The influence of socioeconomic factors on health parameters in overweight and obese adults

Childhood obesity's influence on socioeconomic disparities in young adolescents' mental health

PURPOSE

We investigated whether socioeconomic inequalities in young adolescents' mental health are partially due to the unequal distribution of childhood obesity across socioeconomic positions (SEP), i.e. differential exposure, or due to the effect of obesity on mental health being more detrimental among certain SEPs, i.e. differential impact.

METHODS

We studied 4660 participants of the Generation R study, a population-based study in the Netherlands. SEP was estimated by mother's education and household income at age five of the child. We estimated the contribution of the mediating and moderating effects of high body fat percentage to the disparity in mental health. This was done through a four-way decomposition using marginal structural models with inverse probability of treatment weighting.

RESULTS

Comparing children with the least to most educated mothers and the lowest to highest household income, the total disparity in emotional problems was 0.98 points (95%CI:0.35-1.63) and 1.68 points (95%CI:1.13-2.19), respectively. Of these total disparities in emotional problems, 0.50 points (95%CI:0.15-0.85) and 0.24 points (95%CI:0.09-0.46) were due to the differential exposure to obesity. Obesity did not contribute to disparities in behavioural problems.

CONCLUSION

Addressing the heightened obesity prevalence among children in low SEP families may reduce inequalities in emotional problems in early adolescence.

Romantic partner undermining of weight loss: Links between overweight individuals' weight management efforts and perceptions of their partner's undermining motivations and behaviors

This study investigated romantic partners' undermining of weight management (i.e. hindrance of weight loss efforts) and how perceived motivations behind undermining were associated with weight loss progress. Data from 241 overweight individuals currently cohabiting with a romantic partner and trying to lose weight revealed two overarching undermining factors (i.e. verbal criticism/complaint, behavioral interference) and six perceived motivations (e.g. partner believed weight loss was unnecessary, partner relational fears, weight loss was an imposition on partner). Path modeling showed both undermining behaviors were negatively associated with weight management. Yet, only certain motivations (e.g. imposition on partner, weight loss was unnecessary) were linked to weight management, either directly or indirectly, through undermining. Specifically, whereas criticism/complaint mediated the associations between these motivations and weight management, interference only mediated the association between imposition and weight management. Findings are discussed in terms of the theoretical and practical value of distinguishing undermining behaviors and their underlying motivations.

Women with obesity in cervical cancer screening. The double penalty: Underscreening and income inequalities

The regular performance of Pap tests reduces the mortality of cervical cancer. Obesity is associated with low Pap test rates. We analyze the combined role of obesity and low income. We calculated a Slope Index of Inequality. Among the 28,905 women included, 23.1% were underscreened. The rate of underscreening increased with BMI. The income gradient increased significantly from 0.17 among normal-weight women to 0.19 in overweight and 0.23 in obese women (p = 0.047). Women who are obese are subject to a double penalty in cervical cancer screening: they are underscreened and subject to a more unfavorable economic gradient than normalweight women.

Incidence, bystander emergency response management and outcomes of out-of-hospital cardiac arrest at exercise and sport facilities in Australia

OBJECTIVE

Despite growing emphasis on automated external defibrillators (AEDs) at sport venues in Australia, the risk of cardiac events at such locations is unknown. The aim of the present study was to investigate the incidence of out-of-hospital cardiac arrest (OHCA) at exercise and sport facilities (ESF) in Australia and the impact of effective bystander-initiated CPR and AED use on return of spontaneous circulation (ROSC) to hospital admission.

METHODS

Data were obtained from the Queensland Ambulance Service for the 8-year period between January 2007 and January 2015. Data were analysed using descriptive statistics, non-parametric correlational tests and logistic regression. The OHCA incidence rate (IR) for ESF categories was standardised for 100 000 participant-years.

RESULTS

Over the 8-year period, there were 250 OHCA events with a median age of 62 years (interquartile range 49-69) comprising mostly males (86.6%, n = 187). The risk of OHCA for 100 000 participants per year was highest at outdoor sports facilities (IR 5.1) followed by indoor sports or fitness facilities (IR 0.8). On arrival of paramedics, bystander-initiated CPR and AED was present at 12.4% (n = 31) of the cases achieving 33.3% (n = 9) ROSC to hospital admission. The odds of ROSC for effective CPR was 2.3 times the odds of ROSC for no CPR (P = 0.01).

CONCLUSION

These findings have implications for policy development by government agencies and major sport and exercise organisations to improve bystander CPR and AED. This can help to ensure that ESF can properly respond to cardiac emergencies to save lives.

