Intergenerational and socioeconomic gradients of child obesity

Can the rise in obesity among children be attributed to the intergenerational transmission of parental influences? Does this trend affect the influence of parent's socioeconomic status on obesity? This paper documents evidence of an emerging social gradient of obesity in pre-school children resulting from a combination of both socio-economic status and less intensive childcare associated with maternal employment, when different forms of intergenerational transmission are controlled for. We also estimate and decompose income related inequalities in child obesity. We take advantage of a uniquely constructed dataset from Spain that contains records form 13,358 individuals for a time period (years 2003–2006) in which a significant spike in the growth of child obesity was observed. Our results suggest robust evidence of both socioeconomic and intergenerational gradients. Results are suggestive of a high income effect in child obesity, alongside evidence that income inequalities have doubled in just three years with a pure income effect accounting for as much as 72–66% of these income inequality estimates, even when intergenerational transmission is accounted for. Although, intergenerational transmission does not appear to be gender specific, when accounted for, mother's labour market participation only explains obesity among boys but not among girls. Hence, it appears income and parental influences are the central determinants of obesity among children.     

Population-Based Trends in Male Adolescent Obesity in Israel 1967–2003

Obesity increased monotonically from 1.2% to 3.8% of males age 17 (1967–2003). Low socioeconomic status had an independent positive effect on obesity. The likelihood of obesity had risen more steeply over time among the low socioeconomic status group than among other adolescents. Rise in obesity, standard of living, and income inequality (as measured by the Gini index) increased concomitantly.     

A Multilevel Analysis of State and Regional Disparities in Childhood and Adolescent Obesity in the United States

This study examines state- and regional disparities in obesity prevalence among 46,707 US children and adolescents aged 10–17 years before and after adjusting for individual socioeconomic and behavioral characteristics and area deprivation measures. The 2003 National Survey of Children’s Health was used to calculate obesity prevalence in nine geographic regions and in the 50 states and the District of Columbia (DC). Logistic regression was used to estimate odds of obesity and adjusted prevalence. OLS regression was used to determine the amount of variance explained by income inequality, poverty, and violent crime rates. The prevalence of childhood obesity varied substantially across geographic areas, with the Southcentral regions of the US having the highest prevalence (≥18%) and the Mountain region the lowest prevalence (11.4%). Children in West Virginia, Kentucky, Texas, Tennessee, and North Carolina (adjusted prevalence >18.3%) had over twice the odds of being obese than their Utah counterparts (adjusted prevalence = 10.4%). Geographic disparities in obesity were similar for male and female children. Individual characteristics such as race/ethnicity, household socioeconomic status, neighborhood social capital, television viewing, recreational computer use, and physical activity accounted for 55% of the state and 25% of the regional disparities in obesity. Area poverty rates accounted for an additional 18% of the state variance in adjusted obesity prevalence. Although individual and area level socioeconomic factors are important predictors, substantial geographic disparities in childhood and adolescent obesity remain. Prevention efforts targeting individual risk factors as well as contextual social and environmental factors may reduce geographic disparities in childhood and adolescent obesity.     

An Increasing Socioeconomic Gap in Childhood Overweight and Obesity in China

We used a new conceptual framework that integrates tenets from health economics, social epidemiology, and health behavior to analyze the impact of socioeconomic forces on the temporal changes in the socioeconomic status (SES) gap in childhood overweight and obesity in China. In data from the China Health and Nutrition Survey for 1991 to 2006, we found increased prevalence of childhood overweight and obesity across all SES groups, but a greater increase among higher-SES children, especially after 1997, when income inequality dramatically increased. Our findings suggest that for China, the increasing SES gap in purchasing power for obesogenic goods, associated with rising income inequality, played a prominent role in the country’s increasing SES gap in childhood obesity and overweight.It is well documented that family socioeconomic status (SES) is associated with childhood overweight and obesity1–3; however, the pathways linking SES with overweight and obesity may be strongly conditioned by a country’s stage of economic development. For example, an inverse relationship between SES and obesity is typically observed among children in developed countries,2,4 whereas in many developing countries, overweight and obesity are more common among socioeconomic elites.1,5,6 Several questions are unanswered: What contextual factors connect the stage of economic development with the sign and strength of the association between SES and childhood overweight and obesity? What is the relative importance of these factors? What happens when these contextual factors exert contradictory effects on risk for childhood obesity and overweight? The dramatic social and economic changes in China that took place after 1997 provided a unique opportunity to explore these questions.Until now, the only study of the change in the SES–overweight and obesity association among Chinese children focused on the annual change in overweight prevalence by income.7 This study found that overweight prevalence increased fastest among high-income children between 1991 and 2004. To date, however, no study has thoroughly explored the contextual factors contributing to the changing relationship between SES and overweight and obesity in children and adolescents, in China or in any other developing country.The direction of causality between SES and obesity for children is relatively easy to discern, because their SES is predetermined by that of their parents; hence, their obesity status is unlikely to affect their childhood SES.1 We developed a conceptual framework to address specific contextual factors that could shape the SES–childhood overweight and obesity relationship. We test several major tenets of this framework in data collected from 1991 to 2006 by the China Health and Nutrition Survey (CHNS).8     

