The social gradient of obesity in Spain. What do we know and what should we know?
DOI:
https://doi.org/10.14422/icade.i99.y2016.002Keywords:
Obesity, socioeconomic factors, health inequality, social gradient.Abstract
Introduction: WHO defines the social gradient as inequality in health along the continuum of socioeconomic status. Obesity is the result of multiple and complex causes and reflects a problem of social inequality. The objective of this article is to review and discuss available scientific evidence on the association between socioeconomic status (income, occupation, social class and education) and overweight / obesity in Spain in children and adults. Methodology: Critical review of the literature through PubMed and Econlit. Studies measuring the socioeconomic gradient of obesity in children and adults, published between 2000 and 2016.
Results: 17 primary studies measuring the socioeconomic gradient of obesity in Spain have been reviewed, and another 8 that compare Spain with other countries. The mechanisms that explain the gradient are multiple and include less receptivity to messages and recommendations of primary prevention, less healthy eating patterns among children and adolescents of low socioeconomic status, and the obesogenic environment of low socioeconomic level households. To measure the gradient, the Absolute Inequality Index, the Relative Inequality index, the Concentration Index and the percentage attributable to the unfavorable socioeconomic level are used. Although the overall prevalence of obesity in adults seems to be stabilizing in Spain, there is a strong inverse social gradient by educational level and low socioeconomic status in both adults and children. Education is the most important inequality factor in any age group. Obese girls and women suffer from double discrimination, as the gradient is significantly higher for them than for the male gender.
Conclusions: more studies are needed with high methodological quality and a long-term prospective design and objective measurement of body mass index to monitor trends and contribute to the design of effective policies against obesity, which are not only health policies but also policies enhancing equity.
References
ARANCETA , J., et al. (2001), “Influence of sociodemographic factors in the prevalence of obesity in Spain. The SEEDO’97 Study”, European Journal of Clinical Nutrition, vol. 55, núm. 6, pp. 430-435.
ARANCETA , J., et al. (2003), “Sociodemographic and lifestyle determinants of food patterns in Spanish children and adolescents: the enKid study”, European Journal of Clinical Nutrition, núm. 57, pp. S40-S44.
BAMMANN, K., et al. (2013), “Socioeconomic factors and childhood overweight in Europe: results from the multi-centre IDEFICS study”, Pediatric Obesity, vol. 8, núm. 1, pp. 1-12.
BANERJEE, A. V. y DUFLO, E. (2009), “The Experimental Approach to Development Economics”, Annual Review of Economics, vol. 1, núm. 1, pp. 151-178.
BIBILONI, M., et al. (2010), “Prevalence and risk factors for obesity in Balearic Islands adolescents”, British Journal of Nutrition, vol. 103, núm. 1, p. 99-106.
BLACK, J. L. y MACINKO, J. (2008), “Neighborhoods and obesity”, Nutritional Review, vol. 66, núm. 1, pp. 2-20.
CHRISTAKIS , N. A. y FOWLER , J. H. (2007), “The spread of obesity in a large social network over 32 years”, New England Journal of Medicine, vol. 357, núm. 4, pp. 370-379.
CIRERA, L., et al. (2015), “Life-course social position, obesity and diabetes risk in the EPIC-Spain Cohort”, The European Journal of Public Health, p. ckv218.
COLE, T. J., et al. (2000), “Establishing a standard definition for child overweight and obesity worldwide: international survey”, BMJ, núm. 320(7244), p. 1240.
COSTA -FONT, J. y GIL, J. (2013), “Intergenerational and socioeconomic gradients of child obesity”, Social Science & Medicine, núm. 93, pp. 29-37.
DEVAUX, M., et al. (2011), “Exploring the relationship between education and obesity, OECD Journal: Economic Studies, vol. 1, pp. 121-159.
DEVAUX, M. y SASSI, F. (2013), “Social inequalities in obesity and overweight in 11 OECD countries”, European Journal of Public Health, vol. 23, núm. 3, pp. 464-469.
DUARTE -SALLES, T., et al. (2011), “Social inequalities in health among
adolescents in a large southern European city”, Journal of Epidemiology Community Health, vol. 65, núm. 2, pp. 166-173.
DUE, P., et al. (2009), “Socioeconomic position, macroeconomic environment and overweight among adolescents in 35 countries”, International Journal of Obesity, vol. 33, núm. 10, pp. 1084-1093.
