Social class differences in years of potential life lost: size, trends, and principal causes.
Blane D,Smith G D,Bartley M
BMJ (Clinical research ed.)
British social class differences in mortality are examined in terms of years of potential life lost, a measure that gives more weight to deaths that take place at younger ages. It shows wider class differences during the years of working life than those found when mortality is expressed in terms of standardised mortality ratios. Examination of the change in class differences between 1971 and 1981 for all causes of death combined and for the three categories of death which during these ages make a major contribution to total years of potential life lost shows complex changes. Inequalities in years of potential life lost have increased between 1971 and 1981, during which all the principal causes of death have shown stationary or rising rates among the manual classes. The use of years of potential life lost as a measure of population health trends focuses attention on the major contribution of violent death, which occurs mainly in younger men, to widening class differences in mortality.
Social inequalities and health status in western Germany.
Helmert U,Shea S
STUDY OBJECTIVE:To examine social class gradients for seven self-reported diseases in western Germany. DESIGN:A pooled analysis of three cross-sectional representative health surveys in western Germany and three health surveys in the six intervention regions of the German Cardiovascular Prevention Study. PARTICIPANTS:44,363 study subjects, of both sexes, with German nationality, aged 25-69 years, were examined in the national and regional health surveys from 1984 to 1991. MEASUREMENT AND MAIN RESULTS:Assessment of disease prevalence was carried out by a standardized self-administered questionnaire. Social class was assessed using a composite index combining educational achievement, occupational status and household income. Cigarette smoking and Pattern A behaviour were based on self-report. Height and weight were measured by physical examination and body mass index was calculated. Statistical analysis were performed using multiple logistical regression. Response rates ranged from 66.0 to 71.4% in the national surveys and from 65.9 to 83.8% in the regional surveys. For both sexes, the prevalence of previous myocardial infarction and the prevalence of stroke, diabetes mellitus and chronic bronchitis was significantly higher in the lower social classes. In males only, the prevalence of intervertebral disc damage and peptic ulcer was significantly higher in the lower social classes. In females only, there was a similar gradient for hyperuricaemia and gout. In both sexes, allergies and hay fever were the only diseases with higher prevalence in the higher social classes. Adjusting these trends for smoking, obesity and Pattern A behaviour resulted in only minor changes in the slopes of the disease-specific social class gradients. CONCLUSION:In western Germany, despite a health system with almost free access for the general population, strong social class inequalities exist for many diseases. These inequalities cannot be explained by social class differences in smoking, obesity or Pattern A behaviour. More research is needed to identify underlying causes for these persistent social inequalities in health status.
Socioeconomic differences in weight gain and determinants and consequences of coronary risk factors.
Martikainen P T,Marmot M G
The American journal of clinical nutrition
BACKGROUND:The increasing prevalence of overweight and obesity is a major public health concern in many developed countries. OBJECTIVE:We aimed to describe socioeconomic differences in change in body mass index (BMI; in kg/m2) from age 25 y, assess possible factors behind these differences, and study whether socioeconomic differences in a variety of coronary risk factors can be accounted for by change in BMI. DESIGN:The data come from a cohort study of London-based civil servants (Whitehall II), who participated in the first (1985-1988) and third (1991-1993) phases of the study and were 35-55-y old at phase 1: altogether there were 5507 men and 2466 women. Both study phases included a questionnaire and a screening examination. RESULTS:In men and women, employment grade--the measure of socioeconomic status used in this cohort--was strongly related to BMI gain from age 25 y to phase 3 (25 y apart on average). The lower the grade the larger the gain in BMI. Adjustment for health behaviors reduced the grade differences in BMI gain by approximately 20%. A substantial part of the grade differences in diastolic and systolic blood pressure and plasma triacylglycerol concentrations could be accounted for by BMI change from age 25 y. CONCLUSIONS:Grade differences in BMI change are evident, but many of the determinants of these differences remain unknown. If lower-status persons continue to gain weight more rapidly than higher-status persons, overweight is likely to be of growing importance as a pathway to social inequalities in ill health.
Educational disparities in the metabolic syndrome in a rapidly changing society--the case of South Korea.
Kim Myoung-Hee,Kim Mi-Kyung,Choi Bo Youl,Shin Young-Jeon
International journal of epidemiology
BACKGROUND:Most of the evidence about socioeconomic inequalities in the metabolic syndrome comes from Western industrialized societies. The aim of this study is to examine how the inequalities appear and what could explain them in Korea, a rapidly changing society. METHODS:We analysed the nationwide survey data of 1998 and 2001 with a sample of 4630 men and 5896 women (> or = 25 years). The subjects were grouped into four birth cohorts based on the historical context: born before 1946, 1946-53, 1954-62, and since 1963. Socioeconomic position was defined by education level: high school graduation or above as the more educated group, and below that as the less educated one. The syndrome was defined according to ATP III criteria using abdominal obesity for Asians. The covariates included family history of diabetes, smoking, drinking, daily physical activity, regular exercise, suicidal ideation, weight change, and carbohydrates intake. The associations were examined by stratified logistic regression models across cohorts and gender. RESULTS:Less-educated women had higher prevalence with widening gaps across successive cohorts; the age-adjusted odds ratios of the less-educated group were 1.22 (0.86-1.71), 1.41 (1.01-1.97), 2.50 (1.87-3.35), and 2.64 (1.69-4.14). They hardly changed after covariate adjustment, and remained significant with considerable attenuation after controlling body mass index. However, educational disparities were not observed in men. CONCLUSIONS:We could observe the complex pattern of disparities in the metabolic syndrome across cohorts and gender. An equity-sensitive health promotion programme to prevent further spread of social inequalities may have beneficial effects on the metabolic syndrome and its components in Korea.
Preschool children's health and its association with parental education and individual living conditions in East and West Germany.
du Prel Xianming,Krämer Ursula,Behrendt Heidrun,Ring Johannes,Oppermann Hanna,Schikowski Tamara,Ranft Ulrich
BMC public health
BACKGROUND:Social inequalities in health exist globally and are a major public health concern. This study focus on a systematic investigation into the associations between health indicators, living conditions and parental educational level as indicator of the social status of 6-year-old children living in West and East Germany in the decade after re-unification. Explanations of observed associations between parental education and health indicators were examined. METHODS:All boys and girls entering elementary school and living in predefined areas of East and West Germany were invited to participate in a series of cross-sectional surveys conducted between 1991 and 2000. Data of 28,888 German children with information on parental education were included in the analysis. Information about educational level of the parents, individual living conditions, symptoms and diagnoses of infectious diseases and allergies were taken from questionnaire. At the day of investigation, atopic eczema was diagnosed by dermatologists, blood was taken for the determination of allergen-specific immuno-globulin E, height and weight was measured and lung function tests were done in subgroups. Regression analysis was applied to investigate the associations between the health indicators and parental educational level as well as the child's living conditions. Gender, urban/rural residency and year of survey were used to control for confounding. RESULTS:Average response was 83% in East Germany and 71% in West Germany. Strong associations between health indicators and parental education were observed. Higher educated parents reported more diagnoses and symptoms than less educated. Children of higher educated parents were also more often sensitized against grass pollen or house dust mites, but had higher birth weights, lower airway resistance and were less overweight at the age of six. Furthermore, most of the health indicators were significantly associated with one or more living conditions such as living as a single child, unfavourable indoor air, damp housing condition, maternal smoking during pregnancy or living near a busy road. The total lung capacity and the prevalence of an atopic eczema at the day of investigation were the only health indicators those did not show associations with any of the predictor variables. CONCLUSION:Despite large differences in living conditions and evidence that some poor health outcomes were directly associated with poor living conditions, only few indicators demonstrated poorer health in social disadvantaged children. These were in both parts of Germany increased levels of overweight, higher airway resistance and, in East Germany only, reduced height in children with lower educated parents compared to those of higher education. In both East and West Germany, higher prevalence of airway symptoms was associated with a damp housing condition, and lower birth weight, reduced height and increased airway resistance at the age of six were associated with maternal smoking during pregnancy. The latter explained to a large extent the difference in birth weight and airway resistance between the educational groups.
Socioeconomic position at different stages of the life course and its influence on body weight and weight gain in adulthood: a longitudinal study with 13-year follow-up.
Giskes Katrina,van Lenthe Frank J,Turrell Gavin,Kamphuis Carlijn B M,Brug Johannes,Mackenbach Johan P
Obesity (Silver Spring, Md.)
Socioeconomic inequalities in body weight have been demonstrated in numerous cross-sectional studies; however, little research has investigated these inequalities from a life course and longitudinal perspective. We examined the association between child- and adulthood socioeconomic position (SEP) and BMI and overweight/obesity in 1991 (baseline) and changes in BMI and the prevalence of overweight and obesity between 1991 and 2004. Data from the 1991 and 2004 waves of the longitudinal Dutch GLOBE study were used. Participants (n = 1,465) were aged 40-60 years at baseline. BMI was calculated from self-reported height and weight collected by postal questionnaire. Retrospective recall of father's occupation was used as childhood socioeconomic indicator, and adulthood SEP was measured by the occupation of the main income earner of the household. The findings showed that among women, childhood SEP exerted a greater influence on body weight than SEP in adulthood: at baseline, women from disadvantaged backgrounds in childhood had a higher BMI and were more likely to be overweight or obese, and they gained significantly more weight between baseline and follow-up. In contrast, adult SEP had a greater impact than childhood circumstances on men's body weight: those from disadvantaged households had a higher mean BMI and were more likely to be overweight or obese at baseline, and they gained significantly more weight between 1991 and 2004. The findings suggest that exposure to disadvantaged circumstances at critically important periods of the life course is associated with body weight and weight gain in adulthood. Importantly, these etiologically relevant periods differ for men and women, suggesting gender-specific pathways to socioeconomic inequalities in body weight in adulthood.
A national study of the association between neighbourhood access to fast-food outlets and the diet and weight of local residents.
Pearce Jamie,Hiscock Rosemary,Blakely Tony,Witten Karen
Health & place
Differential locational access to fast-food retailing between neighbourhoods of varying socioeconomic status has been suggested as a contextual explanation for the social distribution of diet-related mortality and morbidity. This New Zealand study examines whether neighbourhood access to fast-food outlets is associated with individual diet-related health outcomes. Travel distances to the closest fast-food outlet (multinational and locally operated) were calculated for all neighbourhoods and appended to a national health survey. Residents in neighbourhoods with the furthest access to a multinational fast-food outlet were more likely to eat the recommended intake of vegetables but also be overweight. There was no association with fruit consumption. Access to locally operated fast-food outlets was not associated with the consumption of the recommended fruit and vegetables or being overweight. Better neighbourhood access to fast-food retailing is unlikely to be a key contextual driver for inequalities in diet-related health outcomes in New Zealand.
Employment trajectory as determinant of change in health-related lifestyle: the prospective HeSSup study.
Virtanen Pekka,Vahtera Jussi,Broms Ulla,Sillanmäki Lauri,Kivimäki Mika,Koskenvuo Markku
European journal of public health
BACKGROUND:Changes in employment status may be associated with changes in health-related lifestyle, but population level research of such associations is very limited. This study aimed to determine associations between lifestyle and five employment trajectories, i.e. 'stable', 'unstable', 'upward' 'downward' and 'chronic unemployment'. METHODS:A cohort of 10,100 employees was followed up for 5 years. Associations of the employment trajectories with changes in smoking, alcohol drinking, body weight, physical activity and sleep duration were assessed with analysis of variance for repeated measures and pairwise post hoc comparisons. RESULTS:Smoking was the only lifestyle component that was not associated with employment trajectory. In both genders, sleep duration decreased during chronic unemployment and among those on a downward employment trajectory. In men, alcohol consumption also increased in these two groups and body weight increased in the latter group. In women, physical activity decreased among those on a downward trajectory. In contrast, an upward labour market trajectory was associated with healthy or no changes in lifestyle both in men and women. CONCLUSION:Changes in lifestyle may contribute to development of the health gradients between the employed and unemployed, whereas unstable employment versus permanent employment does not incur risk of unhealthy lifestyle changes. In order to prevent widening of employment-related health inequalities, passages into employment should be facilitated and opportunities for health promotion should be improved among those trapped in or moving towards the labour market periphery.
Body weight and health from early to mid-adulthood: a longitudinal analysis.
Zajacova Anna,Burgard Sarah A
Journal of health and social behavior
We analyze the influence of body weight in early adulthood, and changes in weight over time, on self-rated health as people age into middle adulthood. While prior research has focused on cross-sectional samples of older adults, we use longitudinal data from the NHANES I Epidemiologic Follow-up Study and double-trajectory latent growth models to study the association between body mass index (BMI) and self-rated health trajectories over 20 years. Results indicate that high BMI in early adulthood and gaining more weight over time are both associated with a faster decline in health ratings. Among white women only, those with a higher BMI at the baseline also report lower initial self-rated health. A small part of the weight-health association is due to sociodemographic factors, but not baseline health behaviors or medical conditions. The findings provide new support for the cumulative disadvantage perspective, documenting the increasing health inequalities in a cohort of young adults.
Prevalence of obesity in Switzerland 1992-2007: the impact of education, income and occupational class.
Faeh D,Braun J,Bopp M
Obesity reviews : an official journal of the International Association for the Study of Obesity
Prevalence of excess weight varies substantially by socioeconomic position (SEP). SEP can be defined with different indicators. The strength of the association of SEP with excess weight differs by SEP indicator, between populations and over time. We examined the prevalence of overweight and obesity (body mass index 25-29.9 and ≥30 kg m(-2) ) in Switzerland by educational level, household income tertile and occupational class (three categories for each indicator). Self-reported data stem from four cross-sectional population surveys including 53 588 persons aged between 25 and 74 years. The overall prevalence of overweight increased between 1992 and 2007 from 37.4% to 41.4% in men and from 18.8% to 21.9% in women. Obesity prevalence increased from 7.2% to 9.7% in men and from 5.4% to 8.6% in women. Inequalities were calculated with multivariable logistic regression. Inequalities were larger in women than in men and for obesity than for overweight. However, overweight and obesity inequalities did not significantly change over time, despite overall increasing prevalence. Although all SEP indicators were independently associated with excess weight, the association was strongest with education, particularly in women. Programmes and policies aimed at preventing excess weight should target individuals with low education early in life.
Socioeconomic position and effectiveness of lifestyle intervention in prevention of type 2 diabetes: one-year follow-up of the FIN-D2D project.
Rautio Nina,Jokelainen Jari,Oksa Heikki,Saaristo Timo,Peltonen Markku,Niskanen Leo,Puolijoki Hannu,Vanhala Mauno,Uusitupa Matti,Keinänen-Kiukaanniemi Sirkka,
Scandinavian journal of public health
AIMS:Lifestyle intervention is effective in prevention of type 2 diabetes (T2D) in high-risk individuals. However, health behaviour and health outcomes are modified by socioeconomic position through various mechanisms. It is therefore possible that success in lifestyle intervention may be determined by factors such as level of education or occupation. In this study we assessed the impact of the level of education and occupation on the baseline anthropometric and clinical characteristics and their changes during a one-year follow-up in a cohort of Finnish men and women at high risk for T2D aged 20-64 years. METHODS:As part of a Finnish national diabetes prevention programme 2003-2007 (FIN-D2D), high-risk individuals were identified using opportunistic screening for lifestyle intervention in primary health care. 1,067 men and 2,122 women had one-year follow-up data. Education and occupation were used as factors of socioeconomic position. Measures of anthropometric and clinical characteristics included weight, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, total, HDL and LDL cholesterol, triglycerides, FINDRISC scores and glucose tolerance status. RESULTS:The effect of intervention was similar in all socioeconomic groups, but the level of education was related to glucose tolerance status in both genders. In addition, socioeconomic differences existed in blood pressure, weight, BMI, waist circumference and HDL cholesterol. CONCLUSIONS:Socioeconomic position did not seem to have any impact on the effectiveness of lifestyle intervention in individuals at high risk for T2D, which is encouraging from the point of view of reducing health inequalities.
Perceived weight status may contribute to education inequalities in five-year weight change among mid-aged women.
Siu Jessica,Giskes Katrina,Shaw Jonathan,Turrell Gavin
Australian and New Zealand journal of public health
OBJECTIVES:To examine education differences in five-year weight change among mid-aged adults, and to ascertain if this may be due to socioeconomic differences in perceived weight status or weight control behaviours (WCBs). METHODS:Data were used from the Australian Diabetes, Obesity and Lifestyle Study. Mid-aged men and women with measured weights at both baseline (1999-2000) and follow-up (2004-2005) were included. Percent weight change over the five-year interval was calculated and perceived weight status, WCBs and highest attained education were collected at baseline. RESULTS:Low-educated men and women were more likely to be obese at baseline compared to their high-educated counterparts. Women with a certificate-level education had a greater five-year weight gain than those with a bachelor degree or higher. Perceived weight status or WCBs did not differ by education among men and women, however participants that perceived themselves as very overweight had less weight gain than those perceiving themselves as underweight or normal weight. WCBs were not associated with five-year weight change. CONCLUSIONS AND IMPLICATIONS:The higher prevalence of overweight/obesity among low-educated women may be a consequence of greater weight gain in mid-adulthood. Education inequalities in overweight/obesity among men and women made be due (in part) to overweight or obese individuals in low-educated groups not perceiving themselves as having a weight problem.
Projected socioeconomic disparities in the prevalence of obesity among Australian adults.
Backholer Kathryn,Mannan Haider R,Magliano Dianna J,Walls Helen L,Stevenson Chris,Beauchamp Alison,Shaw Jonathan E,Peeters Anna
Australian and New Zealand journal of public health
OBJECTIVE:To project prevalence of normal weight, overweight and obesity by educational attainment, assuming a continuation of the observed individual weight change in the 5-year follow-up of the national population survey, the Australian Diabetes, Obesity and Lifestyle study (AusDiab; 2000-2005). METHODS:Age-specific transition probabilities between BMI categories, estimated using logistic regression, were entered into education-level-specific, incidence-based, multi-state life tables. Assuming a continuation of the weight change observed in AusDiab, these life tables estimate the prevalence of normal weight, overweight and obesity for Australian adults with low (secondary), medium (diploma) and high (degree) levels of education between 2005 and 2025. RESULTS:The prevalence of obesity among individuals with secondary level educational attainment is estimated to increase from 23% in 2000 to 44% in 2025. Among individuals with a degree qualification or higher, it will increase from 14% to 30%. If all current educational inequalities in weight change could be eliminated, the projected difference in the prevalence of obesity by 2025 between the highest and lowest educated categories would only be reduced by half (to a 6 percentage point difference from 14 percentage points). CONCLUSION:We predict that almost half of Australian adults with low educational status will be obese by 2025. Current trends in obesity have the potential to drive an increase in the absolute difference in obesity prevalence between educational categories in future years. IMPLICATIONS:Unless obesity prevention and management strategies focus specifically on narrowing social inequalities in obesity, inequalities in health are likely to widen.
Occupational class differences in body mass index and weight gain in Japan and Finland.
Silventoinen Karri,Tatsuse Takashi,Martikainen Pekka,Rahkonen Ossi,Lahelma Eero,Sekine Michikazu,Lallukka Tea
Journal of epidemiology
BACKGROUND:Occupational class differences in body mass index (BMI) have been systematically reported in developed countries, but the studies have mainly focused on white populations consuming a Westernized diet. We compared occupational class differences in BMI and BMI change in Japan and Finland. METHODS:The baseline surveys were conducted during 1998-1999 among Japanese (n = 4080) and during 2000-2002 among Finnish (n = 8685) public-sector employees. Follow-up surveys were conducted among those still employed, in 2003 (n = 3213) and 2007 (n = 7086), respectively. Occupational class and various explanatory factors were surveyed in the baseline questionnaires. Linear regression models were used for data analysis. RESULTS:BMI was higher at baseline and BMI gain was more rapid in Finland than in Japan. In Finland, baseline BMI was lowest among men and women in the highest occupational class and progressively increased to the lowest occupational class; no gradient was found in Japan (country interaction effect, P = 0.020 for men and P < 0.0001 for women). Adjustment for confounding factors reflecting work conditions and health behavior increased the occupational class gradient among Finnish men and women, whereas factors related to social life had no effect. No statistically significant difference in BMI gain was found between occupational classes. CONCLUSIONS:The occupational class gradient in BMI was strong among Finnish employees but absent among Japanese employees. This suggests that occupational class inequalities in obesity are not inevitable, even in high-income societies.
A systematic review of the effectiveness of individual, community and societal-level interventions at reducing socio-economic inequalities in obesity among adults.
Hillier-Brown F C,Bambra C L,Cairns J-M,Kasim A,Moore H J,Summerbell C D
International journal of obesity (2005)
BACKGROUND:Socioeconomic inequalities in obesity are well established in high-income countries. There is a lack of evidence of the types of intervention that are effective in reducing these inequalities among adults. OBJECTIVES:To systematically review studies of the effectiveness of individual, community and societal interventions in reducing socio-economic inequalities in obesity among adults. METHODS:Nine electronic databases were searched from start date to October 2012 along with website and grey literature searches. The review examined the best available international evidence (both experimental and observational) of interventions at an individual, community and societal level that might reduce inequalities in obesity among adults (aged 18 years or over) in any setting and country. Studies were included if they reported a body fatness-related outcome and if they included a measure of socio-economic status. Data extraction and quality appraisal were conducted using established mechanisms and narrative synthesis was conducted. RESULTS:The 'best available' international evidence was provided by 20 studies. At the individual level, there was evidence of the effectiveness of primary care delivered tailored weight loss programmes among deprived groups. Community based behavioural weight loss interventions and community diet clubs (including workplace ones) also had some evidence of effectiveness-at least in the short term. Societal level evaluations were few, low quality and inconclusive. Further, there was little evidence of long term effectiveness, and few studies of men or outside the USA. However, there was no evidence to suggest that interventions increase inequalities. CONCLUSIONS:The best available international evidence suggests that some individual and community-based interventions may be effective in reducing socio-economic inequalities in obesity among adults in the short term. Further research is required particularly of more complex, multi-faceted and societal-level interventions.
Increasing health inequalities between women in and out of work--the impact of recession or policy change? A repeated cross-sectional study in Stockholm county, 2006 and 2010.
Blomqvist Sandra,Burström Bo,Backhans Mona C
International journal for equity in health
INTRODUCTION:The social insurance system in Sweden underwent extensive change between 2006 and 2010, with the overall aim of making people enter the labour market. At the same time, economic recession hit Sweden. Previous studies suggest that the economic recession particularly affected women. In light of these changes, the aim of this study is to investigate whether health inequalities between employed women and groups outside the labour market changed between 2006 and 2010. A second aim is to examine the explanatory weight of socio-demographic factors vs social and economic conditions. METHODS:Data consists of the Stockholm Public Health Surveys (SPHS) for 2006 and 2010. Women aged 18-64 were studied. Through logistic regression, levels of mental distress and limiting longstanding illness (LLI), were compared between four labour market groups; employed and unemployed, sickness absentees and disability pension recipients, at the two time points. RESULTS:Mental distress increased among women in all four labour market groups between 2006 and 2010. Differences in mental distress between those employed and groups outside the labour market also increased. These were explained primarily by social and economic conditions. Levels of LLI were unchanged except among the unemployed. The difference in LLI between the unemployed and the employed was mostly explained by social and economic conditions. In the other groups socio-demographic factors were more salient. For both health outcomes, the weight of social and economic conditions had increased in 2010 compared to 2006. CONCLUSIONS:Results indicate that levels of mental distress increased in all groups, but more so among groups outside the labour market, possibly due to stricter eligibility criteria and lower benefit levels, which particularly affected their social and economic conditions.
