Social Inequalities in Obesity Persist in the Nordic Region Despite Its Relative Affluence and Equity
Maria Magnusson
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Thorkild I. A. Srensen
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Steingerdur Olafsdottir
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Susanna Lehtinen-Jacks
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Turid Lingaas Holmen
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B. L. Heitmann National Institute of Public Health, University of Southern Denmark
, Odense M,
Denmark
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T. L. Holmen HUNT Research Centre, Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU)
, Forskningsveien 2, 7600 Levanger,
Norway
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S. Lehtinen-Jacks Nutrition Unit, National Institute for Health and Welfare
, Mannerheimintie 166,
00280 Helsinki, Finland
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S. Lehtinen-Jacks School of Health Sciences (HES) Medisiinarinkatu 3, University of Tampere
, 33014 Tampere,
Finland
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S. Olafsdottir Department of Food and Nutrition, and Sport Science, University of Gothenburg
, Laroverksgatan 5, Box 320, 405 30 Gothenburg,
Sweden
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T. I. A. Srensen Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen
,
Copenhagen, Denmark
Social inequalities in overweight and obesity Reasons that increased inequality does not unequivocally (OWOB) have persisted in the affluent and reputedly egalitarmirror in a steepened social gradient in obesity may include ian Nordic countries. In this review we examine associations methodological questions as well as societal efforts to counbetween socioeconomic position (SEP) and OWOB, and secteract obesity. Multi-level efforts are needed to prevent ular trends in such associations. Determinants and possible Norway . Obesity . Obesogenic . Occupation . Overweight . Secular trends . Social gradient . Socioeconomic position .
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causes of the relations are discussed together with
opportunities to cope with OWOB as a public health problem. The
findings show a persisting inverse social gradient. An
interaction between SEP and gender is noted for adults in Denmark,
Finland and Iceland and for children in Sweden. There are
overall tendencies for increased inequality, however no
consistent trend for an increased social gradient in OWOB.
Socioeconomic status . Sweden . Obesity . Social
inequalities . Nordic region
The occurrence of obesity in humans is associated with
socioeconomic position (SEP). A trend towards an inverse social
gradient, first documented in the USA [1, 2], has since then
spread to most populations in the Western world [3, 4] and
thereafter also to the poorer countries [5]. Reasons for this are
not fully understood. Societal organization on a macro-level
seems to matter. For example; a high degree of
marketliberalism [6] has been suggested to increase the prevalence
of obesity in the population. Inequality within countries seems
to be positively associated with an inverse gradient between
SEP and overweight and obesity (OWOB) [7].
The Nordic countries (Sweden, Denmark, Finland, Norway
and Iceland, order by number of inhabitants) are affluent,
highly regulated welfare states, and hence relatively
egalitarian. Measured by the Gini coefficient (describing the
distribution of income within a country) they are all among the top ten
of the world; aiming at providing all citizens with basic
education, food, health care, social support and economic
protection when ill or unemployed (Table 1). For comparison;
20002011 the GINI-coefficient for the European Union rose
from 2930 [7, 8]. Relative poverty is another commonly used
indicator of income dispersion within countries [9]. The
Nordic countries, with the possible exception of Iceland, are also
among those in Europe with the lowest prevalence of OWOB
(Table 1) [10, 11].
In this review, we will assess the presence of social
inequality in OWOB in the Nordic countries. Specifically, we
will examine socioeconomic gradients in obesity among
adults and children, differences between genders and between
areas of different social status, and, to the extent possible,
secular trends in the social gradient in each country. Finally,
we will discuss the implications of the findings with regard to
Table 1 Data on population and
markers of inequality in the
Nordic countries. A Gini coefficient
of zero expresses perfect equality
and a Gini coefficient of 100 (on
the percentile scale) expresses
maximal inequality
a Self-reported data, response rate
varying from 21 (Norway) to
63 % (Denmark)
Population (million)
Gini coefficient, Eurostat data [8]
understanding the determinants and possible causes of the
relations as well as to the opportunities to cope with OWOB
as a public health problem.
Gradients in Adults and Children, and Trends
in the Gradients
There are no nationally representative objective data on
prevalence of obesity in Swedish adults, but all available data point
to a large increase in prevalence in the latter part of the
twentieth century. High prevalence of obesity in
socioeconomically disadvantaged groups in Sweden has also been
observed consistently during this period.
An early example is from the 1968/9 baseline examination (...truncated)