The weight of place: A multilevel analysis of gender, neighborhood material deprivation, and body mass index among Canadian adults
Introduction
“Choices people make are important, but the nation has played the willpower and restraint cards for years and finds itself trumped again and again by an environment that overwhelms the resources of most people” (Brownell & Horgen, 2004, p. 5).
It has commonly been accepted in medical sociology and social epidemiology that women consistently have more health problems across the lifespan and that men have higher death rates. New research suggests that the direction and magnitude of sex differences in health depend on the health condition under investigation and on the stage of the life cycle (Macintyre, Hunt, & Sweeting, 1996). While there is acceptance of the importance of examining gender in the context of health, most studies merely adjust for the impact of gender, rather using gender as central explanatory variable (Verbrugge, 1989). In fact, studies that integrate structures of inequalities and gender differences in health are rare, especially those that examine whether gender differences vary by socioeconomic position (Macintyre & Hunt, 1997; Macintyre et al., 1996). The majority of studies on socioeconomic inequalities in morbidity and mortality data have been presented for both sexes combined (Kennedy, Kawachi, & Prothrow-Stith, 1996), for one sex only (Davey, Neaton, Wentworth, Stamler, & Stamler, 1998; Mobley et al., 2006) or for men and women separately without elucidation on whether the patterns are similar or different for men and women (Macintyre, 1993). Both gender and socioeconomic status (SES) structure opportunities and life chances, so it is important to examine how they interact and impact health.
The prevalence of overweight and obesity has been on the rise within the last 25 years in most of the developed world. In part, this increasing trend is due to changes in agriculture, transportation, and food technology. Biological preferences for energy-dense foods and innate taste for sweet, fatty, and salty foods are thought to be rooted in evolutionary benefits (Drewnowski & Specter, 2004). The combination of innate preference for such foods and technological advancements that have enabled widespread availability of low-cost, energy-dense foods is a recipe for increasing girth. Socioeconomic disparities have an impact on diet quality as measured by the Healthy Eating Index (HEI). In general, women tend to have higher HEI scores (better diet quality) than men; but this is not the case for low-SES women who report food insufficiency or insecurity. Studies have shown that food insecurity is associated with lower food expenditures, low fruit and vegetable consumption, and with lower-quality diets and has been linked to obesity, especially in low income women (Adams, Grummer-Strawn, & Chavez, 2003; Kennedy et al., 1996; Sarlio-Lahteenkorva & Lahelma, 2001; Townsend, Peerson, Love, Achterberg, & Murphy, 2001; Vozoris & Tarasuk, 2003).
Section snippets
Women, weight, and place
Multilevel studies examining the impact of neighborhood on health have found that neighborhood disadvantage is independently associated with individual-level body mass index (BMI), overweight, obesity, and coronary heart disease after adjusting for individual-level SES, other sociodemographic characteristics, and lifestyle factors (Cubbin et al., 2006 Cubbin, Sundquist, Ahlén, Johansson, Winkleby, & Sundquist, 2006; Diez-Roux et al., 2001; Ellaway, Anderson, & Macintyre, 1997).
A growing body of
Data sources
Two data sources, both collected by Statistics Canada, were used to investigate the association between neighborhood context and BMI. The Canadian Community Health Survey (CCHS) is a cross-sectional nationally representative survey that provides detailed information on health determinants and outcomes for individuals (see Beland, 2002 for detailed methodology). Two cycles of the CCHS (cycle 1.1 and cycle 2.1 collected in 2000–2001 and 2003–2004, respectively) were combined to create a large
Discussion
In many cases it is imperative that researchers specifically examine gender differences in health rather than assuming that health outcomes and their potential causes are the same for men and women. A growing body of research has shown that living in a neighborhood marked by material deprivation (area-level poverty or low SES) is associated with higher BMI scores relative to living in less disadvantage areas. Recent studies that have evaluated gender differences in BMI for those living in high
Conclusions
Our findings suggest that interventions that support healthy weight control may need to be gender responsive. A single intervention for the entire population may not prove effective. Our findings also suggest that what we traditionally have thought to be triggering factors for weight gain and maintenance of unhealthy BMI—lifestyle and behavioral factors—are not sufficient explanations. Indeed, these factors only account for a portion of the explanation of why neighborhood stress is associated
Acknowledgments
This research was funded by the Social Sciences and Humanities Research Council of Canada (Standard Research Grant # 410-2005-2306). The authors gratefully acknowledge the support of the Ontario Ministry of Health and Long-Term Care. The views expressed in this manuscript are the views of the authors and do not necessarily reflect the views of the Ontario Ministry of Health and Long-Term Care. We appreciate the thoughtful comments of the reviewers and the senior editor. Appreciation also is
References (67)
- et al.