Diet And Perceptions Change With Supermarket Introduction In A Food Desert, But Not Because Of Supermarket Use.
Dubowitz Tamara,Ghosh-Dastidar Madhumita,Cohen Deborah A,Beckman Robin,Steiner Elizabeth D,Hunter Gerald P,Flórez Karen R,Huang Christina,Vaughan Christine A,Sloan Jennifer C,Zenk Shannon N,Cummins Steven,Collins Rebecca L
Health affairs (Project Hope)
Placing full-service supermarkets in food deserts--areas with limited access to healthy food--has been promoted as a way to reduce inequalities in access to healthy food, improve diet, and reduce the risk of obesity. However, previous studies provide scant evidence of such impacts. We surveyed households in two Pittsburgh, Pennsylvania, neighborhoods in 2011 and 2014, one of which received a new supermarket in 2013. Comparing trends in the two neighborhoods, we obtained evidence of multiple positive impacts from new supermarket placement. In the new supermarket neighborhood we found net positive changes in overall dietary quality; average daily intakes of kilocalories and added sugars; and percentage of kilocalories from solid fats, added sugars, and alcohol. However, the only positive outcome in the recipient neighborhood specifically associated with regular use of the new supermarket was improved perceived access to healthy food. We did not observe differential improvement between the neighborhoods in fruit and vegetable intake, whole grain consumption, or body mass index. Incentivizing supermarkets to locate in food deserts is appropriate. However, efforts should proceed with caution, until the mechanisms by which the stores affect diet and their ability to influence weight status are better understood.
Socio-demographic inequalities in overweight and obesity among Lithuanian adults: time trends from 1994 to 2014.
Kriaucioniene Vilma,Petkeviciene Janina,Klumbiene Jurate,Sakyte Edita,Raskiliene Asta
Scandinavian journal of public health
AIM: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. METHODS: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. RESULTS: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.
Growth Trajectories of Refugee and Nonrefugee Children in the United States.
Dawson-Hahn Elizabeth,Pak-Gorstein Suzinne,Matheson Jasmine,Zhou Chuan,Yun Katherine,Scott Kevin,Payton Colleen,Stein Elizabeth,Holland Annette,Grow H Mollie,Mendoza Jason A
BACKGROUND AND OBJECTIVES:Limited data examine longitudinal nutrition outcomes of refugee children after United States resettlement. Among refugee children, our aims were to (1) assess the changes in weight-based nutritional status between baseline (0-3 months) and 10-24 months after arrival and (2) compare the BMI (BMIz) or weight-for-length z score (WFLz) trajectories to nonrefugee children for up to 36 months after arrival. METHODS:We conducted a retrospective study of refugees aged 0-16 years from Washington and Pennsylvania and compared them with an age and sex-matched nonrefugee low-income sample from Washington. Data included anthropometric measurements from the initial screening medical visit and subsequent primary care visits. Multilevel linear mixed-effects regression models evaluated the change in BMIz or WFLz trajectory. RESULTS:The study included 512 refugee and 1175 nonrefugee children. The unadjusted prevalence of overweight/obesity increased from 8.9% to 20% (P < .001) for 2- to 16-year-old refugees from baseline to 10-24 months. Refugees (2-16 years old) had a steeper increase in their BMIz per 12 months compared with nonrefugees (coefficient 0.18 vs 0.03; P < .001). Refugees <2 years old had a less steep increase in their WFLz per 12 months compared with nonrefugees (coefficient 0.12 vs 0.36, P = .002). CONCLUSIONS:Older refugee children exhibited a higher risk of obesity than nonrefugees, whereas refugees <2 years old exhibited a slower increase in their risk of obesity than nonrefugee children. All age groups experienced increasing obesity prevalence. Targeted and culturally tailored obesity prevention interventions may mitigate health and nutrition inequities among refugee children.
Food insecurity and health status in deprived populations, 2014: a multicentre survey in seven of the social and medical healthcare centres (CASOs) run by Doctors of the World, France.
Laurence S,Durand E,Thomas E,Chappuis M,Corty J F
OBJECTIVE:To document eating practices and socio-economic profiles of patients seen in the social and medical healthcare centres (CASOs in its French acronym) run by Doctors of the World (Médecins du Monde, MdM) in France and evaluate their nutritional and health status. STUDY DESIGN:The survey was carried out between April and May 2014 in seven CASOs in France. METHODS:All the patients attending MdM clinics were given a nutrition and health questionnaire. Their anthropometric measurements were taken on site. RESULTS:77.7% of the households surveyed were food insecure due to constrained resources. On average, the patients interviewed declared spending €2.5 per person per day on food. A total of 46.3% of adults declared not having eaten for a whole day at least once in the month preceding the survey. One third of the patients declared having lost weight over the last two weeks. A chronic pathology was diagnosed in more than one in two patients; 19% were obese and 34% were overweight. CONCLUSIONS:Constrained resources lead people living in very precarious conditions to eat without adequate nutrition, which could have consequences for their health, such as diabetes, obesity and cardiovascular disease.
Non-pharmacological interventions designed to reduce health risks due to unhealthy eating behaviour and linked risky or excessive drinking in adults aged 18-25 years: a systematic review protocol.
Scott Stephanie,Parkinson Kathryn,Kaner Eileen,Robalino Shannon,Stead Martine,Power Christine,Fitzgerald Niamh,Wrieden Wendy,Adamson Ashley
BACKGROUND:Excess body weight and heavy alcohol consumption are two of the greatest contributors to global disease. Alcohol use peaks in early adulthood. Alcohol consumption can also exacerbate weight gain. A high body mass index and heavy drinking are independently associated with liver disease but, in combination, they produce an intensified risk of damage, with individuals from lower socio-economic status groups disproportionately affected. METHODS:We will conduct searches in MEDLINE, Embase, PubMed, PsycINFO, ERIC, ASSIA, Web of Knowledge (WoK), Scopus, CINAHL via EBSCO, LILACS, CENTRAL and ProQuest Dissertations and Theses for studies that assess targeted preventative interventions of any length of time or duration of follow-up that are focused on reducing unhealthy eating behaviour and linked risky alcohol use in 18-25-year-olds. Primary outcomes will be reported changes in: (1) dietary, nutritional or energy intake and (2) alcohol consumption. We will include all randomised controlled trials (RCTs) including cluster RCTs; randomised trials; non-randomised controlled trials; interrupted time series; quasi-experimental; cohort involving concurrent or historical controls and controlled before and after studies. Database searches will be supplemented with searches of Google Scholar, hand searches of key journals and backward and forward citation searches of reference lists of identified papers. Search records will be independently screened by two researchers, with full-text copies of potentially relevant papers retrieved for in-depth review against the inclusion criteria. Methodological quality of RCTs will be evaluated using the Cochrane risk of bias tool. Other study designs will be evaluated using the Cochrane Public Health Review Group's recommended Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Studies will be pooled by meta-analysis and/or narrative synthesis as appropriate for the nature of the data retrieved. DISCUSSION:It is anticipated that exploration of intervention effectiveness and characteristics (including theory base, behaviour change technique; modality, delivery agent(s) and training of intervention deliverers, including their professional status; and frequency/duration of exposure) will aid subsequent co-design and piloting of a future intervention to help reduce health risk and social inequalities due to excess weight gain and alcohol consumption. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42016040128 .
Does psychosocial stress explain socioeconomic inequities in 9-year weight gain among young women?
Ball Kylie,Schoenaker Danielle A J M,Mishra Gita D
Obesity (Silver Spring, Md.)
OBJECTIVE: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. METHODS: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. RESULTS: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%). CONCLUSIONS:Education-based inequities in weight gain over time were not attributable to greater psychosocial stress among women with lower education levels.
Health impact assessment of the UK soft drinks industry levy: a comparative risk assessment modelling study.
Briggs Adam D M,Mytton Oliver T,Kehlbacher Ariane,Tiffin Richard,Elhussein Ahmed,Rayner Mike,Jebb Susan A,Blakely Tony,Scarborough Peter
The Lancet. Public health
BACKGROUND:In March, 2016, the UK Government proposed a tiered levy on sugar-sweetened beverages (SSBs; high tax for drinks with >8 g of sugar per 100 mL, moderate tax for 5-8 g, and no tax for <5 g). We estimate the effect of possible industry responses to the levy on obesity, diabetes, and dental caries. METHODS:We modelled three possible industry responses: reformulation to reduce sugar concentration, an increase of product price, and a change of the market share of high-sugar, mid-sugar, and low-sugar drinks. For each response, we defined a better-case and worse-case health scenario. We developed a comparative risk assessment model to estimate the UK health impact of each scenario on prevalence of obesity and incidence of dental caries and type 2 diabetes. The model combined data for sales and consumption of SSBs, disease incidence and prevalence, price elasticity estimates, and estimates of the association between SSB consumption and disease outcomes. We drew the disease association parameters from a meta-analysis of experimental studies (SSBs and weight change), a meta-analysis of prospective cohort studies (type 2 diabetes), and a prospective cohort study (dental caries). FINDINGS:The best modelled scenario for health is SSB reformulation, resulting in a reduction of 144 383 (95% uncertainty interval 5102-306 743; 0·9%) of 15 470 813 adults and children with obesity in the UK, 19 094 (6920-32 678; incidence reduction of 31·1 per 100 000 person-years) fewer incident cases of type 2 diabetes per year, and 269 375 (82 211-470 928; incidence reduction of 4·4 per 1000 person-years) fewer decayed, missing, or filled teeth annually. An increase in the price of SSBs in the better-case scenario would result in 81 594 (3588-182 669; 0·5%) fewer adults and children with obesity, 10 861 (3899-18 964; 17·7) fewer incident cases of diabetes per year, and 149 378 (45 231-262 013; 2·4) fewer decayed, missing, or filled teeth annually. Changes to market share to increase the proportion of low-sugar drinks sold in the better-case scenario would result in 91 042 (4289-204 903; 0·6%) fewer adults and children with diabetes, 1528 (4414-21 785; 19·7) fewer incident cases of diabetes per year, and 172 718 (47 919-294 499; 2·8) fewer decayed, missing, or filled teeth annually. The greatest benefit for obesity and oral health would be among individuals aged younger than 18 years, with people aged older than 65 years having the largest absolute decreases in diabetes incidence. INTERPRETATION:The health impact of the soft drinks levy is dependent on its implementation by industry. Uncertainty exists as to how industry will react and about estimation of health outcomes. Health gains could be maximised by substantial product reformulation, with additional benefits possible if the levy is passed on to purchasers through raising of the price of high-sugar and mid-sugar drinks and activities to increase the market share of low-sugar products. FUNDING:None.
Neighborhood socioeconomic disadvantage and body mass index among residentially stable mid-older aged adults: Findings from the HABITAT multilevel longitudinal study.
Rachele Jerome N,Kavanagh Anne,Brown Wendy J,Healy Aislinn M,Schmid Christina J,Turrell Gavin
Despite a body of evidence on the relationship between neighborhood socioeconomic disadvantage and body mass index (BMI), few studies have examined this relationship over time among ageing populations. This study examined associations between level of neighborhood socioeconomic disadvantage and the rate of change in BMI over time. The sample included 11,035 participants aged between 40 and 65years at baseline from the HABITAT study, residing in 200 neighborhoods in Brisbane, Australia. Data were collected biennially over four waves from 2007 to 2013. Self-reported height and weight were used to calculate BMI, while neighborhood disadvantage was measured using a census-based composite index. All models were adjusted for age, education, occupation, and household income. Analyses were conducted using multilevel linear regression models. BMI increased over time at a rate of 0.08kg/m (95% CI 0.02, 0.13) and 0.17kg/m (95% CI 0.11, 0.29) per wave for men and women respectively. Both men and women residing in the most disadvantaged neighborhoods had a higher average BMI than their counterparts living in the least disadvantaged neighborhoods. There were no evident differences in the rate of BMI change over time by level of neighborhood disadvantage. The findings suggest that by mid-older age, the influence of neighborhood socioeconomic conditions over time on BMI may have already played out. Future research should endeavor to identify the genesis of neighborhood socioeconomic inequalities in BMI, the determinants of these inequalities, and then suitable approaches to intervening.
Tailoring lifestyle interventions to low socio-economic populations: a qualitative study.
Coupe Nia,Cotterill Sarah,Peters Sarah
BMC public health
BACKGROUND:People living in deprived areas are more likely to be overweight or obese, have poorer health outcomes, and tend to benefit less from interventions than those from more affluent backgrounds. One approach to address such health inequalities is to tailor existing interventions to low socio-economic populations, yet there is limited evidence to inform their design. This study aims to identify how best to tailor lifestyle interventions to low socio-economic populations to improve outcomes. METHODS:Following direct observations of community-run weight loss groups, we interviewed 11 group facilitators and 14 service users from a health improvement service in a low socio-economic area in the North West of England. Audio-recorded interviews were transcribed verbatim and analysed thematically. RESULTS:We identified two overarching themes within the data. The first theme, managing diversity, included challenges faced in delivering a generic intervention to a diverse population in terms of knowledge, language and literacy skills, and cultural diversity. The second theme incorporated all issues relating to the environment, such as cost, access and availability of food and leisure facilities, and 'life gets in the way'. CONCLUSIONS:Tailoring interventions for this population is necessary, and more attention is needed to develop ways to ensure service providers and users engage with behaviour change techniques such as goal setting, rather than focusing on information provision alone. Interventions should also be mindful of cost, cultural diversity, and language and literacy barriers, as well as potential for disengaging this hard to reach population.
The effect of personalised weight feedback on weight loss and health behaviours: Evidence from a regression discontinuity design.
Using a regression-discontinuity approach on a U.K. longitudinal dataset, this research analyses whether personalised weight feedback resulted in individuals losing weight over a period of between 2 and 7 years. The analysis presented here finds that being told one was "overweight" had, on average, no effect on subsequent weight loss; however, being told one was "very overweight" resulted in individuals losing, on average, approximately 1% of their bodyweight. The effect of feedback was found to be strongly moderated by household income, with those in higher income households accounting for seemingly all of the estimated effect due, in part, to increased physical activity. These findings suggest that the provision of weight feedback may be a cost-effective way to reduce obesity in adults. They do however also highlight that the differential response to the provision of health information may be a driver of health inequalities and that the provision of feedback may bias longitudinal health studies.
Randomised controlled trial and economic evaluation of a task-based weight management group programme.
McRobbie Hayden,Hajek Peter,Peerbux Sarrah,Kahan Brennan C,Eldridge Sandra,Trépel Dominic,Parrott Steve,Griffiths Chris,Snuggs Sarah,Smith Katie Myers
BMC public health
BACKGROUND:Obesity is a rising global threat to health and a major contributor to health inequalities. Weight management programmes that are effective, economical and reach underprivileged groups are needed. We examined whether a multi-modal group intervention structured to cater for clients from disadvantaged communities (Weight Action Programme; WAP) has better one-year outcomes than a primary care standard weight management intervention delivered by practice nurses (PNI). METHODS:In this randomised controlled trial, 330 obese adults were recruited from general practices in London and allocated (2:1) to WAP (N = 221) delivered over eight weekly group sessions or PNI (N = 109) who received four sessions over eight weeks. Both interventions covered diet, physical activity and self-monitoring. The primary outcome was the change in weight from baseline at 12 months. To indicate value to the NHS, a cost effectiveness analysis estimated group differences in cost and Quality-Adjusted Life-Years (QALYs) related to WAP. RESULTS:Participants were recruited from September 2012 to January 2014 with follow-up completed in February 2015. Most participants were not in paid employment and 60% were from ethnic minorities. 88% of participants in each study arm provided at least one recorded outcome and were included in the primary analysis. Compared with the PNI, WAP was associated with greater weight loss overall (- 4·2 kg vs. - 2·3 kg; difference = - 1·9 kg, 95% CI: -3·7 to - 0·1; P = 0·04) and was more likely to generate a weight loss of at least 5% at 12 months (41% vs. 27%, OR = 14·61 95% CI: 2·32 to 91·96, P = 0·004). With an incremental cost-effectiveness ratio (ICER) of £7742/QALY, WAP would be considered highly cost effective compared to PNI. CONCLUSIONS:The task-based programme evaluated in this study can provide a template for an effective and economical approach to weight management that can reach clients from disadvantaged communities. TRIAL REGISTRATION:ISRCTN ISRCTN45820471 . Registered 12/10/2012 (retrospectively registered).
The double burden of under- and overnutrition among Bangladeshi women: Socioeconomic and community-level inequalities.
Rahman Md Aminur,Rahman Md Mosfequr,Rahman Md Mosiur,Jesmin Syeda S
BACKGROUND:The prevalence of overweightness in Bangladesh is increasing, while underweightness also continues to persist. A better understanding of the patterns and socioeconomic risk factors of both conditions, particularly among women, is critical in order to promote the development of interventions to improve maternal health in Bangladesh. This study therefore sought to assess the patterns of under- and overweightness between 2004 and 2014 and to examine the predictors of individual and community-level inequalities of under- and overnutrition in Bangladesh. METHODS:Cross-sectional data of 10, 431, and 16,478 ever-married nonpregnant women aged between 15 and 49 years who did not give birth in the two months preceding the survey were extracted from the 2004 and 2014 Bangladesh Demographic and Health Surveys, respectively. Body mass index was used to measure weight status, and underweightness, at-risk for overweightness, overweightness, and obesity were the main outcome variables. Patterns of nutritional change over time was examined by considering the annual average rate of change. Multilevel multinomial logistic regression and quantile regression were used to identify the inequalities. RESULTS:In 2014, the age-adjusted prevalence values of underweightness, at-risk for overweightness, overweightness, and obesity were 19.7%, 14.9%, 18.1% and 4.0%, respectively. A higher average annual rate of reduction of underweightness was found among wealthier, highly educated, and wealthier community-living women, while a rate of increase of overweightness was found among poorer, uneducated, and poor community-living women. Individual and community-level inequalities of malnutrition were observed among these populations. In comparison with women living in low wealth communities, women from wealthier communities were at an increased risk of being at-risk for overweightness [adjusted odds ratio (AOR): 1.53, 95% confidence interval (CI): 1.23-1.91], overweight (AOR: 1.60, 95% CI: 1.27-2.00), and obese (AOR: 2.12, 95% CI: 1.42-3.18). CONCLUSIONS:This study suggests the coexistence of a double burden of under- and overnutrition in Bangladesh and that the prevalence of overweightness surpasses that of underweightness. The burdens of under- and overnutrition are strongly associated with women's individual socioeconomic positions and the nature of the community in which they live.
Trends in urban/rural inequalities in physical growth among Chinese children over three decades of urbanization in Guangzhou: 1985-2015.
Hu Yan,Lin Weiqun,Tan Xuying,Liu Yu,Wen Yuqi,Xing Yanfei,Ma Ying,Liu Huiyan,Song Yanyan,Liang Jingjing,Lam Kin Bong Hubert,Lin Suifang
BMC public health
BACKGROUND:Great growth inequalities between urban and rural areas have been reported in China over the past years. By examining urban/rural inequalities in physical growth among children < 7 years old over the past three decades from 1985 to 2015 in Guangzhou, we analyzed altering trends of anthropometric data in children and their association with economic development during the period of rapid urbanization in Guangzhou. METHODS:The height, body weight and nutrition status of children under 7 years old were obtained from two successive cross-sectional surveys and one health surveillance system. Student's t-test, Spearman's rank-order correlation and polynomial regression were used to assess the difference in physical growth between children in urban and rural areas and the association between socioeconomic index and secular growth changes. RESULTS:A height and weight difference was found between urban and rural children aged 0-6 years during the first two decades of our research (1985-2005), which gradually narrowed in both sex groups over time. By the end of 2015, elder boys (age group ≥5 year) and girls (age group ≥4 year) in rural areas were taller than their counterparts in urban areas (p < 0.05).The same trend could be witnessed in the weight of children aged 6 years, with a - 1.30 kg difference (P = 0.03) for boys, and a - 0.05 difference (P = 0.82) for girls. When GDP increased, the gap in boys' weight-for-age z-score (WAZ from 0.25 to 0.01) and height-for-age z-score (HAZ from 0.55 to 0.03) between urban and rural areas diminished, and disappeared when the GDP per capita (USD) approached 25,000. In either urban or rural areas, the urbanization rate and GDP were positively associated with the prevalence of obesity (all R > 0.90 with P < 0.05) and negatively correlated with the prevalence of stunted growth (all R < -0.87 with P < 0.05). CONCLUSION:Growth inequalities gradually decreased with economic development and urbanization, while new challenges such as obesity emerged. To eliminate health problems due to catch-up growth among rural children, comprehensive intervention programs for early child growth should be promoted in rural areas.
Intergenerational social mobility and body mass index trajectories - A follow-up study from Finland.
Salmela J,Lallukka T,Kanerva N,Pietiläinen O,Rahkonen O,Mauramo E
SSM - population health
Evidence remains unclear on how intergenerational social mobility is associated with body mass index (BMI) and its long-term changes. Our study identified BMI trajectories from middle to older age by intergenerational social mobility groups and stratified the analyses by gender and two birth cohorts (birth years 1940‒1947 and 1950-1962). We used questionnaire-based cohort data that consists of four survey phases: 2000-2002, 2007, 2012, and 2017. In Phase 1, participants were 40-60-year-old employees of the City of Helsinki, Finland. Our analytical sample consisted of 6,971 women and 1,752 men. Intergenerational social mobility was constructed based on self-reported parental and own education-both divided into high and low-yielding four groups: stable high socioeconomic position (SEP) (high-high), upward social mobility (low-high), downward social mobility (high-low), and stable low SEP (low-low). BMI was calculated from self-reported height and weight from all four phases. Using mixed-effects linear regression, we found increasing BMI trajectories in all four social mobility groups until the age of 65. Women and men with stable high SEP had lower BMI trajectories compared to those with stable low SEP. In the younger birth cohort, women with upward social mobility had a lower BMI trajectory than women with stable low SEP. Additionally, women and men with downward social mobility had higher BMI trajectories than those with stable high SEP. In the older birth cohort, however, the BMI trajectories of upward and downward social mobility groups were somewhat similar and settled between the BMI trajectories of stable high and stable low SEP groups. Our results indicate that the associations between intergenerational social mobility and BMI may depend on gender and birth cohort. Nevertheless, to reduce socioeconomic inequalities in unhealthy weight gain, obesity prevention actions that focus on people who are likely to remain in low SEP might be worthwhile.
Socioeconomic inequalities in the prevalence of overweight and obesity among Portuguese preschool-aged children: Changes from 2009 to 2016.
