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A population perspective on obesity prevention: lessons learned from Sweden and the U.S.
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Obesity prevalences are increasing in Sweden and the US. Obesity has many health consequences and health risks are associated with small increases in weight and marked obesity. Cross-sectional and panel surveys from northern Sweden and upstate NY provide the basis for furthering understanding of body mass index (BMI) development. BMI and weight change (+/-3%) were used to evaluate obesity and weight loss, maintenance, or gain. The 1989 prevalences of obesity were 9.6% and 21.3% in Sweden and the US; 1999 prevalences were 18.4% and 32.3%. Ten-year incidences (1989-1999) of overweight and obesity were 337/1000 and 120/1000 for Sweden and 336/1000 and 173/1000 for the US. Cross-sectional data suggest obesity is a problem of older age while panel data show that the young are gaining weight most rapidly. Individual changes in BMI have similar trends for Sweden and the US; the majority of adults are gaining weight. Older age, being a woman, higher BMI, and type 2 diabetes were associated with higher odds of weight non-gain. Younger age, being a man, being married and using snuff (snus) increased the odds of weight gain. The obese were 2-7 times more likely to report self-rated poor health. Healthy behaviours explain more of the person-to-person variability in BMI than do unhealthy behaviours or chronic diseases. Encouraging trends were found among Västerbotten Intervention Programme participants: a higher proportion of adults maintained weight in more recent survey years. The proportion of weight-gaining adults with identified health risk factors is smaller than those without risk factors. Frequently weight maintenance is felt to be important only for those identified as having a problem with weight or an obesity-related health condition. The largest proportion of those gaining weight are those with a normal BMI. Obesity prevention should target those usually considered low-risk (young, without cardiovascular risk factors, normal BMI).

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin , 2006. , 75 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1050
Keyword [en]
Public health, body weight changes, body mass index, cross-sectional studies, health behavior, health surveys, New York/epidemiology, obesity, rural health, self-rated health, Sweden/epidemiology, United States/epidemiology
Keyword [sv]
Folkhälsomedicin
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-893ISBN: 91-7264-163-0 (print)OAI: oai:DiVA.org:umu-893DiVA: diva2:144930
Public defence
2006-11-02, 135, Byggnad 9A, Norrlands universitetssjukhus, Umea, 09:00 (English)
Opponent
Supervisors
Available from: 2006-10-12 Created: 2006-10-12 Last updated: 2009-10-20Bibliographically approved
List of papers
1. High obesity incidence in northern Sweden: how will Sweden look by 2009?
Open this publication in new window or tab >>High obesity incidence in northern Sweden: how will Sweden look by 2009?
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2006 (English)In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 21, no 5, 377-382 p.Article in journal (Refereed) Published
Abstract [en]

The study objective was to evaluate the incidence of overweight and obesity in two rural areas of Sweden and the U.S. Previously collected data were used from 1990 to 1999 Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) studies in northern Sweden. Health censuses of adults in Otsego County, New York were collected in 1989 and 1999. Adults aged 25-64 year in 1989 with reports from both surveys were included. The 10-year change in body mass index (BMI), overweight (BMI 25-29.9 kg/m2) and obesity (BMI>or=30) were obtained from panel studies. Incidences of overweight and obesity were calculated and compared between countries. The 10-year incidence of obesity was 120/1000 in Sweden and 173/1000 in the U.S. (p<0.001 for difference between countries). In 1999, prevalence of obesity rose to 18.4% (Sweden) and 32.3% (U.S.). Cumulative distribution curves show that the BMI distribution in Sweden during 1999 is nearly identical to the U.S. during 1989. The obese proportions of these rural populations increased from 1989 to 1999. Sweden's obesity epidemic has a progression similar to that of the U.S., implying that by 2009, the prevalence of obesity in rural northern Sweden may mimic that present in rural New York during 1999. Attention should be paid to the increased obesity rates in rural areas.

Identifiers
urn:nbn:se:umu:diva-16144 (URN)doi:10.1007/s10654-006-9001-5 (DOI)16763883 (PubMedID)
Available from: 2007-08-28 Created: 2007-08-28 Last updated: 2017-12-14Bibliographically approved
2. Newly Diagnosed Type 2 Diabetics Have the Lowest Body Mass Index Change among Rural Populations of Sweden and the United States.
Open this publication in new window or tab >>Newly Diagnosed Type 2 Diabetics Have the Lowest Body Mass Index Change among Rural Populations of Sweden and the United States.
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2006 (English)In: The Internet journal of health, ISSN 1528-8315, Vol. 5, no 1Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-5418 (URN)
Available from: 2006-10-12 Created: 2006-10-12 Last updated: 2011-08-24Bibliographically approved
3. Who is maintaining weight in a middle-aged population in Sweden? A longitudinal analysis over 10 years.
Open this publication in new window or tab >>Who is maintaining weight in a middle-aged population in Sweden? A longitudinal analysis over 10 years.
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2007 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 7, 108- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Obesity has primarily been addressed with interventions to promote weight loss and these have been largely unsuccessful. Primary prevention of obesity through support of weight maintenance may be a preferable strategy although to date this has not been the main focus of public health interventions. The aim of this study is to characterize who is not gaining weight during a 10 year period in Sweden.

