Causes of obesity

Nick Townsend , Angela Scriven , in Public Health Mini-Guides: Obesity, 2014

Socioeconomic status

Socioeconomic status (SES) (a measure of an individual's or family's social position relative to others) is linked to adiposity, 98 with those from lower SES backgrounds in high-income countries found to indulge in more obesogenic behaviours, such as eating more energy-dense food and being less physically active. 99 This relationship is found to be stronger for women than men 100 and is also true for children, 101 with SES in childhood a predictor of obesity in adulthood. However, there is some evidence that women are more likely to adopt the BMI standard of the SES they move to later in life. 102 The relationship between SES and obesity can vary by characteristics such as age, sex and ethnicity 103, 104 with an opposing relationship found in many lower-income countries where obesity can be considered a sign of affluence and lead to less healthy dietary behaviour. 105

Some have suggested it is economic inequality which accounts for most of the social inequality in obesity rates, 106 with the price elasticity of various foods decreasing with increasing income, 107 so that as consumers become more affluent they respond less to price changes in food. The cost of food may thus be one barrier to adopting healthier diets, with studies suggesting that energy-dense and nutrient-poor foods provide dietary energy at lower cost than do more healthy foods. 108, 109 Additionally less affluent individuals are more concerned by food waste and are therefore less likely to buy foods that will be wasted, leading to more restricted diets. 110 Although the economics prove to be important they are not the only factor. There are links between SES and environmental influences, including likelihood of breastfeeding, 111–114 nutrition in infancy and childhood, psychological factors and cultural or social norms in relation to diet choice and attitudes to body shape. 102 Some studies also report a reverse causality between SES and obesity, in that obesity adversely affects SES. It is possible, however, that external factors may influence both SES and obesity simultaneously. 115, 116

Read full chapter

URL:

https://www.sciencedirect.com/science/article/pii/B9780702046346000042

Childhood Obesity as an Amplifier of Societal Inequality in the United States

Stanley J. Ulijaszek , in Global Perspectives on Childhood Obesity, 2011

Introduction

Social and economic factors are important in the production of population obesity [1], contributing to widely differing rates among similarly economically developed nations [2]. In addition, cultural factors contribute to differences in obesity rates by way of perceptions of appropriate, healthy, and beautiful body size [3]. In industrialized society, obesity is a characteristic of lower social and economic classes [1], having been once associated with higher classes prior to widespread economic prosperity [4]. The potential influences of social and economic forces on the production of obesity are well known [1, 5]. Inequality has been associated with population obesity [6], and Sobal [7] has suggested pathways whereby obesity can influence socioeconomic status (SES). In his formulation, the perception of obesity by oneself and others is central to the attainment of education, occupation, and income by way of values and behaviors that result in prejudice, bias, discrimination, and stigma ( Fig. 43.1). Sobal's [7] formulation places education, income, and occupation equal in the production of SES among obese people. However, education and occupation condition income, and income must therefore play a dominant role in the production of SES.

FIGURE 43.1. Social and behavioral factors that mediate the influence of obesity on socioeconomic status.

 (adapted from Sokal 1991)

Obesity and low SES are tied in a transgenerational vicious circle, such that obesity leads to low SES, and low SES produces obesity. According to Sobal [7], obesity in childhood and adolescence

may exert a strong influence on socioeconomic status. Most adults have largely attained their final educational, occupational, and marital status. For them, the values, types of behavior, and resources associated with their socioeconomic position influence their weight more strongly. Thus, obesity causes status and status causes obesity, each under different conditions of the life cycle. (p.241)

Children and adolescents in households enmeshed in a physical and social environment configured by the low SES of their parents and caregivers are more likely to develop obesity that persists into adulthood [8], increasing and accelerating the risks of ill health [9, 10] as well as psychiatric disorders [11, 12]. Given the rapid and continuing rise in obesity rates in the United States [13], the most striking prediction concerning the long-term effect of obesity is demographic, through reduced life expectancy because of increased mortality from chronic disease [14]. This may in part be attributed to the long-term health risks of developing obesity in childhood [15]. Childhood obesity is also socially stigmatized [16, 17], and in the United States such stigma transcends ethnic and racial categories [18] but is more pronounced in some groups than others. Obese children then go on to face social disadvantages in employment, education, healthcare, and interpersonal relationships [19, 20].

