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Obesity and economic wealth

Greater obesity among the less educated in rich countries

The results from this study showed that obesity was positively associated with country GDP only among individuals with lower levels of education
educational inequalities in obesity were reversed with GDP; in low-income countries, obesity was more prevalent in individuals with higher education in medium-income and high-income countries

Obesity is more common among the lower educated In rich countries, whilst in poor countries obesity is more common among the higher educated, according to a study from the Norwegian Institute of Public Health, which confirms earlier research. The research, ‘Educational inequalities in obesity and gross domestic product: evidence from 70 countries’, was published in the Journal of Epidemiology Community Health.

Previous studies have shown that the number of people with obesity increases with the gross domestic product (GDP) of a country, as well as indicating that education can be an important factor in this context. The aim of this study was to explore the assumption from previous studies that obesity is linked to GDP and education, and to include new data from several different countries.

The researchers have included more extensive and up-to-date data than what has been done in previous studies. Previous research as focused mostly on low - and medium-cost countries. The present study also included a number of high-cost countries. The dataset included information on 412,921 individuals (individuals’ education, age, gender, height and weight) from 70 countries in the period 2002–2013 and the researchers assessed the association between obesity and GDP by education using a two-stage mixed effects model. Country-specific educational inequalities in obesity were investigated using regression-based inequality indices.

The results from this study showed that obesity was positively associated with country GDP only among individuals with lower levels of education, while this association was absent or reduced in those with higher levels of education. This pattern was more pronounced in women than in men (Figure 1). Furthermore, educational inequalities in obesity were reversed with GDP; in low-income countries, obesity was more prevalent in individuals with higher education, in medium-income and high-income countries, obesity shifts to be more prevalent among those with lower levels of education  The study also found that the relationship was somewhat more marked among women than among men.

The figure shows estimated obesity and GDP by educational groups

“When countries become richer, changes in living conditions occur that predominantly affect the weight of those with low education”, said lead author Jonas Minet Kinge, a researcher at the Norwegian Institute of Public Health and also Associate Professor at the Department of Health Management and Health Economics at the University of Oslo. “For example, earlier literature suggests that low education in poorer countries is associated with limited resources available for excess food consumption, and more physically demanding work. These conditions limit obesity among those with low education in developing countries.”

The reason why the association was found to be more pronounced in women than in men is less clear. The study did not test whether the differences between the sexes are significant. But it may be that women and men often have different educational backgrounds and professions, and that they experience different norms and ideals from their society.

“In rich countries with economies based largely on service and technology industries, most people can afford calorie-rich foods and there are, overall, fewer jobs with physically demanding work. This boosts the prevalence of obesity among those with lower education in high GDP countries,” explained Kinge.

It is important to emphasize that the study has not studied causality. The researchers cannot determine, for example, whether it is education and GDP that affect obesity or vice versa. Neither can they rule out that the results are influenced by other factors not included in the study. Another limitation of the study is that it used self-reported height and weight, which is not optimal.

Nevertheless, Kinge believes the results from this study may be useful for health promotion work, emphasizing the interplay between social and economic factors and obesity. Perhaps especially in developing countries, health promotion efforts should take these factors into consideration.

The study was conducted in collaboration between researchers at the Norwegian Institute of Public Health, the University of Oslo and the University of Bergen in Norway, and Columbia University in the USA.

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