DETERMINANTS OF OBESITY IN RELATION TO SOCIOECONOMIC-STATUS AMONG MIDDLE-AGED SWEDISH WOMEN

Background. It has been previously demonstrated that obesity is common among women with low socioeconomic status (SES), but the factors acco unting for this association are not well known. According to our hypot hesis, low SES is associated with psychosocial stress, an unhealthy li festyle, and reproductive history, which may increase the likelihood o f women with low SES to be overweight or obese. Methods. We examined o verweight and obesity in relation to SES among 300 healthy women ages 30-65 years, who constitute the control group of the Stockholm Female Coronary Risk Study, a population-based case-control study of women wi th coronary heart disease. This control group was compared with a larg e population-based sample and found to be representative of healthy Sw edish women ages 30-65 years. We used an aggregate of education and oc cupation as a measure of SES and defined overweight as body mass index (BMI) between 23.8 and 28.6 kg/m(2) and obesity as BMI > 28.6 kg/m(2) . Results. Low SES was a strong determinant of overweight and obesity among middle-aged healthy Swedish women. The odds of being overweight or obese increased with lower social position. After adjustment for ag e, the odds ratios for overweight and obesity among women in a low vs high position were 2.2 (95% confidence interval (CI) 1.1 to 4.4) and 2 .7 (95% CI 1.1 to 6.7), respectively. Both low social position and obe sity were related to reproductive history (higher parity and earlier a ge at menarche), unhealthy dietary habits, and unfavorable psychosocia l factors (poor quality of life, low self-esteem, and job strain). The se factors together explained 53% of the low-SES-obesity association. Conclusions. Reproductive history, unhealthy dietary habits, and psych osocial stress accounted for a large part of the association between l ow SES and obesity. Dietary habits and psychosocial stress are potenti ally modifiable factors, which should be taken into account in interve ntion programs among women with low SES. (C) 1997 Academic Press.