Place of residence and obesity in 1,578,694 young Swedish men between 1969 and 2005

Exposure to source-specific air pollution in residential areas and its association with dementia incidence: a cohort study in Northern Sweden

The aim of this study was to investigate the relationship between source-specific ambient particulate air pollution concentrations and the incidence of dementia. The study encompassed 70,057 participants from the Västerbotten intervention program cohort in Northern Sweden with a median age of 40 years at baseline. High-resolution dispersion models were employed to estimate source-specific particulate matter (PM) concentrations, such as PM10 and PM2.5 from traffic, exhaust, and biomass (mainly wood) burning, at the residential addresses of each participant. Cox regression models, adjusted for potential confounding factors, were used for the assessment. Over 884,847 person-years of follow-up, 409 incident dementia cases, identified through national registers, were observed. The study population's average exposure to annual mean total PM10 and PM2.5 lag 1-5 years was 9.50 µg/m3 and 5.61 µg/m3, respectively. Increased risks were identified for PM10-Traffic (35% [95% CI 0-82%]) and PM2.5-Exhaust (33% [95% CI - 2 to 79%]) in the second exposure tertile for lag 1-5 years, although no such risks were observed in the third tertile. Interestingly, a negative association was observed between PM2.5-Wood burning and the risk of dementia. In summary, this register-based study did not conclusively establish a strong association between air pollution exposure and the incidence of dementia. While some evidence indicated elevated risks for PM10-Traffic and PM2.5-Exhaust, and conversely, a negative association for PM2.5-Wood burning, no clear exposure-response relationships were evident.

Long-term residential exposure to source-specific particulate matter and incidence of diabetes mellitus - A cohort study in northern Sweden

Diabetes mellitus (DM) incidence have been assessed in connection with air pollution exposure in several studies; however, few have investigated associations with source-specific local emissions. This study aims to estimate the risk of DM incidence associated with source-specific air pollution in a Swedish cohort with relatively low exposure. Individuals in the Västerbotten intervention programme cohort were followed until either a DM diagnosis or initiation of treatment with glucose-lowering medication occurred. Dispersion models with high spatial resolution were used to estimate annual mean concentrations of particulate matter (PM) with aerodynamic diameter ≤10 μm (PM₁₀) and ≤2.5 μm (PM_2.5) at individual addresses. Hazard ratios were estimated using Cox regression models in relation to moving averages 1-5 years preceding the outcome. During the study period, 1479 incident cases of DM were observed during 261,703 person-years of follow-up. Increased incidence of DM was observed in association with PM₁₀ (4% [95% CI: -54-137%] per 10 μg/m³), PM₁₀-traffic (2% [95% CI: -6-11%] per 1 μg/m³) and PM_2.5-exhaust (11% [95% CI: -39-103%] per 1 μg/m³). A negative association was found for both PM_2.5 (-18% [95% CI: -99-66%] per 5 μg/m³), but only in the 2nd exposure tertile (-10% [95% CI: -25-9%] compared to the first tertile), and PM_2.5-woodburning (-30% [95% CI: -49-4%] per 1 μg/m³). In two-pollutant models including PM_2.5-woodburning, there was an 11% [95% CI: -11-38%], 6% [95% CI: -16-34%], 13% [95% CI: -7-36%] and 17% [95% CI: 4-41%] higher risk in the 3rd tertile of PM₁₀, PM_2.5, PM₁₀-traffic and PM_2.5-exhaust, respectively, compared to the 1st. Although the results lacked in precision they are generally in line with the current evidence detailing particulate matter air pollution from traffic as an environmental risk factor for DM.

Trends in the prevalence of adult overweight and obesity in Australia, and its association with geographic remoteness

The prevalence of overweight and obesity has been increasing globally and has become a significant public health concern in Australia in the two past decades. This study explores the most recent national prevalence and trends of adult overweight and obesity in Australia. It will also investigate geographic remoteness as a potential risk factor for an individual being overweight or obese in adulthood. A retrospective longitudinal study that utilised 14 successive waves (wave 6 through 19) of a nationally representative linked individual-level survey. Data was obtained from the Household, Income and Labour Dynamics in Australia survey. The data on 199,675 observations from 26,713 individuals aged ≥ 15 years over the period 2006 to 2019 was analysed. Random-effects logit model was employed to estimate the association between geographic remoteness and the risk of excessive weight gain. The results reveal that the prevalence of overweight, obesity and combined overweight and obesity among Australian adults in 2019 were 34%, 26% and 60%, respectively. The analysis shows that the prevalence of overweight and obesity varies by geographic remoteness. Adults from regional city urban (OR 1.53, 95% CI 1.16-2.03) and rural areas (OR 1.32, 95% CI 1.18-1.47) were more likely to be obese compared with their counterparts from major city urban areas. The results also show that adults living in major city urban areas, regional city urban areas, and regional city rural areas in Australia were 1.53 (OR 1.53, 95% CI 1.16-2.03), 1.32 (OR 1.32, 95% CI 1.18-1.47), and 1.18 (OR 1.18, 95% CI 1.08-1.29) times more likely to be overweight compared with their counterparts from major city urban areas in Australia. Substantial geographic variation in the prevalence of overweight and obesity exists among Australian adults and appears to be increasing. Public health measures should focus on contextual obesogenic factors and behavioural characteristics to curb the rising prevalence of adult obesity.

