Social patterning of obesity in Spain: A systematic review of the relationship between education and obesity
DOI:
https://doi.org/10.14306/renhyd.17.2.13Keywords:
educational status, epidemiology, overweight, obesity, social class, reviewAbstract
Introduction: In high-income countries around the world, there appears to be an inverse association between educational attainment and obesity. However, the literature about this association in Spain remains disorganized and disparate.
Material and Methods: We systematically reviewed peer-reviewed English- or Spanish language studies of this association in Spain from 10 databases from all periods of time available.
Results: Our search identified twenty-four studies. In both nationally representative and subnational studies, women with less education had higher odds of obesity than their more educated counterparts. Men, despite exhibiting greater variability in the education-body weight relationship, also demonstrated a similar social patterning of body weight in many studies, with those at lower levels of educational attainment having higher odds of obesity relative to their more-educated counterparts. These associations in men and women were fairly consistent across time and place, though some regional variations did exist.
Discussion and conclusions: We encourage future researchers to move towards more meaningful, unbiased estimates of the association between educational attainment and obesity by measuring height and weight with physical exams, controlling for a more robust set of possible confounders, and exploring potential modifying factors of the association. Additionally, when possible, we encourage researchers to employ prospective study designs that facilitate causal inference with respect to this association.
References
Berghöfer A, Pischon T, Reinhold T, Apovian CM, Sharma AM, et al. Obesity prevalence from a European perspective: a systematic review. BMC Public Health. 2008;8:200. PMID: 18533989
Valdés Pizarro J, Royo-Bordonada MA. Prevalence of childhood obesity in Spain: National Health Survey 2006-2007. Nutr Hosp. 2012;27(1):154–160. PMID: 22566315
Regidor E, Gutierrez-Fisac JL, de los Santos Ichaso M, Fernández E. Trends in principal cancer risk factors in Spain. Annals of Oncology. 2010;21(Supplement 3):iii37–iii42. PMID: 20427359
Cámara AD, Spijker JJ. Super size Spain? A cross-sectional and quasi-cohort trend analysis of adult overweight and obesity in an accelerated transition country. J Biosoc Sci. 2010;42(3):377–93.
Basterra-Gortari FJ, Beunza JJ, Bes-Rastrollo M, Toledo E, García-López M, Martínez-González MA. [Increasing trend in the prevalence of morbid obesity in Spain: from 1.8 to 6.1 per thousand in 14 years]. Rev Esp Cardiol. 2011;64(5):424–26.
Font JC, Fabbri D, Gil J. Decomposing cross-country differences in levels of obesity and overweight: does the social environment matter? Soc Sci Med. 2010;70(8):1185–93.
Wilson PWF, D'Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med. 2002;162(16):1867–72.
Wellman NS, Friedberg B. Causes and consequences of adult obesity: health, social and economic impacts in the United States. Asia Pac J Clin Nutr. 2002;11 (Suppl 8):S705–9.
Müller-Riemenschneider F, Reinhold T, Berghöfer A, Willich SN. Health-economic burden of obesity in Europe. Eur J Epidemiol. 2008;23(8):499–509.
Rabin BA, Boehmer TK, Brownson RC. Cross-national comparison of environmental and policy correlates of obesity in Europe. Eur J Public Health. 2007;17(1):53–61.
Black JL, Macinko J. Neighborhoods and obesity. Nutr Rev. 2008;66(1):2–20.
Prentice AM, Jebb SA. Fast foods, energy density and obesity: a possible mechanistic link. Obes Rev. 2003;4(4):187–94.
Molnar BE, Gortmaker SL, Bull FC, Buka SL. Unsafe to play? Neighborhood disorder and lack of safety predict reduced physical activity among urban children and adolescents. Am J Health Promot. 2004;18(5):378–86.
Lawlor DA, Batty GD, Morton SM, Clark H, Macintyre S, Leon DA. Childhood socioeconomic position, educational attainment, and adult cardiovascular risk factors: the Aberdeen children of the 1950s cohort study. Am J Public Health. 2005;95(7):1245–51.
Galesic M, Garcia-Retamero R. Statistical numeracy for health: a cross-cultural comparison with probabilistic national samples. Arch Intern Med. 2010;170(5):462–8.
Nelson M, Erens B, Bates B, Church S, Boshier T. Low income diet and nutrition survey. London: Food Standards Agency; 2007.
El-Sayed AM, Scarborough P, Galea S. Unevenly distributed: a systematic review of the health literature about socioeconomic inequalities in adult obesity in the United Kingdom. BMC Public Health. 2012;12:18.
