Letting the "Gini" out of the bottle: social causation and the obesity epidemic

The Association Between Income Inequality and Oral Health in Canada

Societies exhibiting higher levels of economic inequality experience poorer health outcomes, and the proposed pathways used to explain these patterns are also relevant to oral health. This study therefore examines the relationship between the level of income inequality and the oral health and dental care services utilization of residents from eleven Canadian metropolitan areas. We calculated Pearson correlation coefficients (r) between each metropolitan area's Gini coefficient (used as a proxy for income inequality, calculated from 2006 Canadian census data) and each area's experience of dental pain, self-reported oral health, and use of dental care services (provided by data from the 2003 Canadian Community Health Survey). Greater levels of income inequality in the selected metropolitan areas were related to an increased likelihood of residents self-reporting their oral health as poor/fair and reporting a prolonged absence from visiting a dentist. There was, however, no relationship between the level of income inequality and the likelihood of respondents reporting a recent toothache, tooth sensitivity, or jaw pain. Policies designed to improve the oral health of the population, and Canadians' access to dental care generally, may therefore work best when supported by policies that promote greater economic equality within Canada.

Socio-environmental influences on physical activity among young people: a qualitative study

This multi-methods qualitative study aimed to identify environmental factors that influence physical activity participation among young people in Edinburgh, Scotland. School pupils (aged 11-13 years) took part using photography, computer blogs, maps and focus group discussions (FGDs). Eleven computer sessions (n = 131) and 14 FGDs (n = 63) took place. Factors influencing physical activity behaviour included proximity and access to local facilities, family and peers and the school physical activity environment. A variety of facilitators and barriers to participation were also reported. Most notable was the importance of cost and value for money when choosing physical activities which, although more evident among pupils attending schools in areas of low socio-economic status (SES), was relevant across all SES groups. Reporting easy access to sports facilities was more common among pupils attending schools from high/medium SES. Use of greenspace for physical activity was reported among pupils from all schools, but was more common among those from low SES schools. Pupils were, in general, satisfied with the facilities available at school, but felt time for physical education could be increased. Findings may help inform interventions, aimed at promoting physical activity at local level.

Pediatric obesity: a review for the child psychiatrist

Child and adolescent psychiatrists frequently encounter children who are obese in their practices and may be asked to work alongside primary care physicians and other specialists who treat youngsters with obesity. To offer expert consultation, they must understand all aspects of the pediatric obesity epidemic. By summarizing the relevant endocrinology, cardiology, nutrition, exercise science, and public health literature, this review of pediatric obesity assesses the epidemic's background, delineates the challenges of clinical care, and appraises the therapeutic recommendations for this population of patients and their families.

Pediatric obesity: a review for the child psychiatrist

Child and adolescent psychiatrists frequently encounter children who are obese in their practices and may be asked to work alongside primary care physicians and other specialists who treat youngsters with obesity. To offer expert consultation, they must understand all aspects of the pediatric obesity epidemic. By summarizing the relevant endocrinology, cardiology, nutrition, exercise science, and public health literature, this review of pediatric obesity assesses the epidemic's background, delineates the challenges of clinical care, and appraises the therapeutic recommendations for this population of patients and their families.

Wider income gaps, wider waistbands? An ecological study of obesity and income inequality

OBJECTIVES

To see if obesity, deaths from diabetes, and daily calorie intake are associated with income inequality among developed countries.

DESIGN

Ecological study of 21 developed countries.Countries: Countries were eligible for inclusion if they were among the top 50 countries with the highest gross national income per capita by purchasing power parity in 2002, had a population over 3 million, and had available data on income inequality and outcome measures.

MAIN OUTCOME MEASURES

Percentage of obese (body mass index >30) adult men and women, diabetes mortality rates, and calorie consumption per capita per day.

RESULTS

Adjusting for gross national per capita income, income inequality was positively correlated with the percentage of obese men (r = 0.48, p = 0.03), the percentage of obese women (r = 0.62, p = 0.003), diabetes mortality rates per 1 million people (r = 0.46, p = 0.04), and average calories per capita per day (r = 0.50, p = 0.02). Correlations were stronger if analyses were weighted for population size. The effect of income inequality on female obesity was independent of average calorie intake.

CONCLUSIONS

Obesity, diabetes mortality, and calorie consumption were associated with income inequality in developed countries. Increased nutritional problems may be a consequence of the psychosocial impact of living in a more hierarchical society.

Saturated fats: what dietary intake?

Public health recommendations for the US population in 1977 were to reduce fat intake to as low as 30% of calories to lower the incidence of coronary artery disease. These recommendations resulted in a compositional shift in food materials throughout the agricultural industry, and the fractional content of fats was replaced principally with carbohydrates. Subsequently, high-carbohydrate diets were recognized as contributing to the lipoprotein pattern that characterizes atherogenic dyslipidemia and hypertriacylglycerolemia. The rising incidences of metabolic syndrome and obesity are becoming common themes in the literature. Current recommendations are to keep saturated fatty acid, trans fatty acid, and cholesterol intakes as low as possible while consuming a nutritionally adequate diet. In the face of such recommendations, the agricultural industry is shifting food composition toward lower proportions of all saturated fatty acids. To date, no lower safe limit of specific saturated fatty acid intakes has been identified. This review summarizes research findings and observations on the disparate functions of saturated fatty acids and seeks to bring a more quantitative balance to the debate on dietary saturated fat. Whether a finite quantity of specific dietary saturated fatty acids actually benefits health is not yet known. Because agricultural practices to reduce saturated fat will require a prolonged and concerted effort, and because the world is moving toward more individualized dietary recommendations, should the steps to decrease saturated fatty acids to as low as agriculturally possible not wait until evidence clearly indicates which amounts and types of saturated fatty acids are optimal?

Increasing prevalence of obesity in South Australian 4-year-olds: 1995-2002

OBJECTIVE

To determine prevalence of, and trends in, overweight and obesity in South Australian children aged 4 years during the period 1995-2002.

METHODS

Data from 114 669 children collected as part of Child and Youth Health 'preschool health assessments' of 4-year-olds throughout the state in the years 1995-2002 were analysed. Body mass index was calculated from height and weight data and prevalence of overweight and obesity for males and females determined using a standard world-wide definition. Yearly prevalence rates were compared for changes over time.

RESULTS

Rates of overweight and obesity have increased over the period 1995-2002. In 1995, of females 12.8% were overweight or obese (obese 3.5%). Of males 10.2% were overweight or obese (obese 3.2%). The equivalent figures in 2002 were for females 21.4% (obese 5.8%) and males 17.3% (obese 4.1%). Rates of overweight and obesity were greater in females than males in all years (except obesity rate in 1995).

CONCLUSION

Data from this large, consecutive yearly dataset of South Australian 4-year-old children show a significant increase in the rates of overweight and obesity. Much of this increase appears to have occurred in the mid-to-late 1990s. It is uncertain if these changes have plateaued at this time. These results reinforce rising obesity prevalence as a significant child health issue. They also indicate that obesity is seen as early as the preschool years; with implications for theories of causation and for prevention and treatment strategies.

Prevalence of overweight among children in Europe

Estimates of the prevalence of childhood overweight and obesity have been made in several European countries during the last decade. The methods used and the assessment criteria differ from survey to survey. The present paper reports the prevalence data from 21 surveys in Europe using a single, internationally accepted definition of overweight in childhood, allowing direct comparisons to be made. A tendency for a higher prevalence of overweight among children in western and especially southern Europe is shown and some possible reasons for this are discussed.