Socioeconomic differences in weight gain and determinants and consequencesof coronary risk factors

Background: The increasing prevalence of overweight and obesity is a major public health concern in many developed countries. Objective: We aimed to describe socioeconomic differences in change in body mass index (BMI; in kg/m(2)) from age 25 y, assess possible factors behind these differences, and study whether socioeconomic differences in a variet y of coronary risk factors can be accounted for by change in BMI. Design: The data come from a cohort study of London-based civil servants (W hitehall II), who participated in the first (1985-1988) and third (1991-199 3) phases of the study and were 35-55-y old at phase 1; altogether there we re 5507 men and 2466 women. Both study phases included a questionnaire and a screening examination. Results: In men and women, employment grade-the measure of socioeconomic st atus used in this cohort-was strongly related to BMI gain from age 25 y to phase 3 (25 y apart on average). The lower the grade the larger the gain in BMI. Adjustment for health behaviors reduced the grade differences in BMI gain by approximate to 20%. A substantial part of the grade differences in diastolic and systolic blood pressure and plasma triacylglycerol concentrat ions could be accounted for by BMI change from age 25 y. Conclusions: Grade differences in BMI change are evident, but many of the d eterminants of these differences remain unknown. If lower-status persons co ntinue to gain weight more rapidly than higher-status persons, overweight i s likely to be of growing importance as a pathway to social inequalities in ill health.