METHODS: Cross-sectional and longitudinal studies were conducted in adults aged 30, 40, 50 and 60 years during the Västerbotten Intervention Programme in Sweden. Height, weight, demographics and selected cardiovascular risk factors were collected on each participant. Prevalences of obesity were calculated for the 40, 50 and 60 year olds from the cross-sectional studies between 1990 and 2004. In the longitudinal study, 10-year non-gain (lost weight or maintained body weight within 3% of baseline weight) or weight gain (&gt; or = 3%) was calculated for individuals aged 30, 40, or 50 years at baseline. A multivariate logistic regression model was built to predict weight non-gain.

RESULTS: There were 82,927 adults included in the cross-sectional studies which had an average annual participation rate of 63%. Prevalence of obesity [body mass index (BMI) in kg/m2 &gt; or = 30] increased from 9.4% in 1990 to 17.5% in 2004, and 60 year olds had the highest prevalence of obesity. 14,867 adults with a BMI of 18.5-29.9 at baseline participated in the longitudinal surveys which had a participation rate of 74%. 5242 adults (35.3%) were categorized as non-gainers. Older age, being female, classified as overweight by baseline BMI, later survey year, baseline diagnosis of diabetes, and lack of snuff use increased the chances of not gaining weight.

CONCLUSION: Educational efforts should be broadened to include those adults who are usually considered to be at low risk for weight gain--younger individuals, those of normal body weight, and those without health conditions (e.g. diabetes type 2) and cardiovascular risk factors--as these are the individuals who are least likely to maintain their body weight over a 10 year period. The importance of focusing obesity prevention efforts on such individuals has not been widely recognized.

Keyword
Adult, Age Distribution, Analysis of Variance, Body Composition, Body Mass Index, Body Weight, Cross-Sectional Studies, Exercise, Female, Health Education/*organization & administration, Humans, Incidence, Life Style, Logistic Models, Longitudinal Studies, Male, Middle Aged, Multivariate Analysis, Obesity/*epidemiology/*prevention & control, Patient Participation, Primary Prevention/organization & administration, Retrospective Studies, Risk Factors, Sex Distribution, Sweden/epidemiology
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-16213 (URN)10.1186/1471-2458-7-108 (DOI)17565692 (PubMedID)
Available from: 2007-08-31 Created: 2007-08-31 Last updated: 2017-12-14Bibliographically approved
4. Cardiovascular risk factor burden has a stronger association with self-rated poor health in adults in the US than in Sweden, especially for the lower educated.
Open this publication in new window or tab >>Cardiovascular risk factor burden has a stronger association with self-rated poor health in adults in the US than in Sweden, especially for the lower educated.
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2006 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 34, no 2, 140-149 p.Article in journal (Refereed) Published
Abstract [en]

Background: There is an ongoing debate about the importance of biomedical and sociodemographic risk factors in the prediction of self-rated health. Objectives: To compare the association of sociodemographic and cardiovascular risk factors and self-rated health in Sweden and the US. Design: Data from two population-based cross-sectional health surveys, one in Sweden and one in the US. Subjects: The surveys included questionnaire and measured data from 5,461 adults in Sweden and 7,643 in the US. Participants were between 35 and 65 years of age. Results: The odds ratios for poor self-rated health for the included cardiovascular risk factors were greater in the US. Low education was significantly more prevalent among those with self-rated poor health in the US, but not in Sweden. Using Swedes with high education as reference group (OR51), adults in the US with low education and 2+ risk factors had a greater than threefold risk (OR56.3) of self-rated poor health compared with Swedish low-educated adults with the same risk factor burden (OR51.9). The better-educated US adults with 2+ risk factors were significantly more likely to report poor health (OR53.4) compared with their Swedish counterparts (OR52.4). Conclusions: The interaction between risk factors, education, and self-rated health suggests a frightening picture, especially for the US. Public health interventions for reducing cardiovascular risk factors need to include both population and individual measures. Taking people’s overall evaluation of their health into account when assessing total health risk is important.

Keyword
Adult, Aged, Cardiovascular Diseases/epidemiology/*etiology, Cross-Sectional Studies, Educational Status, Female, Health Surveys, Humans, Life Style, Male, Middle Aged, Questionnaires, Risk Assessment/methods, Risk Factors, Self Concept, Socioeconomic Factors, Sweden/epidemiology, United States/epidemiology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-14127 (URN)10.1080/14034940510032365 (DOI)16581706 (PubMedID)
Available from: 2007-05-23 Created: 2007-05-23 Last updated: 2017-12-14Bibliographically approved
5. Design Issues in the Combination of International Data from Two Rural Community Cardiovascular Intervention Programs.
Open this publication in new window or tab >>Design Issues in the Combination of International Data from Two Rural Community Cardiovascular Intervention Programs.
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2001 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 29, no suppl. 56, 33-39 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-5421 (URN)10.1080/140349401316898117 (DOI)11681561 (PubMedID)
Available from: 2006-10-12 Created: 2006-10-12 Last updated: 2017-12-14Bibliographically approved

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