioeconomic differences in trends in child and adolescent overweight and obesity over time were analysed. Differences in trends between SEP groups were observed across a majority of studies. Over half the studies indicated increasing prevalence among low SEP children and adolescents compared to a third of studies among children and adolescents with a high SEP. Around half the studies indicated widening socioeconomic inequalities in overweight and obesity. Since 2000 a majority of studies demonstrated no change or a decrease in prevalence among both high and low SEP groups. However around 40% of studies indicated widening of socioeconomic inequalities post-2000. While our study provides grounds for optimism, socioeconomic inequalities in overweight and obesity continue to widen. These findings highlight the need for greater consideration of different population groups when implementing obesity interventions.

Why are poorer children at higher risk of obesity and overweight? A UK cohort study.

Background: There is limited evidence on which risk factors attenuate income inequalities in child overweight and obesity; whether and why these inequalities widen as children age. Method: Eleven thousand nine hundred and sixty five singletons had complete data at age 5 and 9384 at age 11 from the Millennium Cohort Study (UK). Overweight (age 5 : 15%; age 11 : 20%) and obesity (age 5 : 5%; age 11 : 6%) were defined using the International Obesity Taskforce body mass index cut-points. To measure socioeconomic inequalities, we used quintiles of family income and as risk factors, we considered markers of maternal health behaviours and of children’s physical activity, sedentary behaviours and diet. Binary and multinomial logistic regression models were used. Results: The unadjusted analyses revealed stark income inequalities in the risk of obesity at age 5 and 11. At age 5, children in the bottom income quintile had 2.0 (95% CI: 1.4–2.8) increased relative risk of being obese whilst at age 11 they had 3.0 (95% CI: 2.0–4.5) increased risk compared to children in the top income quintile. Similar income inequalities in the risk of overweight emerged by age 11. Physical activity and diet were particularly important in explaining inequalities. Income inequalities in obesity and overweight widened significantly between age 5 and 11 and a similar set of risk factors protected against upward and promoted downward movements across weight categories. Conclusions: To reduce income inequalities in overweight and obesity and their widening across childhood the results support the need of early interventions which take account of multiple risk factors.

Inequities in energy-balance related behaviours and family environmental determinants in European children: baseline results of the prospective EPHE evaluation study.

BackgroundTackling inequalities in overweight, obesity and related determinants has become a top priority for the European research and policy agendas. Although it has been established that such inequalities accumulate from early childhood onward, they have not been studied extensively in children. The current article discusses the results of an explorative analysis for the identification of inequalities in behaviours and their determinants between groups with high and low socio-economic status.MethodsThis study is part of the Epode for the Promotion of Health Equity (EPHE) evaluation study, the overall aim of which is to assess the impact and sustainability of EPODE methodology to diminish inequalities in childhood obesity and overweight. Seven community-based programmes from different European countries (Belgium, Bulgaria, France, Greece, Portugal, Romania, The Netherlands) participate in the EPHE study. In each of the communities, children aged 6–8 years participated, resulting in a total sample of 1266 children and their families. A parental self-administrated questionnaire was disseminated in order to assess the socio-economic status of the household, selected energy balance-related behaviours (1. fruit and vegetable consumption; 2. soft drink/ fruit juices and water consumption; 3. screen time and 4. sleep duration) of the children and associated family environmental determinants. The Mann–Whitney U test and Pearson’s chi-square test were used to test differences between the low and high education groups. The country-specific median was chosen as the cut-off point to determine the educational level, given the different average educational level in every country.ResultsChildren with mothers of relatively high educational level consumed fruits and vegetables more frequently than their peers of low socio-economic status. The latter group of children had a higher intake of fruit juices and/or soft drinks and had higher screen time. Parental rules and home availability were consistently different between the two socio-economic groups in our study in all countries. However we did not find a common pattern for all behaviours and the variability across the countries was large.ConclusionsOur findings are indicative of socio-economic inequalities in our samples, although the variability across the countries was large. The effectiveness of interventions aimed at chancing parental rules and behaviour on health inequalities should be studied.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2540-5) contains supplementary material, which is available to authorized users.