ESCOLAR PUJOLAR, A. (2009), “Social determinants vs. lifestyle in type 2 diabetes mellitus in Andalusia (Spain): difficulty in making ends meet or obesity?”, Gaceta Sanitaria, vol. 23, núm. 5, pp. 427-432.
FONT-RIBERA, L., et al. (2014), “The study of social inequalities in child and adolescent health in Spain”, Gaceta Sanitaria, vol. 28, núm. 4, pp. 316-325.
GARCINUNO, A. C., et al. (2010), “Social disparities in the prevalence of overweight and obesity in adolescents”, Anales de Pediatría, vol. 73, núm. 5, pp. 241-248.
GEYER, S., et al. (2006), “Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice”, Journal of Epidemiology and Community Health, núm. 60(9), pp. 804-810.
GONZALEZ JIMENEZ, E., et al. (2012), “Influence of family environment of the development of obesity and overweight in a population of school children in Granada (Spain)”, Nutrición Hospitalaria, vol. 27, núm. 1, pp. 177-184.
GUTIERREZ-FISAC, J., et al. (2002), “The size of obesity differences associated with educational level in Spain, 1987 and 1995/97”, Journal of Epidemiology and Community Health, vol. 56, núm. 6, pp. 457-460.
HILLIER-BROWN, F. C., et al. (2014), “A systematic review of the effectiveness of individual, community and societal level interventions at reducing socioeconomic inequalities in obesity amongst children”, BMC Public Health, núm. 14, p. 834.
HOFFMANN, R., et al. (2015), “Obesity and the potential reduction of social inequalities in mortality: evidence from 21 European populations”, The European Journal of Public Health, p. ckv090.
JIMENEZ-PAVON, D., et al. (2010), “Influence of socioeconomic factors on fitness and fatness in Spanish adolescents: the AVENA study”, International Journal of Pediatry Obesity, vol. 5, núm. 6, pp. 467-73.
KARK, M. y RASMUSSEN, F. (2005), “Growing social inequalities in the occurrence of overweight and obesity among young men in Sweden”, Scandinavian Journal of Public Health, vol. 33, núm. 6, pp. 472-477.
KAUTIAINEN , S., et al. (2009), “Sociodemographic factors and a secular trend of adolescent overweight in Finland”, International Journal Pediatric Obesity, vol. 4, núm. 4, pp. 360-370.
KNAI, C., et al. (2012), “Socioeconomic patterning of childhood overweight status in Europe”, International Journal of Enviromental Research and Public Health, vol. 9, núm. 4, pp. 1472-1489.
LAAKSONEN, M., SARLIO-LÄHTEENKORVA , S. y LAHELMA, E. (2004), “Multiple dimensions of socioeconomic position and obesity among employees: The Helsinki Health Study”, Obesity Research, vol. 12, núm. 11, pp. 1851-1858.
LARRANAGA, N., et al. (2007), “Prevalence of obesity in 4-18-year-old population in the Basque Country, Spain”, Obesity Reviews, vol. 8, núm. 4, pp. 281-287.
LOBSTEIN, T., MILLSTONE, E. y POR GROW RESEARCH, T. (2007), “Context for the PorGrow study: Europe’s obesity crisis”, Obesity Reviews, núm. 8 Supl. 2, pp. 7-16.
MACKENBACH, J. P. y KUNST, A. E. (1997), “Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe”, Social Science & Medicine, vol. 44, núm. 6, pp. 757-771.
MAGNUSSON, M., et al. (2014), “Social Inequalities in Obesity Persist in the Nordic Region Despite Its Relative Affluence and Equity”, Current Obesity Reports, núm. 3, pp. 1-15.
MARMOT, M., et al. (2008), “Closing the gap in a generation: health equity through action on the social determinants of health”, The Lancet, núm. 372(9650), pp. 1661-1669.
MOLARIUS, A., et al. (2000), “Educational level, relative body weight, and changes in their association over 10 years: an international perspective from the WHO MONICA Project”, American Journal of Public Health, vol. 90, núm. 8, pp. 1260-1268.
MORAEUS, L., et al. (2012), “Multi-level influences on childhood obesity in Sweden: societal factors, parental determinants and child’s lifestyle”, International Journal of Obesity, vol. 36, núm. 7, pp. 969-976.
MORENO, L. A., et al. (2004), “Micro-environmental and socio-demographic determinants of childhood obesity”, International Journal of Obesisty and Related Metabolic Disordes, núm. 28 Sup. 3, pp. S16-20.
PAMPEL, F. C., KRUEGER, P. M. y DENNEY, J. T. (2010), “Socioeconomic disparities in health behaviors”, Annual Review of Sociology, núm. 36, pp. 349-370.