Aggregation and the measurement of income inequality: effects on morbidity

This is a cross-sectional study using records from the National Health Interview Survey linked to Census geography. The sample is restricted to white males ages 25-64 in the United States from three years (1989-1991) of the National Health Interview Survey. Perceived health is used to measure morbidity. Individual covariates include income-to-needs ratio, education and occupation. Contextual level measures of income inequality, median household income and percent in poverty are constructed at the US census county and tract level. The association between inequality and morbidity is examined using logistic regression models. Income inequality is found to exert an independent adverse effect on self-rated health at the county level, controlling for individual socioeconomic status and median income or percent poverty in the county. This corresponding effect at the tract level is reduced. Median income or percent poverty and individual socioeconomic status are the dominant correlates of perceived health status at the tract level. These results suggest that the level of geographic aggregation influences the pathways through which income inequality is actualized into an individuals' morbidity risk. At higher levels of aggregation there are independent effects of income inequality, while at lower levels of aggregation, income inequality is mediated by the neighborhood consequences of income inequality and individual processes.     

Reducing Obesity: Motivating Action While Not Blaming the Victim

Context: The rise in obesity in the United States may slow or even reverse the long‐term trend of increasing life expectancy. Like many risk factors for disease, obesity results from behavior and shows a social gradient. Especially among women, obesity is more common among lower‐income individuals, those with less education, and some ethnic/racial minorities. Methods: This article examines the underlying assumptions and implications for policy and the interventions of the two predominant models used to explain the causes of obesity and also suggests a synthesis that avoids “blaming the victim” while acknowledging the role of individuals' health behaviors in weight maintenance. Findings: (1) The medical model focuses primarily on treatment, addressing individuals' personal behaviors as the cause of their obesity. An underlying assumption is that as independent agents, individuals make informed choices. Interventions are providing information and motivating individuals to modify their behaviors. (2) The public health model concentrates more on prevention and sees the roots of obesity in an obesogenic environment awash in influences that lead individuals to engage in health‐damaging behaviors. Interventions are modifying environmental forces through social policies. (3) There is a tension between empowering individuals to manage their weight through diet and exercise and blaming them for failure to do so. Patterns of obesity by race/ethnicity and socioeconomic status highlight this tension. (4) Environments differ in their health‐promoting resources; for example, poorer communities have fewer supermarkets, more fast‐food outlets, and fewer accessible and safe recreational opportunities. Conclusions: A social justice perspective facilitates a synthesis of both models. This article proposes the concept of “behavioral justice” to convey the principle that individuals are responsible for engaging in health‐promoting behaviors but should be held accountable only when they have adequate resources to do so. This perspective maintains both individuals' control and accountability for behaviors and society's responsibility to provide health‐promoting environments.     

