Women carry the weight of deprivation on physical inactivity: Moderated mediation analyses in a European sample of adults over 50 Years of age.

Deprived people are less physically active than privileged individuals. However, pathways underlying the association between deprivation and physical activity remain overlooked. We examined whether the association between deprivation and physical activity was mediated by body mass index (BMI). Consistent with an intersectional perspective (how the combination of belongingness to vulnerable social categories widens inequalities), we tested whether gender moderated this mediating pathway and hypothesized that the mediating effect of BMI would be stronger among women (vs men). Large-scale longitudinal data from 20,961 adults 50 years of age or older (57% women) from the Survey of Health, Ageing and Retirement in Europe were used. Social and material deprivation were measured by questionnaire, BMI and physical activity were reported from two to six years later. Simple mediation models showed that BMI partly mediated the association of material (total effect  = -0.14, proportion of mediated effect = 8%) and of social deprivation ( = -0.24, proportion of mediated effect = 4%) with physical activity. Moderated mediation models revealed that this mediating pathway was moderated by gender. The effect of deprivation on BMI was stronger among women (vs men), with BMI mediating 18% and 7% of the association of material and social deprivation with physical activity among women (vs 4% and 2% among men). Lower levels of physical activity observed among deprived older adults could be partly attributed to a higher BMI. Critically, this mechanism was exacerbated among women, reinforcing the need to understand how deprivation and gender interact to predict health behaviors.