Sick Individuals and Sick (Microbial) Populations: Challenges in Epidemiology and the Microbiome

The human microbiome represents a new frontier in understanding the biology of human health. While epidemiology in this area is still in its infancy, its scope will likely expand dramatically over the coming years. To rise to the challenge, we argue that epidemiology should capitalize on its population perspective as a critical complement to molecular microbiome research, allowing for the illumination of contextual mechanisms that may vary more across populations rather than among individuals. We first briefly review current research on social context and the gut microbiome, focusing specifically on socioeconomic status (SES) and race/ethnicity. Next, we reflect on the current state of microbiome epidemiology through the lens of one specific area, the association of the gut microbiome and metabolic disorders. We identify key methodological shortcomings of current epidemiological research in this area, including extensive selection bias, the use of noncompositionally robust measures, and a lack of attention to social factors as confounders or effect modifiers.

Pronounced social inequality in health-related factors and quality of life in women and men from Austria who are overweight or obese

BACKGROUND

The burden of social inequalities in health as well as the association between obesity with morbidity and mortality is a worldwide problem. Therefore, the aim of our study was to investigate health-related factors, health, and quality of life in Austrian women and men with normal weight, overweight, and obesity with a different socioeconomic status (SES) based on actual data from 2015.

METHODS

This representative population-based study was based on self-reported data of 15,338 Austrian adults (8,425 women and 6,933 men) in 2014/2015. Data of the Austrian Health Interview Survey was analyzed stratified by sex and adjusted for age concerning health-related behavior, health, and quality of life.

RESULTS

The results have shown that people with a low SES differ significantly from those of high SES concerning health-related factors (e.g., eating behavior, physical activity), health and impairment due to chronic conditions, as well as quality of life. Obesity in women and men was associated with poorer health-related factors and more chronic conditions as well as unfavorable psychological aspects. In women, the results showed a significant body mass index*SES interaction for impairment due to disorders, the number of chronic conditions and quality of life in the domain of physical health. In men, the interaction was significant regarding alcohol consumption, as well as health impairment. The SES has a strong negative impact on health which implies that people of low SES have more health problems which especially concerns individuals who are obese. Therefore, a continuous target group-oriented, non-discriminatory, interdisciplinary public health program is required, prioritizing women, and men with obesity with a low SES.

The moderating effect of income on the relationship between body mass index and health-related quality of life in Northern Sweden

Objectives: This study aimed to investigate the relationship between body mass index (BMI) and health-related quality of life (HRQoL) and whether this relationship is influenced by the level of income in Northern Sweden. Overweight and obesity are rising major public health problems which also affect HRQoL. While socioeconomic inequalities in health are persisting or increasing in many countries, including Sweden, little attention has been paid to the more complex roles of income in relation to health. Methods: Data were drawn from a 2014 cross-sectional survey from Northern Sweden (Health on Equal Terms), comprising individuals aged 20-84 years (N = 20,082 individuals included for analysis). BMI and HRQoL were self-reported and individual disposable income in 2012 was retrieved from population registers. Multiple linear regressions were performed with HRQoL scores regressed on BMI and income, their interaction and additional covariates. Results: The underweight, overweight and obesity groups reported significantly lower HRQoL compared to the normal weight group. Moreover, the relationship between BMI and HRQoL varied significantly by level of income, with a stronger association among those with the lowest level of income. Conclusions: Income has a role as an effect modifier in the relationship between BMI and HRQoL that can be construed as an indirect income inequality. Efforts to promote HRQoL in populations should consider the different impact of being overweight and obese in different socioeconomic groups.

Women, weight, poverty and menopause: understanding health practices in a context of chronic disease prevention

Socioeconomic inequalities in health persist despite major investments in illness prevention campaigns and universal healthcare systems. In this context, the increased risks of chronic diseases of specific sub-groups of vulnerable populations should be further investigated. The objective of this qualitative study is to examine the interaction between socioeconomic status (SES) and body weight in order to understand underprivileged women's increased vulnerability to chronic diseases after menopause. By drawing specifically on Pierre Bourdieu's sociocultural theory of practice, 20 semi-structured interviews were conducted from May to December of 2013 to investigate the health practices of clinically overweight, postmenopausal women living an underprivileged life in Canada. Findings emphasise that poor life conditions undermine personal investment in preventive health and weight loss, showing the importance for policy makers to bring stronger consideration on upstream determinants of health.

Body image discrepancy and subjective norm as mediators and moderators of the relationship between body mass index and quality of life

BACKGROUND AND OBJECTIVE

Despite the strength and consistency of the relationship between body mass index (BMI) and quality of life (QoL), a reduction in BMI does not necessarily lead to an improvement in QoL. Between-subject variability indicates the presence of mediators and moderators in the BMI-QoL association. This study aimed to examine the roles of body image discrepancy (BID) and subjective norm (SN) as potential mediators and moderators.

