Obesity and socioeconomic status

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Obesity has frequently been reported in the past to occur disproportionately among economically disadvantaged populations in the United States (15-17); however, more recently, substantial variation in obesity rates between income and ethnic groups over time have emerged (14,18). Using level of education attainment to categorize socioeconomic status (SES), Zhang and Wang found a gradual decrease in the association between SES (determined according to level of education) and obesity between 1971 and 2000, particularly among women, and a disproportionate increase in the obesity prevalence in the high-SES groups (18) (Fig. 3).

Table 5

BMI in 18- to 64-Yr-Old Non-Hispanic White and Black Men and Women Between NHANES I (1960-1962) and 1999-2002*

Women

Table 5

BMI in 18- to 64-Yr-Old Non-Hispanic White and Black Men and Women Between NHANES I (1960-1962) and 1999-2002*

Women

Non-Hispanic

Non-Hispanic

Non-Hispanic

Non-Hispanic

white

black

white

black

mean BMI

mean BMI

mean BMI

mean BMI

NHANES I

24.3

26.9

25.4

25.4

NHANES II

24.5

26.9

25.3

25.3

NHANES III

25.9

28.5

28.5

26.4

1999-2002

27.6

31.0

27.9

27.3

aAdapted from ref. 14.

aAdapted from ref. 14.

Fig. 3. Secular trends in the association between SES and obesity among US adults, 1971-2000. With permission from ref. 18.

Chang and Lauderdale (14) compared obesity rates in non-Hispanic blacks, whites, and Mexican Americans by income using the poverty-income ratio (PIR) (grouped into four categories, 1 low, 4 high) between NHANES I and the 1999-2000 NHANES. They found that obesity increased over this interval at all levels of income in all ethnic/ racial groups. In African American and Caucasian women the lowest obesity prevalence occurred in the highest income category; however, among African American and Mexican American men, obesity prevalence was highest in the highest income category (28.3 and 36.2%, respectively) and lowest in the lowest two income categories (category 1 in African Americans, 22.8%; and category 2 for Mexican Americans, 19.3%). Additionally, the rate of increase in obesity was greater among the more affluent than the poor. Among African American women the rate of increase for obesity was lowest among the lowest PIR (14.5%) and highest in the middle-income category (27%); among non-Hispanic white women the lowest increase (13.0%) was found in the highest income category (PIR category 4) and the highest increase was found in PIR category 2. The significant "catch-up" in obesity prevalence that has occurred in high-SES groups implies that obesity is a much more equal-opportunity condition than previously suspected. These findings suggest that social-environmental factors that affect all SES groups may be the primary contributors to the increase in obesity that has occurred over the past 30 yr.

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