Rodrigues Daniela,Costa Diogo,Gama Augusta,Machado-Rodrigues Aristides M,Nogueira Helena,Silva Maria-Raquel G,Rosado-Marques Vítor,Padez Cristina
American journal of human biology : the official journal of the Human Biology Council
OBJECTIVES:We evaluated, for the first time in Portugal, the prevalence of overweight and obesity according to parental education in a population of preschool-aged Portuguese children in 2009/2010 and 2016/2017. METHODS:Anthropometric data were collected in public and private preschools (n = 1996 in 2009/2010; n = 2077 in 2016/2017). Body mass index was calculated and weight status categories were based on the International Obesity Task Force cutoff points. Parental education level was self-reported. RESULTS:Prevalence of overweight (17.1%-14.1%; p < 0.001) and obesity (6.6%-3.9%, p < 0.001) was lower in 2016/2017 than in 2009/2010, with higher rates being found in the north of the country. Parental education was significantly associated with childhood overweight and obesity and inequalities between low- and high-education increased between the two periods. CONCLUSIONS:While a decrease in childhood overweight and obesity were positive findings, the prevalence is still high and shows pronounced socioeconomic differences. Policies for obesity prevention need to be inclusive and tackle inequalities, with interventions tailored to suit local contexts.
The impact of hypothetical interventions on adiposity in adolescence.
Gebremariam Mekdes K,Nianogo Roch A,Lien Nanna,Bjelland Mona,Klepp Knut-Inge,Bergh Ingunn H,Ommundsen Yngvar,Arah Onyebuchi A
In order to develop effective public health initiatives aimed at promoting healthy weight development, identifying the interventions/combination of interventions with the highest beneficial effect on body weight is vital. The study aimed to estimate the mean BMI at age 13 under hypothetical interventions targeting dietary behavior, physical activity and screen time at age 11. We used data from a school-based cohort study of 530 participants followed between the ages of 11 and 13. We used g-computation, a causal modeling method, to estimate the impact of single and combined hypothetical behavioral interventions at age 11 on BMI at age 13. Of the hypothetical interventions, the one with the largest population mean difference in BMI was the one combining all interventions (dietary behavior, physical activity and screen time interventions) and assuming 100% intervention adherence, with a population mean differences of - 0.28 (95% CI - 0.59, 0.07). Isolated behavioral interventions had a limited impact on BMI. This study demonstrated that a combination of healthy dietary behavior and physical activity promotion, as well as screen time reduction interventions at age 11 could have the highest beneficial effect on the reduction of BMI at age 13, although the change in BMI was small. The findings highlight the importance of a systems approach to obesity prevention focusing on multicomponent interventions.
Explicit incorporation of equity considerations into economic evaluation of public health interventions.
Cookson Richard,Drummond Mike,Weatherly Helen
Health economics, policy, and law
Health equity is one of the main avowed objectives of public health policy across the world. Yet economic evaluations in public health (like those in health care more generally) continue to focus on maximizing health gain. Health equity considerations are rarely mentioned. Health economists rely on the quasi-egalitarian value judgment that 'a QALY is a QALY'--that is QALYs are equally weighted and the same health outcome is worth the same no matter how it is achieved or to whom it accrues. This value judgment is questionable in many important circumstances in public health. For example, policy-makers may place rather little value on health outcomes achieved by infringing individual liberties or by discriminating on the basis of age, sex, or race. Furthermore, there is evidence that a majority of the general public wish to give greater weight to health gains accruing to children, the severely ill, and, to a lesser extent, the socio-economically disadvantaged. This paper outlines four approaches to explicit incorporation of equity considerations into economic evaluation in public health: (i) review of background information on equity, (ii) health inequality impact assessment, (iii) analysis of the opportunity cost of equity, and (iv) equity weighting of health outcomes. The first three approaches can readily be applied using standard methods of health technology assessment, where suitable data are available; whereas approaches for generating equity weights remain experimental. The potential benefits of considering equity are likely to be largest in cases involving: (a) interventions that target disadvantaged individuals or communities and are also relatively cost-ineffective and (b) interventions to encourage lifestyle change, which may be relatively ineffective among 'hard-to-reach' disadvantaged groups and hence may require re-design to avoid increasing health inequalities.
Diet and growth in infancy: relationship to socioeconomic background and to health and development in the Avon Longitudinal Study of Parents and Children.
Emmett Pauline M,Jones Louise R
To assess the relationship between diet and growth in infancy and socioeconomic background, all publications from the Avon Longitudinal Study of Parents and Children (ALSPAC) covering breastfeeding, diet and growth in infancy, and the associations of these factors with socioeconomic background and later health and developmental outcomes were reviewed. Diet was assessed by parent-completed food records and parent-completed food frequency questionnaires covering infant feeding practices. Infancy growth was monitored through routine screening and by standardized measurements. Indicators of socioeconomic background were obtained by parent-completed questionnaires. Childhood outcomes were measured by standardized procedures. Rapid early weight gain was associated with later obesity. Longer breastfeeding duration was associated with lower body fat, but not lower body mass index, and with higher IQ in mid-childhood. Breastfed infants were better at regulating their energy intake than bottle-fed infants. In bottle-fed infants, energy intake at 4 months was associated with greater weight gain up to 5 years of age. Feeding cow's milk as a main drink in infancy was associated with anemia and high salt intake. Maternal education was a strong determinant of dietary differences: low education was associated with never breastfeeding and not following feeding guidelines. ALSPAC has provided unique insights into the relationship between diet and growth in infancy and later developmental outcomes.
The PILI 'Ohana Project: a community-academic partnership to achieve metabolic health equity in Hawai'i.
Kaholokula Joseph Keawe'aimoku,Kekauoha Puni,Dillard Adrienne,Yoshimura Sheryl,Palakiko Donna-Marie,Hughes Claire,Townsend Claire Km
Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health
Native Hawaiians and Pacific Islanders (NHPI) have higher rates of excess body weight and related medical disorders, such as diabetes and cardiovascular disease, compared to other ethnic groups in Hawai'i. To address this metabolic health inequity, the Partnership for Improving Lifestyle Intervention (PILI) 'Ohana Project, a community-academic partnership, was formed over eight years ago and developed two community-placed health promotion programs: the PILI Lifestyle Program (PLP) to address overweight/obesity and the Partners in Care (PIC) to address diabetes self-care. This article describes and reviews the innovations, scientific discoveries, and community capacity built over the last eight years by the PILI 'Ohana Project's (POP) partnership in working toward metabolic health equity. It also briefly describes the plans to disseminate and implement the PLP and PIC in other NHPI communities. Highlighted in this article is how scientific discoveries can have a real-world impact on health disparate populations by integrating community wisdom and academic expertise to achieve social and health equity through research.
Loss to follow-up in cohort studies: bias in estimates of socioeconomic inequalities.
Howe Laura D,Tilling Kate,Galobardes Bruna,Lawlor Debbie A
Epidemiology (Cambridge, Mass.)
BACKGROUND:Although cohort members tend to be healthy and affluent compared with the whole population, some studies indicate this does not bias certain exposure-outcome associations. It is less clear whether this holds when socioeconomic position (SEP) is the exposure of interest. METHODS:As an illustrative example, we use data from the Avon Longitudinal Study of Parents and Children. We calculate estimates of maternal education inequalities in outcomes for which data are available on almost the whole cohort (birth weight and length, breastfeeding, preterm birth, maternal obesity, smoking during pregnancy, educational attainment). These are calculated for the full cohort (n~12,000) and in restricted subsamples defined by continued participation at age 10 years (n∼7,000) and age 15 years (n∼5,000). RESULTS:Loss to follow-up was related both to SEP and outcomes. For each outcome, loss to follow-up was associated with underestimation of inequality, which increased as participation rates decreased (eg, mean birth-weight difference between highest and lowest SEP was 116 g [95% confidence interval = 78 to 153] in the full sample and 93 g [45 to 141] and 62 g [5 to 119] in those attending at ages 10 and 15 years, respectively). CONCLUSIONS:Considerable attrition from cohort studies may result in biased estimates of socioeconomic inequalities, and the degree of bias may worsen as participation rates decrease. However, even with considerable attrition (>50%), qualitative conclusions about the direction and approximate magnitude of inequalities did not change among most of our examples. The appropriate analysis approaches to alleviate bias depend on the missingness mechanism.
Social and environmental determinants of child health in Mongolia across years of rapid economic growth: 2000-2010.
Joshi Nehal,Bolorhon Bolormaa,Narula Indermohan,Zhu Shihua,Manaseki-Holland Semira
International journal for equity in health
BACKGROUND:To understand the effect of economic growth on health, we investigated the trend in socio-economic and regional determinants of child health in Mongolia. This Central Asian country had the fastest economic growth amongst low and middle-income countries (LMICs) from 2000 to 2010 and a healthcare system in transition. METHODS:Data was from Mongolian multiple indicator cluster surveys (MICS) in 2000, 2005 and 2010. Child nutrition/growth was measured by height-for-age z-score (HAZ), weight-for-age z-score (WAZ), prevalence of stunted (HAZ < -2) and underweight (WAZ < -2) children. Access to health care was measured by prevalence of fully immunised children <5 years. Multivariate multi-level logistic mixed modelling was used to estimate the effect of socio-economic and environmental health determinants on each outcome in each year; 2000, 2005 and 2010. T-tests were used to measure significant change in HAZ and WAZ over the decade. RESULTS:Overall, from 2000 to 2010, there was a significant improvement (p < 0.001) in all three outcomes, but the effect of socio-economic factors increased on both stunting and weight. In 2000, region was a significant determinant: children living in three provinces were significantly more likely to be stunted and less likely to be immunised than Ulaanbaatar, but this was not significant by 2010. By 2010, none of the factors were significant determinants of immunisation in children. In 2000, economic status had no effect on stunting (OR = 0.91; 95%CI:0.49,1.66), however by 2010, children in the poorest economic quintile were 4 times more likely to be stunted than the richest (OR = 0.24; 95% CI:0.13,0.45; p < 0.001). The effect of maternal education on stunting prevalence continued over the 10 years, in both 2000 and 2010 children were twice as likely to be stunted if their mother had no education compared to university education (2000 OR = 0.45; 95% CI:0.28,0.73, p < 0.01,2010 OR =0.55; 95% CI:0.35,0.87, p < 0.05). CONCLUSION:Economic growth in Mongolia from 2000 to 2010 resulted in an increase in the effect of social determinants of child health; whilst focused policy improved access to immunisation. Children with less educated mothers and lower household incomes should be targeted in interventions to reduce health inequity.
Social disparities in obesity treatment for children age 3-10 years: A systematic review.
Lobstein Tim,Neveux Margot,Brown Tamara,Chai Li Kheng,Collins Clare E,Ells Louisa J,Nowicka Paulina,
Obesity reviews : an official journal of the International Association for the Study of Obesity
Socio-economic status and ethnic background are recognized as predictors of risk for the development of obesity in childhood. The present review assesses the effectiveness of treatment for children according to their socio-economic and ethnic background. Sixty-four systematic reviews were included, from which there was difficulty reaching general conclusions on the approaches to treatment suitable for different social subgroups. Eighty-one primary studies cited in the systematic reviews met the inclusion criteria, of which five directly addressed differential effectiveness of treatment in relation to social disparities, with inconsistent conclusions. From a weak evidence base, it appears that treatment effectiveness may be affected by family-level factors including attitudes to overweight, understanding of the causes of weight gain and motivation to make and maintain family-level changes in health behaviours. Interventions should be culturally and socially sensitive, avoid stigma, encourage motivation, recognize barriers and reinforce opportunities and be achievable within the family's time and financial resources. However, the evidence base is remarkably limited, given the significance of social and economic disparities as risk factors. Research funding agencies need to ensure that a focus on social disparities in paediatric obesity treatment is a high priority for future research.
Intersecting Social Inequalities and Body Mass Index Trajectories from Adolescence to Early Adulthood.
Hargrove Taylor W
Journal of health and social behavior
This study combines multiple-hierarchy stratification and life course perspectives to address two research questions critical to understanding U.S. young adult health. First, to what extent are racial-ethnic inequalities in body mass index (BMI) gendered and/or classed? Second, do racial-ethnic, gender, and socioeconomic inequalities in BMI widen or persist between adolescence and early adulthood? Using data from the National Longitudinal Survey of Youth 1997 cohort and growth curve models, results suggest that among white, black, and Hispanic American men and women ages 13 to 31, racial-ethnic inequality in BMI is greatest among women. Black women experience the highest adolescent BMI and the greatest increases in BMI with age. Furthermore, socioeconomic resources are less protective against weight gain for blacks and Hispanics, with the nature of these relationships varying by gender. Findings present a more nuanced picture of health inequality that renders visible the disproportionate burden of poor health experienced by marginalized groups.
Global, regional and country trends in underweight and stunting as indicators of nutrition and health of populations.
Neufeld L M,Osendarp S J M
Nestle Nutrition Institute workshop series
Stunting and wasting provide indicators of different nutritional deficiency problems, the causes of which are well established. Underweight based on weight-for-age cannot distinguish between these two and is therefore not useful to target programs and has limited value for tracking progress. Stunting reduces later school attainment and income as adults and increases the risk of obesity and noncommunicable diseases in later life. Globally, the estimated number of stunted children is decreasing, but is not on track to meet the goal of 100 million by 2025 (165 million), and there has been little change in the number of children suffering from wasting since 2004. Stunting and wasting provide excellent indicators of inequity. For example, from 1990 to 2010, the number of stunted children in Asia declined from 188.7 to 98.4 million, while in sub-Saharan Africa there was essentially no change in prevalence, and the number of stunted children increased from 45.7 to 55.8 million. Recent global development movements are recognizing the need for robust measures of trends in nutritional status of children, particularly during the critical first years of life. Such measures are needed to track progress and improve accountability, and should be aspirational to mobilize sufficient investment in nutrition.
Influence of delivery characteristics and socioeconomic status on giving birth by caesarean section - a cross sectional study during 2000-2010 in Finland.
Räisänen Sari,Gissler Mika,Kramer Michael R,Heinonen Seppo
BMC pregnancy and childbirth
BACKGROUND:Caesarean section (CS) rates especially without medical indication are rising worldwide. Most of indications for CS are relative and CS rates for various indications vary widely. There is an increasing tendency to perform CSs without medical indication on maternal request. Women with higher socioeconomic status (SES) are more likely to give birth by CS. We aimed to study whether giving birth by CS was associated with SES and other characteristics among singleton births during 2000-2010 in Finland with publicly funded health care. METHODS:Data were gathered from the Finnish Medical Birth Register. The likelihood of giving birth by CS according to CS type (planned and non-planned), parity (nulliparous vs. multiparous), socio-demographic factors, delivery characteristics and time periods (2000-2003, 2004-2007 and 2008-2010) was determined by using logistic regression analysis. SES was classified as upper white collar workers (highest SES), lower white collar workers, blue collar workers (lowest SES), others (all unclassifiable cases) and cases with missing information. RESULTS:In total, 19.8% (51,511 of 259,736) of the nulliparous women and 13.1% (47,271 of 360,727) of the multiparous women gave birth by CS. CS was associated with several delivery characteristics, such as placental abruption, placenta previa, birth weight and fear of childbirth, among both parity groups. After adjustment, the likelihood of giving birth by planned CS was reduced by 40% in nulliparous and 55% in multiparous women from 2000-2003 to 2008-2010, whereas the likelihood of non-planned CSs did not change. Giving birth by planned and non-planned CS was up to 9% higher in nulliparous women and up to 17% higher in multiparous women in the lowest SES groups compared to the highest SES group. CONCLUSIONS:Giving birth by CS varied by clinical indications. Women with the lowest SES were more likely to give birth by CS, indicating that the known social disparity in pregnancy complications increases the need for operative deliveries in these women. Overall, the CS policy in Finland shows favoring a trial of labor over planned CS and reflects no inequity in healthcare services.
Parental preferences and allocations of investments in children's learning and health within families.
Abufhele Alejandra,Behrman Jere,Bravo David
Social science & medicine (1982)
Empirical evidence suggests that parental preferences may be important in determining investment allocations among their children. However, there is mixed or no evidence on a number of important related questions. Do parents invest more in better-endowed children, thus reinforcing differentials among their children? Or do they invest more in less-endowed children to compensate for their smaller endowments and reduce inequalities among their children? Does higher maternal education affect the preferences underlying parental decisions in investing among their children? What difference might such intrafamilial investments among children make? And what is the nature of these considerations in the very different context of developing countries? This paper gives new empirical evidence related to these questions. We examine how parental investments affecting child education and health respond to initial endowment differences between twins within families, as represented by birth weight differences, and how parental preference tradeoffs and therefore parental investment strategies vary between families with different maternal education. Using the separable earnings-transfers model (Behrman et al., 1982), we first illustrate that preference differences may make a considerable difference in the ratios of health and learning differentials between siblings - up to 30% in the simulations that we provide. Using a sample of 2000 twins, collected in the 2012 wave of the Early Childhood Longitudinal Survey for Chile, we find that preferences are not at the extreme of pure compensatory investments to offset endowment inequalities among siblings nor at the extreme of pure reinforcement to favor the better-endowed child with no concern about inequality. Instead, they are neutral, so that parental investments do not change the inequality among children due to endowment differentials. We also find that there are not significant preference differences between families with low- and high-educated mothers. Our estimates are consistent with previous empirical evidence that finds that parents do not invest differentially within twins.
Estimating Reductions in Ethnic Inequalities in Child Adiposity from Hypothetical Diet, Screen Time, and Sports Participation Interventions.
Lara Macarena,Labrecque Jeremy A,van Lenthe Frank J,Voortman Trudy
Epidemiology (Cambridge, Mass.)
BACKGROUND:Childhood obesity is a global epidemic, and its prevalence differs by ethnicity. The objective of this study was to estimate the change in ethnic inequalities in child adiposity at age 10 resulting from interventions on diet at age 8 and screen time and sports participation at age 9. METHODS:We conducted a population-based cohort study, the Generation R Study, from 9,749 births in Rotterdam (2002-2006), of which 9,506 children remained in the analysis. We measured ethnicity, diet, screen time, and sports participation through questionnaires; we measured weight, body mass index (BMI), fat mass index, and fat-free mass index directly. We used sequential G-estimation to estimate the reduction in inequality that would result from the interventions. RESULTS:We observed that sociodemographic characteristics, diet, screen time, sports participation, and all adiposity measurements were more favorable in children from Western versus non-Western ethnic backgrounds: weight = -1.2 kg (95% confidence interval [CI] = -1.7, -0.8), BMI = -1.0 kg/m (CI = -1.2, -0.9), and fat mass index = -0.8 kg/m (CI = -0.9, -0.7). We estimated that extreme intervention (maximum diet score of 10, no screen time, and >4 hours/week of sports) reduced ethnic inequalities by 21% (CI = 8%, 35%) for weight, 9% (CI = 4%, 14%) for BMI, and 9% (CI = 6%, 13%) for fat mass index. A diet score ≥5 points, screen time ≤2 hours/day, and sports participation >2 hours/week reduced ethnic inequalities by 17% (CI = 6%, 28%) for weight, 7% (CI = 3%, 11%) for BMI, and 7% (CI = 4%, 10%) for fat mass index. CONCLUSIONS:Our results are consistent with the hypothesis that interventions integrating diet, screen time, and sports participation have a moderate impact on reducing ethnic inequalities in child adiposity.
A Health Equity Problem for Low Income Children: Diet Flexibility Requires Physician Authorization.
Stookey Jodi D
Obesity, open access
USDA programs, such as the Child and Adult Care Food Program (CACFP), School Breakfast Program (SBP), and/or National School Lunch Program (NSLP), enable child care centers and schools to provide free and reduced price meals, daily, to millions of low income children. Despite intention to equalize opportunity for every child to have a healthy diet, USDA program rules may be contributing to child obesity disparities and health inequity. USDA program rules require child care centers and schools to provide meals that include a specified number of servings of particular types of foods and beverages. The rules are designed for the average, healthy weight child to maintain weight and growth. They are not designed for the underweight child to gain weight, obese child to normalize weight, or pre-diabetic child to avoid incident diabetes. The rules allow for only one meal pattern and volume, as opposed to a flexible spectrum of meal patterns and portion sizes. Parents of children who participate in the CACFP, SBP, and/or NSLP do not have control over the amount or composition of the subsidized meals. Parents of overweight, obese, or diabetic children who participate in the subsidized meal programs can request dietary change, special meals or accommodations to address their child's health status, but child care providers and schools are not required to comply with the request unless a licensed physician signs a "Medical statement to request special meals and/or accommodations". Although physicians are the only group authorized to change the foods, beverages, and portion sizes served daily to low income children, they are not doing so. Over the past three years, despite an overweight and obesity prevalence of 30% in San Francisco child care centers serving low income children, zero medical statements were filed to request special meals or accommodations to alter daily meals in order to prevent obesity, treat obesity, or prevent postprandial hyperglycemia. Low income children have systematically less dietary flexibility than higher income children, because of reliance on free or reduced-price meals, federal food program policy, and lack of awareness that only physicians have authority to alter the composition of subsidized meals in child care centers and schools. Compared with higher income children, low income children do not have equal opportunity to change their daily dietary intake to balance energy requirements.
Parental socioeconomic position and development of overweight in adolescence: longitudinal study of Danish adolescents.
Morgen Camilla Schmidt,Mortensen Laust Hvas,Rasmussen Mette,Andersen Anne-Marie Nybo,Sørensen Thorkild I A,Due Pernille
BMC public health
BACKGROUND:An inverse social gradient in overweight among adolescents has been shown in developed countries, but few studies have examined whether weight gain and the development of overweight differs among adolescents from different socioeconomic groups in a longitudinal study. The objective was to identify the possible association between parental socioeconomic position, weight change and the risk of developing overweight among adolescents between the ages 15 to 21. METHODS:Prospective cohort study conducted in Denmark with baseline examination in 1996 and follow-up questionnaire in 2003 with a mean follow-up time of 6.4 years. A sample of 1,656 adolescents participated in both baseline (mean age 14.8) and follow-up (mean age 21.3). Of these, 1,402 had a body mass index (BMI = weight/height2kg/m2) corresponding to a value below 25 at baseline when adjusted for age and gender according to guidelines from International Obesity Taskforce, and were at risk of developing overweight during the study period. The exposure was parental occupational status. The main outcome measures were change in BMI and development of overweight (from BMI < 25 to BMI > = 25). RESULTS:Average BMI increased from 21.3 to 22.7 for girls and from 20.6 to 23.6 in boys during follow-up. An inverse social gradient in overweight was seen for girls at baseline and follow-up and for boys at follow-up. In the full population there was a tendency to an inverse social gradient in the overall increase in BMI for girls, but not for boys. A total of 13.4% developed overweight during the follow-up period. Girls of lower parental socioeconomic position had a higher risk of developing overweight (OR's between 4.72; CI 1.31 to 17.04 and 2.03; CI 1.10-3.74) when compared to girls of high parental socioeconomic position. A tendency for an inverse social gradient in the development of overweight for boys was seen, but it did not meet the significance criteria CONCLUSIONS:The levels of overweight and obesity among adolescents are high and continue to rise. Results from this study suggest that the inverse social gradient in overweight becomes steeper for girls and emerges for boys in late adolescence (age span 15 to 21 years). Late adolescence seems to be an important window of opportunity in reducing the social inequality in overweight among Danish adolescents.
Area-level and family-level socioeconomic position and body composition trajectories: longitudinal analysis of the UK Millennium Cohort Study.
