Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2013

Open Access 01-12-2013 | Research article

Socioeconomic status, financial hardship and measured obesity in older adults: a cross-sectional study of the EPIC-Norfolk cohort

Authors: Annalijn I Conklin, Nita G Forouhi, Marc Suhrcke, Paul Surtees, Nicholas J Wareham, Pablo Monsivais

Published in: BMC Public Health | Issue 1/2013

Login to get access

Abstract

Background

Socioeconomic status is strongly associated with obesity. Current economic circumstances are also independently associated with self-reported weight status in Finnish civil servants. We aimed to examine three types of financial hardship in relation to measured general and central obesity in a general population of older adults, while considering conventional socioeconomic indicators.

Methods

Data from 10,137 participants (≥50 years) in the EPIC-Norfolk cohort who responded to a postal Health and Life Experiences Questionnaire (1996–2000) and attended a clinical assessment (1998–2002). Multivariable logistic regression models assessed likelihood of general obesity (BMI ≥30 kg/m2) and central obesity (women: ≥88 cm; men: ≥102 cm) calculated from measured anthropometrics.

Results

Obesity prevalence was consistently patterned by standard socioeconomic indicators, with over-50s in the lowest social class being twice as likely to be obese than those in the highest class (women OR 2.10 [CI95: 1.41—3.13]; men OR 2.36 [1.44—3.87]). After adjustment for socioeconomic status, reporting having less than enough money for one’s needs (compared to more than enough) was associated with obesity in women (OR 2.04 [1.54—2.69]) and men (OR 1.83 [1.34—2.49]). Similar associations were demonstrated between obesity and always or often not having enough money for food/clothing (women OR 1.40 [1.03—1.90]; men OR 1.81 [1.28—2.56]), compared to reporting this never occurred. The strongest independent associations were seen for obesity and reported greatest level of difficulty paying bills (women OR 2.20 [1.37—3.55]; men 2.40 [1.38—4.17]), compared to having no difficulties. Findings for central obesity were slightly higher in women and lower in men.