Rural-urban differences in health among youth in northern Sweden: an outcome-wide epidemiological approach

The aim of this research was to contribute knowledge about rural–urban differences in health among young northern Swedish women and men. This study was based on the 2014 “Health on Equal Terms” survey, distributed in the four northernmost counties of Sweden, with complementary information on areas of residence classified as rural, semi-urban and urban from total population registers. The analytical sample included 2,691 individuals who were selected using a probabilistic sampling method. Prevalence ratios were calculated in multivariable log-binomial regression analyses to measure the association between place of residence and nine outcomes covering three health dimensions (general, mental and lifestyle behaviours). The results indicated that daily smoking and being overweight were more common, while feelings of stress and psychological distress were less prevalent, among youths in rural as compared to urban areas. After including covariates, this pattern appeared stronger for young women, although the direction of the results also applied to young men, albeit without revealing significant differences. In conclusion, the findings from this study indicate that for youths – particularly young women – the rural setting may imply an increased risk of poor general health and lifestyle behaviours, while simultaneously playing a partially protective role for mental health.

The shelf space and strategic placement of healthy and discretionary foods in urban, urban-fringe and rural/non-metropolitan Australian supermarkets

Objective

Supermarkets are a key influence on eating behaviours, but it is unknown if the promotion of food within stores varies on a geographic gradient from urban, to urban-fringe and non-metropolitan areas. The present study aimed to assess the shelf space and strategic placement of healthy and discretionary foods in each of urban, urban-fringe and non-metropolitan Australian supermarkets.

Design/Setting

In-store audits were conducted in stores from one of the two major Australian supermarket chains in urban (n19), urban-fringe (n20) and non-metropolitan (n26) areas of Victoria. These audits examined selected food items (crisps/chips, chocolate, confectionery, soft drinks/sodas, fruits and vegetables) and measured the shelf space and the proportion of end-of-aisle and cash register displays containing these products. Store size was measured as the sum of aisle length. Differences in the supermarket food environment with respect to location were assessed, before and after adjustment for neighbourhood socio-economic position.

Results

The strategic placement of discretionary foods was commonly observed in all supermarkets. Adjusting for store size (larger in urban-fringe and rural areas), urban stores had greater shelf space devoted to fruits and vegetables, and less checkouts with soft drinks, than urban-fringe and rural/non-metropolitan areas. Differences remained following adjustment for neighbourhood socio-economic position. No clear pattern was observed for end-of-aisle displays, or the placement of chocolate and confectionery at checkouts.

Conclusions

The shelf space of healthy and discretionary foods in urban-fringe and rural stores parallels the prevalence of overweight and obesity in these areas. Interventions in urban-fringe and rural stores targeting the shelf space of healthy foods and the placement of soft drinks at key displays may be useful obesity prevention initiatives.

Changes in Obesity Odds Ratio among Iranian Adults, since 2000: Quadratic Inference Functions Method

Background. Monitoring changes in obesity prevalence by risk factors is relevant to public health programs that focus on reducing or preventing obesity. The purpose of this paper was to study trends in obesity odds ratios (ORs) for individuals aged 20 years and older in Iran by using a new statistical methodology. Methods. Data collected by the National Surveys in Iran, from 2000 through 2011. Since responses of the member of each cluster are correlated, the quadratic inference functions (QIF) method was used to model the relationship between the odds of obesity and risk factors. Results. During the study period, the prevalence rate of obesity increased from 12% to 22%. By using QIF method and a model selection criterion for performing stepwise regression analysis, we found that while obesity prevalence generally increased in both sexes, all ages, all employment, residence, and smoking levels, it seems to have changes in obesity ORs since 2000. Conclusions. Because obesity is one of the main risk factors for many diseases, awareness of the differences by factors allows development of targets for prevention and early intervention.

Stability in the prevalence of Swedish children who were overweight or obese in 2003 and 2011

AIM

We aimed to explore the prevalence and determinants of overweight including obesity among children in Sweden in 2003 and 2011.

METHODS

Two population-based cross-sectional surveys included 7728 and 12 882 12-year-old children in Sweden, and 1198 and 2699 eight-year-old children in Stockholm County, in 2003 and 2011. Weighted prevalence of overweight including obesity and multivariate-adjusted relative risks (RRs) with 95% confidence intervals (CIs) was calculated.

RESULTS

In 2011, the overweight prevalence was lower for 12-year-old girls than boys (RR=0.84, CI=0.77-0.92), lower for girls and boys with a higher rather than a lower educated mother (for example, RRgirls =0.76, CI=0.65-0.88), but higher for girls and boys in smaller rather than main cities (RRgirls =1.52, CI=1.28-1.82). There was no difference in overweight prevalence between 2003 and 2011 among the 12-year-old children. However, eight-year-old girls had a lower overweight prevalence in 2011 than in 2003 (RR=0.76, CI=0.59-0.97). The strongest decrease in overweight was among eight-year-old girls with mothers with lower levels of education (RR=0.63, CI=0.47-0.86).

CONCLUSION

The prevalence of overweight including obesity was stable among Swedish children between 2003 and 2011. Gradients in the determinants of overweight persisted. There was some evidence of a less steep socio-economic gradient in overweight in eight-year-old girls over time.

Associations Between Swedish Mothers' and 3- and 5-Year-Old Children's Food Intake

OBJECTIVE

To investigate associations between mothers' and children's food intake.

DESIGN

Cross-sectional study. Background variables collected through self-reports and from the register of the total population. Mothers recorded their own and their children's food intake in a diary during 2 4-day periods.

SETTING

Eight counties in mid Sweden.

PARTICIPANTS

Three- and 5-year-old children and their mothers were randomly selected from the register of the total population. A total of 2,045 families were invited, 355 of whom accepted. Mothers who accepted were older and to a larger extent born in Sweden. The final sample of mother-child pairs with complete food records was 189.