Staatz Charis Bridger,Kelly Yvonne,Lacey Rebecca E,Hardy Rebecca
The Lancet. Public health
BACKGROUND:Inequalities in the trajectories of body composition in childhood and adolescence have been infrequently studied. Despite the importance of environmental factors in obesity development, little research has looked at area-level socioeconomic position, independent of family socioeconomic position. We aimed to assess how inequalities in body composition develop with age. METHODS:The Millennium Cohort Study is a longitudinal study of 19 243 families who had a child born between 2000 and 2002 in the UK. Multilevel growth curve models were applied to examine change in fat mass index (FMI), fat free mass index (FFMI; using the Benn index), and fat mass to fat free mass ratio (FM:FFM), measured using Bioelectrical Impedance Analysis, from ages 7 years to 17 years by the Index of Multiple Deprivation (IMD) and household income at baseline. FINDINGS:Inequalities in FMI and FM:FFM ratio are evident at age 7 years and widen with age. At age 17 years, adolescents in the most disadvantaged IMD group had FMI 0·57 kg/m (B=Benn parameter; 95% CI 0·43 to 0·70) higher and FM:FFM ratio 0·037 (95% CI 0·026 to 0·047) higher compared with the most advantaged group. Disadvantaged socioeconomic position is associated with higher FFMI but is reversed in adolescence after adjustment for FMI. Inequalities were greater in girls at age 7 years (mean FMI 0·22 kg/m; 95% CI 0·13 to 0·32) compared with boys of the same age (0·05 kg/m; -0·04 to 0·15, p=0·3), but widen fastest in boys, especially for FMI, in which there was over an 11 times increase in the inequality from age 7 years of 0·05kg/m (95% CI -0·04 to 0·15) to 0·62 kg/m at 17 years (0·42 to 0·82). Inequalities for the IMD were similar to income, and persisted at age 17 years independent of family socioeconomic position. INTERPRETATION:Childhood and adolescence is an important period to address inequalities in body composition, as they emerge and widen. Policies should consider FFM as well as FM, and inequalities in the environment. FUNDING:Medical Research Council, Economic and Social Research Council.
Childhood and Adolescent Obesity: A Review.
Kansra Alvina R,Lakkunarajah Sinduja,Jay M Susan
Frontiers in pediatrics
Obesity is a complex condition that interweaves biological, developmental, environmental, behavioral, and genetic factors; it is a significant public health problem. The most common cause of obesity throughout childhood and adolescence is an inequity in energy balance; that is, excess caloric intake without appropriate caloric expenditure. Adiposity rebound (AR) in early childhood is a risk factor for obesity in adolescence and adulthood. The increasing prevalence of childhood and adolescent obesity is associated with a rise in comorbidities previously identified in the adult population, such as Type 2 Diabetes Mellitus, Hypertension, Non-alcoholic Fatty Liver disease (NAFLD), Obstructive Sleep Apnea (OSA), and Dyslipidemia. Due to the lack of a single treatment option to address obesity, clinicians have generally relied on counseling dietary changes and exercise. Due to psychosocial issues that may accompany adolescence regarding body habitus, this approach can have negative results. Teens can develop unhealthy eating habits that result in Bulimia Nervosa (BN), Binge- Eating Disorder (BED), or Night eating syndrome (NES). Others can develop Anorexia Nervosa (AN) as they attempt to restrict their diet and overshoot their goal of "being healthy." To date, lifestyle interventions have shown only modest effects on weight loss. Emerging findings from basic science as well as interventional drug trials utilizing GLP-1 agonists have demonstrated success in effective weight loss in obese adults, adolescents, and pediatric patients. However, there is limited data on the efficacy and safety of other weight-loss medications in children and adolescents. Nearly 6% of adolescents in the United States are severely obese and bariatric surgery as a treatment consideration will be discussed. In summary, this paper will overview the pathophysiology, clinical, and psychological implications, and treatment options available for obese pediatric and adolescent patients.
Intergenerational Change in Birthweight: Effects of Foreign-born Status and Race/Ethnicity.
Andrasfay Theresa,Goldman Noreen
Epidemiology (Cambridge, Mass.)
BACKGROUND:Foreign-born women have heavier infants than US-born women, but it is unclear whether this advantage persists across generations for all races and ethnicities. METHODS:Using 1971-2015 Florida birth records, we linked records of female infants within families to assess intergenerational changes in birthweight and prevalence of low birthweight by grandmother's race/ethnicity and foreign-born status. We also assessed educational gradients in low birthweight in two generations. RESULTS:Compared with daughters of US-born black women, daughters of foreign-born black women had substantially higher birthweights (3,199 vs. 3,083 g) and lower prevalence of low birthweight (7.8% vs. 11.8%). Daughters of foreign-born Hispanic women had moderately higher birthweights (3,322 vs. 3,268 grams) and lower prevalence of low birthweight (4.5% vs. 6.2%) than daughters of US-born Hispanic women. In the next generation, a Hispanic foreign-origin advantage persisted in low birthweight prevalence (6.1% vs. 7.2%), but the corresponding black foreign-origin advantage was almost eliminated (12.2% vs. 13.1%). Findings were robust to adjustment for sociodemographic and medical risk factors. In contrast to patterns for other women, the prevalence of low birthweight varied little by maternal education for foreign-born black women. However, a gradient emerged among their US-born daughters. CONCLUSIONS:The convergence of birthweight between descendants of foreign-born and US-born black women is consistent with theories positing that lifetime exposure to discrimination and socioeconomic inequality is associated with adverse health outcomes for black women. The emergence of a distinct educational gradient in low birthweight prevalence between generations underscores hypothesized adverse effects of multiple dimensions of disadvantage.
The Polish Panel Survey (POLPAN) dataset: Capturing the impact of socio-economic change on population health and well-being in Poland, 1988-2018.
Zelinska Olga,Gugushvili Alexi,Bulczak Grzegorz,Tomescu-Dubrow Irina,Sawiński Zbigniew,Słomczyński Kazimierz M
Data in brief
The Polish Panel Survey, POLPAN, one of the longest continuously run panel studies in Europe, is designed to facilitate research on the socio-economic structure, inequalities and the individual life course under conditions of social change in Poland. POLPAN is well suited for studying how women's and men's health and wellbeing are influenced by their life conditions, such as financial and social resources, that Poland's post-1989 profound socio-economic transformations impacted, and how health outcomes further shape individuals' attitudes and behaviours. Initiated in 1987-88, POLPAN has been fielded in five-year intervals, most recently in 2018, with wave-specific samples representative of the Polish adult population and response rates for full panelists consistently above 70%. In POLPAN, health assessment measures are collected in all waves, as part of respondents' multi-dimensional and life course inequality profile. Data on self-rated physical and psychological health, collected since 1998 (Wave Three), are complemented with respondents' Nottingham Health Profile and core anthropometric information about personal weight and height (Wave Five onwards); health and wellbeing related reasons for work interruptions (since Wave Four); information on extensive hospital stays (Wave Six onwards) and respondents' chronic or protracted illnesses (in Wave Six), respondents' disability status (all waves). The newly released integrated 1988-2018 POLPAN dataset is available on Harvard Dataverse, or upon request, via e-mail: firstname.lastname@example.org.
Socioeconomic status and changes in appetite from toddlerhood to early childhood.
Kininmonth Alice R,Smith Andrea D,Llewellyn Clare H,Fildes Alison
Understanding the mechanisms through which deprivation predisposes a child to increased obesity risk is key to tackling health inequality. Appetite avidity is a key driver of variation in early weight gain. Low socioeconomic status (SES) can be a marker of a more 'obesogenic' food environment which may encourage the behavioural expression of appetite avidity. The objective was to test the hypothesis that children of lower SES demonstrate increases in appetite avidity from toddlerhood to five years. Data were from the Gemini twin birth cohort, with one twin per family selected at random. Parents completed the Child Eating Behaviour Questionnaire (CEBQ) to assess appetitive traits at 16 months and five years. SES was defined using a weighted composite measure comprising seven key correlates. Linear regression models examined the cross-sectional and prospective associations between SES and appetite from 16 months to 5 years, controlling for appetite at 16 months, sex, birth weight and parental BMI. Cross-sectionally, lower SES was significantly associated with higher food responsiveness (β = -0.09 ± 0.024), higher enjoyment of food (β = -0.13 ± 0.024), lower satiety responsiveness (β = 0.09 ± 0.024), and lower food fussiness (β = 0.09, ±0.024) at 16 months. At age 5, lower SES was significantly associated with higher food responsiveness (β = -0.10 ± 0.032), higher desire to drink (β = -0.22 ± 0.031) and higher emotional overeating (β = -0.10 ± 0.032). Prospectively, lower SES predicted greater increases in two key weight-related appetitive traits, from 16 months to 5 years: emotional overeating (β = -0.10 ± 0.032; p < 0.01) and food responsiveness (β = -0.09, ±0.030; p < 0.01). The results indicate that appetite may be a behavioural mediator of the well-established link between childhood deprivation and obesity risk.
Social inequality in excessive gestational weight gain.
Holowko N,Mishra G,Koupil I
International journal of obesity (2005)
OBJECTIVE:Optimal gestational weight gain (GWG) leads to better outcomes for both the mother and child, whereas excessive gains can act as a key stage for obesity development. Little is known about social inequalities in GWG. This study investigates the influence of education level on pre-pregnancy body mass index (BMI) and GWG. DESIGN:Register-based population study. SETTING:Sweden PARTICIPANTS:Four thousand and eighty women born in Sweden who were a part of the third generation Uppsala Birth Cohort Study. Register data linkages were used to obtain information on social characteristics, BMI and GWG of women with singleton first births from 1982 to 2008. MAIN OUTCOME MEASURE:Pre-pregnancy BMI and the Institute of Medicine's (IOM) categories of GWG for a given pre-pregnancy BMI. RESULTS were adjusted for calendar period, maternal age, living arrangements, smoking, history of chronic disease and pre-pregnancy BMI when appropriate. RESULTS:Although most women (67%) were of healthy pre-pregnancy BMI, 20% were overweight and 8% were obese. Approximately half of all women in the sample had excessive GWG, with higher pre-pregnancy BMI associated with higher risk of excessive GWG, regardless of education level; this occurred for 76% of overweight and 75% of obese women. Lower educated women with a healthy pre-pregnancy BMI were at greater risk of excessive GWG-odds ratio 1.76 (95% confidence interval 1.28-2.43) for elementary and odds ratio 1.32 (1.06-1.64) for secondary compared with tertiary educated, adjusted for age and birth year period. Nearly half of women with an elementary or secondary education (48%) gained weight excessively. CONCLUSION:Education did not provide a protective effect in avoiding excessive GWG among overweight and obese women, of whom ∼75% gained weight excessively. Lower educated women with a BMI within the healthy range, however, are at greater risk of excessive GWG. Health professionals need to tailor their pre-natal advice to different groups of women in order to achieve optimal pregnancy outcomes and avoid pregnancy acting as a stage in the development of obesity.
Positioning of Weight Bias: Moving towards Social Justice.
Nutter Sarah,Russell-Mayhew Shelly,Alberga Angela S,Arthur Nancy,Kassan Anusha,Lund Darren E,Sesma-Vazquez Monica,Williams Emily
Journal of obesity
Weight bias is a form of stigma with detrimental effects on the health and wellness of individuals with large bodies. Researchers from various disciplines have recognized weight bias as an important topic for public health and for professional practice. To date, researchers from various areas have approached weight bias from independent perspectives and from differing theoretical orientations. In this paper, we examined the similarities and differences between three perspectives (i.e., weight-centric, non-weight-centric (health-centric), and health at every size) used to understand weight bias and approach weight bias research with regard to (a) language about people with large bodies, (b) theoretical position, (c) identified consequences of weight bias, and (d) identified influences on weight-based social inequity. We suggest that, despite differences, each perspective acknowledges the negative influences that position weight as being within individual control and the negative consequences of weight bias. We call for recognition and discussion of weight bias as a social justice issue in order to change the discourse and professional practices extended towards individuals with large bodies. We advocate for an emphasis on social justice as a uniting framework for interdisciplinary research on weight bias.
Green space, health inequality and pregnancy.
Dadvand Payam,de Nazelle Audrey,Figueras Francesc,Basagaña Xavier,Su Jason,Amoly Elmira,Jerrett Michael,Vrijheid Martine,Sunyer Jordi,Nieuwenhuijsen Mark J
Green spaces have been suggested to improve physical and mental health and well-being by increasing physical activity, reducing air pollution, noise, and ambient temperature, increasing social contacts and relieving psychophysiological stress. Although these mechanisms also suggest potential beneficial effects of green spaces on pregnancy outcomes, to our knowledge there is no available epidemiological evidence on this impact. We investigated the effects of surrounding greenness and proximity to major green spaces on birth weight and gestational age at delivery and described the effect of socioeconomic position (SEP) on these relationships. This study was based on a cohort of births (N=8246) that occurred in a major university hospital in Barcelona, Spain, during 2001-2005. We determined surrounding greenness from satellite retrievals as the average of Normalized Difference Vegetation Index (NDVI) in a buffer of 100 m around each maternal place of residence. To address proximity to major green spaces, a binary variable was used to indicate whether maternal residential address is situated within a buffer of 500 m from boundaries of a major green space. For each indicator of green exposure, linear regression models were constructed to estimate change in outcomes adjusted for relevant covariates including individual and area level SEP. None of the indicators of green exposure was associated with birth weight and gestational age. After assessing effect modification based on the level of maternal education, we detected an increase in birth weight (grams) among the lowest education level group (N=164) who had higher surrounding NDVI (Regression coefficient (95% confidence interval (CI) of 436.3 (43.1, 829.5)) or lived close to a major green space (Regression coefficient (95% CI)) of 189.8 (23.9, 355.7)). Our findings suggest a beneficial effect of exposure to green spaces on birth weight only in the lowest SEP group.
Inequality, green spaces, and pregnant women: roles of ethnicity and individual and neighbourhood socioeconomic status.
Dadvand Payam,Wright John,Martinez David,Basagaña Xavier,McEachan Rosemary R C,Cirach Marta,Gidlow Christopher J,de Hoogh Kees,Gražulevičienė Regina,Nieuwenhuijsen Mark J
Evidence of the impact of green spaces on pregnancy outcomes is limited with no report on how this impact might vary by ethnicity. We investigated the association between residential surrounding greenness and proximity to green spaces and birth weight and explored the modification of this association by ethnicity and indicators of individual (maternal education) and neighbourhood (Index of Multiple Deprivation) socioeconomic status. Our study was based on 10,780 singleton live-births from the Born in Bradford cohort, UK (2007-2010). We defined residential surrounding greenness as average of satellite-based Normalized Difference Vegetation Index (NDVI) in buffers of 50 m, 100 m, 250 m, 500 m and 1000 m around each maternal home address. Residential proximity to green spaces was defined as living within 300 m of a green space with an area of ≥ 5000 m(2). We utilized mixed effects models to estimate adjusted change in birth weight associated with residential surrounding greenness as well as proximity to green spaces. We found a positive association between birth weight and residential surrounding greenness. Furthermore, we observed an interaction between ethnicity and residential surrounding greenness in that for White British participants there was a positive association between birth weight and residential surrounding greenness whereas for participants of Pakistani origin there was no such an association. For surrounding greenness in larger buffers (500 m and 1000 m) there were some indications of stronger associations for participants with lower education and those living in more deprived neighbourhoods which were not replicated for surrounding greenness in smaller buffer sizes (i.e. 50 m, 100 m, and 250 m). The findings for residential proximity to a green space were not conclusive. Our study showed that residential surrounding greenness is associated with better foetal growth and this association could vary between different ethnic and socioeconomic groups.
Behavioural interventions delivered through interactive social media for health behaviour change, health outcomes, and health equity in the adult population.
Petkovic Jennifer,Duench Stephanie,Trawin Jessica,Dewidar Omar,Pardo Pardo Jordi,Simeon Rosiane,DesMeules Marie,Gagnon Diane,Hatcher Roberts Janet,Hossain Alomgir,Pottie Kevin,Rader Tamara,Tugwell Peter,Yoganathan Manosila,Presseau Justin,Welch Vivian
The Cochrane database of systematic reviews
BACKGROUND:Social networking platforms offer a wide reach for public health interventions allowing communication with broad audiences using tools that are generally free and straightforward to use and may be combined with other components, such as public health policies. We define interactive social media as activities, practices, or behaviours among communities of people who have gathered online to interactively share information, knowledge, and opinions. OBJECTIVES:We aimed to assess the effectiveness of interactive social media interventions, in which adults are able to communicate directly with each other, on changing health behaviours, body functions, psychological health, well-being, and adverse effects. Our secondary objective was to assess the effects of these interventions on the health of populations who experience health inequity as defined by PROGRESS-Plus. We assessed whether there is evidence about PROGRESS-Plus populations being included in studies and whether results are analysed across any of these characteristics. SEARCH METHODS:We searched CENTRAL, CINAHL, Embase, MEDLINE (including trial registries) and PsycINFO. We used Google, Web of Science, and relevant web sites to identify additional studies and searched reference lists of included studies. We searched for published and unpublished studies from 2001 until June 1, 2020. We did not limit results by language. SELECTION CRITERIA:We included randomised controlled trials (RCTs), controlled before-and-after (CBAs) and interrupted time series studies (ITSs). We included studies in which the intervention website, app, or social media platform described a goal of changing a health behaviour, or included a behaviour change technique. The social media intervention had to be delivered to adults via a commonly-used social media platform or one that mimicked a commonly-used platform. We included studies comparing an interactive social media intervention alone or as a component of a multi-component intervention with either a non-interactive social media control or an active but less-interactive social media comparator (e.g. a moderated versus an unmoderated discussion group). Our main outcomes were health behaviours (e.g. physical activity), body function outcomes (e.g. blood glucose), psychological health outcomes (e.g. depression), well-being, and adverse events. Our secondary outcomes were process outcomes important for behaviour change and included knowledge, attitudes, intention and motivation, perceived susceptibility, self-efficacy, and social support. DATA COLLECTION AND ANALYSIS:We used a pre-tested data extraction form and collected data independently, in duplicate. Because we aimed to assess broad outcomes, we extracted only one outcome per main and secondary outcome categories prioritised by those that were the primary outcome as reported by the study authors, used in a sample size calculation, and patient-important. MAIN RESULTS:We included 88 studies (871,378 participants), of which 84 were RCTs, three were CBAs and one was an ITS. The majority of the studies were conducted in the USA (54%). In total, 86% were conducted in high-income countries and the remaining 14% in upper middle-income countries. The most commonly used social media platform was Facebook (39%) with few studies utilising other platforms such as WeChat, Twitter, WhatsApp, and Google Hangouts. Many studies (48%) used web-based communities or apps that mimic functions of these well-known social media platforms. We compared studies assessing interactive social media interventions with non-interactive social media interventions, which included paper-based or in-person interventions or no intervention. We only reported the RCT results in our 'Summary of findings' table. We found a range of effects on health behaviours, such as breastfeeding, condom use, diet quality, medication adherence, medical screening and testing, physical activity, tobacco use, and vaccination. For example, these interventions may increase physical activity and medical screening tests but there was little to no effect for other health behaviours, such as improved diet or reduced tobacco use (20,139 participants in 54 RCTs). For body function outcomes, interactive social media interventions may result in small but important positive effects, such as a small but important positive effect on weight loss and a small but important reduction in resting heart rate (4521 participants in 30 RCTs). Interactive social media may improve overall well-being (standardised mean difference (SMD) 0.46, 95% confidence interval (CI) 0.14 to 0.79, moderate effect, low-certainty evidence) demonstrated by an increase of 3.77 points on a general well-being scale (from 1.15 to 6.48 points higher) where scores range from 14 to 70 (3792 participants in 16 studies). We found no difference in effect on psychological outcomes (depression and distress) representing a difference of 0.1 points on a standard scale in which scores range from 0 to 63 points (SMD -0.01, 95% CI -0.14 to 0.12, low-certainty evidence, 2070 participants in 12 RCTs). We also compared studies assessing interactive social media interventions with those with an active but less interactive social media control (11 studies). Four RCTs (1523 participants) that reported on physical activity found an improvement demonstrated by an increase of 28 minutes of moderate-to-vigorous physical activity per week (from 10 to 47 minutes more, SMD 0.35, 95% CI 0.12 to 0.59, small effect, very low-certainty evidence). Two studies found little to no difference in well-being for those in the intervention and control groups (SMD 0.02, 95% CI -0.08 to 0.13, small effect, low-certainty evidence), demonstrated by a mean change of 0.4 points on a scale with a range of 0 to 100. Adverse events related to the social media component of the interventions, such as privacy issues, were not reported in any of our included studies. We were unable to conduct planned subgroup analyses related to health equity as only four studies reported relevant data. AUTHORS' CONCLUSIONS:This review combined data for a variety of outcomes and found that social media interventions that aim to increase physical activity may be effective and social media interventions may improve well-being. While we assessed many other outcomes, there were too few studies to compare or, where there were studies, the evidence was uncertain. None of our included studies reported adverse effects related to the social media component of the intervention. Future studies should assess adverse events related to the interactive social media component and should report on population characteristics to increase our understanding of the potential effect of these interventions on reducing health inequities.
Three-year change in diet quality and associated changes in BMI among schoolchildren living in socio-economically disadvantaged neighbourhoods.
Lioret Sandrine,McNaughton Sarah A,Cameron Adrian J,Crawford David,Campbell Karen J,Cleland Verity J,Ball Kylie
The British journal of nutrition
Findings from research that has assessed the influence of dietary factors on child obesity have been equivocal. In the present study, we aimed to test the hypothesis that a positive change in diet quality is associated with favourable changes in BMI z-scores (zBMI) in schoolchildren from low socio-economic backgrounds and to examine whether this effect is modified by BMI category at baseline. The present study utilised data from a subsample (n 216) of the Resilience for Eating and Activity Despite Inequality study, a longitudinal cohort study with data collected in 2007-8 (T1) and 2010-11 (T2) in socio-economically disadvantaged women and children (5-12 years at T1). Dietary data were collected using a FFQ and diet quality index (DQI) scores derived at both time points. The objective measures of weight, height and physical activity (accelerometers) were included. The other variables were reported in the questionnaires. We examined the association between change in DQI and change in zBMI, using linear regression analyses adjusted for physical activity, screen sedentary behaviour and maternal education level both in the whole sample and in the sample stratified by overweight status at baseline. After accounting for potential covariates, change in diet quality was found to be inversely associated with change in zBMI only in children who were overweight at baseline (P= 0.035), thus supporting the hypothesis that improvement in diet quality is associated with a concurrent improvement in zBMI among already overweight children, but not among those with a normal BMI status. The identification of modifiable behaviours such as diet quality that affect zBMI longitudinally is valuable to inform future weight gain prevention interventions in vulnerable groups.
Does an increase of low income families affect child health inequalities? A Swedish case study.
