Social Inequalities in Obesity Persist in the Nordic Region Despite Its Relative Affluence and Equity

Current Obesity Reports, Mar 2014

Social inequalities in overweight and obesity (OWOB) have persisted in the affluent and reputedly egalitarian Nordic countries. In this review we examine associations between socioeconomic position (SEP) and OWOB, and secular trends in such associations. Determinants and possible 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. Reasons that increased inequality does not unequivocally mirror in a steepened social gradient in obesity may include methodological questions as well as societal efforts to counteract obesity. Multi-level efforts are needed to prevent OWOB.

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Social Inequalities in Obesity Persist in the Nordic Region Despite Its Relative Affluence and Equity

Maria Magnusson 0 1 2 3 4 5 Thorkild I. A. Srensen 0 1 2 3 4 5 Steingerdur Olafsdottir 0 1 2 3 4 5 Susanna Lehtinen-Jacks 0 1 2 3 4 5 Turid Lingaas Holmen 0 1 2 3 4 5 0 B. L. Heitmann National Institute of Public Health, University of Southern Denmark , Odense M, Denmark 1 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 2 S. Lehtinen-Jacks Nutrition Unit, National Institute for Health and Welfare , Mannerheimintie 166, 00280 Helsinki, Finland 3 S. Lehtinen-Jacks School of Health Sciences (HES) Medisiinarinkatu 3, University of Tampere , 33014 Tampere, Finland 4 S. Olafsdottir Department of Food and Nutrition, and Sport Science, University of Gothenburg , Laroverksgatan 5, Box 320, 405 30 Gothenburg, Sweden 5 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 . - 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)


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Maria Magnusson, Thorkild I. A. Sørensen, Steingerdur Olafsdottir, Susanna Lehtinen-Jacks, Turid Lingaas Holmen, Berit Lilienthal Heitmann, Lauren Lissner. Social Inequalities in Obesity Persist in the Nordic Region Despite Its Relative Affluence and Equity, Current Obesity Reports, 2014, pp. 1-15, Volume 3, Issue 1, DOI: 10.1007/s13679-013-0087-2