Obesity and education: recent trends and disparities among 65- to 84-year-old men and women in Finland

Do associations between education and obesity vary depending on the measure of obesity used? A systematic literature review and meta-analysis

Background

Consistent evidence suggests a relationship between lower educational attainment and total obesity defined using body mass index (BMI); however, a comparison of the relationships between educational attainment and total obesity (BMI ≥30 kg/m²) and central obesity (waist circumference (WC) > 102 cm for men and WC > 88 cm for women) has yet to be carried out. This systematic literature review (SLR) and meta-analyses aimed to understand whether i) the associations between education and obesity are different depending on the measures of obesity used (BMI and WC), and ii) to explore whether these relationships differ by gender and region.

Methods

Medline, Embase and Web of Science were searched to identify studies investigating the associations between education and total and central obesity among adults in the general population of countries in the Organisation for Economic Co-operation and Development (OECD). Meta-analyses and meta-regression were performed in a subset of comparable studies (n=36 studies; 724,992 participants).

Results

86 eligible studies (78 cross-sectional and eight longitudinal) were identified. Among women, most studies reported an association between a lower education and total and central obesity. Among men, there was a weaker association between lower education and central than total obesity (OR central vs total obesity in men 0.79 (95% CI 0.60, 1.03)). The association between lower education and obesity was stronger in women compared with men (OR women vs men 1.66 (95% CI 1.32, 2.08)). The relationship between lower education and obesity was less strong in women from Northern than Southern Europe (OR Northern vs Southern Europe in women 0.37 (95% CI 0.27, 0.51)), but not among men.

Conclusions

Associations between education and obesity differ depending on whether total or central obesity is used among men, but not in women. These associations are stronger among women than men, particularly in Southern European countries.

Social Capital as a Mediator through the Effect of Education on Depression and Obesity among the Elderly in China

Objectives: Global aging is an increasingly serious problem. The health problems faced by the elderly, such as depression and obesity, require serious consideration. Education, depression and obesity are inextricably linked; for the elderly, education is constant, and the factors which can mediate the relationship between education, depression and obesity are still being discussed by scholars. The mediating effect of social capital is rarely studied. The objective of this study was to assess the mediating role of cognitive social capital and structural social capital, as well as the effect of education on depression and obesity among the elderly using China Family Panel Studies (CFPS) data. Methods: In total, 4919 respondents were included in the final analysis. Education was measured by years of schooling. Trust and participation were used as measures of cognitive social capital and structural social capital. Depression symptoms and BMI were used as outcomes. Structural equation models were developed to examine the direct and indirect effect of social capital and education on health outcomes. Results: Education was negatively correlated with depression symptom (r = −0.15, p < 0.001), while education was positively correlated with BMI (r = 0.08, p < 0.001). Older adults with a higher education level have higher cognitive social capital (r = 0.11, p < 0.001) and structural social capital (r = 0.20, p < 0.001). Social capital plays a mediatory role. Older adults with higher social capital have a lower risk of depression (cognitive: r = −0.23, p < 0.001; structural: r = −0.03, p < 0.01) but a higher risk of obesity (cognitive: r = 0.06, p < 0.01; structural: r = 0.03, p < 0.01). For depression, the mediating function of cognitive social capital (a1b1= −0.025) is stronger than that of structural social capital (a2b2 = −0.006). While, for obesity, the effects of both cognitive and structural social capital are the same (a1c1 = a2c2 = 0.005). Conclusions: Social capital as a mediator through the effect of education on depression and obesity among the elderly in China. Meanwhile, using the positive effects of social capital to avoid negative effects should also be seriously considered.

Cardiometabolic and Inflammatory Biomarkers as Mediators Between Educational Attainment and Functioning at the Age of 90 Years

BACKGROUND

Low socioeconomic status is associated both with poorer functioning and elevated levels of inflammatory and cardiometabolic biomarkers; however, knowledge of such relations for the oldest old is limited. Our aim was to study whether education is associated with cardiometabolic (cholesterol levels, body mass index, and leptin) and inflammatory (C-reactive protein, interleukin-6, interleukin-1Ra) biomarkers for the 90-year-olds who participated in the Vitality 90+ study. In addition, we investigated whether these biomarkers explain educational inequalities in functioning.

