Background: The prevalence of excess weight has been increasing globally in the last decades, affecting disproportionally adults from low socio-economic backgrounds. The associated increased risk of chronic disease and loss of productivity puts undue pressure on health systems and societal resources. In England, tackling unfair and unjust health inequalities is at the heart of national public health policy and a prerequisite for enabling these decision makers to set policy priorities is an understanding of the prevalence of excess weight inequalities in their local population. Just as important is to understand how individual and socio-economic factors contribute to inequality across the excess weight spectrum to enable tailored inequity-curbing policy design.
Methods: We conducted both pooled (England) and regional-level (nine regions: North-East, North-West, Yorkshire and Humber, East Midlands, West Midlands, East of England, London, South East and South West) analyses of individual level data from a nationally representative sample of adults. We used concentration indices to measure relative inequalities in excess weight across three dimensions of socio-economic deprivation: neighbourhood-level deprivation, occupational status and educational qualification. We used a Shapley decomposition method to evaluate their relative contribution to inequality.
Results: At a national level, all three dimensions of socio-economic deprivation were found to be positively associated with excess weight across the adult population, with educational qualification ranking first [CCI: 0.066 (0.009)], closely followed by neighbourhood-level deprivation [CCI: 0.054 (0.008)]. Large variation was found between regions and genders, with inequality being either considerably higher or exclusively patterned among women. The strongest independent factor contributing to excess weight inequalities was having a long-lasting limiting illness, especially among women and towards the right tail of the excess weight spectrum. Heterogeneous patterns of contribution across the excess weight spectrum were found, however age played a dominant role toward the left tail of the distribution.
Conclusions: While socio-economic inequalities in excess weight exist in the English adult population, careful consideration as to which dimensions of deprivation and contributing factors to target in policy making is needed to avoid a widening of inequalities in excess weight, and therefore resulting population health and well-being.
What will audience learn from your presentation?
Different dimensions of socio-economic deprivation independently pattern excess weight in adults.
Large variation in the prevalence of these inequalities exists between regions and genders.
Long-lasting illness is the strongest independent factor contributing to these inequalities.
What contributes to excess weight inequality differs across the excess weight spectrum.