Conclusions

Obesity in British over-50s was more likely in study participants who reported greater financial hardship, even after education, social class and home ownership were taken into account. Public health policies need to consider the hitherto neglected role of financial hardship in older people, especially difficulty paying bills, as part of strategies to prevent or reduce obesity.
Appendix
Available only for authorised users
Literature
1.
WHO: Global health risks: mortality and burden of disease attributable to selected major risks. 2009, Geneva: World Health Organization
2.
Finkelstein EA, Trogdon JG, Brown DS, Allaire BT, Dellea PS, Kamal-Bahl SJ: The lifetime medical cost burden of overweight and obesity: implications for obesity prevention. Obesity. 2008, 16 (8): 1843-1848. 10.1038/oby.2008.290.CrossRefPubMed
3.
Nolte E, McKee M: Caring for people with chronic conditions: a health system perspective. 2008, Maidenhead, UK: Open University Press/McGraw Hill Education
4.
Wakabayashi I: Necessity of both waist circumference and waist-to-height ratio for better evaluaion of central obesity. Metab Syndr Relat Disord. 2013, 11 (3): 189-94. 10.1089/met.2012.0131.CrossRefPubMed
5.
Pomerlau J, Knai C, Branca F, Robertson A, Rutter H, McKee M, Brunner E, Consortium TE-P: Tackling the social and economic determinants of nutrition and physical activity for the prevention of obesity across Europe: D3.1 Review of the literature of obesity (and inequalities in obesity) in Europe and of its main determinatns: nutrition and physical activity. 2008, London, UK: London School of Hygiene& Tropical Medicine, 1-55.
6.
McLaren L: Socioeconomic status and obesity. Epid Rev. 2007, 29 (1): 29-48. 10.1093/epirev/mxm001.CrossRef
7.
Langenberg C, Hardy R, Kuh D, Brunner E, Wadsworth M: Central and total obesity in middle aged men and women in relation to lifetime socioeconomic status: evidence from a national birth cohort. J Epidemiol Commun H. 2003, 57 (10): 816-822. 10.1136/jech.57.10.816.CrossRef
8.
Laaksonen M, Sarlio-Lähteenkorva S, Lahelma E: Multiple dimensions of socioeconomic position and obesity among employees: The Helsinki Health Study. Obes Res. 2004, 12 (11): 1851-1858. 10.1038/oby.2004.230.CrossRefPubMed
9.
10.
Loman T, Lallukka T, Laaksonen M, Rahkonen O, Lahelma E: Multiple socioeconomic determinants of weight gain: the Helsinki Health Study. BMC Public Health. 2013, 13: 259-266. 10.1186/1471-2458-13-259.CrossRefPubMedPubMedCentral
11.
Ouellette T, Burstein N, Long D, Beecroft E: Measures of material hardship: final report. 2004, Washington: U.S. Department of Health and Human Services
12.
Laaksonen E, Lallukka T, Lahelma E, Ferrie JE, Rahkonen O, Head J, Marmot MG, Martikainen P: Economic difficulties and physical functioning in Finnish and British employees: contribution of social and behavioural factors. Eur J Public Health. 2011, 21 (4): 456-462. 10.1093/eurpub/ckq089.CrossRefPubMed
13.
Laaksonen E, Martikainen P, Lallukka T, Lahelma E, Ferrie J, Rahkonen O, Marmot M, Head J: Economic difficulties and common mental disorders among Finnish and British white-collar employees: the contribution of social and behavioural factors. J Epidemiol Commun H. 2009, 63 (6): 439-446. 10.1136/jech.2008.077198.CrossRef
14.
Ferrie J, Martikainen P, Shipley M, Marmot M: Self-reported economic difficulties and coronary events in men: evidence from the Whitehall II study. Int J Epidemiol. 2005, 34 (3): 640-648.CrossRefPubMed
15.
Lallukka T, Ferrie JE, Rahkonen O, Shipley MJ, Pietiläinen O, Kivimäki M, Marmot MG, Lahelma E, et al: Change in economic difficulties and physical and mental functioning: evidence from British and Finnish employee cohorts. Scand J Work Environ Health. 2013, doi: 10.5271/sjweh.3366
16.
Rahkonen O, Laaksonen M, Karvonen S: The contribution of lone parenthood and economic difficulties to smoking. Soc Sci Med. 2005, 61 (1): 211-216. 10.1016/j.socscimed.2004.11.044.CrossRefPubMed