In industrialized nations, obesity, high dietary energy intake, and low physical activity levels cluster among low-income groups [7, 21]. Social class is also negatively associated with diet quality, primarily through the mechanism of cost [22], although economic factors alone cannot explain variation in nutritional health within communities [23] or across nations [6]. Although the relationships among SES and obesity are powerful and synergistic, the SES construct is insufficient to describe some of the cultural influences on status production in society, and therefore on obesity production. Socioeconomic status has two closely related dimensions. The economic one is represented by financial wealth, whereas the social one can incorporate education, occupational prestige, authority, and community standing. Whereas economic status is easy to measure (assuming that someone will accurately reveal his or her income in survey), occupational prestige, authority, and community standing are more difficult to estimate. Cultural factors overlap with social ones, values that help confer status in society include forms of knowledge, skills, and education [24]. Although the SES construct can be made numerically tractable, there is no consensus definition of SES, nor is there a widely accepted SES measurement tool [25, 26]. And although prestige is a component of social distance [27], ethnicity is not a consistent predictor of household prestige [28]. Measures of economic status may differ in their meaning across ethnic groups because of different cultural valuation of material goods and services. Similarly, measures of social status may vary culturally. Thus, it is important to separate the effects of SES from ethnicity or race [27]. Oakes and Rossi [26] have proposed a material, social, and human capital model of SES that omits race, as there is no easy way to quantify it. However, race and ethnicity remain important but imperfect markers of cultural variation that may carry health consequences that are independent of SES [29, 30].

A way of addressing the issue of race in considering inequality and obesity is put forward here, using Bourdieu and Boltanski's [31] "theory of practice." This links economic, social, and cultural forms of capital (or value) in an overarching category of symbolic capital. These represent categories through which power relationships within society are negotiated. This construct permits a more complete examination of societal stratification and its human biological consequences and amplifiers, including ethnicity, because it incorporates the notion of cultural value of, for example, preferences in body size and shape, which shows variation within and between groups.

In this chapter, I examine ways in which obesity in childhood and adolescence is structured by symbolic capital both inherited from parents and caregivers and formed by individuals across life. The focus is primarily on the United States, although it draws on literature from elsewhere in the industrialized world where appropriate. Differences in obesity rates across major ethnic groups are discussed, because this is an area in which social and cultural forms of capital differ and may offer insights into obesity and its associated traits as a form of symbolic capital. Although classifications of ethnicity can obscure as much as they can reveal, they are dominant categories that structure the thinking of those involved in obesity policy, research, and practice and are therefore used here to describe major differences in obesity rates within the U.S. population. It is argued that if obesity carries embodied capital in a low SES or particular group, it may be one of the few forms of capital they have. If branded fast-food outlets surround them, the selection, purchase, and consumption of fast food may be another achievable form of cultural capital, that of objectified capital where other forms of bought status are out of reach. Given that children, adolescents, and adults have become increasingly segregated by media use in current society and that food choices are plastic, it is argued that children's food choices have become increasingly influenced by corporate interests and not solely their family, caregivers, or social group.

Rates of childhood and adolescent obesity have risen dramatically in the United States since the 1970s [32] across a period of steady expansion of economic inequality only reversed briefly and marginally during the years of the Clinton administration [33]. With the current political administration avowed to a reduction in societal inequalities, it is perhaps timely to examine how childhood obesity may be an inadvertent amplifier of societal inequality. First, it is important to elaborate the concept of symbolic capital and why it is appropriate for framing the problem in hand.

