Wamala S P, Wolk A, Orth-Gomér K
Department of Public Health Sciences, Karolinska Institute, Huddinge, Sweden.
Prev Med. 1997 Sep-Oct;26(5 Pt 1):734-44. doi: 10.1006/pmed.1997.0199.
It has been previously demonstrated that obesity is common among women with low socioeconomic status (SES), but the factors accounting for this association are not well known. According to our hypothesis, low SES is associated with psychosocial stress, an unhealthy lifestyle, and reproductive history, which may increase the likelihood of women with low SES to be overweight or obese.
We examined overweight and obesity in relation to SES among 300 healthy women ages 30-65 years, who constitute the control group of the Stockholm Female Coronary Risk Study, a population-based case-control study of women with coronary heart disease. This control group was compared with a large population-based sample and found to be representative of healthy Swedish women ages 30-65 years. We used an aggregate of education and occupation as a measure of SES and defined overweight as body mass index (BMI) between 23.8 and 28.6 kg/m2 and obesity as BMI > 28.6 kg/m2.
Low SES was a strong determinant of overweight and obesity among middle-aged healthy Swedish women. The odds of being overweight or obese increased with lower social position. After adjustment for age, the odds ratios for overweight and obesity among women in a low vs high position were 2.2 [95% confidence interval (CI) 1.1 to 4.4) and 2.7 (95% CI 1.1 to 6.7), respectively. Both low social position and obesity were related to reproductive history (higher parity and earlier age at menarche), unhealthy dietary habits, and unfavorable psychosocial factors (poor quality of life, low self-esteem, and job strain). These factors together explained 53% of the low-SES-obesity association.
Reproductive history, unhealthy dietary habits, and psychosocial stress accounted for a large part of the association between low SES and obesity. Dietary habits and psychosocial stress are potentially modifiable factors, which should be taken into account in intervention programs among women with low SES.
先前已有研究表明，社会经济地位（SES）较低的女性中肥胖现象较为普遍，但导致这种关联的因素尚不明确。根据我们的假设，低社会经济地位与心理社会压力、不健康的生活方式及生育史相关，这些因素可能会增加社会经济地位较低的女性超重或肥胖的可能性。
我们在300名年龄在30 - 65岁的健康女性中研究了超重和肥胖与社会经济地位的关系，这些女性构成了斯德哥尔摩女性冠心病风险研究的对照组，该研究是一项基于人群的冠心病女性病例对照研究。将这个对照组与一个基于人群的大样本进行比较，发现其代表了年龄在30 - 65岁的健康瑞典女性。我们用教育程度和职业的综合指标作为社会经济地位的衡量标准，并将超重定义为体重指数（BMI）在23.8至28.6千克/平方米之间，肥胖定义为BMI大于28.6千克/平方米。
低社会经济地位是中年健康瑞典女性超重和肥胖的一个重要决定因素。社会地位越低，超重或肥胖的几率越高。在调整年龄后，低社会地位与高社会地位女性中超重和肥胖的比值比分别为2.2 [95%置信区间（CI）1.1至4.4] 和2.7（95% CI 1.1至6.7）。低社会地位和肥胖都与生育史（多胎及初潮年龄较早）、不健康的饮食习惯以及不良的心理社会因素（生活质量差、自尊心低和工作压力大）有关。这些因素共同解释了低社会经济地位与肥胖关联的53%。
生育史、不健康的饮食习惯和心理社会压力在很大程度上解释了低社会经济地位与肥胖之间的关联。饮食习惯和心理社会压力是潜在的可改变因素，在针对社会经济地位较低女性的干预项目中应予以考虑。
