Neighbourhood socioeconomic inequality and gender differences in body mass index: The role of unhealthy behaviours

Area-level socioeconomic inequalities in overweight and obesity: Systematic review on moderation by built-environment attributes

Residents of lower socioeconomic status (SES) areas are at a higher risk of overweight/obesity than those from higher SES areas. Built environment attributes may mitigate such inequalities. This systematic review synthesised findings of studies examining built environment attributes as potential moderators of the associations between area-level SES and overweight/obesity in adults. From five databases, nine eligible studies were identified. The SES-overweight/obesity relationship was stronger in inner areas and suburbs of large cities, while it was weaker in more rural areas. Two studies examined walkability and reported contrasting findings: no moderation in one and marginally significant moderation (less inequality in higher walkability areas) in the other. No evidence of moderation was found for street connectivity, population density, the food environment, access to physical activity facilities and several perceived environmental attributes. Further research is needed on other built environment attributes (e.g., access to, quantity and quality of green spaces, active transport features), and ideally using prospective study designs and objective makers of adiposity.

Associations of Cumulative and Point-in-Time Neighborhood Poverty and Walkability with Body Mass from Age 30 to 39

Few studies examining the effects of neighborhood exposures have accounted for longitudinal residential history. This study examined associations of body mass index (BMI, kg/m2) with neighborhood-level walkability and poverty, both assessed concurrently and cumulatively in the years leading up to BMI assessment. Participants (N = 808) were from a cohort study of individuals originally recruited from public schools in Seattle, Washington, in fifth grade in 1985. Height and weight for BMI were obtained at four assessments at ages: 30 (in 2005), 33, 35, and 39. Participants also completed residential timelines listing each address where they lived from ages 28 to 39, creating a continuous record of addresses and moves. Neighborhood-level walkability and poverty were based on census block groups of each address. Generalized estimating equation models estimated associations of standardized neighborhood variables, both at point-in-time concurrently with assessment of BMI and cumulatively up to the time of BMI assessment. Mean BMI across observations was 28.8 (SD = 7.1). After adjusting for covariates, cumulative walkability was associated with lower BMI (b =  - 0.28; 95% CI: - 0.55, - 0.02), and cumulative neighborhood poverty was associated with higher BMI (b = 0.35; 95% CI: 0.09, 0.60). When examining point-in-time concurrent walkability and poverty with BMI, adjusted associations were close to the null and non-significant. This study provides evidence for a significant role of cumulative exposure to neighborhood built and socioeconomic environments predicting BMI. It underscores the relative strength and importance of cumulative assessments to capture neighborhood exposure not captured through point-in-time assessments.

Environmental Factors in the Rehabilitation Framework: Role of the One Health Approach to Improve the Complex Management of Disability

Environment factors play a crucial implication in human health, with strong evidence suggesting that several biological, chemical, physical and social factors could be possible targets to implement effective strategies for human health promotion. On the other hand, a large gap of knowledge still exists about the implications of environmental factors in terms of functional impairment and disability, while the integration of an environmental-based approach in the therapeutic care of patients affected by disabilities remains still challenging. In this scenario, the One Health approach has been recently introduced in clinical care and aims to optimize health outcomes by recognizing the interconnection between people and the environment. Concurrently, the "Rehabilitation 2030 Initiative" proposed in 2017 by the WHO emphasized the need to integrate environmental-based strategies to promote rehabilitation across different health systems and different nations. However, no previous study underlined the potential implications of the One Health approach in the rehabilitation setting, nor the role of a comprehensive rehabilitation approach focused on environmental factors. Therefore, the aim of this narrative review was to present a comprehensive overview of the data currently available assessing the close relationship between rehabilitation and the environment to provide a different perspective on the comprehensive care of patients affected by disability.

Neighbourhood socioeconomic status and overweight/obesity: a systematic review and meta-analysis of epidemiological studies

OBJECTIVE

Low neighbourhood socioeconomic status (NSES) has been linked to a higher risk of overweight/obesity, irrespective of the individual's own socioeconomic status. No meta-analysis study has been done on the association. Thus, this study was done to synthesise the existing evidence on the association of NSES with overweight, obesity and body mass index (BMI).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Embase, Scopus, Cochrane Library, Web of Sciences and Google Scholar databases were searched for articles published until 25 September 2019.

ELIGIBILITY CRITERIA

Epidemiological studies, both longitudinal and cross-sectional ones, which examined the link of NSES to overweight, obesity or BMI, were included.

DATA EXTRACTION AND SYNTHESIS

Data extraction was done by two reviewers, working independently. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale for the observational studies. The summary estimates of the relationships of NSES with overweight, obesity and BMI statuses were calculated with random-effects meta-analysis models. Heterogeneity was assessed by Cochran's Q and I² statistics. Subgroup analyses were done by age categories, continents, study designs and NSES measures. Publication bias was assessed by visual inspection of funnel plots and Egger's regression test.