Read full chapter

URL:

https://www.sciencedirect.com/science/article/pii/B978012374995610043X

Environmental factors related to the obesity epidemic

Lindsey G. Kahan B.S. , Raman Mehrzad M.D., M.H.L., M.B.A. , in Obesity, 2020

Socioeconomic status

SES has been widely studied in its relationship to obesity. In developing countries, a direct relationship between SES and obesity has been shown, with a higher SES having a higher likelihood of having obesity [3]. Interestingly, different groups have shown different associations between BMI and obesity. For example, in a study comparing black, brown, and white Brazilian adults, it was found that men and black women had higher odds of obesity with increasing SES, yet brown and white women in the study had decreased odds of obesity with increasing SES [4]. At the lowest SES level, black women had 30% decreased odds of obesity compared to white women. At the highest SES level, black women had a three-fold increase of obesity compared to white women [4]. It was suggested that the racial disparities could be explained by a culmination of physiological, psychological, cultural, and environmental effects. Some of these potential factors include stress due to racial discrimination causing negative mental health outcomes and physiologic disturbances on the hypothalamic–pituitary–adrenal axis, or overeating secondary due to psychological distress [4].

In developed countries, an inverse relationship has been shown between BMI and obesity, more so with women than for men and children [3, 5, 6]. In a 34-article literature review of studies on SES and obesity, there were relatively consistent inverse associations between occupational status and weight gain. When income level was used as a proxy for SES, however, inconsistent findings were reported with fewer studies. In a prospective analysis of children, it was found that after controlling for ethnicity, children from lower SES families had a greater likelihood of being overweight than children of higher SES families [7].

Structural racism has led to racial inequalities in SES [8, 9], given that SES is measured through educational attainment, household income, occupation, and wealth. Structural racism, which encompasses policies and practices that white Americans have over other ethnic and racial minority groups [10], has influenced residential environments and health through disparities in home loans and housing assistance programs only historically available to whites [11–13]. These practices, of which housing disparity is a single example, have been widely shown to be associated with fewer health-promoting resources, and account for the racial differences in SES [11–15]. It is therefore important to consider structural racism in the later discussed concepts of racial/ethnic disparities in environments and their relationship to obesity.

Read full chapter

URL:

https://www.sciencedirect.com/science/article/pii/B9780128188392000107

Measurement and Distribution of Periodontal Diseases

Paul I. EKE PhD, MPH, PhD , ... Jasim M. Albandar DDS, DMD, PhD , in Burt and Eklund's Dentistry, Dental Practice, and the Community, 2021

Socioeconomic Status

Socioeconomic status (SES) is a multifaceted, complex measure of social standing that can include cultural, societal, and geographical factors in addition to the educational, occupational, and financial components. Generally, those who are better educated, wealthier, and live in more affluent circumstances enjoy better health status, including periodontal health, than the less educated and poorer segments of society. This association might be explained by factors associated with low SES status, such as smoking, stress, depression, anxiety, poor coping skills, and allostatic load (the latter is discussed in more detail in subsequent text). A study in a Norwegian population found that SES and smoking are the main predictors of periodontitis, whereas the likelihood of periodontitis was not reduced by regular dental visits, 46 a finding further demonstrated by a systematic review. 87

Read full chapter

URL:

https://www.sciencedirect.com/science/article/pii/B9780323554848000150

Gender Differences in the Role of Stress and Emotion in Cardiovascular Function and Disease

DAVID E. ANDERSON PhD , MARGARET A. CHESNEY PhD , in Principles of Gender-Specific Medicine, 2004

A. Socioeconomic Status

Low socioeconomic status, whether assessed via education, occupation, or income, has been consistently associated with increased rates of hypertension [ 158] and CHD [159–161] in men and women in industrialized countries. The gradient of association for both is steeper in women than in men. Changes in earning power over 10-years was found to predict changes in blood pressure over that interval more strongly even than socioeconomic status at baseline [162]. Part of these findings can be accounted for by the fact that lower socioeconomic status is associated with an unhealthy life style. Thus, one study found men with a low socioeconomic status to be characterized by a more atherogenic diet, less physical exercise, and more smoking than those in higher brackets [163]. In a cohort of women with chest pain, low socioeconomic status was found to be associated with cigarette smoking, lower reported activity levels, and higher body mass index and waist–hip ratios [122].