Singh-Manoux A, Gourmelen J, Lajnef M, Sabia S, Sitta R, Menvielle G, et al. Prevalence of educational inequalities in obesity between 1970 and 2003 in France. Obes Rev. 2009;10(5):511–8.
Sarlio-Lähteenkorva S, Lissau I, Lahelma E. The social patterning of relative body weight and obesity in Denmark and Finland. Eur J Public Health. 2006;16(1):36–40.
Gutierrez-Fisac JL, Banegas JR, Artalejo FR, Regidor E. Increasing prevalence of overweight and obesity among Spanish adults, 1987-1997. Int J Obes Relat Metab Disord. 2000;24(12):1677–82.
Alcácera MA, Marques-Lopes I, Fajó-Pascual M, Puzo J, Blas-Pérez J, Bes-Rastrollo M, et al. Lifestyle Factors Associated with BMI in a Spanish Graduate Population: The SUN Study. Obes Facts. 2008;1(2):80–7.
Aranceta J, Rodrigo CP, Majem LS, et al. Prevalencia de la obesidad en España: estudio SEEDO'97. Med Clin (Barc). 1998;111(12):441–5.
Aranceta J, Perez-Rodrigo C, Serra-Majem L, Ribas L, Quiles-Izquierdo J, Vioque J, et al. Influence of sociodemographic factors in the prevalence of obesity in Spain. The SEEDO'97 Study. Eur J Clin Nutr. 2001;55(6):430–5.
Aranceta J, Pérez Rodrigo C, Serra Majem L, Ribas Barba L, Quiles Izquierdo J, Vioque J, et al. Prevalencia de la obesidad en España: resultados del estudio SEEDO 2000. Med Clin (Barc). 2003;120(16):608–12.
Rodríguez-Artalejo F, López García E, Gutiérrez-Fisac JL, Banegas Banegas JR, Lafuente Urdinguio PJ, Domínguez Rojas V. Changes in the prevalence of overweight and obesity and their risk factors in Spain, 1987-1997. Prev Med. 2002;34(1):72–81.
Cirera L, Tormo MJ, Chirlaque MD, Navarro C. Cardiovascular risk factors and educational attainment in Southern Spain: a study of a random sample of 3091 adults. Eur J Epidemiol. 1998;14(8):755–63.
García-Mendizábal MJ, Carrasco JM, Pérez-Gómez B, Aragonés N, Guallar-Castillón P, Rodríguez-Artalejo F, et al. Role of educational level in the relationship between Body Mass Index (BMI) and health-related quality of life (HRQL) among rural Spanish women. BMC Public Health. 2009;9:120.
Gutiérrez-Fisac JL, Regidor E, Rodríguez C. Trends in obesity differences by educational level in Spain. J Clin Epidemiol. 1996;49(3):351–4.
Gutiérrez-Fisac JL, López E, Banegas JR, Graciani A, Rodríguez-Artalejo F. Prevalence of overweight and obesity in elderly people in Spain. Obes Res. 2004;12(4):710–5.
Gutiérrez-Fisac JL, Rodríguez Artalejo F, Guallar-Castillon P, Banegas Banegas JR, del Rey Calero J. Determinants of geographical variations in body mass index (BMI) and obesity in Spain. Int J Obes Relat Metab Disord. 1999;23(4):342–7.
Martín AR, Nieto JM, Ruiz JP, Jiménez LE. Overweight and obesity: the role of education, employment and income in Spanish adults. Appetite. 2008;51(2):266–72.
Martínez-Ros MT, Tormo MJ, Navarro C, Chirlaque MD, Pérez-Flores D. Extremely high prevalence of overweight and obesity in Murcia, a Mediterranean region in south-east Spain. Int J Obes Relat Metab Disord. 2001;25(9):1372–80.
Mataix J, López-Frías M, Martínez-de-Victoria E, López-Jurado M, Aranda P, Llopis J. Factors associated with obesity in an adult Mediterranean population: influence on plasma lipid profile. J Am Coll Nutr. 2005;24(6):456–65.
Roskam A-JR, Kunst AE. The predictive value of different socio-economic indicators for overweight in nine European countries. Public Health Nutr. 2008;11(12):1256–66.
Soriguer F, Rojo-Martínez G, Esteva de Antonio I, Ruiz de Adana MS, Catalá M, Merelo MJ, et al. Prevalence of obesity in south-east Spain and its relation with social and health factors. Eur J Epidemiol. 2004;19(1):33–40.