Journal of epidemiology and community health
STUDY OBJECTIVE:Reduction of health inequalities is a primary public health target in many countries. A change of proportion of low income families might affect child health inequalities. Yet, the importance of family incomes in high income welfare states is not well established. The aim of this study was to investigate the effect of increased percentage of low income families on child health inequalities during an economic recession in Sweden, 1991-1996. DESIGN:Health inequalities for six health indicators were assessed during the period 1991-1996 and during adjacent periods. Relative inequality indices were estimated according to Pamuk and Mackenback. Appraisal of a child's socioeconomic situation was based on social data for the child's residency area. SETTING:The total population of children and adolescents 0-<19 years old living in Stockholm County, Sweden, was studied. Each one year cohort comprised 20 470-25 420 people. MAIN OUTCOME MEASURES:Mortality; rate of low birth weight; days of hospital care for infections, asthma/allergic disorders, and unintentional injuries; and rate of abortions. MAIN RESULTS:Mortality decreased annually by 6.9%. The average relative inequality index for mortality before the recession was 1.40 and was lower during the recession, 1.14. The remaining five health indicators, and the relative inequality index for these indicators, did not differ significantly between the recession years (1991-1996) and adjacent periods. CONCLUSIONS:Relative health inequalities did not change, or decreased, during the recession years. The findings indicate that the connection was weak between child health inequalities and family incomes, within the frame of time and the range of income changes that occurred during the study period.
Mid-term Body Mass Index increase among obese and non-obese individuals in middle life and deprivation status: a cohort study.
Lyratzopoulos Georgios,McElduff Patrick,Heller Richard F,Hanily Margaret,Lewis Philip S
BMC public health
BACKGROUND:In the UK, obesity is associated with a clear socioeconomic gradient, with individuals of lower socioeconomic status being more likely to be obese. Several previous studies, using individual measures of soecioeconomic status, have shown a more rapid increase in Body Mass Index (BMI) over time among adults of lower socioeconomic status. We conducted a study to further examine whether ecologically defined deprivation status influences within-individual BMI change during middle life, as the answer to this question can help determine optimal preventive strategies both for obesity per se, and its' associated socioeconomic disparities. METHODS:Anonymised records of participants to the Stockport population-based cardiovascular disease risk factor screening programme were analysed. Individuals aged 35-55 who had a first screening episode between 1989 and 1993, and a subsequent screening episode were included in the study. Deprivation status was defined using quintiles of the Townsend score. Mean annual BMI change by deprivation group was calculated using linear regression. Subsequently, deprivation group was included in the model as an ordinal variable, to test for trend. The modelling was repeated separately for individuals who were obese (BMI < 30) and non-obese at the time of first screening. In supplementary analysis, regression models were also adjusted for baseline BMI. RESULTS:Of 21,976 women and 19,158 men initially screened, final analysis included just over half of all individuals [11,158 (50.8%) women and 9,831 (51.3%) men], due to the combined effect of loss to follow-up and incomplete BMI ascertainment. In both sexes BMI increased by 0.19 kg/m2 annually (95% Confidence Intervals 0.15-0.24 for women and 0.16-0.23 for men). All deprivation groups had similar mean annual change, and there was no evidence of a significant deprivation trend (p = 0.801, women and 0.892, men). Restricting the analysis to individuals who were non-obese at baseline did not alter the results in relation to the lack of a deprivation effect. When restricting the analysis to individuals who were obese at baseline however, the findings were suggestive of an association of BMI increase with higher deprivation group, which was further supported by a significant association when adjusting for baseline BMI. CONCLUSION:In the study setting, the BMI of non-obese individuals aged 35-55 was increasing over time independently of deprivation status; among obese individuals a positive association with higher deprivation was found. The findings support that socioeconomic differences in mean BMI and obesity status are principally attained prior to 35 years of age. Efforts to tackle inequalities in mean BMI and obesity status should principally concentrate in earlier life periods, although there may still be scope for focusing inequality reduction efforts on obese individuals even in middle life.
The impact of parental educational trajectories on their adult offspring's overweight/obesity status: a study of three generations of Swedish men and women.
Chaparro M P,Koupil Ilona
Social science & medicine (1982)
The objective of this study was to investigate the impact of grandparental and parental education and parental educational trajectory on their adult offspring's overweight/obesity. We used register data from the Uppsala Birth Cohort Multigenerational Study, based on a representative cohort born in Sweden 1915-1929 (G1). Our sample included 5122 women and 11,204 men who were grandchildren of G1 (G3), their parents (G2), and grandparents. G3's overweight/obesity (BMI≥25 kg/m2) was based on pre-pregnancy weight/height for women before their first birth (average age=26 years), and measured weight/height at conscription for men (average age=18 years). G1's, G2's, and G3's highest educational attainment was obtained from routine registers and classified as low, intermediate, or high based on respective sample distributions. Parental (G2) educational trajectory was defined as change in education between their own and their highest educated parent (G1), classified into 5 categories: always advantaged (AA), upward trajectory (UT), stable-intermediate (SI), downward trajectory (DT), and always disadvantaged (AD). We used hierarchical gender-stratified logistic regression models adjusted for G3's age, education, year of BMI collection, lineage and G2's year of birth and income. Grandparental and parental education were negatively associated with men's odds of overweight/obesity and parental education affected women's overweight/obesity risk. Furthermore, men and women whose parents belonged to the UT, SI, DT, and AD groups had greater odds of overweight/obesity compared to men and women whose parents belonged to the AA group (adjusted for G3's age, year of BMI collection, lineage, and G2's year of birth). These associations were attenuated when further adjusting for parental income and G3's own education. Socioeconomic inequalities can have long-term consequences and impact the health of future generations. For overweight/obesity in concurrent young cohorts, this inequality is not fully offset by upward educational trajectory in their parent's generation.
The relationship between childhood obesity and neighborhood food ecology explored through the context of gentrification in New York City.
Rhodes-Bratton Brennan,Rundle Andrew,Lovasi Gina S,Herbstman Julie
International public health journal
Inequity and health disparities can be exacerbated as a result of gentrification when long-term residents are displaced, or remain but are not able to take advantage of new opportunities. The disappearance of old and emergence of new food establishments may increase the proximity to and density of healthy food options, however, affordability and consumption of healthy food, nor a decrease in risk of adverse health outcomes are not guaranteed. Our study aims to understand the relationship between gentrification, neighborhood food environment, and childhood obesity. We describe food opportunities changes in New York City using National Establishments Time Series Database stratified by gentrification status. Using data from the Columbia Center for Children's Environmental Health birth cohort study, we evaluate the impact of the area-level changing food chances on the body mass index z-scores of children at age five. Overall, gentrifying neighborhoods have the highest number of food chances and experience the most substantial increase in both healthy (p < 0.001) and unhealthy (p < 0.001) food chances between 1990-2010. After adjusting for covariates, higher access to healthy food chances was associated with both lower BMI z-score (p < 0.01) and less likelihood of being overweight or obese (p < 0.001) for five-year-old children. Our results suggest gentrification was associated with contemporaneous changes in the neighborhood food chances in NYC and children exposed to greater healthy foods experienced a lower probability of excess body weight by five years old. Further research is needed to understand other potential pathways connecting gentrification to childhood BMI.
Socioeconomic position across life and body composition in early old age: findings from a British birth cohort study.
Bann David,Cooper Rachel,Wills Andrew K,Adams Judith,Kuh Diana,
Journal of epidemiology and community health
BACKGROUND:Previous studies have reported associations between lower lifetime socioeconomic position (SEP) and higher body mass index in adulthood, but few have examined associations with direct measures of fat and lean mass which are likely to have independent roles in health and physical functioning. METHODS:We examined associations of SEP across life with dual-energy X-ray absorptiometry measures of fat and lean mass at 60-64 years using data from a total of 1558 men and women participating in the Medical Research Council (MRC) National Survey of Health and Development. We also examined whether associations of childhood SEP with fat and lean mass were explained by preadulthood weight gain (birth weight, 0-7 and 7-20 years) and adult SEP. RESULTS:Lower SEP across life was associated with higher fat mass and higher android to gynoid fat mass ratio. For example, the mean difference in fat mass index comparing the lowest with the highest paternal occupational class at 4 years (slope index of inequality) was 1.04 kg/m(1.2) in men (95% CI 0.09 to 1.99) and 2.61 in women (1.34 to 3.89), equivalent to a 8.6% and 16.1% difference, respectively. After adjustment for fat mass, lower SEP across life was associated with lower lean mass in women, while only contemporaneous household income was associated in men. Associations between childhood SEP and outcomes were partly explained by preadulthood weight gain and adult SEP. CONCLUSIONS:This study identified lifetime socioeconomic patterning of fat and lean mass in early old age. This is likely to have important implications and may partly explain socioeconomic inequalities in health and physical functioning.
SES-of-Origin and BMI in Youth: Comparing Germany and Minnesota.
Johnson Wendy,Hahn Elisabeth,Gottschling Juliana,Lenau Franziska,Spinath Frank M,McGue Matt
Increasing obesity is a world-wide health concern. Its most commonly used indicator, body mass index (BMI), consistently shows considerable genetic and shared environmental variance throughout life, the latter particularly in youth. Several adult studies have observed less total and genetically influenced variance with higher attained SES. These studies offer clues about sources of the 'obesity epidemic' but analogous youth studies of SES-of-origin are needed. Genetic and environmental influences and moderating effects of SES may vary in countries with different health policies, lifestyles, and degrees/sources of social inequality, offering further clues to the sources of the obesity epidemic. We examined SES-of-origin moderation of BMI variance in the German TwinLife study's cohorts assessed around ages 5, 11, 17, and 23-24, and in the Minnesota Twin Family Study's (MTFS) 11- and 17-year-old birth cohorts assessed longitudinally around ages 11, 17, and 23-24, comparing male and female twins and their parents. Age for age, both sexes' means and variances were greater in MTFS than in TwinLife. We observed that SES generally moderated genetic influences, more strongly in females, similar to most adult studies of attained-SES moderation of BMI. We interpreted differences in our SES-of-origin observations in light of inevitably-missing covariance between SES-of-origin and BMI in the models, mother-father and parent-offspring BMI correlations, and parental attained-SES-BMI correlations. We suggest that one source of the present obesity epidemic is social change that amplifies expression of genes both constraining SES attainment and facilitating weight gain.
Educational level, relative body weight, and changes in their association over 10 years: an international perspective from the WHO MONICA Project.
Molarius A,Seidell J C,Sans S,Tuomilehto J,Kuulasmaa K
American journal of public health
OBJECTIVES:This study assessed the consistency and magnitude of the association between educational level and relative body weight in populations with widely different prevalences of over-weight and investigated possible changes in the association over 10 years. METHODS:Differences in age-adjusted mean body mass index (BMI) between the highest and the lowest tertiles of years of schooling were calculated for 26 populations in the initial and final surveys of the World Health Organization (WHO) MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Project. The data are derived from random population samples, including more than 42,000 men and women aged 35 to 64 years in the initial survey (1979-1989) and almost 35,000 in the final survey (1989-1996). RESULTS:For women, almost all populations showed a statistically significant inverse association between educational level and BMI; the difference between the highest and the lowest educational tertiles ranged from -3.3 to 0.4 kg/m2. For men, the difference ranged from -1.5 to 2.2 kg/m2. In about two thirds of the populations, the differences in BMI between the educational levels increased over the 10-year period. CONCLUSION:Lower education was associated with higher BMI in about half of the male and in almost all of the female populations, and the differences in relative body weight between educational levels increased over the study period. Thus, socioeconomic inequality in health consequences of obesity may increase in many countries.
Social and spatial patterns of obesity diffusion over three decades in a Norwegian county population: the HUNT Study.
Krokstad Steinar,Ernstsen Linda,Sund Erik R,Bjørngaard Johan Håkon,Langhammer Arnulf,Midthjell Kristian,Holmen Turid Lingaas,Holmen Jostein,Thoen Håvard,Westin Steinar
BMC public health
BACKGROUND:In order to develop effective preventive strategies, knowledge of trends in socioeconomic and geographical differences in risk factor levels is important. The objective of this study was to examine social and spatial patterns of obesity diffusion in a Norwegian population during three decades. METHODS:Data on adults aged 30-69 years from three cross-sectional health surveys eleven years apart in the Nord-Trøndelag Health Study, Norway, HUNT1 (1984-1986), HUNT2 (1995-1997) and HUNT3 (2006-2008) were utilized. Body mass index (BMI) was used as a measure of obesity. Height and weight were measured clinically. Age standardized prevalences, absolute prevalence differences and ratios, prevalence odds ratios for BMI and the Relative Index of Inequality (RII) were calculated. Multilevel statistical models were fitted for analysing geographical patterns. RESULTS:The prevalence of obesity was systematically higher in groups with lower socio-economic status and increased successively in all groups in the population during the three decades. The relative socioeconomic inequalities in obesity measured by level of education did not change substantially in the period. In HUNT1 (1984-86) obesity was most prevalent among low educated women (14.1%) and in HUNT3 (2006-08) among low educated men (30.4%). The RII for men changed from 2.60 to 1.91 and 2.36 in HUNT1, HUNT2 and HUNT3. In women the RIIs were 1.71, 2.28 and 2.30 correspondingly. However, the absolute obesity prevalence inequalities increased, and a geographical diffusion from central to distal districts was observed from HUNT2 to HUNT3. CONCLUSIONS:The prevalence of obesity increased in all socioeconomic groups in this Norwegian adult county population from the 1980ies up to present time. The data did not suggest increasing relative inequalities, but increasing absolute socioeconomic differences and a geographical diffusion towards rural districts. Public health preventive strategies should be oriented to counteract the obesity epidemic in the population.
Are geographic regions with high income inequality associated with risk of abdominal weight gain?
Kahn H S,Tatham L M,Pamuk E R,Heath C W
Social science & medicine (1982)
Geographic regions characterized by income inequality are associated with adverse mortality statistics, but the pathophysiologic mechanisms that mediate this ecologic relationship have not been elucidated. This study used a United States mail survey of 34158 male and 42741 female healthy-adult volunteers to test the association between residence in geographic regions with relative income inequality and the likelihood of weight gain at the waist. Respondents came from 21 states that were characterized by the household income inequality (HII) index, a measure reflecting the proportion of total income received by the more well off 50% of households in the state. The main outcome measure was self-reported weight gain mainly at the waist as opposed to weight gain at other anatomic sites. After controlling for age, other individual-level factors, and each state's median household income, men's likelihood of weight gain at the waist was positively associated (p = 0.0008) with the HII index. Men from states with a high HII (households above the median receive 81.6% to 82.6% of the income) described weight gain at the waist more often than men from states with a low HII (households above the median receive 77.0% to 78.5% of the income) (odds ratio = 1.12, 95% confidence interval 1.03 to 1.22). Women's results showed a non-significant trend in the same direction. An association between ecologically defined socio-environmental stress and abdominal obesity may help to clarify the pathophysiologic pathways leading to several major chronic diseases.
Why are women slimmer than men in developed countries?
Maruyama Shiko,Nakamura Sayaka
Economics and human biology
Women have a lower BMI than men in developed countries, yet the opposite is true in developing countries. We call this the gender BMI puzzle and investigate its underlying cause. We begin by studying time trends in Japan, where, consistent with the cross-country puzzle, the BMI of adult women has steadily decreased since the 1950s, whereas the BMI of adult men has steadily increased. We study how changes in energy intake and energy expenditure account for the over-time gender BMI puzzle using the Japanese National Nutrition Survey from 1975 to 2010, which provides nurse-measured height and weight and nutritionist-assisted food records. Because long-term data on energy expenditure do not exist, we calculate energy expenditure using a steady-state body weight model. We then conduct cross-country regression analysis to corroborate what we learn from the Japanese data. We find that both energy intake and energy expenditure have significantly decreased for Japanese adult men and women and that a larger reduction in energy expenditure among men than women accounts for the increasing male-to-female BMI gap. Trends in BMI and energy expenditure vary greatly by occupation, suggesting that a relatively large decrease in physical activity in the workplace among men underlies the gender BMI puzzle. The cross-country analysis supports the generalizability of the findings beyond the Japanese data. Furthermore, the analysis suggests the increasing male-to-female BMI gap is driven not only by a reduction in the energy requirements of physically demanding work but also by weakening occupational gender segregation. No support is found for other explanations, such as increasing female labor force participation, greater female susceptibility to malnutrition in utero, and gender inequality in nutrition in early life.
Associations between major chain fast-food outlet availability and change in body mass index: a longitudinal observational study of women from Victoria, Australia.
Lamb Karen E,Thornton Lukar E,Olstad Dana Lee,Cerin Ester,Ball Kylie
OBJECTIVES:The residential neighbourhood fast-food environment has the potential to lead to increased levels of obesity by providing opportunities for residents to consume energy-dense products. This longitudinal study aimed to examine whether change in body mass index (BMI) differed dependent on major chain fast-food outlet availability among women residing in disadvantaged neighbourhoods. SETTING:Eighty disadvantaged neighbourhoods in Victoria, Australia. PARTICIPANTS:Sample of 882 women aged 18-46 years at baseline (wave I: 2007/2008) who remained at the same residential location at all three waves (wave II: 2010/2011; wave III: 2012/2013) of the Resilience for Eating and Activity Despite Inequality study. PRIMARY OUTCOME:BMI based on self-reported height and weight at each wave. RESULTS:There was no evidence of an interaction between time and the number of major chain fast-food outlets within 2 (p=0.88), 3 (p=0.66) or 5 km (p=0.24) in the multilevel models of BMI. Furthermore, there was no evidence of an interaction between time and change in availability at any distance and BMI. CONCLUSIONS:Change in BMI was not found to differ by residential major chain fast-food outlet availability among Victorian women residing in disadvantaged neighbourhoods. It may be that exposure to fast-food outlets around other locations regularly visited influence change in BMI. Future research needs to consider what environments are the key sources for accessing and consuming fast food and how these relate to BMI and obesity risk.
Measuring and tracking obesity inequality in the United States: evidence from NHANES, 1971-2014.
Pak Tae-Young,Ferreira Susana,Colson Gregory
Population health metrics
BACKGROUND:Because people care about their weight relative to peers and society, obesity inequality plays a role in explaining obesity incidence and the impacts of being obese on subjective well-being. While the increase in obesity prevalence and mean body mass index (BMI) is well documented, the measurement of distributional changes and corresponding obesity inequality is yet to be fully explored. METHODS:The present study analyzed BMI data for adults aged 20 to 74 from the National Health and Nutritional Examination Survey (NHANES) I (1971-1974), II (1976-1980), III (1988-1994), and continuous NHANES (1999-2014). We applied tools developed to measure income inequality to analyze the inter-temporal variation in the BMI distribution among US adults. Using stochastic dominance tests, we construct partial orderings on cumulative BMI distributions during the study period. Shapley decompositions and inequality indices are employed to quantify the source and extent of temporal variation and decompose the inequality into within and between-group components considering age, gender, and race. RESULTS:The BMI distribution of each NHANES study first-order stochastically dominated the BMI distribution of the previous wave from 1971-1974 to 2003-2006, whereas more recent comparisons failed to reject the null hypothesis of non-dominance. The Shapley decomposition analysis revealed that horizontal shifts of BMI distributions accounted for a majority of the increase in obesity prevalence since 1988-1991. Especially in recent years when the rate of obesity growth has slowed down, the contribution of the redistribution component dropped significantly and even became negative between 2007-2010 and 2011-2014. The inequality indexes consistently show a worsening of obesity inequality from the mid-1970s to the mid-2000s regardless of population subgroups, and this disproportionate shift of the BMI distribution is unlikely to be a result of a changing ethnic composition of the US population. CONCLUSION:Our findings demonstrate that seemingly similar increases in obesity prevalence can be accompanied by very different patterns of distribution change. We find that the early phase of the obesity epidemic in the US was largely driven by increasing skewness, whereas more recent growth is a population-wide experience, regardless of demographic characteristics. Increasing morbid obesity certainly played an important role in the initial phase of the epidemic, but more recently the BMI distribution has largely horizontally shifted to the right.
Inter-individual inequality in BMI: An analysis of Indonesian Family Life Surveys (1993-2007).
Vaezghasemi Masoud,Razak Fahad,Ng Nawi,Subramanian S V
SSM - population health
Widening inequalities in mean Body Mass Index (BMI) between social and economic groups are well documented. However, whether changes in mean BMI are followed by changes in dispersion (or variance) and whether these inequalities are also occurring within social groups or across individuals remain understudied. In addition, a substantial body of literature exists on the global increase in mean BMI and prevalence of overweight and obesity. However, whether this weight gain is shared proportionately across the whole spectrum of BMI distribution, also remains understudied. We examined changes in the distribution of BMI at the population level over time to understand how changes in the dispersion reflect between-group compared to within-group inequalities in weight gain. Moreover, we investigated the entire distribution of BMI to determine in which percentiles the most weight gain is occurring over time. Utilizing four waves (from 1993 to 2007) of Indonesian Family Life Surveys (IFLS), we estimated changes in the mean and the variance of BMI over time and across various socioeconomic groups based on education and households' expenditure per capita in 53,648 men and women aged 20-50 years. An increase in mean and standard deviation was observed among men (by 4.3% and 25%, respectively) and women (by 7.3% and 20%, respectively) over time. Quantile-Quantile plots showed that higher percentiles had greater increases in BMI compared to the segment of the population at lower percentiles. While between socioeconomic group differences decreased over time, within-group differences increased and were more prominent among individuals with poor education and lower per capita expenditures. Population changes in BMI cannot be fully described by average trends or single parameters such as the mean BMI. Moreover, greater increases in within-group dispersion compared with between-group differences imply that growing inequalities are not merely driven by these socioeconomic factors at the population level.
Genetic associations with temporal shifts in obesity and severe obesity during the obesity epidemic in Norway: A longitudinal population-based cohort (the HUNT Study).
