Increasing prevalence of overweight and obesity among Spanish adults, 1987–1997

International Journal of Obesity (2000) 24, 1677±1682 ß 2000 Macmillan Publishers Ltd All rights reserved 0307±0565/00 $15.00 www.nature.com/ijo Increasing prevalence of overweight and obesity among Spanish adults, 1987 ± 1997 JL GutieÂrrez-Fisac1*, JR Banegas Banegas1, F RodrõÂguez Artalejo2 and E Regidor3 1 Department of Preventive Medicine and Public Health, Universidad AutoÂnoma de Madrid, Madrid, Spain; 2Department of Preventive Medicine and Public Health, Universidad del PaõÂs Vasco, Spain; and 3Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain OBJECTIVE: To study the trend in the prevalence of obesity and overweight in Spanish men and women 25 ± 64 y of age between 1987 and 1997. DESIGN: Cross-sectional surveys of representative samples of the non-institutionalized population in Spain in 1987, 1995 and 1997. SUBJECTS: 14,676 and 7004 adults aged 25 ± 64 who were representative of the Spanish population in 1987 and 1995=1997. MEASURES: Body mass index (BMI) calculated from self-reported weight and height. Overweight is de®ned as BMI ˆ 27 ± 29.9 kg=m2 and obesity as BMI  30 kg=m2. RESULTS: Between 1987 and 1995=97, the prevalence of overweight in the Spanish population aged 25 ± 64 increased by 2.2% (P < 0.01); the increase was greater in men (3.8%; P < 0.01) than in women (0.6%; P > 0.05). The largest increases in the prevalence of overweight were seen in men (5.2%; P < 0.01) and women (2.3%; P < 0.05) aged 25 ± 34. During the same period, the prevalence of obesity increased by 3.9% (P < 0.01), 4.6% in men (P < 0.01) and 3.2% in women (P < 0.01). The largest increases were seen in men aged 45 ± 54 (6.5%, P < 0.01) and in women aged 25 ± 34 (2.2%, P < 0.05). By educational level, the prevalence of overweight increased signi®cantly in men with fewer than 12 y of education (4.7%, P < 0.01). Obesity increased by 4.6% (P < 0.01) and by 4.9% (P < 0.01) in men and women with fewer than 12 y of education, respectively. CONCLUSIONS: The prevalence of overweight and obesity is increasing in Spain, the same as it is in other developed countries. The increase, which is found in most age and sex groups in the population, especially affects middle-aged men, young women and persons with lower educational level. The causes of the increase in the prevalence of overweight and obesity are likely to be multifactorial. International Journal of Obesity (2000) 24, 1677±1682 Keywords: obesity; overweight; survey; trends Introduction Obesity is not only a well-de®ned disease entity, but is also one of the most important risk factors for cardiovascular disease, adult-onset diabetes, some types of cancer and other chronic disorders.1 ± 4 In addition, there is a high prevalence of obesity in the general population, making it the principal nutritional problem in the developed world today. For a number of years, a major increase in the prevalence of obesity and overweight in the adult population has been observed in most developed countries. In the USA, the prevalence of overweight has risen by about 1% per year in absolute terms since the early eighties, while the prevalence of obesity has risen by 0.5%.5,6 Similar increases have been *Correspondence: JL GutieÂrrez-Fisac, Departamento de Medicina Preventiva Salud PuÂblica, Facultad de Medicina, Universidad AutoÂnoma de Madrid, Avda. Arzobispo Morcillo s=n, 28029 Madrid, Spain. Received 9 September 1999; revised 24 May 2000; accepted 7 July 2000 observed in several European countries7 such as the UK,8 The Netherlands,9 Sweden,10,11 Germany12 and France.13 In Spain, periodic national health interview surveys have been carried out since 1987 on representative samples of the population. Data from these surveys can be used to monitor obesity in the general population, study trends over time, and analyse the population subgroups that are most affected by this health problem. These studies, based on health interview surveys and some other population studies, have shown large variations by age, sex, educational level and many other socio-demographic factors.14,15 Likewise, regional differences in body mass index (BMI) and in the prevalence of obesity have been shown in Spain.16 Some of these variations suggest that there is a potential for the reduction of the magnitude of the problem through public health intervention programs directed both to the general population and to the groups most affected. Much less investigated has been the trend over time in the prevalence of overweight and obesity. Identi®cation of the groups in which trends in obesity are less Trends in overweight and obesity in Spain JL GutieÂrrez-Fisac et al 1678 favourable could contribute to the planning of more effective interventions. The objective of the present study is to describe the trend in the prevalence of overweight and obesity in men and women aged 25 ± 64 y in the decade 1987 ± 1997. Materials and methods The data presented were taken from the national health interview surveys carried out in 1987, 1995 and 1997 on representative samples of the Spanish population.17 ± 19 The samples were obtained by multistage strati®ed sampling in which the primary units (municipalities) and secondary units (census districts) were selected by simple random sampling, and the last stage units (individuals) by age and sex quotas. The sampling universe was made up of the national noninstitutionalized population of one or more years of age. In order to compensate for the difference in the sample sizes in the 1987 survey and those of 1995 and 1997, the latter two were combined into a single sample; thus, the results are presented for 1987 and 1995=1997. The study population was limited to persons aged 25 ± 64 y, so that the ®nal samples for analysis, after eliminating persons with missing information for some of the variables considered, was 14,676 in 1987 and 7004 in 1995=97. Table 1 shows the percent distribution of the samples by age, sex and educational level of those interviewed. We calculated the body mass index (BMI) as weight in kg divided by height in metres squared, using information on weight and height obtained by asking the following two questions: `Can you tell me about how much you weigh without your shoes or clothes on? (in kg)' and `Can you tell me about how tall you are without your shoes on? (in cm)'. The response rate to the question about weight and height was 77.8% in the 1987 sample and 86.8% in the 1995=1997 sample. After calculating the BMI for each person in the sample, two indicators were de®ned20 for the study: overweight (BMI ˆ 27 ± 29.9 kg=m2) and obesity (BMI  30 kg=m2). The results are presented as percentages of the population by age, sex and educational level for each of the two mentioned indicators. The standard errors of the percentages were calculated. Since the study involved an analysis of trends, the percentages of the population with overweight and obesity were age-adjusted following t (...truncated)