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. 2022;15(6):753-761.
doi: 10.1159/000527070. Epub 2022 Sep 15.

Long-Term Trends in Obesity Prevalence by Socio-Economic Group in Five European Countries and the USA: The Relevance of the Diffusion of Innovations Theory

Eva Kagenaar  1 , Wanda Monika Johanna Van Hemelrijck  1 , Anton E Kunst  2 , Fanny Janssen  1   3
Affiliations

Long-Term Trends in Obesity Prevalence by Socio-Economic Group in Five European Countries and the USA: The Relevance of the Diffusion of Innovations Theory

Eva Kagenaar et al. Obes Facts. 2022.

Abstract

Introduction: Cross-national comparison suggests that the timing of the obesity epidemic differs across socio-economic groups (SEGs). Similar to the smoking epidemic, these differences might be described by the diffusion of innovations theory, which states that health behaviours diffuse from higher to lower SEGs. However, the applicability of the diffusion of innovations theory to long-term time trends in obesity by SEG is unknown. We studied long-term trends in the obesity prevalence by SEG in England, France, Finland, Italy, Norway, and the USA and examined whether trends are described by the diffusion of innovations theory.

Methods: Obesity prevalence from 1978 to 2019 by educational level, sex, and age group (25+ years) from health surveys was harmonized, age-standardized, Loess-smoothed, and visualized. Prevalence rate differences were calculated, and segmented regression was performed to obtain annual percentage changes, which were compared over time and across SEGs.

Results: Obesity prevalence among lower educated groups has exceeded that of higher educated groups, except among American men, in all countries throughout the study period. A comparable increase across educational levels was observed until approximately 2000. Recently, obesity prevalence stagnated among higher educated groups in Finland, France, Italy, and Norway and lower educated groups in England and the USA.

Discussion: Recent trends in obesity prevalence by SEG are mostly in line with the diffusion of innovations theory; however, no diffusion from higher to lower SEGs at the start of the epidemic was found. The stagnation among higher SEGs but not lower SEGs suggests that the latter will likely experience the greatest future burden.

Keywords: Diffusion of innovations theory; Obesity trends; Socio-economic inequalities.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Loess-smoothed age-standardized prevalence (%) of obesity (BMI ≥30 kg/m2) in men and women in the six countries under study by educational attainment from 1978 to 2019.
See this image and copyright information in PMC

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