Opposing socioeconomic gradients in overweight and obese adults

Objective: Investigate the relationship between socioeconomic status (SES) and prevalence of overweight and/or obesity, by sex, using total annual household income as the indicator of SES and the World Health Organization (WHO) recommended ranges of self‐reported Body Mass Index (BMI) as the indicator of overweight and/or obesity. Methods : Total annual household income and BMI data were obtained from the Victorian Population Health Survey (VPHS), an annual computer‐assisted telephone survey of the health and well‐being of Victorian adults aged 18 years and older. Statistical analysis was conducted using ordinary least squares linear regression on the logarithms of age‐standardised prevalence estimates of overweight (25.0–29.9 kg/m²), obesity (≥30.0 kg/m²), and overweight and obesity combined (≥25.0 kg/m²), by income category and sex. Results: Typical SES gradients were observed in obese males and females, where the prevalence of obesity decreased with increasing income. No SES gradient was observed in overweight females, however, a reverse SES gradient was observed in overweight males, where the prevalence of overweight increased with increasing income. Combining the overweight and obesity categories into a single group eliminated the typical SES gradients observed in males and females for obesity, and resulted in a statistically significant reverse SES gradient in males. Conclusions: Combining the BMI categories of overweight and obesity into a single category masks important SES differences, while combining the data for males and females masks important sex differences. BMI categories of overweight and obesity should be analysed and reported independently, as should BMI data by sex.     

Socioeconomic inequalities in adult obesity risk in Canada: trends and decomposition analyses

This study examines trends in socioeconomic-related inequalities in obesity risk among Canadian adults (aged 18–65 years) from 2000 to 2010 using five nationally representative Canadian Community Health Surveys (CCHSs). We employed the concentration index (C) to quantify the socioeconomic inequalities in obesity risk across different demographic groups and geographic regions in each survey period. A decomposition analysis of inequality is performed to determine factors that lie behind income-related inequality in obesity risk. Although declining over time, the results show that there exists income-related inequality in obesity risk in Canada. The estimated Cs for men indicate that obesity is concentrated among the rich and its trend is increasing over time. The findings, however, suggest that obesity is more prevalent among economically disadvantaged women. While we found that obesity is mainly concentrated among the poor in the Atlantic Provinces, the degree of socioeconomic related inequality in obesity risk is increasing in these provinces. The results for Alberta showed that obesity is concentrated among the better-off individuals. The decomposition analysis suggests that factors such as demographics, income, immigration, education, drinking habits, and physical activity are the key factors explaining income-related inequality in obesity risk in Canada. Our empirical findings suggest that, in order to combat the obesity epidemic, health policies should focus on poorer females and economically well-off males.     

The problems of relative deprivation: why some societies do better than others

In this paper, we present evidence which suggests that key processes of social status differentiation, affecting health and numerous other social outcomes, take place at the societal level. Understanding them seems likely to involve analyses and comparisons of whole societies. Using income inequality as an indicator and determinant of the scale of socioeconomic stratification in a society, we show that many problems associated with relative deprivation are more prevalent in more unequal societies. We summarise previously published evidence suggesting that this may be true of morbidity and mortality, obesity, teenage birth rates, mental illness, homicide, low trust, low social capital, hostility, and racism. To these we add new analyses which suggest that this is also true of poor educational performance among school children, the proportion of the population imprisoned, drug overdose mortality and low social mobility. That ill health and a wide range of other social problems associated with social status within societies are also more common in more unequal societies, may imply that income inequality is central to the creation of the apparently deep-seated social problems associated with poverty, relative deprivation or low social status. We suggest that the degree of material inequality in a society may not only be central to the social forces involved in national patterns of social stratification, but also that many of the problems related to low social status may be amenable to changes in income distribution. If the prevalence of these problems varies so much from society to society according to differences in income distribution, it suggests that the familiar social gradients in health and other outcomes are unlikely to result from social mobility sorting people merely by prior characteristics. Instead, the picture suggests that their frequency in a population is affected by the scale of social stratification that differs substantially from one society to another.     

Long Term Trends and Racial/Ethnic Disparities in the Prevalence of Obesity

Obesity is an epidemic associated with higher rates of hypertension, diabetes, and cardiovascular diseases. However, significant racial disparities in the prevalence of obesity have been reported. To evaluate racial disparities and trends in the prevalence of obesity and obesity-related diseases. A population-based retrospective cohort study utilized data from the 1985 to 2011 California Behavioral Risk Factor Survey. Trends in obesity prevalence were stratified by age, sex, race/ethnicity, and socioeconomic factors. Multivariate logistic regression models evaluated independent predictors of obesity. The prevalence of obesity in significantly increased from 1985 to 2011 (8.6 vs. 22.8 %, p < 0.001). This increase was seen among men and women, and among all race/ethnic, age, and socioeconomic groups. Hypertension and diabetes also increased during this time period (hypertension 20.7–35.9 %; diabetes 4.2–11.2 %). Obesity prevalence was highest in blacks and Hispanics, and lowest in Asians (blacks 33.3 %; Hispanics 28.8 %; Asians 9.0 %; p < 0.001). Obesity prevalence was associated with lower education level, lower income, and unemployment status. After adjustments for age, sex, co morbidities, and surrogates of socioeconomic status, the increased risk of obesity in blacks and Hispanics persisted (blacks OR 1.51; Hispanics OR 1.18), whereas Asians were less likely to be obese (OR 0.37). While the overall prevalence of obesity increased from 1985 to 2011, significant racial/ethnic disparities in obesity have developed, with the highest prevalence seen in blacks and Hispanics, and the lowest seen in Asians.     