MAIN OUTCOME MEASURES

Mothers' and children's food intake (16 food items).

ANALYSIS

Spearman rank-order correlation with 95% confidence intervals (2-sided). Moderation was investigated using generalized estimation equations with robust variance.

RESULTS

The strongest correlations between mothers' and children's food intake were found for pizza and oily fish (r = .70-.80). The weakest correlations were found for sugared drinks and fruit and berries (r = .24-.26). Children's age moderated the relationship between mothers' and children's intake of savoury snacks, as did place of residence for pizza intake.

CONCLUSIONS AND IMPLICATIONS

There were substantial correlations between children's and mothers' intake of various foods. Modeling of mothers' intake might be more effective in influencing young children's intake of certain foods, whereas other strategies, such as encouraging parents to influence food availability (eg, gatekeeping), might be more useful for some foods.

Finding big shots: small-area mapping and spatial modelling of obesity among Swiss male conscripts

BACKGROUND

In Switzerland, as in other developed countries, the prevalence of overweight and obesity has increased substantially since the early 1990s. Most of the analyses so far have been based on sporadic surveys or self-reported data and did not offer potential for small-area analyses. The goal of this study was to investigate spatial variation and determinants of obesity among young Swiss men using recent conscription data.

METHODS

A complete, anonymized dataset of conscription records for the 2010-2012 period were provided by Swiss Armed Forces. We used a series of Bayesian hierarchical logistic regression models to investigate the spatial pattern of obesity across 3,187 postcodes, varying them by type of random effects (spatially unstructured and structured), level of adjustment by individual (age and professional status) and area-based [urbanicity and index of socio-economic position (SEP)] characteristics.

RESULTS

The analysed dataset consisted of 100,919 conscripts, out of which 5,892 (5.8 %) were obese. Crude obesity prevalence increased with age among conscripts of lower individual and area-based SEP and varied greatly over postcodes. Best model's estimates of adjusted odds ratios of obesity on postcode level ranged from 0.61 to 1.93 and showed a strong spatial pattern of obesity risk across the country. Odds ratios above 1 concentrated in central and north Switzerland. Smaller pockets of elevated obesity risk also emerged around cities of Geneva, Fribourg and Lausanne. Lower estimates were observed in North-East and East as well as south of the Alps. Importantly, small regional outliers were observed and patterning did not follow administrative boundaries. Similarly as with crude obesity prevalence, the best fitting model confirmed increasing risk of obesity with age and among conscripts of lower professional status. The risk decreased with higher area-based SEP and, to a lesser degree - in rural areas.

CONCLUSION

In Switzerland, there is a substantial spatial variation in obesity risk among young Swiss men. Small-area estimates of obesity risk derived from conscripts records contribute to its understanding and could be used to design further studies and interventions.

Assessing factors related to waist circumference and obesity: application of a latent variable model

Background. Because the use of BMI (Body Mass Index) alone as a measure of adiposity has been criticized, in the present study our aim was to fit a latent variable model to simultaneously examine the factors that affect waist circumference (continuous outcome) and obesity (binary outcome) among Iranian adults. Methods. Data included 18,990 Iranian individuals aged 20–65 years that are derived from the third National Survey of Noncommunicable Diseases Risk Factors in Iran. Using latent variable model, we estimated the relation of two correlated responses (waist circumference and obesity) with independent variables including age, gender, PR (Place of Residence), PA (physical activity), smoking status, SBP (Systolic Blood Pressure), DBP (Diastolic Blood Pressure), CHOL (cholesterol), FBG (Fasting Blood Glucose), diabetes, and FHD (family history of diabetes). Results. All variables were related to both obesity and waist circumference (WC). Older age, female sex, being an urban resident, physical inactivity, nonsmoking, hypertension, hypercholesterolemia, hyperglycemia, diabetes, and having family history of diabetes were significant risk factors that increased WC and obesity. Conclusions. Findings from this study of Iranian adult settings offer more insights into factors associated with high WC and high prevalence of obesity in this population.

(Un)Healthy in the City: Respiratory, Cardiometabolic and Mental Health Associated with Urbanity

BACKGROUND

Research has shown that health differences exist between urban and rural areas. Most studies conducted, however, have focused on single health outcomes and have not assessed to what extent the association of urbanity with health is explained by population composition or socioeconomic status of the area. Our aim is to investigate associations of urbanity with four different health outcomes (i.e. lung function, metabolic syndrome, depression and anxiety) and to assess whether these associations are independent of residents' characteristics and area socioeconomic status.

METHODS

Our study population consisted of 74,733 individuals (42% males, mean age 43.8) who were part of the baseline sample of the LifeLines Cohort Study. Health outcomes were objectively measured with spirometry, a physical examination, laboratory blood analyses, and a psychiatric interview. Using multilevel linear and logistic regression models, associations of urbanity with lung function, and prevalence of metabolic syndrome, major depressive disorder and generalized anxiety disorder were assessed. All models were sequentially adjusted for age, sex, highest education, household equivalent income, smoking, physical activity, and mean neighborhood income.

RESULTS

As compared with individuals living in rural areas, those in semi-urban or urban areas had a poorer lung function (β -1.62, 95% CI -2.07;-1.16), and higher prevalence of major depressive disorder (OR 1.65, 95% CI 1.35;2.00), and generalized anxiety disorder (OR 1.58, 95% CI 1.35;1.84). Prevalence of metabolic syndrome, however, was lower in urban areas (OR 0.51, 95% CI 0.44;0.59). These associations were only partly explained by differences in residents' demographic, socioeconomic and lifestyle characteristics and socioeconomic status of the areas.