17.
Averett SL, Smith JK: Financial hardship and obesity: the link between weight and household debt. Women. 2013, 100 (100): 100-
18.
Braveman P, Cubbin C, Egerter S, Chideya S, Marchi K, Metzler M, Posner S: Socioeconomic status in health research: one size does not fit all. JAMA. 2005, 294 (22): 2879-2888. 10.1001/jama.294.22.2879.CrossRefPubMed
19.
Kahn JR, Pearlin LI: Financial strain over the life course and health among older adults. J Health Soc Behav. 2006, 47 (1): 17-31. 10.1177/002214650604700102.CrossRefPubMed
20.
Lallukka T, Ferrie JE, Kivimäki M, Shipley MJ, Rahkonen O, Lahelma E: Economic difficulties and subsequent sleep problems: evidence from British and Finnish occupational cohorts. Sleep Med. 2012, 13 (6): 680-685. 10.1016/j.sleep.2011.10.036.CrossRefPubMedPubMedCentral
21.
Office of National Statistics: Family spending 2011 edition: a report on the living costs and food survey 2010. 2011, London: The Stationery Office
22.
Pudrovska T, Schieman S, Pearlin LI, Nguyen K: The sense of mastery as a mediator and moderator in the association between economic hardship and health in late life. J Aging Health. 2005, 17 (5): 634-660. 10.1177/0898264305279874.CrossRefPubMed
23.
Day N, Oakes S, Luben R, Khaw KT, Bingham S, Welch A, Wareham N: EPIC-Norfolk: study design and characteristics of the cohort. European Prospective Investigation of Cancer. Br J Cancer. 1999, 80 (1): 95-103.PubMed
24.
Surtees PG, Wainwright NWJ: The shackles of misfortune: social adversity assessment and representation in a chronic-disease epidemiological setting. Soc Sci Med. 2007, 64 (1): 95-111. 10.1016/j.socscimed.2006.08.013.CrossRefPubMed
25.
Surtees PG, Wainwright NWJ, Brayne C: Psychosocial aetiology of chronic disease: a pragmatic approach to the assessment of lifetime affective morbidity in an EPIC component study. J Epidemiol Community Health. 2000, 54 (2): 114-122. 10.1136/jech.54.2.114.CrossRefPubMedPubMedCentral
26.
McFadden E, Luben R, Wareham N, Bingham S, Khaw K-T: Occupational social class, risk factors and cardiovascular disease incidence in men and women: a prospective study in the European Prospective Investigation of Cancer and Nutrition in Norfolk (EPIC-Norfolk) cohort. Eur J Epidemiol. 2008, 23 (7): 449-458. 10.1007/s10654-008-9262-2.CrossRefPubMed
27.
Pollack CE, Chideya S, Cubbin C, Williams B, Dekker M, Braveman P: Should health studies measure wealth?: a systematic review. Am J Prev Med. 2007, 33 (3): 250-264. 10.1016/j.amepre.2007.04.033.CrossRefPubMed
28.
Surtees PG, Wainwright NWJ, Khaw KT: Obesity, confidant support and functional health: cross-sectional evidence from the EPIC-Norfolk cohort. Int J Obes Relat Metab Disord. 2004, 28 (6): 748-758. 10.1038/sj.ijo.0802636.CrossRefPubMed
29.
Diana FI, Su H, Winters PC, Liang H: Association of workplace chronic and acute stressors with employee weight status: data from worksites in turmoil. J Occup Environ Med. 2010, 52 (Suppl 1): S34-
30.
Kouvonen A, Stafford M, De Vogli R, Shipley MJ, Marmot MG, Cox T, Vahtera J, Väänänen A, Heponiemi T, Singh-Manoux A, et al: Negative aspects of close relationships as a predictor of increased body mass index and waist circumference: the Whitehall II study. Am J Public Health. 2011, 101 (8): 1474-1480. 10.2105/AJPH.2010.300115.CrossRefPubMedPubMedCentral
31.
Brunner EJ, Chandola T, Marmot MG: Prospective effect of job strain on general and central obesity in the Whitehall II study. Am J Epidemiol. 2007, 165 (7): 828-837. 10.1093/aje/kwk058.CrossRefPubMed
32.
Kahn HS, Williamson DF, Stevens JA: Race and weight change in US women: the roles of socioeconomic and marital status. Am J Public Health. 1991, 81: 319-323. 10.2105/AJPH.81.3.319.CrossRefPubMedPubMedCentral
33.
