Year: 1 SSU: 1 Date: Mon 30/11/09 to Fri18/12/09 Student ID: 91022462

Word Count: 2,000

CONSIDERING ONLY ADULTS FROM DEVELOPED COUNTRIES, WHY DOES SOCIOECONOMIC CLASS
HAVE AN EFFECT ON OBESITY?

Abstract:

The reasons behind a link between socioeconomic status and obesity were
the main focus of this literature review. It was hypothesized that weight would
be determined by socioeconomic status (SES), but this paper considers why
SES could in fact be determined by weight. Using four indicators of SES;
education, area, income and occupation; their effects, and obesity’s effects on
them, were studied.

Introduction:

The increasing frequency of obesity across the world (WHO, 1998), coupled
with greater research into its effects on health (NHS, 2008, page 20), means
the continued monitoring of the socioeconomic patterning of weight is
becoming more important than ever.

Obesity is related to socioeconomic status. A review by Sobal and Stunkard

(1989) strongly proved an inverse relationship between SES and obesity
amongst women in developed societies. This means, women of higher SES
are less likely to be obese than those of lower SES. This hypothesis is still
given much backing today. However a new and different review is now
important. It is no longer necessary to study if a relationship between status
and weight exists; it is now necessary to study why these trends are
occurring. As pointed out by McLaren (2007), there are numerous ways of
determining social status. To me it is am embodiment of many different
factors (indicators), that of education, occupation, income and area for
example. You can class someone as being of high SES if, for instance, they
were of good education, or had a high income. When each of these different
indicators is applied to statistical tests regarding a relationship between status
and weight, different results are seen.
In this essay, I will not only be discussing which SES variable is most strongly
associated with body weight. I will also debate whether it is these different
indicators that are having an affect on obesity, and thus why SES group
affects obesity. Or, if it is in fact, obesity having an affect on these indicators
and thus if it is weight that determines SES. For consistency, throughout this
essay, obesity will be considered, as it is by the World Health Organization, as
a body mass index of greater than 30 kg/m2.

Method:

I reviewed many articles during research for this essay. Using the E-library’s
MetaLib, I found the search terms ‘socioeconomic’, ‘obesity’, ‘social class’,
‘income’, ‘education’, ‘employment’ and ‘occupation’ most useful for gathering
the relevant information. This provided a wide range of results and often I
would use two of the terms stated above together. Articles were excluded
where it could be established from the title and abstract that the paper did not
fulfill the chosen criteria. Furthermore, no article with a vested interest to lie
was included. On top of reviewing many articles, I also drew on personal
experience, putting in my own arguments where appropriate.

The relationship:

As stated, there is no longer much argument as to whether or not

socioeconomic status has an influence on obesity, particularly in women. As
put by Ball and Crawford (2004) during their study of 34 reviews in all, looking
for a relationship between socioeconomic status and weight gain, “study
findings show a relatively consistent inverse association between obesity and
SES”. This was a continuation of the work originally carried out by Sobal and
Stunkard (1989) and provided analogous conclusions to other similar studies
(Molarius et al., 2000), thus providing a form of reference and credibility.
However, the differential associations of obesity with different SES, not only
highlight the importance of the selection of a particular indicator, but also
provide insight into how the possible indicators may work.
Influence:

Tables 1-4 (available in appendices 1-4) show the impact of choosing certain
indicators of SES over others on the relationship with obesity. All tables
considered here are results of statistical tests being applied to many number
of reviews gathered surrounding this topic, and were carried out by their
authors in an attempt to see which indicator provided the most amount of
negative association. While tables 2,3 and 4 are from the same source, simply
showing different genders, information from these tables is in agreement with
the information in table 1 and 5 (available in appendix 5), which are from
different sources, providing credibility. Importantly negative associations were
most commonly seen with education (65%), occupation (59%), and area
(52%) as indicators of SES. This information implies that it is ones education
that is most influential in determining your likelihood of obesity, with area,
occupation and income being less influential as the list continues.

