Netherlands Interdisciplinary Demographic Institute-KNAW/University of Groningen, The Hague, The Netherlands.
Department of Public and Occupational Health, Amsterdam UMC - University of Amsterdam, Amsterdam, The Netherlands.
Obes Facts. 2022;15(6):753-761. doi: 10.1159/000527070. Epub 2022 Sep 15.
Cross-national comparison suggests that the timing of the obesity epidemic differs across socio-economic groups (SEGs). Similar to the smoking epidemic, these differences might be described by the diffusion of innovations theory, which states that health behaviours diffuse from higher to lower SEGs. However, the applicability of the diffusion of innovations theory to long-term time trends in obesity by SEG is unknown. We studied long-term trends in the obesity prevalence by SEG in England, France, Finland, Italy, Norway, and the USA and examined whether trends are described by the diffusion of innovations theory.
Obesity prevalence from 1978 to 2019 by educational level, sex, and age group (25+ years) from health surveys was harmonized, age-standardized, Loess-smoothed, and visualized. Prevalence rate differences were calculated, and segmented regression was performed to obtain annual percentage changes, which were compared over time and across SEGs.
Obesity prevalence among lower educated groups has exceeded that of higher educated groups, except among American men, in all countries throughout the study period. A comparable increase across educational levels was observed until approximately 2000. Recently, obesity prevalence stagnated among higher educated groups in Finland, France, Italy, and Norway and lower educated groups in England and the USA.
Recent trends in obesity prevalence by SEG are mostly in line with the diffusion of innovations theory; however, no diffusion from higher to lower SEGs at the start of the epidemic was found. The stagnation among higher SEGs but not lower SEGs suggests that the latter will likely experience the greatest future burden.
跨国比较表明，肥胖症的流行在社会经济群体（SEG）之间存在时间差异。与吸烟流行类似，这些差异可以用创新扩散理论来描述，该理论指出健康行为从高 SEG 向低 SEG 扩散。然而，创新扩散理论对 SEG 中肥胖长期时间趋势的适用性尚不清楚。我们研究了英国、法国、芬兰、意大利、挪威和美国 SEG 中肥胖流行的长期趋势，并检查了这些趋势是否符合创新扩散理论。
使用健康调查中按教育程度、性别和年龄组（25 岁以上）划分的 1978 年至 2019 年的肥胖流行率数据，对其进行了协调、年龄标准化、Loess 平滑处理和可视化。计算了流行率差异，并进行分段回归以获得年百分比变化，然后比较了随时间和 SEG 的变化。
在整个研究期间，除了美国男性外，所有国家中受教育程度较低的群体的肥胖流行率都超过了受教育程度较高的群体。在大约 2000 年之前，各教育水平之间的肥胖流行率呈可比增加趋势。最近，芬兰、法国、意大利和挪威的高 SEG 中肥胖流行率停滞不前，而英国和美国的低 SEG 中肥胖流行率也停滞不前。
SEG 中最近肥胖流行率的趋势与创新扩散理论基本一致；然而，在流行初期并未发现从高 SEG 向低 SEG 的扩散。高 SEG 中肥胖流行率的停滞不前而低 SEG 中肥胖流行率的停滞不前表明，后者可能会面临更大的未来负担。
