Skip to main content
Top
Published in: BMC Public Health 1/2009

Open Access 01-12-2009 | Research article

Over-indebtedness as a marker of socioeconomic status and its association with obesity: a cross-sectional study

Authors: Eva Münster, Heiko Rüger, Elke Ochsmann, Stephan Letzel, André M Toschke

Published in: BMC Public Health | Issue 1/2009

Login to get access

Abstract

Background

The recent credit crunch will have implications for private households. Low socioeconomic status is associated to various diseases. While income, education and occupational status is frequently used in definitions of socioeconomic status, over-indebtedness of private households is usually not considered. Over-indebtedness is currently increasing in high-income countries. However, its association with health – particularly with obesity – remains unknown. Therefore, the aim of this study was to assess an association between over-indebtedness and overweight or obesity.

Methods

A cross-sectional study on over-indebtedness and health including 949 over-indebted subjects from 2006 and 2007 in Rhineland-Palatinate and Mecklenburg-Western Pomerania (Germany) and the telephonic health survey 2003 of the Robert Koch-Institute including 8318 subjects, who are representative for the German population, were analysed with adjusted logistic regression considering overweight (BMI ≥25.0 kg/m2) and obesity (BMI ≥30 kg/m2) as response variable.

Results

After adjusting for socio-economic (age, sex, education, income) and health factors (depression, smoking habits) an independent effect of the over-indebt situation on the probability of overweight (aOR 1.97 95%-CI 1.65–2.35) and obesity (aOR 2.56 95%-CI 2.07–3.16) could be identified.

