Abstract
Objective: The goal of this study was to examine use of weight control strategies in Canadian adults and the role of income as a barrier to using these strategies.
Methods: Data from the Canadian Community Health Survey cycle 4.1 on health behaviour change was used for this study. Analysis was restricted to adults (18+ years) residing in the 10 provinces of Canada. Respondents were categorized as having used weight control strategies in their lifestyle if they responded that they increased exercise, improved/modified their eating habits, or lost weight in the previous 12 months, as the primary means of health improvement. An adjusted household income ratio divided into deciles was used as a measure of income. Multivariable logistic regression was used to examine the relationship between income and weight control strategies adjusting for known confounders.
Results: Of the 103,990 respondents analyzed, 60% were overweight or obese and 45% reported using weight control strategies in the previous 12 months. Age, sex, ethnicity, having a regular doctor, education, and income were all significantly associated with using weight control strategies in the multivariable model. Results that included all two- and three-way interactions between sex, weight category, and income found that lower income was significantly associated with using fewer weight control strategies - more so for obese men and normal weight women.
Conclusion: Efforts must be made to create equal access to services and food products that promote weight reduction or control strategies given the rising prevalence of adult obesity in Canada.
Key words: Income, weight control, barrier, Canada, adults, survey
Résumé
Objectif: Examiner l’utilisation des stratégies de contrôle du poids chez les adultes canadiens et le rôle du revenu comme obstacle à l’utilisation de ces stratégies.
Méthode: Pour cette étude nous avons utilisé les données sur le changement des habitudes de santé du cycle 4.1 de l’Enquête sur la santé dans les collectivités canadiennes. Notre analyse s’est limitée aux adultes (18 ans et plus) résidant dans les 10 provinces du Canada. Les répondants ont été catégorisés comme ayant utilisé des stratégies de contrôle du poids dans leur mode de vie s’ils disaient avoir augmenté leur niveau d’activité physique, amélioré ou modifié leurs habitudes alimentaires ou perdu du poids au cours des 12 mois précédents comme principal moyen d’améliorer leur santé. Nous avons choisi comme indicateur du revenu un ratio de revenu du ménage ajusté divisé en déciles. Par régression logistique multivariée, nous avons examiné la relation entre le revenu et les stratégies de contrôle du poids en tenant compte des facteurs confusionnels connus.
Résultats: Sur les 103 990 répondants analysés, 60 % étaient en surpoids ou obèses et 45 % ont déclaré avoir utilisé des stratégies de contrôle du poids au cours des 12 mois précédents. L’âge, le sexe, l’ethnicité, le fait d’avoir un médecin régulier, la scolarité et le revenu présentaient tous une corrélation significative avec l’utilisation de stratégies de contrôle du poids dans le modèle multivarié. Selon les résultats incluant toutes les interactions possibles entre le sexe, la catégorie de poids et le revenu, un revenu inférieur présentait une corrélation significative avec l’utilisation d’un moins grand nombre de stratégies de contrôle du poids - davantage encore chez les hommes obèses et les femmes de poids normal.
Conclusion: Étant donné la prévalence croissante de l’obésité à l’âge adulte au Canada, il faut s’efforcer d’assurer un accès égal aux services et aux produits alimentaires qui favorisent les stratégies de réduction ou de contrôle du poids.
Mots clés: revenu, contrôle du poids, obstacle, Canada, adulte, enquête
Footnotes
Conflict of Interest: None to declare.
References
- 1.James WP. The epidemiology of obesity: The size of the problem. J Intern Med. 2008;2634:336–52. doi: 10.1111/j.1365-2796.2008.01922.x. [DOI] [PubMed] [Google Scholar]
- 2.World Health Organization. Obesity and overweight fact sheet. Available at: http://www.who.int/mediacentre/factsheets/fs311/en/index.html (Accessed July 10, 2012).
- 3.Tjepkema M. Adult obesity. Health Rep. 2006;17:9–25. [PubMed] [Google Scholar]
- 4.Kant AK, Graubard BI. Secular trends in patterns of self-reported food consumption of adult Americans: NHANES 1971–75 to NHANES 1999–2002. Am J Clin Nutr. 2006;845:1215–23. doi: 10.1093/ajcn/84.5.1215. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Berkey CS, Rockett HRH, Gillman MW, Colditz GA. One-year changes in activity and in inactivity among 10- to 15-year-old boys and girls: Relationship to change in body mass index. Pediatrics. 2003;1114:836–43. doi: 10.1542/peds.111.4.836. [DOI] [PubMed] [Google Scholar]
- 6.Knowler WC, Barrett-Connor F, Fowler SF, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;3466:393–403. doi: 10.1056/NEJMoa012512. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Eilat-Adar S, Eldar M, Goldbourt U. Association of intentional changes in body weight with coronary heart disease event rates in overweight subjects who have an additional coronary risk factor. Am J Epidemiol. 2005;161:352–58. doi: 10.1093/aje/kwi045. [DOI] [PubMed] [Google Scholar]