CONCLUSIONS

Our results suggest a differential health impact of urbanity according to type of disease. Living in an urban environment appears to be beneficial for cardiometabolic health but to have a detrimental impact on respiratory function and mental health. Future research should investigate which underlying mechanisms explain the differential health impact of urbanity.

The educational gradient of obesity increases among Swedish pregnant women: a register-based study

Background

Overweight or obesity is detrimental during pregnancy. We studied time trends in the educational gradient of overweight and obesity among pregnant women. Differences in overweight and obesity by area of residence and country of birth were also examined.

Methods

The study was based on the Swedish Medical Birth Register between 1992 and 2010 and included 1,569,173 singleton pregnancies. Weight and height were registered during the first visit at the antenatal-care clinic. Data on education, country of birth, and area of residence were derived from registers with national coverage.

Results

In 2008–2010, 32% of Swedish nulliparous pregnant women were overweight or obese. The relative risk of obesity among lower educated women compared to women with higher education increased from 1.91 (95% confidence interval: 1.85-1.97) in 1992–1995 to 2.09 (95% confidence interval: 2.05-2.14) in 2008–2010. There was an inverse linear relationship between risks of overweight or obesity, and population density and type of residence municipality. An excessive gestational weight gain according to the American Institute of Medicine was observed among 57-63% of the overweight or obese women, but there were small differences by education. Pregnant women born in Africa, Middle East or Latin America had higher risks of being overweight or obese compared to women born in Sweden.

Conclusions

The prevalence of obesity as well as the social inequalities in obesity during pregnancy increased in Sweden between 1992 and 2010. Further understanding of social inequalities and geographical differentials in health behaviours of pregnant women is needed when planning public health interventions.

Pain management and pain characteristics in obese and normal weight patients before joint replacement

RATIONALE, AIMS AND OBJECTIVES

The objective was to compare the extent of pain interference and pain medication among persons who were classified as obese [body mass index (BMI)≥ 30 kg m(-2) ] and normal weighted (BMI  ≤ 25 kg m(-2) ), before a hip or knee replacement surgery.

METHODS

Patients candidate for an orthopaedic surgery were successively enrolled, over a 6-month period, and classified in either the normal weight (BMI  ≤ 25 kg m(-2) ) or the obese (BMI ≥ 30 kg m(-2) ) categories. Data were collected using self-administered questionnaires with items concerning pain characteristics, pain medication and pain interference. Two standardized questionnaires were associated: the Brief Pain Inventory (BPI) and the Hospital Anxiety and Depression scale (HAD).

RESULTS

Fifty-two obese patients (candidates for 24 hip replacements and 28 knee replacements) and 51 non-obese (23 hip replacements and 28 knee replacements) were enrolled. Obese patients suffered from a higher rate of acute pain episodes than non-obese patients (65 versus 44%, P<0.05). Pain interference on walking distance, sleep and relations with others was higher in obese patients. HAD score showed no significant difference between groups. The use of strong opioids and of non-steroidal anti-inflammatory drugs (NSAIDs) was significantly more important in obese patients (13 versus 0% and 31 versus 14%).

CONCLUSIONS

Obese patients suffer more significantly of unrelieved chronic pain, which lowers considerably their quality of life. Pain relief is more difficult to obtain, as it requires stronger pain medication and NSAIDs.

Attitudes towards obesity in the Swedish general population: the role of one's own body size, weight satisfaction, and controllability beliefs about obesity

This study examined the associations of different socio-demographic and psychological factors with attitudes towards obesity. Individuals with different weight status (N=2436) were drawn from an annual population-based survey in Sweden, and data on attitudes towards obesity (ATOP) and predictor variables were assessed in 2008. The strongest predictor of ATOP was controllability beliefs about obesity (β=0.83). Thus, greater controllability beliefs about obesity predicted more negative attitudes. Sex and weight satisfaction were also independently associated with ATOP. However, there was no, or only a weak, association between weight satisfaction and ATOP among individuals with normal weight or overweight. And the higher the weight satisfactions of individuals with obesity, the more positive were their attitudes. It seems that stigma-reduction strategies in the general public should address the uncontrollable factors in the aetiology of obesity. However, more research is needed to understand the underlying causes of people's attitudes towards obesity.

Weight status at age 18 influences marriage prospects. A population-based study of Swedish men

Background

In a longitudinal population-based study of the relationship between body mass index (BMI) in early adulthood and marital status at 40 years of age, obese men were half as likely to be married compared with men of normal weight. Significant associations between obesity and marital status among men in a longitudinal setting are novel findings.

Methods

The study cohort comprised Swedish men born from 1951 to 1961. Height and weight at age 18 was gathered from the Military Service Conscription Register and information on marital status at 40 years of age was obtained from population registers by record-linkage using the unique personal identification number. The odds ratio (OR) for being married was calculated by polytomous logistic regression analysis adjusting for birth year, intellectual performance, education, country of birth, residential area, socioeconomic position in childhood and adulthood, parental education and muscle strength.

Results

Our study included 486 599 Swedish men. Young men who were obese (BMI≥30.0) at 18 years of age had an OR of 0.49 (95% CI: 0.46–0.52) for being married at 40 years of age compared to normal weight men (BMI: 18.5–24.9). Underweight men (BMI≤18.5) had an OR of 0.84 (0.82–0.86) and overweight men (BMI: 25.0–29.9) had an OR of 0.83 (0.80–0.85) for being married at 40 years of age.

Conclusion

Underweight, overweight and obese men were less likely to be married than their normal weight counterparts. Obese men had the lowest likelihood of being married. Stigmatization and discrimination may partly explain these findings, but further research is needed before firm conclusions can be drawn.