Conclusion

Over-indebtedness was associated with an increased prevalence of overweight and obesity that was not explained by traditional definitions of socioeconomic status. Over-indebtedness should be additionally considered when assessing health effects of socioeconomic status.
Literature
4.
go back to reference Bundesministerium für Gesundheit und Soziale Sicherung, ed. Lebenslagen in Deutschland. Der 2. Armuts- und Reichtumsbericht der Bundesregierung, BMGS (Hrsg.), Bonn. 2005 Bundesministerium für Gesundheit und Soziale Sicherung, ed. Lebenslagen in Deutschland. Der 2. Armuts- und Reichtumsbericht der Bundesregierung, BMGS (Hrsg.), Bonn. 2005
5.
go back to reference Statistisches Bundesamt, ed. Statistisches Jahrbuch 2007 für die Bundesrepublik Deutschland, Statistisches Bundesamt (Federal Statistical Office), Wiesbaden. 2007 Statistisches Bundesamt, ed. Statistisches Jahrbuch 2007 für die Bundesrepublik Deutschland, Statistisches Bundesamt (Federal Statistical Office), Wiesbaden. 2007
6.
go back to reference Wimmer K, ed: Frankfurter Kommentar zur Insolvenzordnung, 4. Auflage. München. 2006, 10.1186/1471-2458-7-23. Wimmer K, ed: Frankfurter Kommentar zur Insolvenzordnung, 4. Auflage. München. 2006, 10.1186/1471-2458-7-23.
7.
go back to reference Bermann KE, GBM M: Themenheft 16 "Übergewicht und Adipositas". Berlin: Robert Koch-Institut. 1999 Bermann KE, GBM M: Themenheft 16 "Übergewicht und Adipositas". Berlin: Robert Koch-Institut. 1999
8.
go back to reference Duvigneaud N, Wijndaele K, Matton L, Deriemaeker P, Philippaerts R, Lefevre J, Thomis M, Duquet W: Socio-economic and lifestyle factors associated with overweight in Flemish adult men and women. BMC Public Health. 2007, 7: 23-10.1038/sj.ejcn.1601503.CrossRefPubMedPubMedCentral Duvigneaud N, Wijndaele K, Matton L, Deriemaeker P, Philippaerts R, Lefevre J, Thomis M, Duquet W: Socio-economic and lifestyle factors associated with overweight in Flemish adult men and women. BMC Public Health. 2007, 7: 23-10.1038/sj.ejcn.1601503.CrossRefPubMedPubMedCentral
9.
go back to reference Hulshof KF, Brussaard JH, Kruizinga AG, Telman J, Lowik MR: Socio-economic status, dietary intake and 10 y trends: the Dutch National Food Consumption Survey. Eur J Clin Nutr. 2003, 57 (1): 128-37. 10.1016/S0140-6736(96)07226-1.CrossRefPubMed Hulshof KF, Brussaard JH, Kruizinga AG, Telman J, Lowik MR: Socio-economic status, dietary intake and 10 y trends: the Dutch National Food Consumption Survey. Eur J Clin Nutr. 2003, 57 (1): 128-37. 10.1016/S0140-6736(96)07226-1.CrossRefPubMed
10.
go back to reference Mackenbach JP, Kunst AE, Cavelaars AE, Groenhof F, Geurts JJ: Socioeconomic inequalities in morbidity and mortality in western Europe. The EU Working Group on Socioeconomic Inequalities in Health. Lancet. 1997, 349 (9066): 1655-9. 10.1016/j.healthpol.2005.01.014.CrossRefPubMed Mackenbach JP, Kunst AE, Cavelaars AE, Groenhof F, Geurts JJ: Socioeconomic inequalities in morbidity and mortality in western Europe. The EU Working Group on Socioeconomic Inequalities in Health. Lancet. 1997, 349 (9066): 1655-9. 10.1016/j.healthpol.2005.01.014.CrossRefPubMed
11.
go back to reference 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): 224-32. 10.1212/01.wnl.0000175987.59991.3d.CrossRefPubMed 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): 224-32. 10.1212/01.wnl.0000175987.59991.3d.CrossRefPubMed
12.
go back to reference WHO: WHO. Diet, physical activity and health. Geneva, Switzerland. 2003 WHO: WHO. Diet, physical activity and health. Geneva, Switzerland. 2003
13.
go back to reference Neuhauser HK, von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T: Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology. 2005, 65 (6): 898-904. 10.1016/S0195-6663(03)00113-2.CrossRefPubMed Neuhauser HK, von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T: Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology. 2005, 65 (6): 898-904. 10.1016/S0195-6663(03)00113-2.CrossRefPubMed
14.
go back to reference Münster E, Rüger H, Ochsmann E, Alsmann C, Letzel S: Überschuldung und Gesundheit-sozialmedizinische Erkenntnisse für die Versorgungsforschung. Arbeitsmedizin Sozialmedizin Umweltmedizin. 2007, 42 (12): 628-634. 10.1016/j.amepre.2004.06.011. Münster E, Rüger H, Ochsmann E, Alsmann C, Letzel S: Überschuldung und Gesundheit-sozialmedizinische Erkenntnisse für die Versorgungsforschung. Arbeitsmedizin Sozialmedizin Umweltmedizin. 2007, 42 (12): 628-634. 10.1016/j.amepre.2004.06.011.
15.
go back to reference WHO: Obesity – preventing and managing the global epidemic. 2000, World Health Organisation, Geneva, Technical Report Series 894 Geneva: WHO WHO: Obesity – preventing and managing the global epidemic. 2000, World Health Organisation, Geneva, Technical Report Series 894 Geneva: WHO