Bingham SA, Gill C, Welch A, Day K, Cassidy A, Khaw K-T, Sneyd M, Key TJA, Roe L, Day NE: Comparison of dietary assessment methods in nutritional epidemiology: weighed records v. 24 h recalls, food-frequency questionnaires and estimated-diet records. Brit J Nutr. 1994, 72 (04): 619-643. 10.1079/BJN19940064.CrossRefPubMed
34.
Wareham NJ, Jakes RW, Rennie KL, Mitchell J, Hennings S, Day NE: Validity and repeatability of the EPIC-Norfolk physical activity questionnaire. Int J Epidemiol. 2002, 31 (1): 168-174. 10.1093/ije/31.1.168.CrossRefPubMed
35.
StataCorp: Stata Statistical Software: Release 12. 2011, College Station, TX: StataCorp LP
36.
Cawley J, Moran J, Simon K: The impact of income on the weight of elderly Americans. Health Econ. 2010, 19 (8): 979-993.CrossRefPubMed
37.
Yoon YS, Oh SW, Park HS: Socioeconomic status in relation to obesity and abdominal obesity in korean adults: a focus on Sex differences. Obesity. 2006, 14 (5): 909-919. 10.1038/oby.2006.105.CrossRefPubMed
38.
Irz X, Fratiglioni L, Kuosmanen N, Mazzocchi M, Modugno L, Nocella G, Shakersain B, Traill WB, Xu W, Zanello G: Sociodemographic determinants of diet quality of the EU elderly: a comparative analysis in four countries. Public Health Nutr. 2013, 1-13. [Epub ahead of print]
39.
Gunderson EP: Childbearing and obesity in women: weight before, during, and after pregnancy. Obstet Gynecol Clin North Am. 2009, 36 (2): 317-10.1016/j.ogc.2009.04.001.CrossRefPubMedPubMedCentral
40.
Weng HH, Bastian LA, Taylor DH, Moser BK, Ostbye T: Number of children associated with obesity in middle-aged women and men: results from the Health and Retirement Study. J Womens Health. 2004, 13 (1): 85-91. 10.1089/154099904322836492.CrossRef
41.
Turrell G, Hewitt B, Patterson C, Oldenburg B: Measuring socio-economic position in dietary research: is choice of socio-economic indicator important?. Public Health Nutr. 2003, 6 (02): 191-200.PubMed
42.
43.
Burns C, Bentley R, Thornton L, Kavanagh A: Reduced food access due to a lack of money, inability to lift and lack of access to a car for food shopping: a multilevel study in Melbourne Victoria. Public Health Nutr. 2011, 14 (06): 1017-1023. 10.1017/S136898001000385X.CrossRefPubMed
44.
Lallukka T, Laaksonen M, Rahkonen O, Roos E, Lahelma E: Multiple socio-economic circumstances and healthy food habits. Eur J Clin Nutr. 2006, 61 (6): 701-710.CrossRefPubMed
45.
Lallukka T, Lahelma E, Rahkonen O: Changes in economic difficulties and subsequent sickness absence: a prospective register-linkage study. BMJ Open. 2013, 3 (1): e002212-10.1136/bmjopen-2012-002212.CrossRefPubMedPubMedCentral
46.
Burkhauser RV, Cawley J: Beyond BMI: The value of more accurate measures of fatness and obesity in social science research. J Health Econ. 2008, 27 (2): 519-529. 10.1016/j.jhealeco.2007.05.005.CrossRefPubMed
47.
Klein S, Allison DB, Heymsfield SB, Kelley DE, Leibel RL, Nonas C, Kahn R: Waist circumference and cardiometabolic risk: a consensus statement from shaping America's health: association for weight management and obesity prevention; NAASO, The Obesity Society; The American Society for Nutrition; and The American Diabetes Association. Am J Clin Nutr. 2007, 85 (5): 1197-1202.PubMed
48.
Janssen I, Katzmarzyk PT, Ross R: Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr. 2004, 79 (3): 379-384.PubMed
49.
Manios Y, Panagiotakos DB, Pitsavos C, Polychronopoulos E, Stefanadis C: Implication of socio-economic status on the prevalence of overweight and obesity in Greek adults: the ATTICA study. Health Policy. 2005, 74 (2): 224-232. 10.1016/j.healthpol.2005.01.014.CrossRefPubMed
50.
Mackenbach JP, Stirbu I, Roskam A-JR, Schaap MM, Menvielle G, Leinsalu M, Kunst AE: Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008, 358 (23): 2468-2481. 10.1056/NEJMsa0707519.CrossRefPubMed
51.
Denton M, Prus S, Walters V: Gender differences in health: a Canadian study of the psychosocial, structural and behavioural determinants of health. Soc Sci Med. 2004, 58 (12): 2585-2600. 10.1016/j.socscimed.2003.09.008.CrossRefPubMed