METHODS

All persons in Tampere, Finland, who were born in 1909 or 1910, were invited to participate, irrespective of their health status or dwelling place. The sample consisted of 262 participants who went through the home interview and blood tests. The socioeconomic status indicator used was the highest education, and physical functioning was assessed using the Barthel index. The association of education with individual and combined biomarker scores, and with functioning, was analyzed cross-sectionally applying generalized linear models.

RESULTS

The low- and mid-level-educated participants had greater odds of belonging to the high risk group in cardiometabolic biomarkers than did the high-educated. Differences were statistically significant in three individual biomarkers (high-density lipoprotein-cholesterol, leptin, and body mass index) and in a cardiometabolic score. There were no educational differences in inflammatory biomarkers. When all biomarkers were combined, they mediated educational differences in functioning on an average of 23%. After controlling for smoking, alcohol use and diseases, biomarkers mediated part of the differences between the mid-level- and high-educated.

CONCLUSIONS

High education was associated with better cardiometabolic biomarkers and functioning among the 90-year-olds. In part, educational inequalities in functioning were explained by cardiometabolic biomarkers.

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

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

Are social inequalities widening in generalised and abdominal obesity and overweight among English adults?

BACKGROUND

Obesity is now more common in lower socioeconomic groups in developed nations, but the socio-economic patterning of obesity has changed over time. This study examines the time trends in the socioeconomic patterning of generalised and abdominal obesity and overweight in English adults.

METHODS

Data were from core annual samples of the Health Survey for England 1993-2008, including 155 661 participants aged 18-75 years. The prevalence of generalised and abdominal obesity and overweight was reported as crude and age-adjusted estimates. Binomial regression was used to model measures of obesity and overweight with age, sex, survey years, and two indicators of socioeconomic position: Registrar General's Social Class (manual and non-manual occupational groups) and relative length of full time education. Trends in socioeconomic patterning were assessed by formal tests for interactions between socioeconomic position measures and survey periods in these models.

RESULTS

The prevalence of generalised and abdominal overweight and obesity increased consistently between 1993 and 2008. There were significant differences in the four outcomes between the two socioeconomic position (SEP) groups in men and women, except for generalised and abdominal overweight with social class in men. The prevalence of obesity and overweight across the whole period was higher in subgroups with lower SEP (differences of 0.2% to 9.5%). There was no significant widening of the socioeconomic gradient of most indicators of greater body fat since the early 1990s, except for educational gradient in generalised obesity in men and women (P = 0.001).

CONCLUSIONS

Substantial social class and education gradients in obesity and overweight are still present in both sexes. However, there is limited evidence that these socioeconomic inequalities have changed since 1993.

Excess weight and physical health-related quality of life in postmenopausal women of diverse racial/ethnic backgrounds

BACKGROUND

Studies of weight and health-related quality of life (HRQOL) generally focus on white populations. This analysis examines the association between clinical weight categories and physical HRQOL in five racial/ethnic groups of older women and determines the extent to which emotional/psychological (social support, caregiver burden) and physical health (diabetes, osteoarthritis) factors modify this relationship.

METHODS

The cross-sectional analysis, completed in 2007, used baseline data from postmenopausal women enrolled in the Women's Health Initiative (WHI) during the 5-year recruitment period (1993-1998).

RESULTS

Of 161,393 women, 83% were non-Hispanic white, 9% were African American, 4% were Hispanic/Latina, 3% were Asian/Pacific Islander, and <1% were American Indian/Alaska Native. Obesity (body mass index [BMI] > or =30 kg/m(2)) was most common in non-Asian minority groups. Regression modeling showed higher odds of poor physical HRQOL with increasing weight category in all groups. In the total sample, these odds were at least 6 times as high in women with class 3 obesity as in women of normal weight and were only mildly attenuated after the analysis adjusted for emotional/psychological factors. Further adjustment for physical health factors made odds ratio (OR) estimates drop from 2.36 to 1.59 for class 1 obesity and from 6.96 to 3.71 for class 3 obesity. This pattern generally persisted within each racial/ethnic group.

CONCLUSIONS

Heavier weight negatively affects physical HRQOL in postmenopausal women across diverse racial/ethnic backgrounds. Weight-relevant physical health factors have a greater impact on this weight-HRQOL association than do emotional/psychological factors.