SUBJECTS AND METHODS

In 2012, 3,016 volunteers (aged ≥18 years) participated in a community-based survey conducted in the French-speaking region of Belgium. Participation was enhanced using a large multimedia campaign (which was supported by a large network of recruiters) that employed the nonstigmatizing slogan, "Whatever your weight, your opinion will count". Participants were invited to complete a web-based questionnaire on their weight-related experiences. Self-reported measures were used to calculate each participant's BMI, BID, SN, and QoL (a French obesity-specific QoL questionnaire was used to calculate the participants' physical dimension of QoL scores [PHY-QoL], psychosocial dimension of QoL scores [PSY/SOC-QoL], and their total scores). The covariates included gender, age, subjective economic status, level of education, household size, and perceived health. The mediation/moderation tests were based on Hayes' method.

RESULTS

Tests showed that the relationships between BMI and PHY-QoL, PSY/SOC-QoL, and TOT-QoL were partially mediated by BID in both males and females and by SN in females. Moreover, BID was a moderator of the relationship between BMI and PSY/SOC-QoL in males and females. SN was a moderator of the relationship between BMI and PSY/SOC-QoL in males and between BMI and total scores in males (when used without BID in the models).

CONCLUSION

BID and SN should be considered as important factors in obesity management strategies. The study shows that targeting BMI only is not sufficient to improve the QoL of overweight and obese subjects, and that other variables, including perceptual factors, should be considered.

Psychological well-being in adolescents with excess weight

BACKGROUND

Self-esteem, perceived health, weight satisfaction, eating habits, physical activity, friendships, intimate relationships, smoking and substance use habits can be regarded as important correlates of psychological well-being in adolescence.

AIM

The present study aimed to determine whether problems in the above-mentioned elements of psychological well-being were more prevalent among mid-adolescent pupils with excess weight than among their healthy-weight peers.

METHODS

The study participants comprised 178 adolescents with excess weight and 1087 healthy-weight peers with a mean age of 14.7 years attending the 8th grade at secondary school. The Rosenberg Self-Esteem Scale, the Eating Disorder Inventory and a questionnaire assessing health- and food-related attitudes and habits were used.

RESULTS

The adolescents with excess weight more often reported weight dissatisfaction, abnormal eating habits and signs of eating disorder pathology than those with healthy weight. No significant difference in self-esteem was observed between weight groups. The proportion of adolescents who were non-smokers, did not use alcohol and had one or more close friends did not differ between those with excess and healthy weight. However, a lower proportion of excess-weight adolescents had dating experience. Inadequate physical activity was highly prevalent among adolescents in both weight groups.

CONCLUSIONS

Despite the high prevalence of eating pathology and weight dissatisfaction, most mid-adolescent pupils with excess weight expressed good psychological health. Targeted psychological interventions should be offered to some adolescents with overweight problems.

The relation of weight to women's health: a matched sample study from Austria

While being underweight, overweight, or obese has been associated with higher rates of morbidity and mortality, such relations have not been studied in Austrian women. Therefore, the aim of this study was to analyze differences in health, health behaviors, and quality of life among women of various weight status categories, using data from the Austrian Health Interview (AT-HIS) 2006/07. First, women between 20 and 60 years of age, from four different weight status groups (underweight, normal weight, overweight, and obese) were matched case to case on age and socioeconomic status. After matching, the total number of women included in the analyses was 516 (N = 129 per). Differences in health status among women in different weight status categories were calculated using multiple conditional logistic regression analyses. Compared to females in the other three groups, women with normal weight had the best state of health: they had better self-reported health, suffered from fewer chronic conditions (e.g., sacrospinal complaints or migraines), and needed medical treatment less often. Moreover, they had better self-reported quality of life. In contrast, women who were underweight or obese showed worse health than women of normal weight. Appropriate health programs for weight risk groups are needed.

Nutrieconomic model can facilitate healthy and low-cost food choices

Objective

Promotion of healthy eating can no longer be postponed as a priority, given the alarming growth rate of chronic degenerative diseases in Western countries. We elaborated a nutrieconomic model to assess and identify the most nutritious and affordable food choices.

Design

Seventy-one food items representing the main food categories were included and their nationally representative prices monitored. Food composition was determined using CRA-NUT (Centro di Ricerca per gli Alimenti e la Nutrizione) and IEO (Istituto Europeo di Oncologia) databases. To define food nutritional quality, the mean adequacy ratio and mean excess ratio were combined. Both prices and nutritional quality were normalised for the edible food content and for the recommended serving sizes for the Italian adult population.