16.
go back to reference Darmon N, Ferguson E, Briend A: Do economic constraints encourage the selection of energy dense diets?. Appetite. 2003, 41 (3): 315-22. 10.1016/S0195-6663(03)00113-2.CrossRefPubMed Darmon N, Ferguson E, Briend A: Do economic constraints encourage the selection of energy dense diets?. Appetite. 2003, 41 (3): 315-22. 10.1016/S0195-6663(03)00113-2.CrossRefPubMed
17.
go back to reference Drewnowski A: Obesity and the food environment: dietary energy density and diet costs. Am J Prev Med. 2004, 27 (3 Suppl): 154-62. 10.1016/S0376-6357(02)00082-7.CrossRefPubMed Drewnowski A: Obesity and the food environment: dietary energy density and diet costs. Am J Prev Med. 2004, 27 (3 Suppl): 154-62. 10.1016/S0376-6357(02)00082-7.CrossRefPubMed
18.
go back to reference Drewnowski A, Darmon N: Food choices and diet costs: an economic analysis. J Nutr. 2005, 135 (4): 900-4. 10.1016/j.brainres.2008.06.067.PubMed Drewnowski A, Darmon N: Food choices and diet costs: an economic analysis. J Nutr. 2005, 135 (4): 900-4. 10.1016/j.brainres.2008.06.067.PubMed
19.
go back to reference Canetti L, Bachar E, Berry EM: Food and emotion. Behav Processes. 2002, 60 (2): 157-164. 10.1164/rccm.200506-977OC.CrossRefPubMed Canetti L, Bachar E, Berry EM: Food and emotion. Behav Processes. 2002, 60 (2): 157-164. 10.1164/rccm.200506-977OC.CrossRefPubMed
20.
go back to reference Chen H, Hansen MJ, Jones JE, Vlahos R, Anderson GP, Morris MJ: Long-term cigarette smoke exposure increases uncoupling protein expression but reduces energy intake. Brain Res. 2008, 1228: 81-8. 10.1016/j.neulet.2006.09.013.CrossRefPubMed Chen H, Hansen MJ, Jones JE, Vlahos R, Anderson GP, Morris MJ: Long-term cigarette smoke exposure increases uncoupling protein expression but reduces energy intake. Brain Res. 2008, 1228: 81-8. 10.1016/j.neulet.2006.09.013.CrossRefPubMed
21.
go back to reference Chen H, Hansen MJ, Jones JE, Vlahos R, Bozinovski S, Anderson GP, Morris MJ: Cigarette smoke exposure reprograms the hypothalamic neuropeptide Y axis to promote weight loss. Am J Respir Crit Care Med. 2006, 173 (11): 1248-54. 10.1164/rccm.200506-977OC.CrossRefPubMed Chen H, Hansen MJ, Jones JE, Vlahos R, Bozinovski S, Anderson GP, Morris MJ: Cigarette smoke exposure reprograms the hypothalamic neuropeptide Y axis to promote weight loss. Am J Respir Crit Care Med. 2006, 173 (11): 1248-54. 10.1164/rccm.200506-977OC.CrossRefPubMed
22.
go back to reference Lee H, Joe KH, Kim W, Park J, Lee DH, Sung KW, Kim DJ: Increased leptin and decreased ghrelin level after smoking cessation. Neurosci Lett. 2006, 409 (1): 47-51. 10.1016/S0002-8223(98)00260-0.CrossRefPubMed Lee H, Joe KH, Kim W, Park J, Lee DH, Sung KW, Kim DJ: Increased leptin and decreased ghrelin level after smoking cessation. Neurosci Lett. 2006, 409 (1): 47-51. 10.1016/S0002-8223(98)00260-0.CrossRefPubMed
23.
go back to reference Nelson MC, Lust K, Story M, Ehlinger E: Credit card debt, stress and key health risk behaviors among college students. Am J Health Promot. 2008, 22 (6): 400-7.CrossRefPubMed Nelson MC, Lust K, Story M, Ehlinger E: Credit card debt, stress and key health risk behaviors among college students. Am J Health Promot. 2008, 22 (6): 400-7.CrossRefPubMed
24.
go back to reference Glanz K, Basil M, Maibach E, Goldberg J, Snyder D: Why Americans eat what they do: taste, nutrition, cost, convenience, and weight control concerns as influences on food consumption. J Am Diet Assoc. 1998, 98 (10): 1118-26. 10.1017/S1368980099000683.CrossRefPubMed Glanz K, Basil M, Maibach E, Goldberg J, Snyder D: Why Americans eat what they do: taste, nutrition, cost, convenience, and weight control concerns as influences on food consumption. J Am Diet Assoc. 1998, 98 (10): 1118-26. 10.1017/S1368980099000683.CrossRefPubMed
25.
go back to reference Bundesministerium Justiz. Insolvenzordnung. Bundesgesetzblatt Teil I. 2007, 13: 509-512. Bundesministerium Justiz. Insolvenzordnung. Bundesgesetzblatt Teil I. 2007, 13: 509-512.
26.
go back to reference Cade J, Upmeier H, Calvert C, Greenwood D: Costs of a healthy diet: analysis from the UK Women's Cohort Study. Public Health Nutr. 1999, 2 (4): 505-12. 10.1017/S1368980099000683.CrossRefPubMed Cade J, Upmeier H, Calvert C, Greenwood D: Costs of a healthy diet: analysis from the UK Women's Cohort Study. Public Health Nutr. 1999, 2 (4): 505-12. 10.1017/S1368980099000683.CrossRefPubMed
27.
go back to reference Drewnowski A: Fat and sugar: an economic analysis. J Nutr. 2003, 133 (3): 838S-840S.PubMed Drewnowski A: Fat and sugar: an economic analysis. J Nutr. 2003, 133 (3): 838S-840S.PubMed
28.