The influence of geographic life environments on cardiometabolic risk factors: a systematic review, a methodological assessment and a research agenda

Recent environmental changes play a role in the dramatic increase in the prevalence of cardiometabolic risk factors (CMRFs) such as obesity, hypertension, type 2 diabetes, dyslipidemias and the metabolic syndrome in industrialized countries. Therefore, identifying environmental characteristics that are associated with risk factors is critical to develop more effective public health interventions. We conducted a systematic review of the literature investigating relationships between characteristics of geographic life environments and CMRFs (131 articles). Most studies were published after 2006, relied on cross-sectional designs, and examined whether sociodemographic and physical environmental characteristics, and more recently service environment characteristics, were associated with obesity or, to a lesser extent, hypertension. Only 14 longitudinal studies were retrieved; diabetes, dyslipidemias and the metabolic syndrome were rarely analysed; and aspects of social interactions in the neighbourhood were critically underinvestigated. Environmental characteristics that were consistently associated with either obesity or hypertension include low area socioeconomic position; low urbanization degree; low street intersection, service availability and residential density; high noise pollution; low accessibility to supermarkets and high density of convenience stores; and low social cohesion. Intermediate mechanisms between environmental characteristics and CMRFs have received little attention. We propose a research agenda based on the assessment of underinvestigated areas of research and methodological limitations of current literature.

Are neighborhood education levels associated with BMI among adults in Cairo, Egypt?

This study examined the association between area-level education and BMI among adults in Cairo, Egypt. A sample of 3993 households including 1990 men and 2003 women were analyzed from the 2007 Cairo Urban Inequity Study, a study which aimed to identify potential intra-urban inequities in health related to the environment and living conditions in Cairo. Using multilevel analysis, we found that residents of high education neighborhoods were significantly less likely to be obese compared to low education neighborhoods. An inverse association between neighborhood education and individual BMI was observed whereby each unit increase in percentage of households with greater than a high school education was associated with a 0.036 kg/m(2) decrease in BMI of individuals. This translated into a difference between high and low education neighborhoods of 6.86 kg (15.1 lb) for women based on an average height of 1.65 m and 6.10 kg (13.4 lb) for men based on an average height of 1.75 m after adjusting for sociodemographic, socioeconomic, health and environmental factors. These findings suggest that programs aiming to reduce BMI among adults in this setting may be well-served by focusing on education since it appears to have an effect at the neighborhood level over and above the impact it has at the individual level. This may be due to several factors such as greater access to knowledge and information regarding health and nutrition, greater food availability, and shifting cultural perceptions of beauty away from an ideal body shape of plumpness in favor of thinness in high education neighborhoods. The cross-sectional nature of our study does not allow for causal interpretations, however, so further studies exploring why the neighborhood education-BMI association is so significant is warranted.

The obesity epidemic slows among the middle-aged population in Sweden while the socioeconomic gap widens

Background

Obesity prevalence has continuously increased in Northern Sweden as elsewhere. A cohort effect has been shown and an increasing proportion of the middle-aged population is maintaining body weight.

Objective

To test the hypothesis that the obesity epidemic continues but at different speeds that are dependent on socioeconomic status.

Design

Cross-sectional (103,940 adults) and longitudinal (26,872 adults) data from the Västerbotten Intervention Program 1990–2007 were included. All adults in Västerbotten County are invited to a health examination at the ages of 40, 50, and 60 years. Body mass index (BMI) and socioeconomic status, assessed by residence location, marital status, and education were evaluated.

Results

BMI increased in all groups but was greater among men. During 1990–1995 and 2002–2007, mean BMIs were 25.9 and 26.8 among men and 25.2 and 25.9 among women. The trend of increasing BMI slowed around the year 2000 (p<0.001), but this was only observed among the highly educated adults in the most urbanized area. The difference between educational groups increased throughout the study period (men p=0.014, women p=0.002). Longitudinal data for both sexes showed a twofold higher baseline prevalence of obesity among individuals with basic compared to high education and it nearly doubled in all groups during the 10-year follow-up. Low education, living in a rural environment, and living alone were independent predictors of obesity development. The overall cumulative 10-year incidence was 9.4% in men, 9.1% in women, and twofold higher among those with basic and mid-level education who live in rural areas compared to those with high education who live in cities.

Conclusion

The trend of increasing obesity has slowed in this middle-aged Northern Sweden population, but this trend shift occurred primarily among those with high education who live in an urban environment. Greater efforts to combat obesogenic environments are needed and should take socioeconomic and sociocultural aspects into account.

Evolution of cardiovascular risk factors among 18-year-old males in Austria between 1986 and 2005

OBJECTIVE

The aims of the study were to determine time trends in cardiovascular risk factors among young Austrian males between 1986 and 2005 and to examine socioeconomic and geographic differences.

METHODS

Data on Austrian conscripts were derived from the nationwide compulsory medical investigations held at military induction at 18 years of age. Four cohorts (1986-1990: n = 252,799; 1991-1995: n = 209,266; 1996-2000: n = 208,427; 2001-2005: n = 209,168) were examined with respect to their place of residence and level of education. Height, weight, waist circumference, blood pressure, serum total-cholesterol and triglycerides were measured. Mean body mass index (BMI) was calculated: overweight was defined as BMI between 25 and <30 and obesity as BMI >or= 30. The Chi-squared test and ANOVA were used to test group differences.