Setting

Stores located in different provinces throughout Italy.

Subjects

Not applicable.

Results

Cereals and legumes presented very similar nutritional qualities and prices per serving. Seasonal fruits and vegetables presented differentiated nutritional qualities and almost equal prices. Products of animal origin showed similar nutritional qualities and varied prices: the best nutrieconomic choices were milk, oily fish and poultry for the dairy products, fish and meat groups, respectively.

Conclusions

Analysing two balanced weekly menus, our nutrieconomic model was able to note a significant decrease in cost of approximately 30 % by varying animal-protein sources without affecting nutritional quality. Healthy eating does not necessarily imply spending large amounts of money but rather being able to make nutritionally optimal choices. The nutrieconomic model is an innovative and practical way to help consumers make correct food choices and nutritionists increase the compliance of their patients.

Weight related health status of patients treated by dietitians in primary care practice: first results of a cohort study

Background

Overweight and obesity are common in the Netherlands: in 2006 51% of adult men and 42% of adult women were overweight; 10% of men and 12% of women were obese. Patients with overweight or obesity in the Netherlands are often referred to dietitians in primary care for weight loss treatment. We followed a prospective observational cohort to study the effectiveness of this treatment and present the baseline results in this article.

Methods

We invited dietitians throughout the country, who completed at baseline a questionnaire for each patient including weight, stature, waist circumference, age, gender, morbidities, medication, education level, ethnicity, referral, treatment expectations, history of previous weight loss attempts, and exercise.

Results

At baseline data from 1546 patients were obtained from 158 dietitians working in 26 practices. The majority (73%) of patients were obese (BMI ≥ 30 kg/m²); and 10% had a BMI of 40 kg/m² or more. The majority of patients (94%) had a high to extremely high weight related health risk (WRHR): (BMI 25–30 kg/m² with comorbidities, or BMI 30–35 kg/m² without comorbidities, up to BMI ≥35 with comorbidities and BMI ≥40 with or without comorbidities). More than half (57%) had comorbidities and a long history of weight loss attempts. An extremely high WRHR was seen in 24.5% of the sample. Patients with very high to extremely high WRHR often had type 2 diabetes mellitus; hypertension; dyslipidaemia; osteo arthritis; and sleep apnoea. Patients of middle and old age had a higher risk for very high and extremely high WRHR. Those with other comorbidities and those who asked for referral themselves had a lower risk.

Conclusion

The study was effective in recruiting dietitians to participate. The sample is representative for dietitians working in primary care. The majority of patients (94%) had a high to extremely high weight related health risk (WRHR).

Health related quality of life, physical fitness and physical activity participation in treatment-seeking obese persons with and without binge eating disorder

This study compared the mental and physical health related quality of life (HRQL) of 40 obese persons with BED with 20 age, gender and body mass index (BMI) matched obese persons without BED and 40 age and gender matched non-obese volunteers. Variables contributing to the variability in HRQL were identified. Participants were asked to fill in the MOS 36-item Short Form Health Survey (SF-36), the Symptoms Checklist-90 (SCL-90), the Baecke questionnaire, the bulimia subscale of the Eating Disorder Inventory and the Body Attitude Test. All participants also performed a 6-minute walk test (6MWT). BED patients showed a significant impaired physical and mental HRQL compared with obese and non-obese control groups. In the BED-group female participants showed a significantly more impaired mental HRQL than male participants (40.0±21.2 versus 66.6±10.1). The distance achieved on the 6MWT (512.1±75.8m) explained 22.5% of the variability in physical HRQL in the obese BED-group while gender and the SCL-90 depression score (39.1±12.2) explained 47.1% of the variability in mental HRQL. The present findings suggest that the treatment of obese individuals with BED might benefit by giving more attention to HRQL, depressive symptoms and physical fitness.

Novel "thrifty" models of increased eating behaviour

The thrifty genotype and phenotype hypotheses were developed to explain the rapid increase in diabetes and obesity in developed countries around the world. Most subsequent "thrifty" research has focused on the early developmental origins of the metabolic syndrome and cardio-metabolic disease. The goal of this manuscript is to review an emerging line of research that uses a similar thrifty framework to understand the early developmental origins of eating-related phenotypes that have primary relevance to many psychiatric disorders. Given the important role of environmental adversity in various psychiatric disorders that involve overeating, and their early age of onset, it is likely that several thrifty mechanisms are relevant in this regard. Understanding the early origins of increased eating behaviour based on a thrifty model might point the way to highly targeted preventative interventions during critical periods of development, and provide a new way of addressing these common and difficult to treat disorders.