PÉREZ-HERNÁNDEZ, B., et al. (2016), “Desigualdades sociales en los factores de riesgo cardiovascular de los adultos mayores de España: estudio ENRICA-Seniors”, Revista Española de Cardiología.
PINILLA, J. G., LÓPEZ-VALCÁRCEL, B. y URBANOS-GARRIDO, R. (2016), “Estimating direct effects of parental occupation on Spaniards’ health by birth cohort”, BMC Public Health, (en prensa).
REGIDOR , E., et al. (2004), “Obesity and socioeconomic position measured at three stages of the life course in the elderly”, European Journal Clinical Nutrition, vol. 58, núm. 3, pp. 488-494.
RODRÍGUEZ-CARO, A., VALLEJO-TORRES, L. y LÓPEZ-VALCÁRCEL, B. (2016), “Unconditional quantile regressions to determine the social gradient of obesity in Spain 1993-2014”, International Journal for Equity in Health, vol. 15, núm. 1.
ROMAN, B., et al. (2009), “Physical activity in children and youth in Spain: future actions for obesity prevention”, Nutrition Reviews, num. 67, sup. 1, pp. S94-S98.
ROSKAM, A. J., et al. (2010), “Comparative appraisal of educational inequalities in overweight and obesity among adults in 19 European countries”, International Journal of Epidemiology, vol. 39, núm. 2, pp. 392-404.
SARLIO-LÄHTEENKORVA, S., SILVENTOINEN , K. y LAHELMA, E. (2004), “Relative weight and income at different levels of socioeconomic status”, American Journal of Public Health, vol. 94, núm. 3, pp. 468-472.
SASSI, F. y Organisation for Economic Co-operation and Development (2010), Obesity and the economics of prevention fit not fat, OECD, Paris.
SERRA-MAJEM, L., et al. (2006), “Prevalence and deteminants of obesity in Spanish children and young people”, British Journal of Nutrition, núm. 96, Sup. 1, pp. S67-72.
SERRA-MAJEM, L., et al. (2003), “Obesidad infantil y juvenil en España. Resultados del Estudio enKid (1998-2000)”, Medicina clínica, núm. 121(19), pp. 725-732.
SOBRADILLO, B., AGUIRRE, A. y ARESTI, U. (2004), Curvas y Tablas de Crecimiento (Estudios longitudinal y transversal), Instituto de Investigación sobre Crecimiento y Desarrollo Fundación F. Orbegozo Eizaguirre, Bilbao.
SORIGUER , F., et al. (2004), “Prevalence of obesity in south-east Spain and its relation with social and health factors”, European Journal of Epidemiology, vol. 19, núm. 1, pp. 33-40.
SWEETING, H. N. (2007), “Measurement and definitions of obesity in childhood and adolescence: a field guide for the uninitiated”, Nutrition Journal, vol. 6, num. 1, p. 1.
VALLEJO-TORRES, L. y MORRIS , S. (2010), “The contribution of smoking and obesity to income-related inequalities in health in England”, Social Science & Medicine, vol. 71, núm. 6, pp. 1189-1198.
VALLEJO-TORRES, L., MORRIS , S. y LÓPEZ-VALCÁRCEL, B. (2016), “Obesity and perceived work discrimination in Spain”, International Journal for Equity in Health, vol. 15, núm. 1.
van STRALEN, M. M., et al. (2012), “Weight status of European preschool children and associations with family demographics and energy balancerelated behaviours: a pooled analysis of six European studies”, Obesity Reviews, núm. 13, Sup. 1, pp. 29-41.
VENTOSA, M. M., y URBANOS-GARRIDO, R. M. (2016), “Disentangling effects of socioeconomic status on obesity: a cross-sectional study of the Spanish adult population” Economics & Human Biology, vol. 22, pp. 216-224.
VILLAR, J. G. Y QUINTANA -DOMEQUE, C. (2009), “Income and body mass index in Europe”, Economics & Human Biology, vol. 7, núm. 1, pp. 73-83.
Downloads
How to Cite
Issue
Section
License
The authors of articles published in icade. Revista de la Facultad de Derecho retain the intellectual property rights over their works and grant the journal their distribution and public communication rights, consenting to their publication under aCreative Commons Attribution-NonCommercial-NoDerivates 4.0 Internacional. Authors are encouraged to publish their work on the Internet (for example, on institutional or personal pages, repositories, etc.) respecting the conditions of this license and quoting appropriately the original source.