- 8.Tsai AG, Wadden TA. Systematic review: An evaluation of major commercial weight loss programs in the United States. Ann Intern Med. 2005;1421:56–66. doi: 10.7326/0003-4819-142-1-200501040-00012. [DOI] [PubMed] [Google Scholar]
- 9.Tuah NA, Amiel C, Qureshi S, Car J, Kaur B, Majeed A. Transtheoretical model for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev 2011;10:CD008066. [DOI] [PubMed]
- 10.Kruger J, Galuska DA, Serdula MK, Jones DA. Attempting to lose weight: Specific practices among US adults. Am J Prev Med. 2004;265:402–6. doi: 10.1016/j.amepre.2004.02.001. [DOI] [PubMed] [Google Scholar]
- 11.Klarenbach S, Padwal R, Wiebe N, Hazel M, Birch D, Manns B, et al. Bariatric surgery for severe obesity: Systematic review and economic evaluation. Ottawa, ON: Canadian Agency for Drugs and Technologies in Health; 2010. [Google Scholar]
- 12.Chinn DJ, White M, Harland J, Drinkwater C, Raybould S. Barriers to physical activity and socioeconomic position: Implications for health promotion. J Epidemiol Community Health. 1999;533:191–92. doi: 10.1136/jech.53.3.191. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Gee ME, Bienek A, Campbell NR, Bancej CM, Robitaille C, Kaczorowski J, et al. Prevalence of, and barriers to, preventive lifestyle behaviors in hypertension (from a national survey of Canadians with hypertension) Am J Cardiol. 2012;1094:570–75. doi: 10.1016/j.amjcard.2011.09.051. [DOI] [PubMed] [Google Scholar]
- 14.Mauro M, Taylor V, Wharton S, Sharma AM. Barriers to obesity treatment. Eur J Intern Med. 2008;19:173–80. doi: 10.1016/j.ejim.2007.09.011. [DOI] [PubMed] [Google Scholar]
- 15.Ball K, Crawford D. Socioeconomic status and weight change in adults: A review. Soc Sci Med. 2005;60:1987–2010. doi: 10.1016/j.socscimed.2004.08.056. [DOI] [PubMed] [Google Scholar]
- 16.Oliver LN, Hayes MV. Effects of neighbourhood income on reported body mass index: An eight year longitudinal study of Canadian children. BMC Public Health. 2008;8:16. doi: 10.1186/1471-2458-8-16. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Lumeng JC, Appugliese D, Cabral HJ, Bradley RH, Zuckerman B. Neighborhood safety and overweight status in children. Arch Pediatr Adolesc Med. 2006;160:25–31. doi: 10.1001/archpedi.160.1.25. [DOI] [PubMed] [Google Scholar]
- 18.Bish CL, Blanck HM, Serdula MK, Marcus M, Kohl H 3, Khan LK. Diet and physical activity behaviors among Americans trying to lose weight: 2000 Behavioral Risk Factor Surveillance System. Obes Res. 2005;133:596–607. doi: 10.1038/oby.2005.64. [DOI] [PubMed] [Google Scholar]
- 19.Serdula MK, Mokdad AH, Williamson DF, Galuska DA, Mendlein JM, Heath GW. Prevalence of attempting weight loss and strategies for controlling weight. JAMA. 1999;28214:1353–58. doi: 10.1001/jama.282.14.1353. [DOI] [PubMed] [Google Scholar]
- 20.Withall J, Jago R, Cross J. Families’ and health professionals’ perceptions of influences on diet, activity and obesity in a low-income community. Health & Place. 2009;15:1078–85. doi: 10.1016/j.healthplace.2009.05.006. [DOI] [PubMed] [Google Scholar]
- 21.Lewis S, Thomas SL, Hyde J, Castle DJ, Komesaroff PA. A qualitative investigation of obese men’s experiences with their weight. Am J Health Behav. 2011;354:458–69. doi: 10.5993/ajhb.35.4.8. [DOI] [PubMed] [Google Scholar]
- 22.Statistics Canada. Canadian community health survey (CCHS) - annual component: User guide 2007–2008 microdata files. Ottawa: Statistics Canada; 2009. [Google Scholar]
- 23.Statistics Canada. Canadian community health survey (CCHS): 2008 (annual component) and 2007–2008 derived variable (DV) specifications master and share files. Ottawa: Statistics Canada; 2009. [Google Scholar]
- 24.World Health Organization. BMI classification. Available at: http://www.who.int/bmi/index.jsp?introPage=intro_3.html (Accessed July 10, 2012).
- 25.Shields M, Gorber SC, Janssen I, Tremblay MS. Bias in self-reported estimates of obesity in Canadian health surveys: An update on correction equations for adults. Health Rep. 2011;223:35–45. [PubMed] [Google Scholar]
- 26.Green KL, Cameron R, Polivy J, Cooper K, Liu L, Leiter L, et al. Weight dissatisfaction and weight loss attempts among Canadian adults. CMAJ. 1997;157(Suppl1):S17–S25. [PMC free article] [PubMed] [Google Scholar]
- 27.Ross R, Bradshaw AJ. The future of obesity reduction: Beyond weight loss. Nature Rev Endocrinol. 2009;56:319–25. doi: 10.1038/nrendo.2009.78. [DOI] [PubMed] [Google Scholar]
- 28.Wang Y, Chen X. How much of racial/ethnic disparities in dietary intakes, exercise, and weight status can be explained by nutrition- and health-related psychosocial factors and socioeconomic status among US adults? J Am Diet Assoc. 2011;11112:1904–11. doi: 10.1016/j.jada.2011.09.036. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Stevens J, McClain JE, Truesdale KP. Selection of measures in epidemiologic studies of the consequences of obesity. Int J Obesity. 2008;32:S60–S66. doi: 10.1038/ijo.2008.88. [DOI] [PubMed] [Google Scholar]
- 30.Sharma AM, Kushner RF. A proposed clinical staging system for obesity. Int J Obes. 2009;333:289–95. doi: 10.1038/ijo.2009.2. [DOI] [PubMed] [Google Scholar]