Obesity and education in three countries of the Central and Eastern Europe: the HAPIEE study

The international pattern of obesity is only partly understood. While in developed countries the association between education and obesity is inverse, in the developing world social distribution of obesity is less predictable. We examined obesity patterns in three countries of Central and Eastern Europe (CEE): Russia, Poland and the Czech Republic, middle-income post-communist countries undergoing social and economic transition. The prevalence of obesity was inversely associated with education of individuals in our three samples of Central and Eastern European populations. In agreement with previous findings, the inverse socioeconomic gradient was more pronounced in the Czech Republic and Poland, countries with higher Gross National Product (GNP) than Russia. In addition, obesity was more common in Russian women than in Czech or Polish women while Russian men were less obese than Czech or Polish men. These findings are consistent with the hypothesis that the social gradient in obesity differs between populations--it is more likely to find a reverse association between socioeconomic position and prevalence of obesity in the more westernized countries with higher population income.     

Obesity among the poor in Brazil: female vulnerability

The increase in obesity among women in the lower income bracket in Brazil has been singled out as a priority issue in the field of Public Health today. Concern about future repercussions of obesity in the less privileged groups calls for an in-depth theoretical approach and the energetic definition of public policy for prevention and control of the affliction in these segments. In this respect, the scope of this work is to attempt to pinpoint some analytical categories in the phenomenon of obesity among the underprivileged female population in Brazil. Biological, socioeconomic and cultural factors appear to interact in the dynamics of female obesity in the context of poverty revealing the complexity of this problem. Public policies of job creation, social inclusion and gender equality in the labor market would appear to be more promising ways of tackling obesity in underprivileged females in Brazil.     

Longitudinal Associations Between Poverty and Obesity From Birth Through Adolescence

Objectives. We examined the relationship between timing of poverty and risk of first-incidence obesity from ages 3 to 15.5 years.Methods. We used the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (1991–2007) to study 1150 children with repeated measures of income, weight, and height from birth to 15.5 years in 10 US cities. Our dependent variable was the first incidence of obesity (body mass index ≥ 95th percentile). We measured poverty (income-to-needs ratio < 2) prior to age 2 years and a lagged, time-varying measure of poverty between ages 2 and 12 years. We estimated discrete-time hazard models of the relative risk of first transition to obesity.Results. Poverty prior to age 2 years was associated with risk of obesity by age 15.5 years in fully adjusted models. These associations did not vary by gender.Conclusions. Our findings suggest that there are enduring associations between early life poverty and adolescent obesity. This stage in the life course may serve as a critical period for both poverty and obesity prevention.There are significant socioeconomic disparities in rates of childhood and adolescent obesity, defined as a body mass index (BMI) at or above the 95th percentile, adjusted for age and gender.1–3 Children of low socioeconomic status (SES) are 1.6 times more likely to be obese than high-SES children4 and have steeper rates of increase in obesity.5,6 Despite evidence that the prevalence of obesity has recently stabilized among children overall, it continues to increase among low-SES children.2,5 The positive relationship between low SES and obesity is especially worrisome because of relatively high rates of childhood poverty that have only increased in the recent economic downturn.7 One in 5 US children (16.4 million) now live in families with incomes below the federal poverty level.8To better understand the relationship between poverty and obesity, longitudinal studies of childhood poverty and its associations with obesity throughout childhood are needed. To develop effective policies preventing the incidence of child obesity, studies must also determine critical periods in childhood during which poverty may exert greater influence on the incidence of obesity.9,10 Most studies demonstrating a link between SES and obesity, however, have used a cross-sectional study design.1,5,6,11–16 Fewer studies address the issue of timing of childhood poverty (or other SES measures) and obesity incidence (or changes in BMI) later in life.17–20 Moreover, these few studies omit key information on weight history17,19 and SES prior to middle childhood (younger than 7 years)18,19 or are based on non-US populations,21 which precludes the study of early life associations between poverty and obesity, and limits generalizability to the United States.We used a comprehensive, community-based data set of US children followed from birth to about 15 years of age and for whom multiple measures of children’s SES, height, and weight were collected. Our objective was to examine critical periods in the relationship between poverty and the risk of the first incidence of obesity across the early life course.     