Prevalence of overweight and obesity in elderly people from Vitória-ES, Brazil

The scope of this study was to estimate the prevalence of overweight and obesity and its association with socio-economic status in a sample of non-institutionalized elderly people from Vitória-ES, Brazil. This was a cross-sectional survey with a sample of 882 elderly people aged 60 and over. Obesity and overweight were assessed using the body mass index (BMI) and waist circumference (WC). All subjects answered a personal and socio-demographic questionnaire in relation to age, gender, marital status, physical activity, number of children, chronic diseases and smoking. Associations between categorical variables were tested using chi-square analysis with a 5% significance level. The prevalence of overweight and obesity was high (41.8% and 23.4%, respectively) and 50.7% of the elderly had a substantially increased waist circumference. About 4.3% of the individuals had diabetes, 50.4% had hypertension and 14.9% were found to have both diseases. It was observed that both the BMI and WC were significant associated (p<0.05) with sex, marital status, the presence of diseases and with cigarette smoking.

Lumbar disc herniation in the Spine Patient Outcomes Research Trial: does educational attainment impact outcome?

STUDY DESIGN

Randomized trial with concurrent observational cohort. A total of 1171 patients were divided into subgroups by educational attainment: high school or less, some college, and college degree or above.

OBJECTIVE

To assess the influence of education level on outcomes for treatment of lumbar disc herniation.

SUMMARY OF BACKGROUND DATA

Educational attainment has been demonstrated to have an inverse relationship with pain perception, comorbidities, and mortality.

METHODS

The Spine Patient Outcomes Research Trial enrolled surgical candidates (imaging-confirmed disc herniation with at least 6 weeks of persistent signs and symptoms of radiculopathy) from 13 multidisciplinary spine clinics in 11 US states. Treatments were standard open discectomy versus nonoperative treatment. Outcomes were changes from baseline for 36-Item Short Form Health Survey (SF-36), bodily pain (BP), and physical function (PF) scales and the modified Oswestry Disability Index (ODI) at 6 weeks, 3 months, 6 months, and yearly through 4 years.

RESULTS

Substantial improvement was seen in all patient cohorts. Surgical outcomes did not differ by level of education. For nonoperative outcomes, however, higher levels of education were associated with significantly greater overall improvement over 4 years in BP (P = 0.007), PF (P = 0.001), and ODI (P = 0.003). At 4 years a "dose-response" type relationship was shown for BP (high school or less = 25.5, some college = 31, and college graduate or above = 36.3, P = 0.004) and results were similar for PF and ODI. The success of nonoperative treatment in the more educated cohort resulted in an attenuation of the relative benefit of surgery.

CONCLUSION

Patients with higher educational attainment demonstrated significantly greater improvement with nonoperative treatment while educational attainment was not associated with surgical outcomes.

Ten-year trends in overweight and obesity in the adult Portuguese population, 1995 to 2005

BACKGROUND

There is little information regarding the trends in body mass index (BMI) and obesity in the overall Portuguese population, namely if these trends are similar according to educational level. In this study, we assessed the trends in the prevalence of overweight and obesity in the Portuguese population, overall and by educational level.

METHODS

Cross-sectional national health interview surveys conducted in 1995-6 (n = 38,504), 1998-9 (n = 38,688) and 2005-6 (n = 25,348). Data were derived from the population and housing census of 1991 and two geographically-based strata were defined. The sampling unit was the house, and all subjects living in the sampling unit were surveyed. Height and weight were self-reported; the effects of gender, age group and educational level were also assessed by self-reported structured questionnaires. Bivariate comparisons were performed using Chi-square or analysis of variance (ANOVA). Trends in BMI levels were assessed by linear regression analysis, while trends in the prevalence of obesity were assessed by logistic regression.

RESULTS

Mean (±standard deviation) BMI increased from 25.2 ± 4.0 in 1995-6 to 25.7 ± 4.5 kg/m² in 2005-6. Prevalence of overweight remained stable (36.1% in 1995-6 and 36.4% in 2005) while prevalence of obesity increased (11.5% in 1995-6 and 15.1% in 2005-6). Similar findings were observed according to age group. Mean age-adjusted BMI increase (expressed in kg/m²/year and 95% confidence interval) was 0.073 (0.062, 0.084), 0.016 (0.000, 0.031) and 0.073 (0.049, 0.098) in men with primary, secondary and university levels, respectively; the corresponding values in women were 0.085 (0.073, 0.097), 0.052 (0.035, 0.069) and 0.062 (0.038, 0.084). Relative to 1995-6, obesity rates increased by 48%, 41% and 59% in men and by 40%, 75% and 177% in women with primary, secondary and university levels, respectively. The corresponding values for overweight were 6%, 1% and 23% in men and 5%, 7% and 65% in women.

