General articleAssociation between socioeconomic status and obesity in 59,556 women☆
Abstract
A study of 59,556 weight-conscious women in the United States who participated and supported this study is reported. A leader-directed confidential questionnaire was administered to small groups of TOPS Club women in 1969 and 1970, and obtained height, education, weight, age, family income, and husband's education.
An inverse relationship between socioeconomic status (income) and obesity was found. The most important finding in the study was that the degree of obesity of the women was inversely related to their husband's education level, but not correlated with their own education level. The strength of the inverse relationship between income (or husband's education) and obesity was much less than that of a study conducted 20 yr ago. This suggests “melting pot” factors in our society which have reduced social class differences with regard to eating behavior and body image goals.
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The differential effect of education and occupation on body mass and overweight in a sample of working people of the general population
2000, Annals of EpidemiologyPURPOSE: To assess whether two indicators of social class, education and occupation, have independent and/or synergistic effects in determining the body mass and overweight.
METHODS: Body mass index (BMI), education, and occupation were assessed in a survey of 1767 men and 1268 women from a representative sample of currently working people of the general population of Geneva, Switzerland. Education and occupation were categorized as low, medium, and high. Overweight was defined as BMI ⩾ 25 kg/m2.
RESULTS: The prevalence of overweight was 52.1% in men and 28.7% in women. Men with overweight were more likely to have low education while women with overweight had lower education and lower occupation. Education and occupation were inversely related to BMI in both genders and, in women, had a synergistic effect (p-value for the interaction = 0.03).
CONCLUSIONS: Education and occupation have independent and, in women, synergistic effects on BMI. The two indicators may express different mechanisms through which low social class is related to high body mass.
Fat and fiber knowledge and behaviors related to body mass index
1997, Nutrition ResearchNumerous dietary recommendations aim to decrease fat and increase fiber in the American diet, yet obesity remains a major public health problem in the United States as indicated by excessive weight for height ratios. The purpose of the Western Regional Project 182 was to examine knowledge, attitudes, and practices of the general population in 11 states and the District of Columbia regarding dietary fat and fiber. This paper specifically discusses the survey results related to the relationships of fat and fiber knowledge and food behavior to body mass index (BMI). Using self-reported weight and height, it was estimated that more than one third of the respondents (n = 1297, 42%) had a BMI ≥ 26. Subjects with BMI scores less than 26 generally had the highest knowledge scores of all BMI groups, but no significant differences in fat knowledge were found among the BMI classifications. Behavior that was related to fat intake was significantly (p < 0.05) different in respondents with a BMI < 26 as compared to those with higher BMI scores. Gender differences for fat, fiber, and overall behavior were also highly significant (p < 0.0001) with favorable diet-related behaviors exhibited by females. Education, income level, residence, and age were consistently related to the BMI of females, but not males. Women who graduated from college, earned more than $50,000 per year, and lived in an urban location of >250,000 people were most likely to have a lower BMI than females with other educational levels, lower economic categories, and from less populated areas. Results support continued use of government and private funds to educate Americans to improve diet and achieve acceptable weights for heights.
Epidemiologic determinants of endometriosis: A hospital-based case- control study
1997, Annals of EpidemiologyPURPOSE: Risk factors for endometriosis were identified through data obtained from a case-control study at Brigham and Women's Hospital in Boston, Massachusetts.
METHODS: Cases were 50 women with infertility-associated endometriosis. The primary control group consisted of 89 fertile women without endometriosis, and an alternate control group consisted of 47 infertile women without endometriosis.
RESULTS: The risk of endometriosis was positively associated with height (odds ratio (OR), 2.8 per 10 cm increase; 95% confidence interval (CI), 1.4–5.6) and inversely associated with weight (OR, 0.7 per 10 kg increase; 95% CI, 0.5 – 1.0) and body mass index (OR, 0.7 per 5 kg/m2 increase; 95% CI, 0.4 – 1.1). We observed an inverse association with exercise (OR, 0.6; 95% CI, 0.3 – 1.5), but the effect was limited to women who exercised ⩾4 hours per week (OR, 0.4; 95% CI, 0.2 – 1.2). Endometriosis was not associated with either smoking or alcohol consumption.
CONCLUSIONS: Our findings suggest that the fertility status of controls can strongly influence associations seen with menstrual characteristics. This study is one of few to address the issue of control selection for a case-control study of endometriosis. Specifically, potential problems encountered using fertile and infertile control women are examined and discussed.
Hysterectomy in Danish women: Weight-related factors, psychologic factors, and life-style variables
1996, Obstetrics and GynecologyTo assess weight-related risk factors, psychologic factors, and life-styles of importance for hysterectomy performed for benign conditions.
In a prevalence study, 2301 Danish women aged 30, 40, 50, or 60 years were selected at random in 1982, and self-report questionnaires were collected from 77%. Information about weight and dieting history, life-style, psychologic factors, gynecologic history, and social background were recorded. Weight, height, and plasma lipids were measured. In an incidence study, the cohort was followed during 1982–1990 via central registers to assess the incidence of hysterectomy. Logistic and Cox regression were used to analyze the data.
In the prevalence study, weight cycling (recurrent weight loss and weight gain of more than 5 kg) was associated with hysterectomy for benign disease (odds ratio 1.77, 95% confidence interval [CI] 1.05–2.99) by multivariate analysis independent of overweight, smoking, psychologic factors, social factors, and gynecologic characteristics. In the incidence study, all the weight-related factors except slimming diets were significant risk factors for hysterectomy performed recently for benign disease in women under age 50. In the multivariate analysis, weight cycling was the only significant weight-related factor (relative risk 2.49, 95% CI 1.10–5.60), explaining the relation between hysterectomy and psychologic factors. Coffee, tea, alcohol, smoking, and plasma lipids were not related to hysterectomy in either study.
Weight cycling might be an important risk factor for premenopausal hysterectomy performed for benign conditions. Whether weight cycling causes menstrual irregularities and leiomyomas, these Resultsgive us a better understanding of the pathways to hysterectomy.
Obesity and overweight in young adults: The CARDIA study
1990, Preventive MedicineThe associations of body size with age, race, sex, and education in young adults were examined in 5,115 black and white, men and women ages 18–30 years. Black women were more obese than white women with greater mean levels of body mass index (25.8 vs 23.1 kg/m2), subscapular skinfold thickness (19.9 vs 15.2 mm), and waist girth (76.7 vs 72.0 cm), all P < 0.0001. Black women were more likely to exceed 20% of ideal body weights (black women 23.7%, white women 9.1%, P < 0.0001). No similar differences were found in men. Associations of measures of body size with age and education differed among race/sex groups. Body mass index and skinfolds increased with age among white and black men and black women, but not among white women. The association of education with obesity was negative among white women and positive among black men with no significant association noted among white men and black women. These data show a complex relationship between age, sex, race, education, and obesity in young adulthood.
Inter-relationships between socio-demographic factors and body mass index in a representative Swedish adult population
1990, Diabetes Research and Clinical Practice
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This work is supported by TOPS Club, Inc., Obesity and Metabolic Research Program of Deaconess Hospital, Milwaukee, WI.
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Research Assistant: premedical student, University of Wisconsin.
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Associate Professor of Preventive Medicine, Medical College of Wisconsin.