Sotillo C, López-Jurado M, Aranda P, López-Frías M, Sánchez C, Llopis J. Body composition in an adult population in southern Spain: influence of lifestyle factors. Int J Vitam Nutr Res. 2007;77(6):406–14.
Tur JA, Serra-Majem L, Romaguera D, Pons A. Profile of Overweight and Obese People in a Mediterranean Region. Obes Res. 2005;13(3):527–36.
Vioque J, Torres A, Quiles J. Time spent watching television, sleep duration and obesity in adults living in Valencia, Spain. Int J Obes Relat Metab Disord. 2000;24(12):1683–8.
Ortiz-Moncada R, Alvarez-Dardet C, Miralles-Bueno JJ, Ruíz-Cantero MT, Dal Re-Saavedra MA, Villar-Villalba C, et al. [Social determinants of overweight and obesity in Spain in 2006]. Med Clin (Barc). 2011;137(15):678–84.
Gutiérrez-Fisac JL, Guallar-Castillon P, León-Muñoz LM, Graciani A, Banegas JR, Rodríguez-Artalejo F. Prevalence of general and abdominal obesity in the adult population of Spain, 2008-2010: the ENRICA study. Obes Rev. 2012;13(4):388–92.
Gutiérrez-Fisac JL, Regidor E, Banegas Banegas JR, Rodríguez Artalejo F. The size of obesity differences associated with educational level in Spain, 1987 and 1995/97. J Epidemiol Community Health. 2002;56(6):457–60.
Molarius A, Seidell JC, Sans S, Tuomilehto J, Kuulasmaa K. Educational level, relative body weight, and changes in their association over 10 years: an international perspective from the WHO MONICA Project. Am J Public Health. 2000;90(8):1260–8.
Roskam A-JR, Kunst AE, Van Oyen H, Demarest S, Klumbiene J, Regidor E, et al. Comparative appraisal of educational inequalities in overweight and obesity among adults in 19 European countries. Int J Epidemiol. 2010;39(2):392–404.
García-Alvarez A, Serra-Majem L, Ribas-Barba L, Castell C, Foz M, Uauy R, et al. Obesity and overweight trends in Catalonia, Spain (1992-2003): Gender and socio-economic determinants. Public Health Nutr. 2007;10(11A):1368–78.
McLaren L. Socioeconomic status and obesity. Epidemiol Rev. 2007;29:29–48.
Ziraba AK, Fotso JC, Ochako R. Overweight and obesity in urban Africa: A problem of the rich or the poor? BMC Public Health. 2009;9:465.
Jacoby E, Goldstein J, López A, Núñez E, López T . Social class, family, and life-style factors associated with overweight and obesity among adults in Peruvian cities. Prev Med. 2003;37(5):396–405.
Boissonnet C, Schargrodsky H, Pellegrini F, Macchia A, Marcet Champagne B, Wilson E, et al. Educational inequalities in obesity, abdominal obesity, and metabolic syndrome in seven Latin American cities: the CARMELA Study.Eur J Cardiovasc Prev Rehabil. 2011;18(4):550–6.
Linetzky B, De Maio F, Ferrante D, Konfino J, Boissonnet C. Sex-stratified socio-economic gradients in physical inactivity, obesity, and diabetes: evidence of short-term changes in Argentina. Int J Public Health. 2013;58(2):277-84.
Marques-Vidal P, Paccaud F, Ravasco P. Ten-year trends in overweight and obesity in the adult Portuguese population, 1995 to 2005. BMC Public Health. 2011;11:772.
Jones-Smith JC, Gordon-Larsen P, Siddiqi A, Popkin BM. Emerging disparities in overweight by educational attainment in Chinese adults (1989-2006). Int J Obes (Lond). 2012;36(6):866–75.
Monteiro CA, Moura EC, Conde WL, Popkin BM. Socioeconomic status and obesity in adult populations of developing countries: a review. Bull. World Health Organ. 2004;82(12):940–6.
Gortmaker SL, Must A, Perrin JM, Sobol AM, Dietz WH. Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med. 1993;329(14):1008–12.
Yu Y. Educational differences in obesity in the United States: a closer look at the trends. Obesity (Silver Spring). 2012;20(4):904–8.
Buttenheim A, Goldman N, Pebley AR, Wong R, Chung C. Do Mexican immigrants “import” social gradients in health to the US? Soc Sci Med. 2010;71(7):1268–76.
This journal 