52.
Bihan H, Castetbon K, Mejean C, Peneau S, Pelabon L, Jellouli F, Le Clesiau H, Hercberg S: Sociodemographic factors and attitudes toward food affordability and health are associated with fruit and vegetable consumption in a low-income French population. J Nutr. 2010, 140 (4): 823-830. 10.3945/jn.109.118273.CrossRefPubMed
53.
Katz E: The intra-household economics of voice and exit. Fem Econ. 1997, 3 (3): 25-46. 10.1080/135457097338645.CrossRef
54.
Brines J: Economic dependency, gender, and the division of labor at home. Am J Sociol. 1994, 100 (3): 652-688. 10.1086/230577.CrossRef
55.
56.
Kamphuis CBM: Explaining socioeconomic inequalities in health behaviours: the role of environmental factors. 2008, Rotterdam: Erasmus
57.
Rodriguez Martin A, Martinez J, Novalbos Ruiz J, Escobar Jimenez L: Overweight and obesity: the role of education, employment and income in Spanish adults. Appetite. 2008, 51 (2): 266-272. 10.1016/j.appet.2008.02.021.CrossRef
58.
Rosmond R, Björntorp P: Psychosocial and socio-economic factors in women and their relationship to obesity and regional body fat distribution. Int J Obes. 1999, 23 (2): 138-145. 10.1038/sj.ijo.0800782.CrossRef
59.
Murcott A: The sociology of food and eating. 1993, Aldershot, UK: Gower Publishing Company Ltd.
60.
Lumbers M, Raats M: Food choices in later life. The Psychology of Food Choice. Volume Frontiers in Nutritional Science. Edited by: Shepherd R, Raats M. 2006, Wallingford, UK: CABI Publishing, 280-310. 3
61.
Bose M, Olivan B, Laferrere B: Stress and obesity: the role of the hypothalamic-pituitary-adrenal axis in metabolic disease. Curr Opin Endocrinol Diabetes Obes. 2009, 16 (5): 340-346. 10.1097/MED.0b013e32832fa137.CrossRefPubMedPubMedCentral
62.
Cappuccio FP, Taggart FM, Kandala N-B, Currie A, Peile E, Stranges S, Miller MA: Meta-analysis of short sleep duration and obesity in children and adults. Sleep. 2008, 31 (5): 619-626.PubMedPubMedCentral
63.
Björntorp P: Do stress reactions cause abdominal obesity and comorbidities?. Obes Rev. 2001, 2 (2): 73-86. 10.1046/j.1467-789x.2001.00027.x.CrossRefPubMed
64.
Killoran A, Kelly M: Evidence based public health: effectiveness and efficiency. 2010, Oxford, UK: Oxford University Press
65.
Kelly M: Social differences in populations and their implications for public health. Perspect Public Health. 2009, 129 (5): 207-208. 10.1177/1757913909343889.CrossRefPubMed
Metadata
Title
Socioeconomic status, financial hardship and measured obesity in older adults: a cross-sectional study of the EPIC-Norfolk cohort
Authors
Annalijn I Conklin
Nita G Forouhi
Marc Suhrcke
Paul Surtees
Nicholas J Wareham
Pablo Monsivais
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2013
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-13-1039

Other articles of this Issue 1/2013

BMC Public Health 1/2013 Go to the issue

Study protocol

The influence of early exposure to vitamin D for development of diseases later in life

Correspondence

Harnessing the power of the grassroots to conduct public health research in sub-Saharan Africa: a case study from western Kenya in the adaptation of community-based participatory research (CBPR) approaches

Research article

Reformulating partially hydrogenated vegetable oils to maximise health gains in India: is it feasible and will it meet consumer demand?

Research article

Life experiences of patients who have completed tuberculosis treatment: a qualitative investigation in southeast Brazil

Research article

Perspectives of pupils, parents, and teachers on mental health problems among Vietnamese secondary school pupils

Research article

Gender differences in HIV disease progression and treatment outcomes among HIV patients one year after starting antiretroviral treatment (ART) in Dar es Salaam, Tanzania