Read full chapter

URL:

https://www.sciencedirect.com/science/article/pii/B9780124409057502929

Socioeconomic Inequalities in Women's Health

NANCY E. MOSS , in Women and Health, 2000

VIII. Socioeconomic Differences in Breast Cancer Incidence: The Inverted Gradient

SES is also positively associated with some health outcomes. The most widely known of these is breast cancer. Devesa and Diamond reported a strong positive association of breast cancer with income and education for white women, and with education but not income for black women [45]. Bacquet et al. also showed a linear relationship between years of education and breast cancer incidence for whites and a weak positive relationship for black women. Among whites, there is a also a strong positive income gradient, but the relationship for black women is more ambivalent [46]. Characteristics of higher SES women such as later and lower fertility [47] are believed to contribute to the positive relationship with incidence of breast cancer.

Read full chapter

URL:

https://www.sciencedirect.com/science/article/pii/B9780122881459500504

Rheumatoid Arthritis

Agustín Escalante , in Women and Health (Second Edition), 2013

Lifestyle Factors

Socioeconomic Status

Socioeconomic status and formal education level are predictive markers for both morbidity and mortality in RA. 31 Lower socioeconomic status and level of education are associated with worse functional status. Neither socioeconomic status nor formal education level is a risk factor for development of the disease.

Diet

There are many beliefs about the influence of diet on arthritis in general and RA in particular. Dairy products, tomatoes, potatoes, and meat products all have been invoked as causing or exacerbating RA. A high dietary intake of fish-oil fatty acids is associated with a significantly decreased risk for developing RA. 32

Dietary modification has been advocated for management of arthritis for decades, including but not limited to RA. Since that time, several possible mechanisms have been studied to relate oral intake to activity or prevention of RA. Food hypersensitivity appears to be a possibility for at least some patients. Exclusion of dietary antigens was found to decrease disease activity in some patients. 33 Fasting 34 and a vegan diet 35 were shown to be mildly beneficial in 2 controlled studies.

Dietary supplementation trials have had mixed results. A trial of supplementation with alpha-linoleic acid using flaxseed and safflower seed failed to show any symptom improvement in 3 months. 36 Marine and botanical lipids may be of some benefit in active RA. 37 The most promising approach appears to be a diet enriched with fish-oil fatty acids. Some improvement in symptoms was found in 11 of 12 studies reviewed using fish-oil supplementation. An objective decrease in several measures of disease activity was also seen. 38 A proposed mechanism is modification of arachidonic-acid metabolites to less inflammatory products, thus decreasing the symptoms of RA or other rheumatic disease. Vitamin treatment has not been shown to improve disease. Of the trace metals, low serum zinc levels are found in RA patients and patients experienced some benefit with repletion. There is no information on other trace metals. Dietary modification and supplementation remain of interest, but of modest clinical impact at this time. 39

Cigarette Smoking

Following an early, serendipitous finding of an association between cigarette smoking and RA, 40 smoking has emerged as a major preventable risk factor for RA susceptibility. 41–43

Read full chapter

URL:

https://www.sciencedirect.com/science/article/pii/B9780123849786000510

Morbidity, Disability, and Mortality

Frances M. Yang , Suzanne G. Leveille , in Women and Health (Second Edition), 2013

Socioeconomic Status of Older Women

Socioeconomic status (SES), usually measured by education, income, or occupational status, is used to determine an individual or a group's social standing. 5 Across all race and ethnic groups in the US in 2010, older women were more than twice as likely to be poor compared to their male counterparts. 3 Older women experience high rates of poverty with 11% of older women in the US living in poverty in 2010, and another 28% living near poverty (below 200% of the poverty threshold) according to the US Census. 3 There are sharp differences according to race, with 9% of older white women living in poverty compared with 27% of older black women, 20% of older Hispanic women, and 12% of older Asian women. 6

