Department of Geography, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway.
Soc Sci Med. 2010 Apr;70(8):1194-202. doi: 10.1016/j.socscimed.2010.01.007. Epub 2010 Feb 12.
The global obesity epidemic is a major public health concern and there is strong evidence that the drivers are varied and operate via diverse pathways. Taking a systems approach allows the contextual influences operating upon the individual to be identified and quantified. We adopt such a perspective in this study, where longitudinal data from a cohort of 24,966 settled individuals participating in two major health surveys, the Nord-Trøndelag Health Study (HUNT 1 and 2) in the county of Nord-Trøndelag, Norway, were used to investigate associations between individual, family and area characteristics and two outcomes: body mass index (BMI) at follow-up and BMI change over an 11 year period. Linear multilevel models were fitted, with individuals nested in 17,500 families, 447 wards and 24 municipalities. A range of putative individual, family, and area predictors were tested. We found both outcomes were strongly associated with individual characteristics, with higher BMIs generally being amongst males, unmarried participants, non-smokers, those of lower education and those undertaking physically demanding work but participating in less physical activity outside work. The characteristics of those in the sample exhibiting higher BMI gain were rather similar except that women gained more and those with no employment income gained less. Contextual influences were also found to be important: although just 1% of the unexplained variance was located on the neighbourhood and municipality levels respectively, and hence suggesting small environmental influences, between 10 and 13% could be attributed to families, highlighting the importance of the familial contextual environment. Rather little is known about the manner by which family influences may operate on bodyweight hence further work is needed to understand likely mechanisms and guide future interventions.
全球肥胖症流行是一个主要的公共卫生关注点，有强有力的证据表明，导致肥胖的因素多种多样，并通过不同的途径起作用。采取系统方法可以识别和量化作用于个体的背景影响。在本研究中，我们采用了这种观点，利用来自挪威诺德兰特伦德拉格县的两个主要健康调查（HUNT1 和 HUNT2）的 24966 名定居个体的队列纵向数据，调查个体、家庭和地区特征与两个结果之间的关系：随访时的体重指数（BMI）和 11 年内 BMI 的变化。使用线性多层模型，将个体嵌套在 17500 个家庭、447 个区和 24 个市中。测试了一系列可能的个体、家庭和地区预测因素。我们发现这两个结果都与个体特征密切相关，一般来说，BMI 较高的是男性、未婚参与者、不吸烟者、受教育程度较低者以及从事体力劳动但工作外体力活动较少者。表现出较高 BMI 增长的样本特征相当相似，只是女性增长更多，没有就业收入的人增长更少。还发现背景影响也很重要：尽管分别只有 1%的未解释方差位于邻里和市一级，这表明环境影响较小，但有 10%至 13%可以归因于家庭，突出了家庭背景环境的重要性。关于家庭影响如何对体重起作用，人们知之甚少，因此需要进一步研究以了解可能的机制并指导未来的干预措施。
