Educational attainment and obesity: a systematic review

Abstract

Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer-reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. The authors systematically review the peer-reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese and Spanish were included. This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the country's economic development level: an inverse association was more common in studies of higher-income countries and a positive association was more common in lower-income countries, with stronger social patterning among women. Relatively few studies reported on lower-income countries, controlled for a comprehensive set of potential confounding variables and/or attempted to assess causality through the use of quasi-experimental designs. Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention.

Keywords: Educational status; obesity; review; social class..

Figure 1

Flow chart of inclusion and exclusion of articles collected in systematic review.

Figure 2A

Articles from 91 countries (shaded) were included in this systematic review. Note: the following countries were represented by the following studies: Albania, Argentina^,, Australia^,,,-, Austria, Bahrain, Bangladesh, Belgium^,,,,,, Benin, Bolivia^,, Botswana, Brazil^,,,,, Burkina Faso^,, Cameroon, Canada^,-, Central African Republic, Chile^,, China^,,,, Colombia^,,,, Cote d'Ivoire, Croatia, Czech Republic^,, Denmark^,,,,-, Dominican Republic^,, Ecuador, Egypt, Estonia^,, Finland^,,,,,,,,-, France^,,-, Germany^,,,,, Ghana^,,, Greece^,,, Guatemala^,, Haiti^,, Honduras, Hungary, Iceland^,, India^,,, Iran^,,,,,-, Ireland^,, Israel, Italy^,,,, Jamaica, Japan, Jordan, Kazakhstan, Kenya^,, Kuwait^,, Kyrgyzstan, Latvia, Lithuania^,, Madagascar, Malawi^,, Malaysia, Mali, Mexico^,,,,,,,, Morocco^,,, Namibia, Netherlands^,,-, New Zealand, Niger^,, Nigeria^,, Norway^,,, Papua New Guinea, Peru^,,,, Poland^,-, Portugal^,,,,,, Russia^,,, Saudi Arabia^-, Senegal^,, Singapore, Slovakia, South Africa^,, South Korea^,, Spain^,,,,,,,,,,,-, Sri Lanka, Sweden^,,,,-, Switzerland^,,,,,, Tanzania^,, Thailand, Tunisia, Turkey^,-, Uganda, United Arab Emirates, United Kingdom^,,,,,-, United States^{,,,,,,,,,,,,-}, Uzbekistan, Venezuela, Vietnam^,,, Yugoslavia (at the time of the study), Zambia, Zimbabwe.

Figure 2B

Countries are shaded darker in proportion to how many articles in this systematic review included data from that country. Note: the number of data points for each country ranged from 0 to 76 (United States).

Figure 3

The countries represented by the highest quality analyses (n=55); countries shaded darker in proportion to number of high quality analyses. The number of studies each country represented had ranged from 1-6.