RESULTS

During the 20-year observation period the prevalence of overweight increased from 13.3% to 15.7% (p < 0.001) and that of obesity from 2.6% to 5.4% (p < 0.001); in accordance, mean BMI and waist circumference increased significantly. Blood pressure and serum total-cholesterol level decreased (p < 0.001) during the period studied, although triglyceride levels (p < 0.001) increased. A significant east-west gradient was identified for the prevalence of overweight and obesity, waist circumference and mean BMI, with lower values in the urban population compared with those of rural inhabitants. Mean BMI and the prevalence of overweight and obesity were higher in conscripts belonging to lower socioeconomic strata.

CONCLUSION

Our study demonstrates a clear increase of mean BMI, waist circumference and the prevalence of overweight and obesity in Austrian male adolescents during the past 20 years. Conscripts from rural regions and with lower levels of education showed the highest values. The investigation of conscript health appears to be a useful tool for risk surveillance in the male population.

Perceived discrimination among men and women with normal weight and obesity. A population-based study from Sweden

AIMS

We examined whether men and women with obesity reported different types of discrimination to a greater extent than those with normal weight, and explored whether these associations were modified by socioeconomic position.

METHOD

National representative sample of men and women, with normal weight (n = 2,000), moderate obesity (n = 2,461) and severe obesity (n = 557). Participants were identified in a yearly population-based survey (1996-2006) and data on perceived discrimination and potential confounding factors were measured in 2008. Logistic regression models tested whether obesity was associated with perceived lifetime, workplace, healthcare and interpersonal discrimination.

RESULTS

The overall response rate was 56%. For men, moderate obesity was associated with workplace discrimination, while severely obese women were more likely to report this sort of discrimination than normal weight women. Severely obese individuals were twice as likely to report healthcare discrimination than normal weight individuals. Women, regardless of weight status group, were in turn twice as likely to report healthcare discrimination as men. Women with severe obesity were significantly more likely to report interpersonal discrimination compared with normal weight women. Socioeconomic position modified the association between weight status and healthcare discrimination. Highly educated individuals with moderate and severe obesity were more likely to report healthcare discrimination than their normal weight counterparts, whereas low educated individuals with normal weight, moderate and severe obesity were equally likely to report discrimination.

CONCLUSIONS

In this large, population-based study, discrimination was more likely to be reported by obese individuals compared with those of normal weight. The associations, however, varied according to gender and socioeconomic position.

Is the prevalence of overweight and obesity declining among 4-year-old Swedish children?

AIM

To investigate the trend in overweight and obesity prevalence among 4-year-old Swedish children.

METHODS

Height and weight data registered at the regular health check up at the child health centres in the county of Västerbotten during the years 2007/2008 (2225 boys and 2156 girls) were analysed and compared with data from 2002/2003 (2231 boys and 2176 girls). Overweight and obesity were estimated using the International Obesity Task Force cut-off values (ISO BMI).

RESULTS

In both boys and girls, overweight prevalence (ISO BMI > 25) decreased over the 5-year period, boys from 17.2% to 14.2% and girls from 22.3% to 19.0%. Among girls, there was also a decrease in obesity prevalence (ISO BMI > 30) from 5.7% to 3.1%.

CONCLUSION

The result of this study indicates that the overweight and obesity epidemic among Swedish pre-school children may be levelling off.

Municipal policies and plans of action aiming to promote physical activity and healthy eating habits among schoolchildren in Stockholm, Sweden: a cross-sectional study

Background

Promoting physical activity and healthy eating habits by structural measures that reach most children in a society is presumably the most sustainable way of preventing development of overweight and obesity in childhood. The main purpose of the present study was to analyse whether policies and plans of action at the central level in municipalities increased the number of measures that aim to promote physical activity and healthy eating habits among schoolchildren aged six to 16. Another purpose was to analyse whether demographic and socio-economic characteristics were associated with the level of such measures.

Methods

Questionnaires were used to collect data from 25 municipalities and 18 town districts in Stockholm County, Sweden. The questions were developed to capture municipal structural work and factors facilitating physical activity and the development of healthy eating habits for children. Local policy documents and plans of action were gathered. Information regarding municipal demographic and socio-economic characteristics was collected from public statistics.

Results

Policy documents and plans of action in municipalities and town districts did not seem to influence the number of measures aiming to promote physical activity and healthy eating habits among schoolchildren in Stockholm County. Municipal demographic and socio-economic characteristics were, however, shown to influence the number of measures. In town districts with a high total population size, and in municipalities and town districts with a high proportion of adults with more than 12 years of education, a higher level of health-promoting measures was found. In municipalities with a high annual population growth, the number of measures was lower than in municipalities with a lower annual population growth. Another key finding was the lack of agreement between what was reported in the questionnaires regarding existence and contents of local policies and plans of action and what was actually found when these documents were scrutinized.

Conclusion

Policy documents and plans of action aiming to promote physical activity and healthy eating habits among schoolchildren aged six to 16 in municipalities and town districts in Stockholm County did not seem to have an impact on the local level of measures. Demographic and socio-economic characteristics of the municipalities and town districts were on the other hand associated with local health-promoting measures.

Combined effects of overweight and smoking in late adolescence on subsequent mortality: nationwide cohort study

OBJECTIVE

To investigate the combined effects on adult mortality of overweight and smoking in late adolescence.

DESIGN

Record linkage study with Cox proportional hazard ratios adjusted for muscle strength, socioeconomic position, and age.

SETTING

Swedish military service conscription register, cause of death register, and census data.

PARTICIPANTS

45 920 Swedish men (mean age 18.7, SD 0.5) followed for 38 years.