go back to reference Drewnowski A, Specter SE: Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr. 2004, 79 (1): 6-16. 10.1079/PHN2003512.PubMed Drewnowski A, Specter SE: Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr. 2004, 79 (1): 6-16. 10.1079/PHN2003512.PubMed
29.
go back to reference Darmon N, Ferguson EL, Briend A: A cost constraint alone has adverse effects on food selection and nutrient density: an analysis of human diets by linear programming. J Nutr. 2002, 132 (12): 3764-71. 10.2105/AJPH.94.9.1555.PubMed Darmon N, Ferguson EL, Briend A: A cost constraint alone has adverse effects on food selection and nutrient density: an analysis of human diets by linear programming. J Nutr. 2002, 132 (12): 3764-71. 10.2105/AJPH.94.9.1555.PubMed
30.
go back to reference Darmon N, Briend A, Drewnowski A: Energy-dense diets are associated with lower diet costs: a community study of French adults. Public Health Nutr. 2004, 7 (1): 21-7. 10.1002/hec.1386.CrossRefPubMed Darmon N, Briend A, Drewnowski A: Energy-dense diets are associated with lower diet costs: a community study of French adults. Public Health Nutr. 2004, 7 (1): 21-7. 10.1002/hec.1386.CrossRefPubMed
31.
go back to reference Drewnowski A, Darmon N, Briend A: Replacing fats and sweets with vegetables and fruits – a question of cost. Am J Public Health. 2004, 94 (9): 1555-9. 10.1016/j.ehb.2009.01.008.CrossRefPubMedPubMedCentral Drewnowski A, Darmon N, Briend A: Replacing fats and sweets with vegetables and fruits – a question of cost. Am J Public Health. 2004, 94 (9): 1555-9. 10.1016/j.ehb.2009.01.008.CrossRefPubMedPubMedCentral
32.
go back to reference Han E, Norton EC, Stearns SC: Weight and wages: fat versus lean paychecks. Health Econ. 2009, 18 (5): 535-548. 10.1002/ajmg.a.20050.CrossRefPubMed Han E, Norton EC, Stearns SC: Weight and wages: fat versus lean paychecks. Health Econ. 2009, 18 (5): 535-548. 10.1002/ajmg.a.20050.CrossRefPubMed
33.
go back to reference Johansson E, Bockerman P, Kiiskinen U, Heliovaara M: Obesity and labour market success in Finland: The difference between having a high BMI and being fat. Econ Hum Biol. 2009, 7 (1): 36-45. 10.1186/1471-2288-8-69.CrossRefPubMed Johansson E, Bockerman P, Kiiskinen U, Heliovaara M: Obesity and labour market success in Finland: The difference between having a high BMI and being fat. Econ Hum Biol. 2009, 7 (1): 36-45. 10.1186/1471-2288-8-69.CrossRefPubMed
34.
go back to reference Toschke AM: Causality and the need of nose length to height curves. Am J Med Genet A. 2003, 119A (1): 95-10.1186/1478-7954-7-2.CrossRefPubMed Toschke AM: Causality and the need of nose length to height curves. Am J Med Genet A. 2003, 119A (1): 95-10.1186/1478-7954-7-2.CrossRefPubMed
35.
go back to reference Dekkers JC, van Wier MF, Hendriksen IJ, Twisk JW, van Mechelen W: Accuracy of self-reported body weight, height and waist circumference in a Dutch overweight working population. BMC Med Res Methodol. 2008, 8 (69): 69-10.1186/1471-2458-1-11.CrossRefPubMedPubMedCentral Dekkers JC, van Wier MF, Hendriksen IJ, Twisk JW, van Mechelen W: Accuracy of self-reported body weight, height and waist circumference in a Dutch overweight working population. BMC Med Res Methodol. 2008, 8 (69): 69-10.1186/1471-2458-1-11.CrossRefPubMedPubMedCentral
36.
go back to reference Reither EN, Utz RL: A procedure to correct proxy-reported weight in the National Health Interview Survey, 1976–2002. Popul Health Metr. 2009, 7 (2): 2-10.1186/1478-7954-7-2.CrossRefPubMedPubMedCentral Reither EN, Utz RL: A procedure to correct proxy-reported weight in the National Health Interview Survey, 1976–2002. Popul Health Metr. 2009, 7 (2): 2-10.1186/1478-7954-7-2.CrossRefPubMedPubMedCentral
37.
go back to reference Villanueva EV: The validity of self-reported weight in US adults: a population based cross-sectional study. BMC Public Health. 2001, 1 (11): 11-10.1186/1471-2458-1-11.CrossRefPubMedPubMedCentral Villanueva EV: The validity of self-reported weight in US adults: a population based cross-sectional study. BMC Public Health. 2001, 1 (11): 11-10.1186/1471-2458-1-11.CrossRefPubMedPubMedCentral
38.
go back to reference Toschke AM, Kurth BM, von Kries R: The choice of cutoffs for obesity and the effect of those values on risk factor estimation. Am J Clin Nutr. 2008, 87 (2): 292-4.PubMed Toschke AM, Kurth BM, von Kries R: The choice of cutoffs for obesity and the effect of those values on risk factor estimation. Am J Clin Nutr. 2008, 87 (2): 292-4.PubMed
Metadata
Title
Over-indebtedness as a marker of socioeconomic status and its association with obesity: a cross-sectional study
Authors
Eva Münster
Heiko Rüger
Elke Ochsmann
Stephan Letzel
André M Toschke
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2009
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-9-286

Other articles of this Issue 1/2009

BMC Public Health 1/2009 Go to the issue