Social Inequalities in Obesity Persist in the Nordic Region Despite Its Relative Affluence and Equity

Abstract

Social inequalities in overweight and obesity (OWOB) have persisted in the affluent and reputedly egalitarian Nordic countries. In this review we examine associations between socioeconomic position (SEP) and OWOB, and secular trends in such associations. Determinants and possible causes of the relations are discussed together with opportunities to cope with OWOB as a public health problem. The findings show a persisting inverse social gradient. An interaction between SEP and gender is noted for adults in Denmark, Finland and Iceland and for children in Sweden. There are overall tendencies for increased inequality, however no consistent trend for an increased social gradient in OWOB. Reasons that increased inequality does not unequivocally mirror in a steepened social gradient in obesity may include methodological questions as well as societal efforts to counteract obesity. Multi-level efforts are needed to prevent OWOB.

Keywords: Adolescents; Adults; BMI; Children; Denmark; Education; Egalitarian; Finland; Gender; Gini coefficient; Iceland; Income; Inequality; Nordic countries; Nordic region; Norway; Obesity; Obesogenic; Occupation; Overweight; Secular trends; Social gradient; Social inequalities; Socioeconomic position; Socioeconomic status; Sweden.

Fig. 1

Prevalence of overweight in 38- and 50-year-old women from the Population Study of Women in Gothenburg, Sweden from 1968/69 to 2004/5. There was no interaction between time and education in relation to overweight

Fig. 2

a (women) and b (men) The proportion of men and women from the greater Copenhagen area, who in the years between 1978 and 2006 had a BMI above 25 kg/m. (With permission from: Jensen HN GC, Jørgensen T. Udvikling i risikofaktorer for hjerte-karsygdom i Vestegnskommunerne 1978–2006. s. 31. Glostrup, Danmark 2008) [26]. After 1983, participants were divided into three categories based on the duration of their vocational training. Before 1983 it was not possible to differentiate the length of the vocational training, and they were categorized with or without vocational training, only

Fig. 3

a (men) and b (women) Data from 25- to 64-year-old participants of the national FINRISK surveys, Finland. The prevalence of obesity (BMI >30 kg/m²) decreased systemically with increasing level of education both in men and women [34]

Fig. 4

a Age-adjusted prevalence of obesity (BMI ≥30 kg/m²) by educational level in men 30–69 years from three surveys (1984–86, 1995–97, and 2006–8) of the HUNT study, Norway [••]. b Age-adjusted prevalence of obesity (BMI ≥30 kg/m²) by educational level in women 30–69 years from three surveys (1984–86, 1995–97, and 2006–8) of the HUNT study, Norway [••]

Fig. 5

a and b Trends in prevalence of overweight and obesity for 16- to 20-year-old Icelandic adolescents by gender and parental level of education in 1992, 2004, 2007, and 2010. Adolescents with low-educated mothers were consistently overrepresented among those with OWOB across four survey years. The gradient OWOB between the high- and low-educated subgroups increased over time. (With permission from: Eidsdottir S, Kristjansson A, Sigfusdottir ID, Garber CE, Allegrante JP. Secular trends in overweight and obesity among Icelandic adolescents: do parental education levels and family structure play a part? Scandinavian journal of public health. 2013;41(4):384–91) [••]