MAIN OUTCOME MEASURES

Body mass index (underweight (BMI <18.5), normal weight (18.5-24.9), overweight (25-29.9), and obesity (>or=30)), muscle strength, and self reported smoking (non-smoker, light smoker (1-10 cigarettes/day), heavy smoker (>10/day)) at mandatory military conscription tests in 1969-70. All cause mortality.

RESULTS

Over 1.7 million person years, 2897 men died. Compared with normal weight men (incidence rate 17/10 000 person years, 95% confidence interval 16 to 18), risk of mortality was increased in overweight (hazard ratio 1.33, 1.15 to 1.53; incidence rate 23, 20 to 26) and obese men (hazard ratio 2.14, 1.61 to 2.85; incidence rate 38, 27 to 48), with similar relative estimates in separate analyses of smokers and non-smokers. No increased risk was detected in underweight men (hazard ratio 0.97, 0.86 to 1.08; incidence rate 18, 16 to 19), though extreme underweight (BMI <17) was associated with increased mortality (hazard ratio 1.33, 1.07 to 1.64; incidence rate 24, 19 to 29). The relative excess risk due to interaction between BMI and smoking status was not significant in any stratum. Furthermore, all estimates of interaction were of small magnitude, except for the combination of obesity and heavy smoking (relative excess risk 1.5, -0.7 to 3.7). Compared with non-smokers (incidence rate 14, 13 to 15), risk was increased in both light (hazard ratio 1.54, 1.41 to 1.70; incidence rate 15, 14 to 16) and heavy smokers (hazard ratio 2.11, 1.92 to 2.31; incidence rate 26, 24 to 27).

CONCLUSIONS

Regardless of smoking status, overweight and obesity in late adolescence increases the risk of adult mortality. Obesity and overweight were as hazardous as heavy and light smoking, respectively, but there was no interaction between BMI and smoking status. The global obesity epidemic and smoking among adolescents remain important targets for intensified public health initiatives.

Adiposity measures as indicators of metabolic risk factors in adolescents

AIM

To examine the relation between adiposity assessment methods (percentage body fat (%BF), BMI, and waist circumference (WC)) and individual metabolic risk factors (f-insulin, HDL cholesterol, triglycerides) and a combined measure of metabolic risk.

METHODS

Crosssectional study of 300 males (BMI 20.8 +/- 3.0 kg/m(2)) and females (BMI 21.3 +/- 2.9 kg/m(2)) 17 years of age. F-insulin and components of the metabolic syndrome defined by the International Diabetes Federation (IDF) were used as metabolic risk indicators, with samples stratified into BMI, %BF, and WC groups, respectively. Diagnostic accuracy was expressed as the area under the ROC curve (AUC).

RESULTS

In males, diagnostic accuracy for HDL and f-insulin was poor to fair for BMI (AUC 0.70, p = 0.001; 0.60, p = 0.22), WC (0.68, p = 0.003; 0.63, p = 0.11), and %BF (0.65, p = 0.009; 0.66, p = 0.04). The diagnostic accuracy for triglycerides was greater for all three measures (BMI 0.92, WC 0.95, %BF 0.87; all p < 0.001). For females, neither test performed better than chance for f-insulin and HDL, and only %BF performed better than chance for triglycerides (0.65, p = 0.08). All three measures exhibited higher accuracy for presence of > or =2 metabolic risk factors (AUCs 0.76-0.91, p < 0.001) in both sexes.

CONCLUSION

%BF was not superior to BMI and WC for detecting metabolic risk in the general adolescent population.

Disability pension, employment and obesity status: a systematic review

Disability pensions incur huge societal costs in many countries. In Sweden, the three greatest drivers of such productivity losses are musculo-skeletal, circulatory and psychiatric disorders, all closely associated with weight status. We identified 16 studies investigating the body mass index (BMI)-disability pension relation. In cross-sectional studies, a significantly greater proportion of obese compared with normal weight subjects were disability pensioners. In longitudinal studies, a J-shaped relation with BMI was generally found in both men and women of various ages. Different definitions of obesity status complicated interpretation, as several studies mixed the underweight and normal weight, which appear to have different disability pension risks. In middle-aged men, relative risks were elevated for circulatory causes only for the overweight and obese, while associations for mental disorders were similar in the underweight and overweight but much higher in the obese. In both sexes, monotonic increases and decreases were seen for circulatory and respiratory causes respectively. In intervention studies, reduced disability pension incidence and increased gainful employment were reported after surgery. In summary, BMI was significantly associated with disability pension, but the direction of causality may vary with underlying cause. Interventions had positive productivity effects in the morbidly obese, but whether this holds for the overweight remains to be proven.

Postpubertal development of total and abdominal percentage body fat: an 8-year longitudinal study

The aim of the present study was to describe postpubertal changes in total and abdominal adiposity in young men and the relation to changes in physical activity (PA). The study included 107 white men with a mean age of 17.1 +/- 1.7 years at baseline. Total percentage body fat (%BF) and abdominal percentage body fat (abd%BF) were measured at baseline and after a mean time of 28, 68, and 92 months using dual-energy X-ray absorptiometry (DXA). PA (h/week) was assessed at each visit by questionnaire. Over the study period, significant increases of 7.8 +/- 5.5%BF and 9.0 +/- 5.6 abd%BF were observed. Subjects who were active athletes throughout the study (n = 24), or nonathletes not changing their level of PA during follow-up (n = 27) increased 5.7 +/- 3.2 and 8.1 +/- 6.7%BF, respectively. Athletes who quit organized training during follow-up period (n = 56) increased by 8.7 +/- 4.9%BF. In the total cohort, the average annual gains in BMI, %BF, and abd%BF were 0.4 kg/m(2), 0.9%BF, and 1.1abd%BF (all P < 0.0001), respectively. Adjustment for changes in PA altered the coefficient magnitudes only marginally. Changes in PA were, however, significantly and inversely associated with changes in %BF and abd%BF (P = 0.005 and P = 0.02, respectively), but were not significantly associated with BMI development (P = 0.15). In summary, our results indicate that the natural course of adiposity development in postpubertal men is characterized by adiposity gains. The influence of PA on especially abd%BF may influence the future risk of cardiovascular disease.