CONCLUSION

Between 1995 and 2005, obesity increased while overweight remained stable in the adult Portuguese population. Although higher rates were found among lesser educated subjects, the strong increase in BMI and obesity levels in highly educated subjects is of concern.

Edentulism associated with obesity: a study of four national surveys of 16 416 Swedes aged 55&#x2013;84 years

OBJECTIVE

To investigate the association between edentulism and obesity in the Swedish population aged 55–84 years over a 22-year period as a result of changes in health and socio-economic factors.

MATERIAL AND METHODS

Subjects aged 55–84 years (n = 16 416) were randomly sampled from the Swedish population by Statistics Sweden on four occasions (1980–81, 1988–89, 1996–97 and 2002). Trained interviewers collected information about dental status and anthropometric, demographic, socio-economic, lifestyle and health-related factors. Statistical analyses were based on logistic regression models.

RESULTS

Edentulism decreased from 43% to 14% in the age group 55–84 years from 1980 to 2002, and the proportion of subjects with removable dentures decreased from 68% to 33%. In the age group 55–74 years, the proportion of subjects with low education decreased from 60% to 28%, and the proportion of obese subjects (body mass index ≥30 kg/m²) increased from 9% to 15%. In women aged 55–74 years, the association between obesity and edentulism, adjusted for health, lifestyle and socioeconomic factors, was significant in all surveys, and the odds ratio for obesity changed from 1.64 (95% confidence interval 1.18–2.27) in 1980 to 3.17 (95% confidence interval 1.69–6.18) in 2002. In men, the association was weaker and was significant only in the sample that combined all surveys and included individuals aged 55–84 years.

CONCLUSION

The study indicated an association between edentulism and obesity, which was most obvious in women aged 55–74 years.

Changes of overweight and obesity in the adult Swiss population according to educational level, from 1992 to 2007

Background

In many high income developed countries, obesity is inversely associated with educational level. In some countries, a widening gap of obesity between educational groups has been reported. The aim of this study was to assess trends in body mass index (BMI) and in prevalence of overweight and obesity and their association with educational level in the adult Swiss population.

Methods

Four cross-sectional National health interview surveys conducted in 1992/93 (n = 14,521), 1997 (n = 12,474), 2002 (n = 18,908) and 2007 (n = 17,879) using representative samples of the Swiss population (age range 18-102 years). BMI was derived from self-reported data. Overweight was defined as BMI ≥ 25 and <30 kg/m², and obesity as BMI ≥ 30 kg/m².

Results

Mean (± standard deviation) BMI increased from 24.7 ± 3.6 in 1992/3 to 25.4 ± 3.6 kg/m² in 2007 in men and 22.8 ± 3.8 to 23.7 ± 4.3 kg/m² in women. Between 1992/3 and 2007, the prevalence of overweight + obesity increased from 40.4% to 49.5% in men and from 22.3% to 31.3% in women, while the prevalence of obesity increased from 6.3% to 9.4% in men and from 4.9% to 8.5% in women. The rate of increase in the prevalence of obesity was greater between 1992/3 and 2002 (men: +0.26%/year; women: +0.31%/year) than between 2002 and 2007 (men: +0.10%/year; women: +0.10%/year). A sizable fraction (~25%) of the increasing mean BMI was due to increasing age of the participants over time. The increase was larger in low than high education strata of the population. BMI was strongly associated with low educational level among women and this gradient remained fairly constant over time. A weaker similar gradient by educational level was apparent in men, but it tended to increase over time.

Conclusion

In Switzerland, overweight and obesity increased between 1992 and 2007 and was associated with low education status in both men and women. A trend towards a stabilization of mean BMI levels was noted in most age categories since 2002. The increase in the prevalence of obesity was larger in low education strata of the population. These findings suggest that obesity preventive measures should be targeted according to educational level in Switzerland.