Brandkvist Maria,Bjørngaard Johan Håkon,Ødegård Rønnaug Astri,Brumpton Ben,Smith George Davey,Åsvold Bjørn Olav,Sund Erik R,Kvaløy Kirsti,Willer Cristen J,Vie Gunnhild Åberge
BACKGROUND:Obesity has tripled worldwide since 1975 as environments are becoming more obesogenic. Our study investigates how changes in population weight and obesity over time are associated with genetic predisposition in the context of an obesogenic environment over 6 decades and examines the robustness of the findings using sibling design. METHODS AND FINDINGS:A total of 67,110 individuals aged 13-80 years in the Nord-Trøndelag region of Norway participated with repeated standardized body mass index (BMI) measurements from 1966 to 2019 and were genotyped in a longitudinal population-based health study, the Trøndelag Health Study (the HUNT Study). Genotyping required survival to and participation in the HUNT Study in the 1990s or 2000s. Linear mixed models with observations nested within individuals were used to model the association between a genome-wide polygenic score (GPS) for BMI and BMI, while generalized estimating equations were used for obesity (BMI ≥ 30 kg/m2) and severe obesity (BMI ≥ 35 kg/m2). The increase in the average BMI and prevalence of obesity was steeper among the genetically predisposed. Among 35-year-old men, the prevalence of obesity for the least predisposed tenth increased from 0.9% (95% confidence interval [CI] 0.6% to 1.2%) to 6.5% (95% CI 5.0% to 8.0%), while the most predisposed tenth increased from 14.2% (95% CI 12.6% to 15.7%) to 39.6% (95% CI 36.1% to 43.0%). Equivalently for women of the same age, the prevalence of obesity for the least predisposed tenth increased from 1.1% (95% CI 0.7% to1.5%) to 7.6% (95% CI 6.0% to 9.2%), while the most predisposed tenth increased from 15.4% (95% CI 13.7% to 17.2%) to 42.0% (95% CI 38.7% to 45.4%). Thus, for 35-year-old men and women, respectively, the absolute change in the prevalence of obesity from 1966 to 2019 was 19.8 percentage points (95% CI 16.2 to 23.5, p < 0.0001) and 20.0 percentage points (95% CI 16.4 to 23.7, p < 0.0001) greater for the most predisposed tenth compared with the least predisposed tenth, defined using the GPS for BMI. The corresponding absolute changes in the prevalence of severe obesity for men and women, respectively, were 8.5 percentage points (95% CI 6.3 to 10.7, p < 0.0001) and 12.6 percentage points (95% CI 9.6 to 15.6, p < 0.0001) greater for the most predisposed tenth. The greater increase in BMI in genetically predisposed individuals over time was apparent after adjustment for family-level confounding using a sibling design. Key limitations include a slightly lower survival to date of genetic testing for the older cohorts and that we apply a contemporary genetic score to past time periods. Future research should validate our findings using a polygenic risk score constructed from historical data. CONCLUSIONS:In the context of increasingly obesogenic changes in our environment over 6 decades, our findings reveal a growing inequality in the risk for obesity and severe obesity across GPS tenths. Our results suggest that while obesity is a partially heritable trait, it is still modifiable by environmental factors. While it may be possible to identify those most susceptible to environmental change, who thus have the most to gain from preventive measures, efforts to reverse the obesogenic environment will benefit the whole population and help resolve the obesity epidemic.
Socioeconomic inequality in excessive body weight in Indonesia.
Aizawa Toshiaki,Helble Matthias
Economics and human biology
Exploiting the Indonesian Family Life Survey (IFLS), this paper studies the transition of socioeconomic-related excess weight disparity, including overweight and obesity, from 1993 to 2014. First, we show that the proportions of overweight and obese people in Indonesia increased rapidly during the time period covered and that poorer groups exhibited a larger annual excess weight growth rate than richer groups (7.49 percent vs. 3.01 percent). Second, by calculating the concentration index, we confirm that the prevalence of obesity affected increasingly poorer segments of Indonesian society. Consequently, the concentration index decreased during the study period, from 0.287 to 0.093. Finally, decomposing the change in the concentration index of excess weight from 2000 to 2014, we show that a large part of the change can be explained by a decrease in the elasticity of wealth and improved sanitary conditions in poorer households. Overall, obesity in Indonesia no longer affects purely the wealthier segments of the population but the entire socioeconomic spectrum.
Do sociodemographic, behavioral or health status variables affect longitudinal anthropometric changes in older adults? Population-based cohort study in Southern Brazil.
Goes Vanessa Fernanda,Wazlawik Elisabeth,d'Orsi Eleonora,Navarro Albert,González-Chica David Alejandro
Geriatrics & gerontology international
AIM:To assess the influence of sociodemographic, behavioral and health status variables on longitudinal changes in height, weight, and waist circumference in older adults. METHODS:This is a population-based cohort study in Southern Brazil (EpiFloripa Study) investigating 1702 individuals aged 70.6 ± 8.0 years (62.5% women). Height, weight and waist circumference were measured in 2009/10 and 2013/14 (n = 1197). Linear mixed regression models were used to estimate age-related changes in anthropometric measurements according to the explanatory variables. RESULTS:Unmarried individuals, with higher education level or household income, with excessive alcohol consumption, former smokers and positives for some chronic disease were heavier than their counterparts. Similar associations were observed for waist circumference in terms of marital status, smoking and the presence of chronic diseases. Height was higher among the wealthiest, in former smokers and those physically active. Only in men were a lower education level and being unmarried associated with higher weight loss after the age of 75 years, but not with waist circumference reduction. CONCLUSIONS:Despite their association with current height, weight and waist circumference, neither behavioral variables nor the presence of chronic diseases influenced the anthropometric changes. Less educated and unmarried men lose weight at a higher rate, showing a higher risk of sarcopenia. Geriatr Gerontol Int 2017; 17: 2074-2082.
Inequalities in the uptake of, adherence to and effectiveness of behavioural weight management interventions: systematic review protocol.
Birch Jack Michael,Griffin Simon J,Kelly Michael P,Ahern Amy L
INTRODUCTION:It has been suggested that interventions focusing on individual behaviour change, such as behavioural weight management interventions, may exacerbate health inequalities. These intervention-generated inequalities may occur at different stages, including intervention uptake, adherence and effectiveness. We will synthesise evidence on how different measures of inequality moderate the uptake, adherence and effectiveness of behavioural weight management interventions in adults. METHODS AND ANALYSIS:We will update a previous systematic literature review from the United States Preventive Services Taskforce to identify trials of behavioural weight management interventions in adults aged 18 years and over that were, or could feasibly be, conducted in or recruited from primary care. Medline, Cochrane database (CENTRAL) and PsycINFO will be searched. Only randomised controlled trials (RCTs) and cluster-RCTs will be included. Two investigators will independently screen articles for eligibility and conduct risk of bias assessment. We will curate publication families for eligible trials. The PROGRESS-Plus acronym (place of residence, race/ethnicity, occupation, gender, religion, education, socioeconomic status, social capital, plus other discriminating factors) will be used to consider a comprehensive range of health inequalities. Data on trial uptake, intervention adherence, weight change and PROGRESS-Plus-related data will be extracted. Data will be synthesised narratively. We will present a Harvest plot for each PROGRESS-Plus criterion and whether each trial found a negative, positive or no health inequality gradient. We will also identify potential sources of unpublished original research data on these factors which can be synthesised through a future individual participant data meta-analysis. ETHICS AND DISSEMINATION:Ethical approval is not required as no primary data are being collected. The completed systematic review will be disseminated in a peer-reviewed journal, at conferences, and contribute to the lead author's PhD thesis. Authors of trials included in the completed systematic review may be invited to collaborate on a future individual participant data meta-analysis. PROSPERO REGISTRATION NUMBER:CRD42020173242.
Obesity in Scotland: a persistent inequality.
Tod Elaine,Bromley Catherine,Millard Andrew D,Boyd Allan,Mackie Phil,McCartney Gerry
International journal for equity in health
BACKGROUND:Obesity is a health problem in its own right and a risk factor for other conditions such as cardiovascular disease. The prevalence of overweight and obesity increased in Scotland between 1995 and 2008 with socio-economic inequalities persisting in adults over time and increasing in children. This paper explores changes in the underlying distribution of body mass index (BMI) which is less well understood. METHODS:Using data from the Scottish Health Survey (SHeS) between 1995 and 2014 for adults aged 18-64 years, we calculated population distributions for BMI for the population overall, and for age, sex and deprivation strata. We used SHeS data for children aged 2-15 years between 1998 and 2014, in addition to data from the Child Health Systems Programme (CHSP) collected from primary one (P1) children in participating local authorities, to describe the overall trends and to compare trends in inequalities by deprivation strata. RESULTS:Amongst adults, the BMI distribution shifted upwards, with a large proportion of the population gaining a small amount of weight between 1995 and 2008 before subsequently stabilising across the distribution. In men the prevalence of obesity showed a linear deprivation gradient in 1995 but over time obesity declined in the least deprived quintile while the remaining four quintiles converged (and stabilised). In contrast, a persistent and generally linear gradient is evident among women for most of the 1995-2014 period. For those aged 2-15 years, obesity increased between 1998 and 2014 for the most deprived 40% of children contrasted with stable trends for the least deprived. The surveillance data for P1 children in Scotland showed a persistent inequality between 2005/06 and 2014/15 though it was less clear if this is widening. CONCLUSIONS:The BMI distribution for adults increased between 1995 and 2008 with a large proportion of the population gaining a small amount of weight before stabilising across the distribution. Inequalities in obesity persist for adults (with different underlying patterns evident for men and women), and may be widening for children. Actions to reduce the obesogenic environment, including structural changes not dependent on individual agency, are urgently needed if the long-term health, social and inequality consequences of obesity are to be reduced.
Socioeconomic disparities in unhealthy weight: A need for health promotion among school-aged children.
Soltani Shahin,Kazemi Zhila,Karyani Ali Kazemi,Matin Behzad Karami,Ebrahimi Mohammad,Rezaei Satar
Journal of education and health promotion
INTRODUCTION:Overweight and obesity as a major public health issue can lead to adverse health consequences during the life span. This study aimed to measure socioeconomic inequality in unhealthy weight among school students in Kermanshah, west of Iran. METHODS:The cross-sectional study measured the socioeconomic-related inequalities in unhealthy weight among 1404 secondary school students aged 11-16 years in Kermanshah in 2018. Unhealthy weight is defined as body mass index of >25 kg/m in the study. Socioeconomic-related inequality in unhealthy weight was calculated using the concentration index (C). A logistic regression model was used to estimate the marginal effect of independent variables. RESULTS:The prevalence of unhealthy weight for the total sample was 0.13 (95% confidence interval [CI]: 0.11 -0.14). Of these, the prevalence of unhealthy weight for girls and boys was 0.11 (95% CI: 0.09-0.14) and 0.15 (95% CI: 0.12-0.18), respectively. The value of C for the total sample was 0.12 (95% CI: 0.03-0.2), which indicates a higher concentration of unhealthy weight among the high socioeconomic status (SES) students. Two factors of SES (49.11%) and gender (40.08%) had the largest contribution to socioeconomic inequality in unhealthy weight among the study students. CONCLUSIONS:Socioeconomic-related inequality in unhealthy weight was concentered among high-SES students in the study. Thus, public health policies need to be formulated to change sedentary lifestyles and unhealthy dietary patterns among students with higher SES.
The mediating role of social capital in the association between neighbourhood income inequality and body mass index.
Mackenbach Joreintje D,Lakerveld Jeroen,van Oostveen Yavanna,Compernolle Sofie,De Bourdeaudhuij Ilse,Bárdos Helga,Rutter Harry,Glonti Ketevan,Oppert Jean-Michel,Charreire Helene,Brug Johannes,Nijpels Giel
European journal of public health
Background:Neighbourhood income inequality may contribute to differences in body weight. We explored whether neighbourhood social capital mediated the association of neighbourhood income inequality with individual body mass index (BMI). Methods:A total of 4126 adult participants from 48 neighbourhoods in France, Hungary, the Netherlands and the UK provided information on their levels of income, perceptions of neighbourhood social capital and BMI. Factor analysis of the 13-item social capital scale revealed two social capital constructs: social networks and social cohesion. Neighbourhood income inequality was defined as the ratio of the amount of income earned by the top 20% and the bottom 20% in a given neighbourhood. Two single mediation analyses-using multilevel linear regression analyses-with neighbourhood social networks and neighbourhood social cohesion as possible mediators-were conducted using MacKinnon's product-of-coefficients method, adjusted for age, gender, education and absolute household income. Results:Higher neighbourhood income inequality was associated with elevated levels of BMI and lower levels of neighbourhood social networks and neighbourhood social cohesion. High levels of neighbourhood social networks were associated with lower BMI. Results stratified by country demonstrate that social networks fully explained the association between income inequality and BMI in France and the Netherlands. Social cohesion was only a significant mediating variable for Dutch participants. Conclusion:The results suggest that in some European urban regions, neighbourhood social capital plays a large role in the association between neighbourhood income inequality and individual BMI.
Trends in group inequalities and interindividual inequalities in BMI in the United States, 1993-2012.
Krishna Aditi,Razak Fahad,Lebel Alexandre,Smith George Davey,Subramanian S V
The American journal of clinical nutrition
BACKGROUND:Marked increases in mean body mass index (BMI) and prevalence of obesity and overweight in the United States are well known. However, whether these average increases were accompanied by changing dispersion (or SD) remains understudied. OBJECTIVE:We investigated population-level changes in the BMI distribution over time to understand how changes in dispersion reflect between-group compared with within-group inequalities in weight gain in the United States. DESIGN:Using data from the Behavioral Risk Factor Surveillance System survey (1993-2012), we analyzed associations between mean, SD, and median BMI and BMI at the 5th and 95th percentiles for 3,050,992 non-Hispanic white, non-Hispanic black, and Hispanic men and women aged 25-64 y. RESULTS:Overall, an increase of 1.0 in mean BMI (in kg/m²) was associated with an increase of 0.70 (95% CI: 0.67, 0.73) in the SD of BMI. A change of 1.0 in median BMI was associated with a change of 0.18 (95% CI: 0.14, 0.21) in the BMI value at the 5th percentile compared with a change of 2.94 (95% CI: 2.81, 3.07) at the 95th percentile. Quantile-quantile plots showed unequal changes in the BMI distribution, with pronounced changes at higher percentiles. Similar patterns were observed in subgroups stratified by sex, race-ethnicity, and education with non-Hispanic black women and women with less than a high school education having highest mean BMI, SD of BMI, and BMI values at the 5th and 95th percentiles. CONCLUSIONS:Mean BMI and the percentage of overweight and obese individuals do not fully describe population changes in BMI. Increases in within-group inequality in BMI represent an underrecognized characteristic of population-level weight gain. Crucially, similar increases in dispersion within groups suggest that growing inequalities in BMI at the population level are not driven by these socioeconomic and demographic factors. Future research should focus on understanding factors driving inequalities in weight gain between individuals.
Socioeconomic transition and its influence on body mass index (BMI) pattern in Bangladesh.
Biswas Raaj Kishore,Kabir Enamul,Khan Hafiz T A
Journal of evaluation in clinical practice
RATIONALE, AIMS, AND OBJECTIVES:Bangladesh is an underdeveloped country that has recently joined the ranks of low-middle-income countries. This study aims to investigate how socioeconomic and developmental factors have influenced women towards a shift in their body mass index (BMI). METHODS:The trend was analysed using data on ever-married women from 6 nationwide surveys covering the years 1996 to 2014, conducted by the Bangladesh Demographic and Health Survey (BDHS). To assess the relationship between the socioeconomic factors and BMI, binary regression models were fitted for 6 surveys and forest plots were applied to display the results. RESULTS:Factors such as age, education, residence, economic status, and contraceptive use were found to have had an increasing influence on BMI over the years that were being analysed. Age and education for women were potential factors influencing BMI. Growing urbanization and economic inequality were found to have been substantial over time, and marital status and contraceptive use were influential whilst the employment status of women held no consequence. CONCLUSIONS:Rapid urbanization allied with growing wealth inequality and dietary alteration seems to have forced a change in the capacity of women in Bangladesh to control their weight. Additional information is still needed on such factors as the amount of time that women are inactive and sitting down, for example, as well as their daily calorie intake in order to assemble all the pieces for addressing necessary health policy changes in Bangladesh. These factors will also help to indicate a shift of focus from rural malnutrition to urban obesity.
Parental Socioeconomic Status and Weight Faltering in Infants in Japan.
Kachi Yuko,Fujiwara Takeo,Yamaoka Yui,Kato Tsuguhiko
Frontiers in pediatrics
Previous studies in the UK and Denmark found no significant association between low socioeconomic status (SES) and weight faltering. However, to our knowledge, there are no studies from other developed countries. We examined the association between parental SES and weight faltering in infants up to 1.5 years of age, and investigated whether the inequalities changed between 2001 and 2010 in Japan. We used data from two Japanese population-based birth cohorts started in 2001 ( = 34,594) and 2010 ( = 21,189). Parental SES was assessed as household income and parental education when the infant was 6 months old. Weight faltering was defined as the slowest weight gaining in 5% of all children in each cohort. Logistic regression analyses were conducted with adjustment for covariates. The relative index of inequality was used to assess relative impact of parental SES on weight faltering. Infants in the lowest quartile of household income were 1.29 (95% confidence interval [CI]: 1.10, 1.52) and 1.27 (95% CI: 1.03, 1.56) times more likely to experience weight faltering than those in the highest income quartile both in the 2001 and 2010 cohorts, respectively. The relative index of inequality for household income was 1.66 (95% CI: 1.36, 1.96) in 2001 and 1.86 (95% CI: 1.42, 2.31) in 2010. Infants from lower income families have a greater risk of weight faltering in Japan. Additionally, the income-related inequalities in weight faltering did not change between the two cohorts. Social policies to address maldistribution of weight faltering due to household income are needed.
A global country-level analysis of the relationship between obesity and COVID-19 cases and mortality.
Foo Oliver,Hiu Shaun,Teare Dawn,Syed Akheel A,Razvi Salman
Diabetes, obesity & metabolism
AIM:To assess the association of country-level obesity prevalence with COVID-19 case and mortality rates, to evaluate the impact of obesity prevalence on worldwide variation. METHODS:Data on COVID-19 prevalence and mortality, country-specific governmental actions, socioeconomic, demographic, and healthcare capacity factors were extracted from publicly available sources. Multivariable negative binomial regression was used to assess the independent association of obesity with COVID-19 case and mortality rates. RESULTS:Across 168 countries for which data were available, higher obesity prevalence was associated with increased COVID-19 mortality and prevalence rates. For every 1% increase in obesity prevalence, the mortality rate was increased by 8.3% (incidence rate ratio [IRR] 1.083, 95% confidence interval [CI] 1.048-1.119; P < 0.001) and the case rate was higher by 6.6% (IRR 1.066, 95% CI 1.035-1.099; P < 0.001). Additionally, higher median population age, greater female ratio, higher Human Development Index (HDI), lower population density, and lower hospital bed availability were all significantly associated with higher COVID-19 mortality rate. In addition, stricter governmental actions, higher HDI and lower mean annual temperature were significantly associated with higher COVID-19 case rate. CONCLUSION:These findings demonstrate that obesity prevalence is a significant and potentially modifiable risk factor of increased COVID-19 national caseload and mortality. Future research to study whether weight loss improves COVID-19 outcomes is urgently required.
Life-course socioeconomic differences and social mobility in preventable and non-preventable mortality: a study of Swedish twins.
Ericsson Malin,Pedersen Nancy L,Johansson Anna L V,Fors Stefan,Dahl Aslan Anna K
International journal of epidemiology
BACKGROUND:Despite advances in life expectancy, low socioeconomic status is associated with a shorter lifespan. This study was conducted to investigate socioeconomic differences in mortality by comparing preventable with non-preventable causes of death in 39 506 participants from the Swedish Twin Registry born before 1935. METHODS:Childhood social class, own education, own social class and social mobility were used as separate indicators of socioeconomic status. These data were linked to the Swedish Cause of Death Register. Cause of death was categorized as preventable or non-preventable mortality according to indicators presented in the Avoidable Mortality in the European Union (AMIEHS) atlas. Using Cox proportional hazard models, we tested the association between the socioeconomic measures and all-cause mortality, preventable mortality and non-preventable mortality. Additional co-twin control analyses indicated whether the associations reflected genetic confounding. RESULTS:The social gradient for mortality was most prominent for the adult socioeconomic measures. There was a social gradient in both preventable mortality and non-preventable mortality, but with an indication of a moderately stronger effect in preventable causes of death. In analyses of social mobility, those who experienced life-time low socioeconomic status (SES) or downward social mobility had an increased mortality risk compared with those with life-time high SES and upward social mobility. Adjustments for genetic confounding did not change the observed associations for education, social class or social mobility and mortality. In the co-twin control analyses of reared-apart twins, the association between childhood social class and mortality weakened, indicating possible genetic influences on this association. CONCLUSIONS:Our results indicate that there is an association between low adult socioeconomic status and increased mortality independent of genetic endowment. Thus, we do not find support for indirect social selection as the basis for mortality inequalities in Sweden.
Weight Gain After Smoking Cessation and Risk of Major Chronic Diseases and Mortality.
Sahle Berhe W,Chen Wen,Rawal Lal B,Renzaho Andre M N
JAMA network open
Importance:Smoking cessation is frequently followed by weight gain; however, whether weight gain after quitting reduces the health benefits of quitting is unclear. Objective:To examine the association between weight change after smoking cessation and the risk of cardiovascular diseases (CVD), type 2 diabetes, cancer, chronic obstructive pulmonary disease (COPD), and all-cause mortality. Design, Setting, and Participants:This cohort study analyzed data from a nationally representative sample of Australian adults aged 18 years or older who were studied between 2006 and 2014. Smoking status and anthropometric measurements were self-reported annually. Cox proportional hazards regressions were used to determine the hazard ratios (HRs) for the association between changes in weight and body mass index (BMI) and the risk of CVD, type 2 diabetes, cancer, COPD, and mortality. Data were analyzed in January 2019. Exposures:Annual self-reported smoking status; years since quitting. Main Outcomes and Measures:Weight gain after quitting, incident CVD, type 2 diabetes, cancer, COPD, and all-cause mortality. Results:Of a total 16 663 participants (8082 men and 8581 women; mean [SD] age, 43.7 [16.3] years), those who quit smoking had greater increases in weight (mean difference [MD], 3.14 kg; 95% CI, 1.39-4.87) and BMI (MD, 0.82; 95% CI, 0.21-1.44) than continuing smokers. Compared with continuing smokers, the HRs for death were 0.50 (95% CI, 0.36-0.68) among quitters who lost weight, 0.79 (95% CI, 0.51-0.98) among quitters without weight change, 0.33 (95% CI, 0.21-0.51) among quitters who gained 0.1 to 5.0 kg, 0.24 (95% CI, 0.11-0.53) among quitters who gained 5.1 to 10 kg, and 0.36 (95% CI, 0.16-0.82) among quitters who gained more than 10 kg. The HRs for death were 0.61 (95% CI, 0.45-0.83) among quitters who lost BMI, 0.86 (95% CI, 0.51-1.44) among quitters without change in BMI, 0.32 (95% CI, 0.21-0.50) among quitters who gained up to 2 in BMI, and 0.26 (95% CI, 0.16-0.45) among quitters who gained more than 2 in BMI. Conclusions and Relevance:This cohort study found that smoking cessation was accompanied by a substantial weight gain; however, this was not associated with an increased risk of chronic diseases or an attenuation of the mortality benefit of cessation.
Association of weight loss and weight loss maintenance following diabetes diagnosis by screening and incidence of cardiovascular disease and all-cause mortality: An observational analysis of the ADDITION-Europe trial.
Strelitz Jean,Sharp Stephen J,Khunti Kamlesh,Vos Rimke C,Rutten Guy E H M,Webb David R,Witte Daniel R,Sandbaek Annelli,Wareham Nicholas J,Griffin Simon J
Diabetes, obesity & metabolism
AIMS:Short-term weight loss may lead to remission of type 2 diabetes but the effect of maintained weight loss on cardiovascular disease (CVD) is unknown. We quantified the associations between changes in weight 5 years following a diagnosis of diabetes, and incident CVD events and mortality up to 10 years after diagnosis. MATERIALS AND METHODS:Observational analysis of the ADDITION-Europe trial of 2730 adults with screen-detected type 2 diabetes from the UK, Denmark and the Netherlands. We defined weight change based on the maintenance at 5 years of weight loss achieved during the year after diabetes diagnosis, and as 5-year overall change in weight. Incident CVD events (n = 229) and all-cause mortality (n = 225) from 5 to 10 years follow-up were ascertained from medical records. RESULTS:Gaining >2% weight during the year after diabetes diagnosis was associated with higher hazard of all-cause mortality versus maintaining weight [hazard ratio (95% confidence interval): 3.18 (1.30-7.82)]. Losing ≥5% weight 1 year after diagnosis was also associated with mortality, whether or not weight loss was maintained at 5 years: 2.47 (0.99-6.21) and 2.72 (1.17-6.30), respectively. Losing ≥10% weight over 5 years was associated with mortality among those with body mass index <30 kg/m [4.62 (1.87-11.42)]. Associations with CVD incidence were inconclusive. CONCLUSIONS:Both weight loss and weight gain after screen-detected diabetes diagnosis were associated with higher mortality, but not CVD events, particularly among participants without obesity. The clinical implications of weight loss following a diagnosis of diabetes probably depend on its magnitude and timing, and may differ by body mass index status. Personalization of weight loss advice and support may be warranted.