Childhood overweight and obesity prevalences levelling off in Stockholm but socioeconomic differences persist

BACKGROUND

Time trends in overweight, obesity and underweight among 10-year-old children were investigated between 1999 and 2003 with attention to gender and areas with different socioeconomic status (SES).

MATERIAL

The study was performed in Stockholm County, where schools within eight different SES areas were randomly sampled. In selected schools, data on height and weight were abstracted from school health records of 2416 ten-year-old boys and girls examined by school nurses in 1999 and 2183 examined in 2003.

RESULTS

Among boys, the prevalence of overweight was 21.6% in 1999 and 20.5% in 2003 (difference -1.1% (95% confidence interval (CI), -4.6; 2.4)) and for obesity 3.2 and 3.8% (difference 0.6% (95% CI, -0.9; 2.2)). Among girls overweight decreased from 22.1 to 19.2% (difference -2.9% (95% CI, -6.3; 0.6)) and obesity from 4.4 to 2.8% (difference -1.6% (95% CI, -3.1; 0.0)). There was a marginally significant difference in obesity trends in girls versus boys (P=0.051). The prevalence of underweight decreased nonsignificantly both in boys and in girls. Strong gradients, with more obesity and overweight in socioeconomically disadvantaged areas, were observed in both genders in 2003. Differences between SES areas were also seen in 1999 but were more pronounced in 2003. Among boys divergent trends in obesity were observed between 1999 and 2003, with evidence for increases in less affluent areas only.

CONCLUSION

This population-based study of 10-year-olds indicates that rates of obesity, overweight and underweight are stable in Stockholm County. However, obesity is more prevalent in relatively less advantaged SES.

Prevalence of obesity and abdominal obesity in Swedish primary care and occupational health clinics

BACKGROUND

The objective of this study was to describe the prevalence of obesity and abdominal obesity in the Swedish primary and occupational health care setting.

PATIENTS AND METHODS

Weight, height, and waist circumference (WC) were measured in 1,583 consecutive patients, aged between 18-65 years (46.4 +/- 12.7 years), in 39 primary care and occupational health practices in Sweden, in 2006. The National Cholesterol Education Program (NCEP) WC reference values were used to define abdominal obesity (102 and 88 cm for men and women, respectively).

RESULTS

The distribution across obesity categories differed significantly between men and women with close to 70 and 55% of men and women, respectively, having a body mass index (BMI) >or= 25. More men than women were overweight (BMI 25-29.9; 45.1 vs. 31.1%) and obese (BMI 30-34.9; 19.8 vs. 12.9%), but less men than women were morbidly obese (4.0 vs. 8.9%; BMI >or= 35). Increasing prevalence with age was seen until age 60 for both overweight and obesity. More women than men were abdominally obese (42.5 vs. 32.7%; p < 0.001). Only 48 and 64% of the abdominally obese women and men, respectively, had a BMI >or= 30.

CONCLUSION

Compared to national Swedish data, the prevalence of overweight and obesity was higher in primary and occupational health care settings. Both morbid obesity and abdominal obesity were highly prevalent and more common in women, implying that awareness of sex differences may be important or that recommended cut-offs are not comparable across sex. Furthermore, a large fraction of the abdominally obese had a BMI < 30. Both BMI and WC may therefore be important to determine routinely and incorporate into treatment guidelines, in order not to miss patients at risk of obesity-related morbidity.

Shift in the composition of obesity in young adult men in Sweden over a third of a century

OBJECTIVE

To assess whether the composition of the obese category (body mass index (BMI)> or =30) has changed during the last one-third of a century in young adult men.

DESIGN

Retrospective study of 1,580,913 men (18.3+/-0.4 years) representing 82% of the Swedish male population at military conscription age between 1969 and 2005. Measured height and weight were used to define moderate and morbid obesity as BMI 30-34.9 and > or =35, respectively. Data on socio-economic position (SEP), place of residence (urban, semi-urban and rural), age and test center were also collected.

RESULTS

From the period 1969-1974 to 2000-2005, the prevalence of moderate obesity almost quintupled (0.8-3.8%; P<0.0001), while morbid obesity increased 10-fold (0.1-1.3%; P<0.0001). The composition of the obese category changed from 12.9 to 25.1% morbidly obese during the same time, corresponding to an annual growth in the odds of 2.8% (CI(95%) 2.5-3.1%) per year within the obese category. Compared to 1969-1974, the odds ratios of obesity and morbid obesity, respectively, were 1.6 (1.6-1.7) and 1.9 (1.7-2.2) in 1980-1984, 2.8 (2.7-2.9) and 4.0 (3.5-4.5) in 1990-1994, and 6.0 (5.7-6.3) and 11.4 (10.1-12.9) in 2000-2005, after adjustment for SEP, urban/rural place of residence, age and test center. Extrapolation of the growth rate during the observation period resulted in an estimated 4% morbidly obese in 2020.

CONCLUSION

Morbid obesity increased faster than moderate obesity during the last 35 years. As the health risks and costs of obesity-related morbidity increase disproportionately in the morbidly obese, it is important to assess morbid obesity in prevalence studies, and distinguish the morbidly from the moderately obese in cost analyses.