Is socioeconomic disparity in disability improving among Korean elders?

The purpose of this study was to evaluate whether the socioeconomic disparity in disability status in Korea improved during the decade between 1994 and 2004. Information was obtained from the National Survey of Elders’ Life and Welfare Desires in 1994, 1998, and 2004. Age-adjusted disability rates by educational level and income were calculated separately for women and men. Prevalence ratios for disability by education and income were estimated using log-binomial regression. The relative index of inequality (RII) was calculated controlling for age. We also assessed trends in the disability rate as well as the RII p-trend by year. We found that disability rates declined during the decade from 1994 to 2004 among Koreans aged 65 years old or older. Older persons with less education and income exhibited greater decline in their disability than did those with higher socioeconomic status. Although the absolute disparity in disability decreased during the studied decade, the relative disparity for any disability remained stable in terms of both education and income. Despite rapid decreases in socioeconomic inequality among older adults with severe disabilities, older adults with lower socioeconomic status have remained more vulnerable to milder forms of disability during recent years.     

Obesity, diets, and social inequalities

Obesity and type 2 diabetes follow a socioeconomic gradient. Highest rates are observed among groups with the lowest levels of education and income and in the most deprived areas. Inequitable access to healthy foods is one mechanism by which socioeconomic factors influence the diet and health of a population. As incomes drop, energy-dense foods that are nutrient poor become the best way to provide daily calories at an affordable cost. By contrast, nutrient-rich foods and high-quality diets not only cost more but are consumed by more affluent groups. This article discusses obesity as an economic phenomenon. Obesity is the toxic consequence of economic insecurity and a failing economic environment.     

我国农村居民不同社会经济地位群体之间的健康差距

目的：考察我国农村居民不同社会经济地位群体之间的健康差距。资料与方法：主要依据全国31个省份2003—2006年农村固定观察点数据,计算不同社会经济地位群体的组间健康集中指数。结果：在我国农村居民中,社会经济地位较好的人群在健康方面享有优势;不同收入组间的健康不平等程度大于不同教育程度组间的健康不平等程度;收入较低和受教育程度较高的人群更容易患上慢性病。讨论：自评健康与收入的相关性要强于其与教育的相关性;受教育程度高的人群更容易患上慢性病,其原因可能与缺乏身体锻炼有关。结论：在我国农村居民中,不同社会经济地位群体间确实存在系统性的健康差异,但这种差异小于个体间的健康差异。     

Individual- and area-level unemployment influence smoking cessation among African Americans participating in a randomized clinical trial

African Americans suffer disproportionately from the adverse health consequences of smoking, and also report substantially lower socioeconomic status than Whites and other racial/ethnic groups in the U.S. Although socioeconomic disadvantage is known to have a negative influence on smoking cessation rates and overall health, little is known about the influence of socioeconomic status on smoking cessation specifically among African Americans. Thus, the purpose of the current study was to characterize the impact of several individual- and area-level indicators of socioeconomic status on smoking cessation among African Americans. Data were collected as part of a smoking cessation intervention study for African American smokers (N = 379) recruited from the Houston, Texas, metropolitan area, who participated in the study between 2005 and 2007. The separate and combined influences of individual-level (insurance status, unemployment, education, and income) and area-level (neighborhood unemployment, education, income, and poverty) indicators of socioeconomic status on continuous smoking abstinence were examined across time intervals using continuation ratio logit modeling. Individual-level analyses indicated that unemployment was significantly associated with reduced odds of smoking abstinence, while higher income was associated with greater odds of abstinence. However, only unemployment remained a significant predictor of abstinence when unemployment and income were included in the model together. Area-level analyses indicated that greater neighborhood unemployment and poverty were associated with reduced odds of smoking abstinence, while greater neighborhood education was associated with higher odds of abstinence. However, only neighborhood unemployment remained significantly associated with abstinence status when individual-level income and unemployment were included in the model. Overall, findings suggest that individual- and area-level unemployment have a negative impact on smoking cessation among African Americans. Addressing unemployment through public policy and within smoking cessation interventions, and providing smoking cessation treatment for the unemployed may have a beneficial impact on tobacco-related health disparities.     