Short-, Medium-, and Long-term Weight Changes and All-Cause Mortality in Old Age: Findings From the National Survey of the Japanese Elderly.
Murayama Hiroshi,Liang Jersey,Shaw Benjamin A,Botoseneanu Anda,Kobayashi Erika,Fukaya Taro,Shinkai Shoji
The journals of gerontology. Series A, Biological sciences and medical sciences
BACKGROUND:Recent studies, predominantly in Western populations, suggest that both weight loss and weight gain are associated with an increased mortality risk in old age. However, evidence of this association in older Asian populations remains sparse. This study aimed to examine the association between weight change and all-cause mortality in a nationally representative sample of community-dwelling older Japanese people. METHODS:Data were obtained from the National Survey of the Japanese Elderly, which included 4869 adults aged ≥60 years. Participants were followed for up to 30 years. We considered 3 indicators of weight change according to the follow-up interval: short-term (3 years), medium-term (6-7 years), and long-term (12-13 years). Weight change was classified as loss ≥ 5%, loss 2.5%-4.9%, stable (±2.4%), gain 2.5%-4.9%, and gain ≥ 5%. Cox proportional hazards models were used to calculate the relative mortality risk of each weight change category. RESULTS:Weight loss ≥ 5% for all intervals was associated with higher mortality than stable weight and the effects were largely similar across all 3 intervals (hazard ratio [95% confidence interval]: 1.36 [1.22-1.51] for short-term, 1.36 [1.22-1.51] for medium-term, and 1.31 [1.11-1.54] for long-term). A similar pattern of results was observed among the young-old and old-old, and among men and women. The effect of weight loss on higher mortality was greater among those with a lower body mass index at baseline. CONCLUSIONS:These findings could inform clinical and public health approaches to body-weight management aimed at improving the health and survival of older adults, particularly in Asian populations.
Deaths, Disparities, and Cumulative (Dis)Advantage: How Social Inequities Produce an Impairment Paradox in Later Life.
Jackson Heide,Engelman Michal
The journals of gerontology. Series A, Biological sciences and medical sciences
BACKGROUND:Research on health across the life course consistently documents widening racial and socioeconomic disparities from childhood through adulthood, followed by stabilization or convergence in later life. This pattern appears to contradict expectations set by cumulative (dis)advantage (CAD) theory. Informed by the punctuated equilibrium perspective, we examine the relationship between midlife health and subsequent health change and mortality and consider the impact of earlier socioeconomic exposures on observed disparities. METHODS:Using the Health and Retirement Study, we characterize the functional impairment histories of a nationally-representative sample of 8,464 older adults between 1994-2016. We employ non-parametric and discrete outcome multinomial logistic regression to examine the competing risks of mortality, health change, and attrition. RESULTS:Exposures to disadvantages are associated with poorer functional health in midlife and mortality. However, a higher number of functional limitations in midlife is negatively associated with the accumulation of subsequent limitations for white men and women and for Black women. The impact of educational attainment, occupation, wealth, and marriage on later life health differs across race and gender groups. CONCLUSIONS:Observed stability or convergence in later-life functional health disparities is not a departure from the dynamics posited by CAD, but rather a result of the differential impact of racial and socioeconomic inequities on mortality and health at older ages. Higher exposure to disadvantages and a lower protective impact of advantageous exposures lead to higher mortality among Black Americans, a pattern which masks persistent health inequities later in life.
Evaluation of Changes in Veterans Affairs Medical Centers' Mortality Rates After Risk Adjustment for Socioeconomic Status.
Trivedi Amal N,Jiang Lan,Silva Gabriella,Wu Wen-Chih,Mor Vincent,Fine Michael J,Kressin Nancy R,Gutman Roee
JAMA network open
Importance:Socioeconomic factors are associated with worse outcomes after hospitalization, but neither the Centers for Medicare & Medicaid Services (CMS) nor the Veterans Affairs (VA) health care system adjust for socioeconomic factors in profiling hospital mortality. Objective:To evaluate changes in Veterans Affairs medical centers' (VAMCs') risk-standardized mortality rates among veterans hospitalized for heart failure and pneumonia after adjusting for socioeconomic factors. Design, Setting, and Participants:In this cross-sectional study, retrospective data were used to assess 131 VAMCs' risk-standardized 30-day mortality rates with or without adjustment for socioeconomic covariates. The study population included 42 892 veterans hospitalized with heart failure and 39 062 veterans hospitalized with pneumonia from January 1, 2012, to December 31, 2014. Data were analyzed from March 1, 2019, to April 1, 2020. Main Outcomes and Measures:The primary outcome was 30-day mortality after admission. Socioeconomic covariates included neighborhood disadvantage, race/ethnicity, homelessness, rurality, nursing home residence, reason for Medicare eligibility, Medicaid and Medicare dual eligibility, and VA priority. Results:The study population included 42 892 veterans hospitalized with heart failure (98.2% male; mean [SD] age, 71.9 [11.4] years) and 39 062 veterans hospitalized with pneumonia (96.8% male; mean [SD] age, 71.0 [12.4] years). The addition of socioeconomic factors to the CMS models modestly increased the C statistic from 0.77 (95% CI, 0.77-0.78) to 0.78 (95% CI, 0.78-0.78) for 30-day mortality after heart failure and from 0.73 (95% CI, 0.72-0.73) to 0.74 (95% CI, 0.73-0.74) for 30-day mortality after pneumonia. Mortality rates were highly correlated (Spearman correlations of ≥0.98) in models that included or did not include socioeconomic factors. With the use of the CMS model for heart failure, VAMCs in the lowest quintile had a mean (SD) mortality rate of 6.0% (0.4%), those in the middle 3 quintiles had a mean (SD) mortality rate of 7.2% (0.4%), and those in the highest quintile had a mean (SD) mortality rate of 8.8% (0.6%). After the inclusion of socioeconomic covariates, the adjusted mean (SD) mortality was 6.1% (0.4%) for hospitals in the lowest quintile, 7.2% (0.4%) for those in the middle 3 quintiles, and 8.6% (0.5%) for those in the highest quintile. The mean absolute change in rank after socioeconomic adjustment was 3.0 ranking positions (interquartile range, 1.0-4.0) among hospitals in the highest quintile of mortality after heart failure and 4.4 ranking positions (interquartile range, 1.0-6.0) among VAMCs in the lowest quintile. Similar findings were observed for mortality rankings in pneumonia and after inclusion of clinical covariates. Conclusions and Relevance:This study suggests that adjustments for socioeconomic factors did not meaningfully change VAMCs' risk-adjusted 30-day mortality rates for veterans hospitalized for heart failure and pneumonia. The implications of such adjustments should be examined for other quality measures and health systems.
Weight change in relation to mortality in middle-aged and elderly Chinese: the Singapore Chinese Health Study.
Pan Xiong-Fei,Yuan Jian-Min,Koh Woon-Puay,Pan An
International journal of obesity (2005)
OBJECTIVES:To examine the association between weight change and mortality in middle-aged and elderly Chinese. METHODS:We used data from the Singapore Chinese Health Study among 36 338 participants aged 45 to 74 years at recruitment (1993-1998). Weight change was computed as the difference between weights at baseline and the follow-up 1 (1999-2004) surveys and classified as moderate-to-large weight loss (≥10%), small weight loss (5.1-9.9%), stable weight (±5%), small weight gain (5.1-9.9%) and moderate-to-large weight gain (≥10%). The participants were free of cancer and cardiovascular disease (CVD) at the follow-up 1 survey and were followed for mortality through linkage with the Singapore Birth and Death Registry. RESULTS:Until 31 December 2016, a total of 7551 deaths were identified during 517 128 person-years of follow-up (mean follow-up: 14.2 years). Compared to those with stable weight, significantly increased risk of all-cause mortality was found for participants with moderate-to-large weight loss (hazard ratio [HR]: 1.39; 95% CI: 1.30, 1.49), small loss (1.14; 1.06, 1.22), and moderate-to-large gain (1.13; 1.05, 1.22). Moderate-to-large weight loss was significantly associated with increased risk of mortality from CVD (including both ischemic heart disease and stroke) and respiratory disease, while moderate-to-large weight gain was significantly associated with CVD mortality. Associations were generally consistent in stratified analyses by sex, age groups (<60 and ≥60 years old), smoking status (never, former and current smoking), and baseline body mass index (<23 and ≥23 kg/m), although significant effect modifications were found for certain strata. CONCLUSIONS:Our findings showed that both moderate-to-large weight gain and loss conferred excess risk for all-cause and CVD mortality in middle-aged and elderly Chinese, with slightly higher risk for weight loss than weight gain. However, it remains to be examined in clinical trials whether maintaining stable body weight should be proposed to reduce mortality risk in middle-aged and elderly populations.
The Risks of Cardiovascular Disease and Mortality Following Weight Change in Adults with Diabetes: Results from ADVANCE.
Lee Alexandra K,Woodward Mark,Wang Dan,Ohkuma Toshiaki,Warren Bethany,Sharrett A Richey,Williams Bryan,Marre Michel,Hamet Pavel,Harrap Stephen,Mcevoy John W,Chalmers John,Selvin Elizabeth
The Journal of clinical endocrinology and metabolism
CONTEXT:Weight loss is strongly recommended for overweight and obese adults with type 2 diabetes. Unintentional weight loss is associated with increased risk of all-cause mortality, but few studies have examined its association with cardiovascular outcomes in patients with diabetes. OBJECTIVE:To evaluate 2-year weight change and subsequent risk of cardiovascular events and mortality in established type 2 diabetes. DESIGN AND SETTING:The Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation was an international, multisite 2×2 factorial trial of intensive glucose control and blood pressure control. We examined 5 categories of 2-year weight change: >10% loss, 4% to 10% loss, stable (±<4%), 4% to 10% gain, and >10% gain. We used Cox regression with follow-up time starting at 2 years, adjusting for intervention arm, demographics, cardiovascular risk factors, and diabetes medication use from the 2-year visit. RESULTS:Among 10 081 participants with valid weight measurements, average age was 66 years. By the 2-year examination, 4.3% had >10% weight loss, 18.4% had 4% to 10% weight loss, and 5.3% had >10% weight gain. Over the following 3 years of the trial, >10% weight loss was strongly associated with major macrovascular events (hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.26-2.44), cardiovascular mortality (HR, 2.76; 95% CI, 1.87-4.09), all-cause mortality (HR, 2.79; 95% CI, 2.10-3.71), but not major microvascular events (HR, 0.91; 95% CI, 0.61-1.36), compared with stable weight. There was no evidence of effect modification by baseline body mass index, age, or type of diabetes medication. CONCLUSIONS:In the absence of substantial lifestyle changes, weight loss may be a warning sign of poor health meriting further workup in patients with type 2 diabetes.
Early adulthood weight, subsequent midlife weight change and risk of cardiovascular disease mortality: an analysis of Norwegian cardiovascular surveys.
Kjøllesdal Marte Karoline Råberg,Ariansen Inger,Næss Øyvind Erik
International journal of obesity (2005)
BACKGROUND:The time between early adulthood and midlife is important for obesity development. There is paucity of studies using objectively measured body mass index (BMI) at both time points with full range of midlife cardiovascular risk factors. We aimed to investigate the risk of cardiovascular disease (CVD) mortality associated with different levels of objectively measured change in body weight from early adulthood to midlife, and to assess whether risk is primarily explained by midlife cardiovascular risk factors. METHODS:Pooled data from Norwegian health surveys (1985-2003), Tuberculosis screenings, Conscript data and the Norwegian Educational database were linked to the Cause of Death Registry. Health survey participants with data on objectively measured weight and height in both early adulthood (18-20 years) and midlife (40-50 years) were included, n = 148,021. Cox regression models were used to assess associations between weight change and CVD mortality. RESULTS:Total analysis time included 2,841,174 person years. Mean follow-up was 19 (standard deviation 4) years. Participants being normal weight in early adulthood and obese in midlife had a hazard ratio (HR) of CVD mortality of 2.09 (95% CI 1.74-2.50) relative to those who were normal weight at both times. The corresponding HR of those being obese at both times was 5.15 (3.61-7.36). Adjustment for CVD risk factors attenuated these associations. Gaining ≥15 kg between early adulthood and midlife was associated with higher CVD mortality after adjustment for early adulthood weight (HR 1.51 (1.20-1.89)), and for smoking and education (HR 1.63 (1.30-2.04)), however not after adjustment for mediating CVD risk factors. CONCLUSIONS:Obesity both in early adulthood and in midlife was associated with CVD mortality. Weight gain of ≥15 kg from early adulthood to midlife was also associated with CVD mortality, but not after adjustment for mediating CVD risk factors.
The association of weight change and all-cause mortality in older adults: a systematic review and meta-analysis.
Alharbi Tagrid A,Paudel Susan,Gasevic Danijela,Ryan Joanne,Freak-Poli Rosanne,Owen Alice J
Age and ageing
OBJECTIVE:there may be age-related differences in the impact of weight change on health. This study systematically reviewed the evidence on the relationship between weight change and all-cause mortality in adults aged 65 years and older. METHODS:MEDLINE, EMBASE and CINAHL were searched from inception to 11 June 2020, PROSPERO CRD 42019142268. We included observational studies reporting on the association between weight change and all-cause mortality in older community-dwelling adults. A random-effects meta-analysis was performed to calculate pooled hazard ratios and scored based on the Agency for Healthcare Research and Quality guidelines. RESULTS:a total of 30 studies, including 1,219,279 participants with 69,255 deaths, demonstrated that weight loss was associated with a 59% increase in mortality risk (hazard ratio (HR): 1.59; 95% confidence interval (CI): 1.45-1.74; P < 0.001). Twenty-seven studies that reported outcomes for weight gain (1,210,116 participants with 65,481 deaths) indicated that weight gain was associated with a 10% increase in all-cause mortality (HR: 1.10; 95%CI: 1.02, 1.17; P = 0.01). Four studies investigated weight fluctuation (2,283 events among 6,901 participants), which was associated with a 63% increased mortality risk (HR: 1.66; 95%CI: 1.28, 2.15). No evidence of publication bias was observed (all P > 0.05). CONCLUSION:for community-dwelling older adults, weight changes (weight loss, gain or weight fluctuation) are associated with an increased risk of all-cause mortality risk relative to stable weight. Further research is needed to determine whether these associations vary depending upon initial weight, and whether or not the weight loss/gain was intentional.
Determinants of inequalities in life expectancy: an international comparative study of eight risk factors.
Mackenbach Johan P,Valverde José Rubio,Bopp Matthias,Brønnum-Hansen Henrik,Deboosere Patrick,Kalediene Ramune,Kovács Katalin,Leinsalu Mall,Martikainen Pekka,Menvielle Gwenn,Regidor Enrique,Nusselder Wilma J
The Lancet. Public health
BACKGROUND:Socioeconomic inequalities in longevity have been found in all European countries. We aimed to assess which determinants make the largest contribution to these inequalities. METHODS:We did an international comparative study of inequalities in risk factors for shorter life expectancy in Europe. We collected register-based mortality data and survey-based risk factor data from 15 European countries. We calculated partial life expectancies between the ages of 35 years and 80 years by education and gender and determined the effect on mortality of changing the prevalence of eight risk factors-father with a manual occupation, low income, few social contacts, smoking, high alcohol consumption, high bodyweight, low physical exercise, and low fruit and vegetable consumption-among people with a low level of education to that among people with a high level of education (upward levelling scenario), using population attributable fractions. FINDINGS:In all countries, a substantial gap existed in partial life expectancy between people with low and high levels of education, of 2·3-8·2 years among men and 0·6-4·5 years among women. The risk factors contributing most to the gap in life expectancy were smoking (19·8% among men and 18·9% among women), low income (9·7% and 13·4%), and high bodyweight (7·7% and 11·7%), but large differences existed between countries in the contribution of risk factors. Sensitivity analyses using the prevalence of risk factors in the most favourable country (best practice scenario) showed that the potential for reducing the gap might be considerably smaller. The results were also sensitive to varying assumptions about the mortality risks associated with each risk factor. INTERPRETATION:Smoking, low income, and high bodyweight are quantitatively important entry points for policies to reduce educational inequalities in life expectancy in most European countries, but priorities differ between countries. A substantial reduction of inequalities in life expectancy requires policy actions on a broad range of health determinants. FUNDING:European Commission and Network for Studies on Pensions, Aging, and Retirement.
Obesity trajectories and risk of dementia: 28 years of follow-up in the Whitehall II Study.
Singh-Manoux Archana,Dugravot Aline,Shipley Martin,Brunner Eric J,Elbaz Alexis,Sabia Séverine,Kivimaki Mika
Alzheimer's & dementia : the journal of the Alzheimer's Association
INTRODUCTION:We examined whether obesity at ages 50, 60, and 70 years is associated with subsequent dementia. Changes in body mass index (BMI) for more than 28 years before dementia diagnosis were compared with changes in BMI in those free of dementia. METHODS:A total of 10,308 adults (33% women) aged 35 to 55 years in 1985 were followed up until 2015. BMI was assessed six times and 329 cases of dementia were recorded. RESULTS:Obesity (BMI ≥30 kg/m) at age 50 years (hazard ratio = 1.93; 1.35-2.75) but not at 60 or 70 years was associated with risk of dementia. Trajectories of BMI differed in those with dementia compared with all others (P < .0001) or to matched control subjects (P < .0001) such that BMI in dementia cases was higher from 28 years (P = .001) to 16 years (P = .05) and lower starting 8 years before diagnosis. DISCUSSION:Obesity in midlife and weight loss in the preclinical phase characterizes dementia; the current obesity epidemic may affect future dementia rates.
Change in Body Mass Index Associated With Lowest Mortality in Denmark, 1976-2013.
Afzal Shoaib,Tybjærg-Hansen Anne,Jensen Gorm B,Nordestgaard Børge G
IMPORTANCE:Research has shown a U-shaped pattern in the association of body mass index (BMI) with mortality. Although average BMI has increased over time in most countries, the prevalence of cardiovascular risk factors may also be decreasing among obese individuals over time. Thus, the BMI associated with lowest all-cause mortality may have changed. OBJECTIVE:To determine whether the BMI value that is associated with the lowest all-cause mortality has increased in the general population over a period of 3 decades. DESIGN, SETTING, AND PARTICIPANTS:Three cohorts from the same general population enrolled at different times: the Copenhagen City Heart Study in 1976-1978 (n = 13,704) and 1991-1994 (n = 9482) and the Copenhagen General Population Study in 2003-2013 (n = 97,362). All participants were followed up from inclusion in the studies to November 2014, emigration, or death, whichever came first. EXPOSURES:For observational studies, BMI was modeled using splines and in categories defined by the World Health Organization. Body mass index was calculated as weight in kilograms divided by height in meters squared. MAIN OUTCOMES AND MEASURES:Main outcome was all-cause mortality and secondary outcomes were cause-specific mortality. RESULTS:The number of deaths during follow-up was 10,624 in the 1976-1978 cohort (78% cumulative mortality; mortality rate [MR], 30/1000 person-years [95%CI, 20-46]), 5025 in the 1991-1994 cohort (53%; MR, 16/1000 person-years [95%CI, 9-30]), and 5580 in the 2003-2013 cohort (6%;MR, 4/1000 person-years [95%CI, 1-10]). Except for cancer mortality, the association of BMI with all-cause, cardiovascular, and other mortality was curvilinear (U-shaped). The BMI associated with the lowest all-cause mortality increased by 3.3 from the 1976-1978 cohort compared with the 2003-2013 cohort. [table: see text] The multivariable-adjusted hazard ratios for all-cause mortality for BMI of 30 or more vs BMI of 18.5 to 24.9 were 1.31 (95%CI, 1.23-1.39;MR, 46/1000 person-years [95%CI, 32-66] vs 28/1000 person-years [95%CI, 18-45]) in the 1976-1978 cohort, 1.13 (95%CI, 1.04-1.22; MR, 28/1000 person-years [95%CI, 17-47] vs 15/1000 person-years [95%CI, 7-31]) in the 1991-1994 cohort, and 0.99 (95%CI, 0.92-1.07;MR, 5/1000 person-years [95%CI, 2-12] vs 4/1000 person-years [95%CI, 1-11]) in the 2003-2013 cohort. CONCLUSIONS AND RELEVANCE Among 3 Danish cohorts, the BMI associated with the lowest all-cause mortality increased by 3.3 from cohorts enrolled from 1976-1978 through 2003-2013. Further investigation is needed to understand the reason for this change and its implications.
Associations of Weight Gain From Early to Middle Adulthood With Major Health Outcomes Later in Life.
Zheng Yan,Manson JoAnn E,Yuan Changzheng,Liang Matthew H,Grodstein Francine,Stampfer Meir J,Willett Walter C,Hu Frank B
Importance:Data describing the effects of weight gain across adulthood on overall health are important for weight control. Objective:To examine the association of weight gain from early to middle adulthood with health outcomes later in life. Design, Setting, and Participants:Cohort analysis of US women from the Nurses' Health Study (1976-June 30, 2012) and US men from the Health Professionals Follow-Up Study (1986-January 31, 2012) who recalled weight during early adulthood (at age of 18 years in women; 21 years in men), and reported current weight during middle adulthood (at age of 55 years). Exposures:Weight change from early to middle adulthood (age of 18 or 21 years to age of 55 years). Main Outcomes and Measures:Beginning at the age of 55 years, participants were followed up to the incident disease outcomes. Cardiovascular disease, cancer, and death were confirmed by medical records or the National Death Index. A composite healthy aging outcome was defined as being free of 11 chronic diseases and major cognitive or physical impairment. Results:A total of 92 837 women (97% white; mean [SD] weight gain: 12.6 kg [12.3 kg] over 37 years) and 25 303 men (97% white; mean [SD] weight gain: 9.7 kg [9.7 kg] over 34 years) were included in the analysis. For type 2 diabetes, the adjusted incidence per 100 000 person-years was 207 among women who gained a moderate amount of weight (≥2.5 kg to <10 kg) vs 110 among women who maintained a stable weight (weight loss ≤2.5 kg or gain <2.5 kg) (absolute rate difference [ARD] per 100 000 person-years, 98; 95% CI, 72 to 127) and 258 vs 147, respectively, among men (ARD, 111; 95% CI, 58 to 179); hypertension: 3415 vs 2754 among women (ARD, 662; 95% CI, 545 to 782) and 2861 vs 2366 among men (ARD, 495; 95% CI, 281 to 726); cardiovascular disease: 309 vs 248 among women (ARD, 61; 95% CI, 38 to 87) and 383 vs 340 among men (ARD, 43; 95% CI, -14 to 109); obesity-related cancer: 452 vs 415 among women (ARD, 37; 95% CI, 4 to 73) and 208 vs 165 among men (ARD, 42; 95% CI, 0.5 to 94). Among those who gained a moderate amount of weight, 3651 women (24%) and 2405 men (37%) achieved the composite healthy aging outcome. Among those who maintained a stable weight, 1528 women (27%) and 989 men (39%) achieved the composite healthy aging outcome. The multivariable-adjusted odds ratio for the composite healthy aging outcome associated with moderate weight gain was 0.78 (95% CI, 0.72 to 0.84) in women and 0.88 (95% CI, 0.79 to 0.97) in men. Higher amounts of weight gain were associated with greater risks of major chronic diseases and lower likelihood of healthy aging. Conclusions and Relevance:In these cohorts of health professionals, weight gain during adulthood was associated with significantly increased risk of major chronic diseases and decreased odds of healthy aging. These findings may help counsel patients regarding the risks of weight gain.