Factors that can affect SES, particularly for older women, include declining health and the death of a spouse. Both of these factors may place low-income older women at a serious disadvantage, as they are more likely to rely on Social Security as their main source of income. Women living alone have the highest rates of poverty (15%), with marked differences across race and ethnicity. Among older adults, older Hispanic women (45%) and black women (33%) living alone had the highest poverty rates. 7 These demographic trends provide an important context for understanding morbidity, mortality, and disability of women over the age of 65.

Read full chapter

URL:

https://www.sciencedirect.com/science/article/pii/B9780123849786000959

Insulin Resistance and Type 2 Diabetes Mellitus: Gender Differences and Similarities

ANN M. COULSTON MS, RD , in Principles of Gender-Specific Medicine, 2004

VIII. Socioeconomic Status of Women with Diabetes

The socioeconomic status of women with diabetes affects health care delivery and access to food. Data from the BRFSS indicate that the socioeconomic status of women with diabetes is markedly lower than that of women without diabetes [ 72]. In this survey women were classified as having low socioeconomic status if they did not complete high school or resided in a household with an annual income of <$25,000. Of the women from this sample, 6.3% had diabetes, by self-report. These women were more likely than women without diabetes to be nonwhite; divorced, separated or widowed; living alone; retired; or unable to work.

Persons with low socioeconomic status have poorer health than others and are less likely to have adequate access to care or receive adequate clinical and preventive services [73]. Thus, it is apparent that the low socioeconomic status of many women with diabetes might compromise their ability to benefit from treatments that might reduce their risks for complications and premature death. Hence, programs designed to meet the needs of women with diabetes should take socioeconomic status into account. The Centers for Disease Control and Prevention have initiated a program entitled "Diabetes and Women's Health Across the Life Stages: A Public Health Perspective" which can be accessed online for additional information and action [72].

Read full chapter

URL:

https://www.sciencedirect.com/science/article/pii/B9780124409057503406

Obesity Screening in Adolescents

Tamasyn Nelson DO , in Adolescent Health Screening: an Update in the Age of Big Data, 2019

Socioeconomic status

SES is a social determinant of health and is defined as the measure of how income, education, and occupation affect an individual's social status. Researchers have found a correlation between low SES and obesity. Several studies have also illuminated a correlation between the presence of limited parental education (used as a proxy for low SES) and obesity. 7,8 Moreover, living in a low-income family corresponds with an increased risk of developing obesity in childhood.

Low-income families have a higher risk of being food insecure or not having access to reliable sources of nutritious food, secondary to financial or other societal restrictions. 9 Food-insecure families more often live in neighborhoods with fewer grocery stores, more fast-food restaurants, and limited access to fresh produce. 10 Additionally, neighborhood stores in food-insecure areas tend to have nutritious foods (fresh produce, lean meats) priced higher than less nutritious, calorie-dense foods (canned fruits and vegetables, packaged foods such as chips and cookies). The cost of food has a more pronounced effect on food-insecure families, which often have less resources to allocate on basic needs such as food. 11 As a result, food-insecure families tend to purchase and eat more of these less nutritious, calorie-dense foods than food-secure families, thus creating the increased risk of obesity in children and adolescents from food-insecure families.

A study of family households with children demonstrated a greater availability of and accessibility to obesogenic foods in food-insecure homes relative to food-secure homes. 12 Of note, the study did not reveal a difference in fruit and vegetable availability among the food-insecure and food-secure homes. The study concluded that the increased availability of nonnutritious foods, and not the presence of nutritious foods, had a greater influence on dietary choices in these food-insecure homes.

Read full chapter

URL:

https://www.sciencedirect.com/science/article/pii/B9780323661300000041