Food insecurity is associated with increased risk of obesity in California women
Journal of Nutrition
(2003) - et al.
Income inequality and weight status in US metropolitan areas
Social Science & Medicine
(2005) - et al.
A lot of sacrifices: Work–family spillover and the food choice coping strategies of low-wage employed parents
Social Science & Medicine
(2006) - et al.
A multilevel analysis of income inequality and cardiovascular disease risk factors
Social Science & Medicine
(2000) - et al.
Poverty and obesity: The role of energy density and energy costs
American Journal of Clinical Nutrition
(2004) - et al.
Potential dieters: who are they?
Journal of the American Dietetic Association
(1970) - et al.
A regional comparison of socioeconomic and health indices in a Canadian province
Social Science & Medicine
(1996) - et al.
Sense of belonging and indicators of social and psychological functioning
Archives of Psychiatric Nursing
(1996) - et al.
Stress-related eating and drinking behavior and body mass index and predictors of this behavior
Preventive Medicine
(2002) - et al.
Gender differences in health: Are things really as simple as they seem?
Social Science & Medicine
(1996)
Urban neighborhoods, chronic stress, gender and depression
Social Science & Medicine
Supermarkets, other food stores, and obesity: The atherosclerosis risk in communities study
American Journal of Preventive Medicine
Neighborhood characteristics associated with the location of food stores and food service places
American Journal of Preventive Medicine
A multilevel analysis of race, community disadvantage, and body mass index among adults in the US
Social Science & Medicine
Food insecurity is associated with past and present economic disadvantage and body mass index
Journal of Nutrition
Food insecurity is positively related to overweight in women
Journal of Nutrition
Household food insufficiency is associated with poorer health
Journal of Nutrition
The sense of belonging to a neighbourhood: Can it be measured and is it related to health and well being in older women?
Social Science & Medicine
Eating disorders
The New England Journal of Medicine
Canadian community health survey—Methodological overview
Health Reports
Gender-specific disparities in obesity
Journal of Community Health
Are Canadian inner cities becoming more dissimilar? An Aaalysis of urban deprivation indicators
Urban Studies
Sitting time and work patterns as indicators of overweight and obesity in Australian adults
International Journal of Obesity
Food fight: The inside story of the food industry, America's obesity crisis, and what we can do about it
Sources of personal neighbor networks: Social integration
Social Forces
Neighborhood deprivation and cardiovascular disease risk factors: Protective and harmful effects
Scandinavian Journal of Public Health
Durkheim's theory of suicide as applied to the family: An empirical test
Social Forces
Mortality differences between black and white men in the USA: Contribution of income and other risk factors among men screened for the MRFIT
Lancet
Neighborhood of residence and incidence of coronary heart disease
The New England Journal of Medicine
Does area of residence affect body size and shape?
International Journal of Obesity and Related Metabolic Disorders
The life course of severe obesity: Does childhood overweight matter?
Journals of Gerontology Series B: Psychological Sciences and Social Sciences
How useful is body mass index for comparison of body fatness across age, sex, and ethnic groups?
American Journal of Epidemiology
Body mass index and health
Health Reports
Cited by (105)
Neighborhood deprivation and obesity: Sex-specific effects of cross-sectional, cumulative and residential trajectory indicators
2022, Social Science and MedicineInfluence of the urban context on the relationship between neighbourhood deprivation and obesity
2020, Social Science and MedicineNeighborhood deprivation, prefrontal morphology and neurocognition in late childhood to early adolescence
2020, NeuroImageCitation Excerpt :In recent years, seminal investigations have aimed to characterize phenomenologically distinct environmental influences on neurocognition during development (Farah et al., 2006; Laus et al., 2011; McLaughlin et al., 2014a; Noble et al., 2005; Pechtel and Pizzagalli, 2011; Sirin, 2005; Wu et al., 2015). Exposure to deprivation, defined as environments that do not provide needs or resources necessary for healthy development, has been identified as a critical environmental vulnerability factor (Cubbin and Winkleby, 2005; Jessop, 1992; Krishnadas et al., 2013; Matheson et al., 2008; McLaughlin et al., 2014b; Verhaeghe and Tampubolon, 2012). Animal and human studies on exposure to deprivation at the individual-level have yielded compelling evidence to its impact on both cognitive function and brain morphology (Akman et al., 2004; Beckett et al., 2006; Gee et al., 2013; Mackes et al., 2020; McLaughlin et al., 2014b; Mehta et al., 2009; Sheridan et al., 2012; Wiesel and Hubel, 1965).