Fast-food outlets and grocery stores near school and adolescents' eating habits and overweight in Finland.

Environmental factors may affect adolescents' eating habits and thereby body weight. However, the contribution of school neighbourhood environment is poorly understood. This study examined the association between proximity of a fast-food outlet or grocery store to school and adolescents' eating habits and overweight. Participants were 23 182 adolescents (mean age 15 years) who responded to a classroom survey in 181 lower secondary schools in Finland (2008-09). School location was linked to data on distance from school to the nearest fast-food outlet or grocery store (≤100 m, 101-500 m, >500 m) using global positioning system-coordinate databases. Outcomes were irregular eating habits (skipping breakfast, skipping free school lunch, skipping free school-provided snacks and not having family dinners), the accumulation of these habits and overweight, including obesity (body mass index ≥ 25 kg/m(2)). Thirteen percentage of the participants were overweight. Having a fast-food outlet or grocery store near school was associated with skipping often breakfast and free school lunch, and the accumulation of irregular eating habits. The proximity of a fast-food outlet or grocery store was associated with a 1.25-fold (95% confidence interval 1.03-1.52) risk of overweight among adolescent with a low socioeconomic status but not among those with higher socioeconomic status. This association was partly (12%) explained by the accumulation of irregular eating habits. Among adolescents from low socioeconomic background, the presence of fast-food retailers near schools is associated with accumulation of irregular eating habits and greater overweight. These findings suggest that obesogenic school neighbourhoods may contribute to social inequalities in overweight.

Trends in overweight and obesity in Danish children and adolescents: 2000-2008 – exploring changes according to parental education

To examine the hypotheses that an overall levelling off in the prevalence of overweight and obesity during the period 2000-2008 has occurred, and that increasing social inequality in overweight and obesity exists in a nationally representative sample of Danish children and adolescents. The population comprised a random sample of 1849 children aged 4-14 years who participated in the Danish National Survey of Diet and Physical Activity in 2000-2002, 2003-2004 and 2005-2008. Parental education was chosen as an indicator of children's socioeconomic status. Body mass index (BMI) was calculated from parent-reported weight and height. Subjects were classified as overweight and obese according to the International Obesity Task Force age- and gender-specific BMI cut-off values. Crude prevalence estimates and logistic regression models were used to analyse trends in overweight and obesity as the main outcome measures. An increase was found in the crude prevalence of overweight (including obesity) in boys (12.8-21.7%, p = 0.0006), but not in girls (17.6-15.9%, p = 0.56), between 2000-2002 and 2005-2008. The prevalence of overweight increased significantly in boys of parents with low educational level only. A strong inverse social gradient in overweight and obesity was documented for boys and girls during the whole survey period. The present study showed an increase in the prevalence of overweight in Danish boys, but not in girls. This increase was due to increasing social inequality in overweight among boys. Public health initiatives aimed at preventing and reducing overweight and obesity should consider gender difference and especially target boys with parents of low educational level.

Differences in adiposity trajectories by birth cohort and childhood social class: evidence from cohorts born in the 1930s, 1950s and 1970s in the west of Scotland

BackgroundSince the 1930s, the environment has become increasingly obesogenic, leading to rising rates of adiposity and socioeconomic inequalities in adiposity. Building on studies comparing body mass index (BMI) for cohorts...

Social Inequalities in Obesity Persist in the Nordic Region Despite Its Relative Affluence and Equity

Social inequalities in overweight and obesity (OWOB) have persisted in the affluent and reputedly egalitarian Nordic countries. In this review we examine associations between socioeconomic position (SEP) and OWOB, and secular trends in such associations. Determinants and possible causes of the relations are discussed together with opportunities to cope with OWOB as a public health problem. The findings show a persisting inverse social gradient. An interaction between SEP and gender is noted for adults in Denmark, Finland and Iceland and for children in Sweden. There are overall tendencies for increased inequality, however no consistent trend for an increased social gradient in OWOB. Reasons that increased inequality does not unequivocally mirror in a steepened social gradient in obesity may include methodological questions as well as societal efforts to counteract obesity. Multi-level efforts are needed to prevent OWOB.