Socioeconomic inequality of obesity in the United States: do gender, age, and ethnicity matter?

This study introduces the concentration index (CI) to assess socioeconomic inequality in the distribution of obesity among American adults aged 18-60 years old. The CI provides a summary measure of socioeconomic inequality, and enabled comparisons across gender, age, and ethnicity. Data from the National Health and Nutrition Examination Survey III, 1988-1994 (NHANES III) were used. The degree of socioeconomic inequality in obesity varied considerably across gender, age, and ethnic groups. Among women, we found a stronger, inverse association between socioeconomic status (SES) and obesity compared with men, as well as greater socioeconomic inequality among middle-aged adults (41-49) compared to other age groups. Consistent with previous studies, we found remarkable ethnic differences in the relationship between SES and obesity. Although the extant literature documented a higher prevalence of obesity among minorities than in whites, our results presented a lower socioeconomic inequality in obesity within minority groups. Our analyses suggested that gender, age, and ethnicity could be important factors on socioeconomic inequality in obesity.     

Waiting times and socioeconomic status: evidence from England

Waiting times for elective surgery, like hip replacement, are often referred to as an equitable rationing mechanism in publicly-funded healthcare systems because access to care is not based on socioeconomic status. Previous work has established that that this may not be the case and there is evidence of inequality in NHS waiting times favouring patients living in the least deprived neighbourhoods in England. We advance the literature by explaining variations of inequalities in waiting times in England in four different ways. First, we ask whether inequalities are driven by education rather than income. Our analysis shows that education and income deprivation have distinct effects on waiting time. Patients in the first quintile with least deprivation in education wait 9% less than patients in the second quintile and 14% less than patients in the third-to-fifth quintile. Patients in the fourth and fifth most income-deprived quintile wait about 7% longer than patients in the least deprived quintile. Second, we investigate whether inequalities arise "across" hospitals or "within" the hospital. The analysis provides evidence that most inequalities occur within hospitals rather than across hospitals. Moreover, failure to control for hospital fixed effects results in underestimation of the income gradient. Third, we explore whether inequalities arise across the entire waiting time distribution. Inequalities between better educated patients and other patients occur over large part of the waiting time distribution. Moreover we find that the education gradient becomes smaller for very long waiting. Fourth, we investigate whether the gradient may reflect the fact that patients with higher socioeconomic status have a different severity as proxied through a range of types and the number of diagnoses (in addition to age and gender) compared to those with lower socioeconomic status. We find no evidence that differences in severity explain the social gradient in waiting times.     

Gender-Specific Disparities in Obesity

Little prior research has investigated whether the correlates of obesity differ between men and women. The objective of this study was to examine gender-specific disparities in obesity by rurality of residence, race/ethnicity, and socioeconomic status. Particular emphasis was devoted to examining potential differences between residents of urban, suburban, and rural areas. Data from the adult version of the 2003 Behavioral Risk Factor Surveillance System (BRFSS) for the state of Texas were used to model the crude and adjusted odds of being obese as compared to normal weight. The findings showed that males of other race/ethnicity had lower adjusted odds of obesity than non-Hispanic whites, but other race/ethnicity was insignificant for females. Females who were Hispanic or black/African American had higher adjusted odds of obesity than non-Hispanic whites, but Hispanic ethnicity and black/African American race were insignificant for males. Men and women residing in non-metropolitan areas had higher adjusted odds of obesity than their counterparts in metropolitan areas. No economic disparities were revealed among men, but females with high household income had lower odds of obesity than those with low income. Educational status was insignificant for men and women. The findings suggest that programs and policies aimed at curbing obesity should target males and females residing in non-metropolitan localities. Other initiatives should focus on particular groups of women, including those who are Hispanic or black/African American and have low household income.