Obesity, weight change, and mortality in older adults with metabolic abnormalities.
Dong S-Y,Wang M-L,Li Z-B,Dong Z,Liu Y-Q,Lu R-J,Li J-M,Tang R
Nutrition, metabolism, and cardiovascular diseases : NMCD
BACKGROUND AND AIMS:It is expected that older adults with metabolic abnormalities may benefit from weight loss; however, data on this population are limited. Our study was to assess the effect of obesity and weight change on mortality risk in older adults with metabolic abnormalities. METHODS AND RESULTS:A total of 3649 Chinese older adults aged 60-90 years with metabolic abnormalities were included between 2000 and 2014. Weight change between two health checkup periods was calculated. During a median follow-up period of 37 months, 503 all-cause mortality and 235 cardiovascular disease mortality occurred. Death rate was the lowest in overweight participants and in the participants with weight stability. After adjustment for covariates, hazard ratios (95% confidence intervals) of overweight participants for all-cause mortality and cardiovascular mortality were 0.71 (0.59, 0.86) and 0.72 (0.55, 0.95), respectively, whereas obesity was not significantly associated with mortality risk. Furthermore, relative to weight stability, risks of mortality significantly increased with the increase in weight loss or weight gain, except small weight gain. These associations were unchanged when the participants were stratified by baseline covariates and even when several definitions of weight change were considered. CONCLUSIONS:Overweight was associated with less mortality risk, and obesity was not associated with mortality risk in older adults with metabolic abnormalities. Mortality risk increased with the increase in weight loss or weight gain, regardless of body weight levels at the baseline. These findings suggest that maintaining a stable weight may be the best choice in older adults with metabolic abnormalities.
Effect of Body Weight, Waist Circumference and Their Changes on Mortality: a 10-Year Population-based Study.
Lee W-J,Peng L-N,Loh C-H,Chen L-K
The journal of nutrition, health & aging
OBJECTIVES:To investigate the effect of body weight, waist circumference and their changes on all-cause and cardiovascular mortality. DESIGN:A nationwide population-based cohort study. PARTICIPANTS:627 community-dwelling older adults. MEASUREMENTS:Participants were interviewed for demographic and anthropometric data collected. Blood were drawn for testing biochemistry data. Central obesity was defined as waist circumference is greater than 80 cm for women and 90 cm for men. Obesity, overweight, normal and underweight were defined as BMI ≥27 kg/m2 , ≥24 kg/m2 ,18.5-24 kg/m2 and < 18.5 kg/m2. Cox proportion hazard model was used to explore the impact of body weight and its change on mortality. RESULTS:The distribution of weight changes and mortality was right skewed, but U-shape of waist change for all-cause mortality was observed. Compared to normal BMI at baseline, the association between underweight (HR: 1.7, 95% CI: 0.7-4.0), overweight (HR:0.7, 95% CI:0.4-1.2) and obesity (HR:1.3,95% CI:0.8-2.3) showed insignificantly associated with all-cause mortality. The HR of those weight loss >5% (HR: 1.7, 95% CI: 1.1-2.8) and waist decrease >5% (HR: 1.7, 95% CI: 1.0-2.8) were higher than those of stable weight/waist +/- 5% over a 6-year period. Compared to those stable weight/waist, the mortality risk was similar in those of weight gain or waist increase (HR 0.7,95%CI: 0.4-1.5 and HR:0.9, 95%CI:0.4-1.6). CONCLUSION:Weight loss and waist decrease were significantly associated with long-term mortality risk, a life-course approach for body weight management is needed to pursuit the most optimal health benefits for the middle-aged and older adults.
Association between insulin-induced weight change and CVD mortality: Evidence from a historic cohort study of 18,814 patients in UK primary care.
Anyanwagu Uchenna,Mamza Jil,Donnelly Richard,Idris Iskandar
Diabetes/metabolism research and reviews
BACKGROUND:This study explores the association of insulin-induced weight (wt) gain on cardiovascular outcomes and mortality among patients with type 2 diabetes (T2D) following insulin initiation using real-world data. METHODS:A historical cohort study was performed in 18,814 adults with insulin-treated T2D derived from the UK The Health Improvement Network database. Based on the average weight change of 5 kg, 1 year postinsulin initiation, patients were grouped into 5 categories (>5 kg wt loss; 1.0-5.0 kg wt loss; no wt change; 1.0-5.0 kg wt gain; >5.0 kg wt gain) and followed-up for 5 years. Cox proportional hazard models and Kaplan-Meier estimators were fitted to estimate the hazards of a 3-point composite of nonfatal myocardial infarction, stroke, and all-cause mortality between categories. RESULTS:The median age was 62.8 (IQR: 52.3-71.8) years, HbA : 8.6% (IQR: 7.4-9.8) and mean BMI: 31.8 (6.5) kg/m . The 5 year probability of survival differed significantly within the wt-change categories (log-rank test P value = .0005). Only 1963 composite events occurred. Compared with the weight-neutral group, the risk of composite events was 31% greater in the >5 kg wt-loss group (aHR: 1.31; 95% CI: 1.02, 1.68), the same in the 1.0 to 5.0 kg wt-gain category, but nonsignificantly increased in the 1.0 to 5.0 kg wt loss (15%) and >5.0 kg wt gain (13%) categories, respectively. In the obese subgroup, this risk was 50% (aHR: 1.50, 95% CI: 1.08-2.08) more in the >5 kg weight-loss group compared with the weight-neutral group. CONCLUSION:Insulin-induced weight gain did not translate to adverse cardiovascular outcomes and mortality in patients with T2D. These data provide reassurance on the cardiovascular safety of insulin patients with T2D.
Attitudes to and experiences with body weight control and changes in body weight in relation to all-cause mortality in the general population.
Morgen Camilla S,Ängquist Lars,Appleyard Merete,Schnohr Peter,Jensen Gorm B,Sørensen Thorkild I A
BACKGROUND AND AIMS:Increased body mass index (BMI = weight/height2; kg/m2) and weight gain is associated with increased mortality, wherefore weight loss and avoided weight gain should be followed by lower mortality. This is achieved in clinical settings, but in the general population weight loss appears associated with increased mortality, possibly related to the struggles with body weight control (BWC). We investigated whether attitudes to and experiences with BWC in combination with recent changes in body weight influenced long-term mortality among normal weight and overweight individuals. POPULATION AND METHODS:The study population included 6,740 individuals attending the 3rd cycle in 1991-94 of the Copenhagen City Heart Study, providing information on BMI, educational level, health behaviours, well-being, weight half-a-year earlier, and answers to four BWC questions about caring for body weight, assumed benefit of weight loss, current and past slimming experiences. Participants reporting previous unintended weight loss (> 4 kg during one year) were excluded. Cox regression models estimated the associations of prior changes in BMI and responses to the BWC questions with approximately 22 years all-cause mortality with age as 'time scale'. Participants with normal weight (BMI < 25.0 kg/m2) and overweight (BMI ≥ 25.0 kg/m2) were analysed separately, and stratified by gender and educational level, health behaviours and well-being as co-variables. RESULTS:Compared with stable weight, weight loss was associated with significantly increased mortality in the normal weight group, but not in the overweight group, and weight gain was not significantly associated with mortality in either group. Participants with normal weight who claimed that it would be good for their health to lose weight or that they were currently trying to lose weight had significantly higher mortality than those denying it. There were no other significant associations with the responses to the BWC questions in either the normal weight or the overweight group. When combining the responses to the BWC questions with the weight changes, using the weight change as either a continuous or categorical variable, there were no significant interaction in their relation to mortality in either the normal weight or the overweight group. CONCLUSION:Attitudes to and experiences with BWC did not notably modify the association of changes in body weight with mortality in either people with normal weight or people with overweight.
Smoking Cessation, Weight Change, Type 2 Diabetes, and Mortality.
Hu Yang,Zong Geng,Liu Gang,Wang Molin,Rosner Bernard,Pan An,Willett Walter C,Manson JoAnn E,Hu Frank B,Sun Qi
The New England journal of medicine
BACKGROUND:Whether weight gain after smoking cessation attenuates the health benefits of quitting is unclear. METHODS:In three cohort studies involving men and women in the United States, we identified those who had reported quitting smoking and we prospectively assessed changes in smoking status and body weight. We estimated risks of type 2 diabetes, death from cardiovascular disease, and death from any cause among those who had reported quitting smoking, according to weight changes after smoking cessation. RESULTS:The risk of type 2 diabetes was higher among recent quitters (2 to 6 years since smoking cessation) than among current smokers (hazard ratio, 1.22; 95% confidence interval [CI], 1.12 to 1.32). The risk peaked 5 to 7 years after quitting and then gradually decreased. The temporary increase in the risk of type 2 diabetes was directly proportional to weight gain, and the risk was not increased among quitters without weight gain (P<0.001 for interaction). In contrast, quitters did not have a temporary increase in mortality, regardless of weight change after quitting. As compared with current smokers, the hazard ratios for death from cardiovascular disease were 0.69 (95% CI, 0.54 to 0.88) among recent quitters without weight gain, 0.47 (95% CI, 0.35 to 0.63) among those with weight gain of 0.1 to 5.0 kg, 0.25 (95% CI, 0.15 to 0.42) among those with weight gain of 5.1 to 10.0 kg, 0.33 (95% CI, 0.18 to 0.60) among those with weight gain of more than 10.0 kg, and 0.50 (95% CI, 0.46 to 0.55) among longer-term quitters (>6 years since smoking cessation). Similar associations were observed for death from any cause. CONCLUSIONS:Smoking cessation that was accompanied by substantial weight gain was associated with an increased short-term risk of type 2 diabetes but did not mitigate the benefits of quitting smoking on reducing cardiovascular and all-cause mortality. (Funded by the National Institutes of Health.).
Association between Weight Change and Mortality in Community Living Older People Followed for Up to 14 Years. The Hordaland Health Study (HUSK).
Haugsgjerd T R,Dierkes J,Vollset S E,Vinknes K J,Nygård O K,Seifert R,Sulo G,Tell G S
The journal of nutrition, health & aging
OBJECTIVES:To study the importance of weight change with regard to mortality in older people. DESIGN:Prospective cohort study. PARTICIPANTS:The cohort includes participants in the Hordaland Health Study, Norway, 1997-99 (N=2935, age 71-74 years) who had previously participated in a survey in 1992-93. MEASUREMENTS:Participants with weight measured at both surveys were followed for mortality through 2012. Cox proportional hazards models were used to calculate risk of death according to changes in weight. Hazard ratios (HR) with 95% confidence intervals (CIs) for people with stable weight (± <5% weight change) were compared to people who lost (≥5%) or gained (≥5%) weight. Cox regression with penalized spline was used to evaluate the association between weight change (in kg) and mortality. Analyses were adjusted for age, sex, physical activity, smoking, diabetes, hypertension, and previous myocardial infarction or stroke. Participants with cancer were excluded. RESULTS:Compared to those with stable weight, participants who lost ≥5% weight had an increased mortality risk (HR 1.59 [95% CI: 1.35-1.89]) while the group with weight gain ≥5% did not (HR 1.07 [95% CI 0.90-1.28]). Penalized spline identified those who lost more than about three kg or gained more than about 12 kg as having increased risk of death. CONCLUSION:Even a minor weight loss of ≥5% or >3 kg were significantly associated with increased risk of mortality. Thus, weight should be routinely measured in older adults.
Socioeconomic inequalities in childhood and adolescent body-mass index, weight, and height from 1953 to 2015: an analysis of four longitudinal, observational, British birth cohort studies.
Bann David,Johnson William,Li Leah,Kuh Diana,Hardy Rebecca
The Lancet. Public health
BACKGROUND:Socioeconomic inequalities in childhood body-mass index (BMI) have been documented in high-income countries; however, uncertainty exists with regard to how they have changed over time, how inequalities in the composite parts (ie, weight and height) of BMI have changed, and whether inequalities differ in magnitude across the outcome distribution. Therefore, we aimed to investigate how socioeconomic inequalities in childhood and adolescent weight, height, and BMI have changed over time in Britain. METHODS:We used data from four British longitudinal, observational, birth cohort studies: the 1946 Medical Research Council National Survey of Health and Development (1946 NSHD), 1958 National Child Development Study (1958 NCDS), 1970 British Cohort Study (1970 BCS), and 2001 Millennium Cohort Study (2001 MCS). BMI (kg/m) was derived in each study from measured weight and height. Childhood socioeconomic position was indicated by the father's occupational social class, measured at the ages of 10-11 years. We examined associations between childhood socioeconomic position and anthropometric outcomes at age 7 years, 11 years, and 15 years to assess socioeconomic inequalities in each cohort using gender-adjusted linear regression models. We also used multilevel models to examine whether these inequalities widened or narrowed from childhood to adolescence, and quantile regression was used to examine whether the magnitude of inequalities differed across the outcome distribution. FINDINGS:In England, Scotland, and Wales, 5362 singleton births were enrolled in 1946, 17 202 in 1958, 17 290 in 1970, and 16 404 in 2001. Low socioeconomic position was associated with lower weight at childhood and adolescent in the earlier-born cohorts (1946-70), but with higher weight in the 2001 MCS cohort. Weight disparities became larger from childhood to adolescence in the 2001 MCS but not the earlier-born cohorts (p=0·001). Low socioeconomic position was also associated with shorter height in all cohorts, yet the absolute magnitude of this difference narrowed across generations. These disparities widened with age in the 2001 MCS (p=0·002) but not in the earlier-born cohorts. There was little inequality in childhood BMI in the 1946-70 cohorts, whereas inequalities were present in the 2001 cohort and widened from childhood to adolescence in the 1958-2001 cohorts (p<0·05 in the later three cohorts but not the 1946 NSHD). BMI and weight disparities were larger in the 2001 cohort than in the earlier-born cohorts, and systematically larger at higher quantiles-eg, in the 2001 MCS at age 11 years, a difference of 0·98 kg/m (95% CI 0·63-1·33) in the 50th BMI percentile and 2·54 kg/m (1·85-3·22) difference at the 90th BMI percentile were observed. INTERPRETATION:Over the studied period (1953-2015), socioeconomic-associated inequalities in weight reversed and those in height narrowed, whereas differences in BMI and obesity emerged and widened. These substantial changes highlight the impact of societal changes on child and adolescent growth and the insufficiency of previous policies in preventing obesity and its socioeconomic inequality. As such, new and effective policies are required to reduce BMI inequalities in childhood and adolescence. FUNDING:UK Economic and Social Research Council, Medical Research Council, and Academy of Medical Sciences/the Wellcome Trust.
Heterogeneity in the uptake, attendance, and outcomes in a clinical trial of a total diet replacement weight loss programme.
Astbury Nerys M,Tudor Kate,Aveyard Paul,Jebb Susan A
BACKGROUND:Trials have shown total diet replacement (TDR) programmes are safe and effective for weight loss in primary care. However, it is not clear whether participant characteristics affect uptake, attendance, or effectiveness of the programme. METHODS:We used data from 272 trial participants who were invited to participate in a clinical weight loss trial via a letter from their GP. We used a Cochran-Mantel-Haenszel analysis to assess whether accepting an invitation to participate in the trial differed by gender, age, BMI, social deprivation, and the presence of a diagnosis of type 2 diabetes or hypertension. We used mixed generalised linear modelling to examine whether participants' age, gender, or social deprivation based on area of residence were associated with weight change at 12 months. RESULTS:Men were less likely to enrol than women (RR 0.59 [95% CI 0.47, 0.74]), and people from the middle and highest BMI tertile were more likely to enrol than those from the lowest tertile (RR 2.88 [95% CI 1.97, 4.22] and RR 4.38 [95% CI 3.05, 6.07], respectively). Patients from practices located in most deprived and intermediate deprived tertiles were more likely to enrol compared with those in the least deprived tertile (RR 1.84 [95% CI 1.81, 2.59] and RR 1.68 [95% CI 1.18, 2.85], respectively). There was no evidence that age or a pre-existing diagnosis of type 2 diabetes (RR 1.10 [95% CI 0.81, 1.50]) or hypertension (RR 0.81 [95% CI 0.62, 1.04]) affected enrolment. In the TDR group, 13% of participants were low engagers, 8% engaged with the weight loss phase only, and 79% engaged in both weight loss and weight maintenance phases of the programme. Those who engaged in the entire programme lost most weight. Subgroup analyses suggested that older participants and those with a higher baseline BMI lost more weight at 1 year than their comparators. CONCLUSION:Despite some heterogeneity in the uptake and outcomes of the programme, if the results of this trial are replicated in routine practice, there is no evidence that TDR weight loss programmes would increase inequity. TRIAL REGISTRATION:The DROPLET trial was prospectively registered on ISRCTN registry (ISRCTN75092026).
Prospective associations between diet quality and body mass index in disadvantaged women: the Resilience for Eating and Activity Despite Inequality (READI) study.
Olstad Dana Lee,Lamb Karen E,Thornton Lukar E,McNaughton Sarah A,Crawford David A,Minaker Leia M,Ball Kylie
International journal of epidemiology
Background:Dietary patterns that align with recommended guidelines appear to minimize long-term weight gain in the general population. However, prospective associations between diet quality and weight change in disadvantaged adults have not been examined. This study examined associations between concurrent change in diet quality and body mass index (BMI) over 5 years among women living in socioeconomically disadvantaged neighbourhoods. Methods:Dietary intake and BMI were self-reported among 1242 women living in disadvantaged neighbourhoods in Victoria, Australia, at three time points from 2007/08 to 2012/13. Diet quality was evaluated using the Australian Dietary Guideline Index (DGI). Associations between concurrent change in diet quality and BMI were assessed over the three time points using fixed effects and mixed models. Models were adjusted for age, smoking, menopausal status, education, marital status, number of births, urban/rural location and physical activity. Results:Average BMI increased by 0.14 kg/m2 per year increase in age in the fixed effects model, and by 0.13 kg/m2 in the mixed model (P < 0.0001). BMI decreased by 0.014 kg/m2 for a woman of average age with each unit increase in DGI score in the fixed effects model (p < 0.0001), and by 0.012 kg/m2 in the mixed model (P = 0.001). The rate of change in BMI with age was greater for those with a lower DGI score than for those with a higher score (P < 0.10). Conclusions:Positive change in diet quality was associated with reduced BMI gain among disadvantaged women. Supporting disadvantaged women to adhere to population-level dietary recommendations may assist them with long-term weight management.
Four decades of socio-economic inequality and secular change in the physical growth of Guatemalans.
Mansukoski Liina,Johnson William,Brooke-Wavell Katherine,Galvez-Sobral J Andres,Furlán Luis,Cole Tim J,Bogin Barry
Public health nutrition
OBJECTIVE:To investigate changes in socio-economic inequalities in growth in height, weight, BMI and grip strength in children born during 1955-1993 in Guatemala, a period of marked socio-economic-political change. DESIGN:We modelled longitudinal data on height, weight, BMI and hand grip strength using Super-Imposition by Translation and Rotation (SITAR). Internal Z-scores summarising growth size, timing and intensity (peak growth velocity, e.g. cm/year) were created to investigate inequalities by socio-economic position (SEP; measured by school attended). Interactions of SEP with date of birth were investigated to capture secular changes in inequalities. SETTING:Urban and peri-urban schools in the region of Guatemala City, Guatemala. PARTICIPANTS:Participants were 40 484 children and adolescents aged 3-19 years of Ladino and Maya ancestry (nobservations 157 067). RESULTS:The difference in height (SITAR size) between lowest and highest SEP decreased from -2·0 (95 % CI -2·2, -1·9) sd to -1·4 (95 % CI -1·5, -1·3) sd in males, and from -2·0 (95 % CI -2·1, -1·9) sd to -1·2 (95 % CI -1·3, -1·2) sd in females over the study period. Inequalities also reduced for weight, BMI and grip strength, due to greater secular increases in lowest-SEP groups. The puberty period was earlier and shorter in higher-SEP individuals (earlier SITAR timing and higher SITAR intensity). All SEP groups showed increases in BMI intensity over time. CONCLUSIONS:Inequality narrowed between the 1960s and 1990s. The lowest-SEP groups were still >1 sd shorter than the highest. Risks remain for reduced human capital and poorer population health for urban Guatemalans.
Inequality of weight status in urban Cuba: 2001-2010.
Nie Peng,Ding Lanlin,Sousa-Poza Alfonso,Leon Alina Alfonso,Xue Hong,Jia Peng,Wang Liang,Wang Youfa
Population health metrics
BACKGROUND:Although understanding changes in the body weight distribution and trends in obesity inequality plays a key role in assessing the causes and persistence of obesity, limited research on this topic is available for Cuba. This study thus analyzed changes in body mass index (BMI) and waist circumference (WC) distributions and obesity inequality over a 9-year period among urban Cuban adults. METHODS:Kolmogorov-Smirnov tests were first applied to the data from the 2001 and 2010 National Survey on Risk Factors and Chronic Diseases to identify a rightward shift in both the BMI and WC distributions over the 2001-2010 period. A Shapley technique decomposed the increase in obesity prevalence into a mean-growth effect and a (re)distributional component. A univariate assessment of obesity inequality was then derived by calculating both the Gini and generalized entropy (GE) measures. Lastly, a GE-based decomposition partitioned overall obesity inequality into within-group and between-group values. RESULTS:Despite some relatively pronounced left-skewing, both the BMI and WC distributions exhibited a clear rightward shift to which the increases in general and central obesity can be mostly attributed. According to the Gini coefficients, both general and central obesity inequality increased over the 2001-2010 period, from 0.105 [95% confidence interval (CI) = 0.103-0.106] to 0.110 [95% CI = 0.107-0.112] and from 0.083 [95% CI = 0.082-0.084] to 0.085 [95% CI = 0.084-0.087], respectively. The GE-based decomposition further revealed that both types of inequality were accounted for primarily by within-group inequality (93.3%/89.6% and 87.5%/84.8% in 2001/2010 for general/central obesity, respectively). CONCLUSIONS:Obesity inequality in urban Cuba worsened over the 2001-2010 time period, with within-group inequality in overall obesity dominant over between-group inequality. In general, the results also imply that the rise in obesity inequality is immune to health care system characteristics.