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

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Abstract

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

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Most cited references 73

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The nutrition transition: worldwide obesity dynamics and their determinants.

B Popkin, P Gordon-Larsen (2004)

This paper explores the major changes in diet and physical activity patterns around the world and focuses on shifts in obesity. Review of results focusing on large-scale surveys and nationally representative studies of diet, activity, and obesity among adults and children. Youth and adults from a range of countries around the world. The International Obesity Task Force guidelines for defining overweight and obesity are used for youth and the body mass index > or =25 kg/m(2) and 30 cutoffs are used, respectively, for adults. The nutrition transition patterns are examined from the time period termed the receding famine pattern to one dominated by nutrition-related noncommunicable diseases (NR-NCDs). The speed of dietary and activity pattern shifts is great, particularly in the developing world, resulting in major shifts in obesity on a worldwide basis. Data limitations force us to examine data on obesity trends in adults to provide a broader sense of changes in obesity over time, and then to examine the relatively fewer studies on youth. Specifically, this work provides a sense of change both in the United States, Europe, and the lower- and middle-income countries of Asia, Africa, the Middle East, and Latin America. The paper shows that changes are occurring at great speed and at earlier stages of the economic and social development of each country. The burden of obesity is shifting towards the poor.

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J Sobal, A Stunkard (1989)

A review of 144 published studies of the relationship between socioeconomic status (SES) and obesity reveals a strong inverse relationship among women in developed societies. The relationship is inconsistent for men and children in developed societies. In developing societies, however, a strong direct relationship exists between SES and obesity among men, women, and children. A review of social attitudes toward obesity and thinness reveals values congruent with the distribution of obesity by SES in different societies. Several variables may mediate the influence of attitudes toward obesity and thinness among women in developed societies that result in the inverse relationship between SES and obesity. They include dietary restraint, physical activity, social mobility, and inheritance.

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Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice.

S. Geyer (2006)

Education, income, and occupational class are often used interchangeably in studies showing social inequalities in health. This procedure implies that all three characteristics measure the same underlying phenomena. This paper questions this practice. The study looked for any independent effects of education, income, and occupational class on four health outcomes: diabetes prevalence, myocardial infarction incidence and mortality, and finally all cause mortality in populations from Sweden and Germany. Sweden: follow up of myocardial infarction mortality and all cause mortality in the entire population, based on census linkage to the Cause of Death Registry. Germany: follow up of myocardial infarction morbidity and all cause mortality in statutory health insurance data, plus analysis of prevalence data on diabetes. Multiple regression analyses were performed to calculate the effects of education, income, and occupational class before and after mutual adjustments. Sweden (all residents aged 25-64) and Germany (Mettman district, Nordrhein-Westfalen, all insured persons aged 25-64). Correlations between education, income, and occupational class were low to moderate. Which of these yielded the strongest effects on health depended on type of health outcome in question. For diabetes, education was the strongest predictor and for all cause mortality it was income. Myocardial infarction morbidity and mortality showed a more mixed picture. In mutually adjusted analyses each social dimension had an independent effect on each health outcome in both countries. Education, income, and occupational class cannot be used interchangeably as indicators of a hypothetical latent social dimension. Although correlated, they measure different phenomena and tap into different causal mechanisms.

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Author and article information

Contributors

: maria.magnusson@allmed.gu.se

: TSOE0005@regionh.dk

: stina.olafsdottir@ped.gu.se

: susanna.lehtinen-jacks@uta.fi , susanna.lehtinen-jacks@thl.fi

: turid.lingaas.holmen@ntnu.no

: Berit.Lilienthal.Heitmann@regionh.dk

: lauren.lissner@medfak.gu.se

Journal

Journal ID (nlm-ta): Curr Obes Rep

Journal ID (iso-abbrev): Curr Obes Rep

Title: Current Obesity Reports

Publisher: Springer US (Boston )

ISSN (Electronic): 2162-4968

Publication date (Electronic): 7 January 2014

Publication date PMC-release: 7 January 2014

Publication date Collection: 2014

Volume: 3

Pages: 1-15

Affiliations

[ ]Department of Public Health and Community Medicine, University of Gothenburg, Box 454, 405 30 Gothenburg, Sweden

[ ]Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital – Part of the Copenhagen University Hospital, Copenhagen, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark

[ ]Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

[ ]Department of Food and Nutrition, and Sport Science, University of Gothenburg, Laroverksgatan 5, Box 320, 405 30 Gothenburg, Sweden

[ ]School of Health Sciences (HES) Medisiinarinkatu 3, University of Tampere, 33014 Tampere, Finland

[ ]Nutrition Unit, National Institute for Health and Welfare, Mannerheimintie 166, 00280 Helsinki, Finland

[ ]HUNT Research Centre, Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Forskningsveien 2, 7600 Levanger, Norway

[ ]National Institute of Public Health, University of Southern Denmark, Odense M, Denmark

Article

Publisher ID: 87

DOI: 10.1007/s13679-013-0087-2

PMC ID: 3920028

PubMed ID: 24533235

SO-VID: 2d764f7c-1471-4f58-a76d-8bbf09b47cfa

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ScienceOpen disciplines: Health & Social care

Keywords: gini coefficient,finland,nordic countries,socioeconomic status,socioeconomic position,egalitarian,overweight,children,sweden,denmark,adults,occupation,nordic region,income,inequality,gender,secular trends,bmi,obesity,education,social inequalities,social gradient,iceland,norway,adolescents,obesogenic

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ScienceOpen disciplines: Health & Social care

Keywords: gini coefficient, finland, nordic countries, socioeconomic status, socioeconomic position, egalitarian, overweight, children, sweden, denmark, adults, occupation, nordic region, income, inequality, gender, secular trends, bmi, obesity, education, social inequalities, social gradient, iceland, norway, adolescents, obesogenic

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

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Abstract

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UCL: UN SDG 10 Reduced Inequalities

Most cited references 73

The nutrition transition: worldwide obesity dynamics and their determinants.

Socioeconomic status and obesity: a review of the literature.

Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice.

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