RESULT

A total of 21 observational studies, covering 1 244 438 individuals, were included in this meta-analysis. Low NSES, compared with high NSES, was found to be associated with a 31% higher odds of overweight (pooled OR 1.31, 95% CI 1.16 to 1.47, p<0.001), a 45% higher odds of obesity (pooled OR 1.45, 95% CI 1.21 to 1.74, p<0.001) and a 1.09 kg/m² increase in mean BMI (pooled beta=1.09, 95% CI 0.67 to 1.50, p<0.001).

CONCLUSION

NSES disparity might be contributing to the burden of overweight/obesity. Further studies are warranted, including whether addressing NSES disparity could reduce the risk of overweight/obesity.

PROSPERO REGISTRATION NUMBER

CRD42017063889.

Does dissatisfaction with, or accurate perception of overweight status help people reduce weight? Longitudinal study of Australian adults

BACKGROUND

With studies around the world suggesting a large proportion of people do not recognise that they are overweight (or feel satisfied with being overweight), this fuels the view that such 'misperceptions' need to be 'corrected'. However, few longitudinal studies have examined the consequences of under-perceived weight status, nor over-perceived weight status (when a person feels overweight when they are not) and weight-related satisfaction on trajectories in body mass index (BMI).

METHODS

Five-year BMI trajectories were examined among 8174 participants in an Australian nationally representative cohort. Each person was classified into groups according to their neighbourhood socioeconomic circumstances, baseline BMI and answers to "how satisfied are you with your current weight?" and "do you consider yourself to be… acceptable weight / underweight / overweight?" Gender-specific multilevel linear regressions were used to examine five-year BMI trajectories for people in each group, adjusting for potential confounders.

RESULTS

At baseline, weight-related dissatisfaction and perceived overweight were generally associated with higher mean BMI for men and women, regardless of whether they were classified as 'normal' or overweight by World Health Organization (WHO) criteria. Mean BMI did not decrease among people classified as overweight who perceived themselves as overweight, or expressed weight-related dissatisfaction, regardless of where they lived. Among men and women with 'normal' BMI at baseline but expressing weight-related dissatisfaction, mean BMI increased disproportionately among those living in disadvantaged areas compared to their counterparts in affluent areas. Similarly, mean BMI rose disproportionately among people in disadvantaged areas who felt they were overweight despite having a 'normal' BMI by WHO criteria, compared to people with the same over-perceptions living in affluent areas. These differences exacerbated pre-existing socioeconomic inequities in mean BMI.

CONCLUSIONS

No evidence was found to suggest accurate recognition of overweight or expressing weight-related dissatisfaction leads to a lower BMI. However, there was evidence of an increase in mean BMI among people who felt dissatisfied with, or over-perceived their 'normal' weight, especially in socioeconomically disadvantaged areas. Correction of under-perceptions may not drive weight loss, but circumstances contributing to over-perception and dissatisfaction with weight status may contribute to increased weight gain and exacerbate socioeconomic inequities in BMI.

Clustering of unhealthy lifestyle behaviours and associations with perceived and actual weight status among primary school children in China: A nationally representative cross-sectional study

Few studies have focused on clustering of unhealthy lifestyle behaviours among primary school children and potential associations with perceived and actual weight status. An index was constructed from adding up 13 unhealthy behaviours measured by survey responses. Multilevel linear regressions were used to analyse associations between child personal characteristics, perceived and actual weight status with the unhealthy lifestyle index among 11,157 children in primary schools across China. Parental and area factors were also taken into account, including education, weight status, physical activity, urban/rural and area socioeconomic circumstances. The unhealthy lifestyle index normally distributed, with 84.5% of children reporting between 2 and 6 unhealthy behaviours. Boys reported more unhealthy behaviours compared with girls (coefficient 0.32, 95%CI 0.26 to 0.37) and children in urban areas had fewer unhealthy behaviours than their rural counterparts (-0.29, 95%CI -0.56 to -0.03). An interaction revealed stronger 'protective' effects of living in cities for girls than boys, which were not explained by differences in child overweight/obesity. More unhealthy behaviours were characteristic of children in more affluent areas, and of those born to mothers and/or fathers with lower educational attainment. Children who perceived themselves as overweight or underweight both scored higher on the unhealthy lifestyle index. Unhealthy behaviours that could increase the risk of childhood obesity are common among Chinese primary school children, particularly among boys in cities, those in more affluent areas and with parents with lower education. There was no effect of actual weight status on number of unhealthy behaviours. Perceived, but not actual weight status, was also a significant correlate of unhealthy behaviours. Clustering of unhealthy lifestyle behaviours that could increase the risk of childhood obesity are common among Chinese primary school children, particularly among boys in cities, those in more affluent areas and with parents with lower education. Perceived, but not actual weight status, was also a significant correlate of unhealthy lifestyle. This has important implications for public health because understanding clustering of unhealthy lifestyle behaviours can be used to assist in the development of targeted obesity prevention initiatives.