Socioeconomic status is therefore not really just about money, there are many
other factors. A useful theme in all these factors arises in work by Bourdieu
(1986). Bourdieu states in his theory of class, that “the body (inclusive of
appearance, style, and behavioural affinities) is a social metaphor for a
person’s status”. In other words, each person is an embodiment of his or her
social stature, an idea that Bourdieu calls ‘habitus’. Within this idea, every
person has ‘capital’, or attributes that can be economical, but also can be
cultural or social in nature. In other words, a thinner body may be more
popular and more materially viable in a society of higher socioeconomic
status, where even if it does not represent economic superiority, it is of
prestige as it is a capital that others do not possess. This idea is seen
throughout this essay.

Education:

Table 5 (appendix 5) shows that as educational qualifications increase, the

incidences of obesity decrease. Education can, rather crudely, be twinned
with aspiration. Academic qualifications, a form of ‘cultural capital’ (McLaren
2007), may imply expectations for other personal achievements. That is,
academic ambitions are usually combined with other senses of expectation,
whether of a general sense or specific to health and thus weight. This may be
because, the more someone is educated (a social norm nowadays), the more
they may be influenced by other societal standards, such as those of
attractiveness and health. Schools now portray messages regarding diet and
physical activity (K. Parmenter, J. Waller and J. Wardle, 2000). This means
more educated people may demonstrate significantly better nutrition
knowledge or at least be better at grasping written materials like newspaper
articles and leaflets, to gain information and implement it in their lifestyles. Yet
simply attending higher education is a recognition and pursuit of attributes that
are valued in developed societies, and these include health and a thin body,
creating a link that proves educations effect on obesity.

Area:

Continuing with Bourdieu’s theory of class, it is conceivable that living in a

prosperous area conveys heightened exposure to and pressure for thinness. If
some members of society are thin, possibly due to other indicators discussed
here, it not only becomes a social normality to be thin, it puts pressure on
other people who value themselves as of equal class to compete for the
‘capital’ that is a slender body. This builds on a new theory that obesity is
contagious. Kahmsi (2007) argues that, “if a friend of yours becomes obese,
you have a nearly 60% higher chance of sliding into this category as well”. It is
this idea of pressure again, and of maintaining your ‘habitus’ that comes into
play. While we must also consider that there are more opportunities for
physical activity and easier local access to healthy foods in certain areas. We
must also consider the other side of the argument, that there is also the
possibility that certain areas may be stereotypical of a particular SES group.
This would mean that your postcode has not affected your weight, but your
weight has affected postcode, as if an area contains a strong portion of
people in a high SES group (and thus thin people), then those of a lower SES
group (the more obese) may be reluctant to move there, preventing them from
reaching the upper echelons of society.
Income:

There are two ways of viewing this section. On the one hand, there is
evidence of an economic gradient in diet. Wealthier people may be thinner
simply due to the fact that they have more economic capacity to purchase
high energy, healthy foods that have been shown to be more expensive
(Adam Drewnowski and SE Specter, 2004). This unfortunate connection
between money and weight is accentuated by studies; for example, where
economists show that obese men and women receive a wage penalty (Baum
and Ford, 2004). This would mean that obese people could not afford the
more expensive foods that could perhaps make them thinner, and thus could
not be thin enough to avoid being penalized on wages.

On the other hand, if obese people are having their wages and thus income
penalized, then it is not the income having an affect on their obesity, but their
obesity having an affect on their income (Baum and Ruhm, 2009). A person
could be obese due to a number of other factors, with their income only being
lowered as a result of their obesity. Although this effect is not aided by the fact
that lower incomes cannot afford healthier foods, here obesity is affecting
income and not the other way round.

Occupation:

It is possible that people high in up in their occupation may already know the
symbolic value of a thin body and a healthy lifestyle (in line with their class),
due to other indicators discussed here. Yet, at the same time their exposure to
a workplace environment that promotes these values will really compound the
issue. For example, as McLaren (2007) writes, “in an environment with on-site
exercise and shower facilities, it is easy to imagine social norms surrounding
practices such as going to the gym during lunch hour”. This is why; when we
look at it, there could be an affect of career success on weight.

However, like with area and income, there is another side of the token, and
again occupational success may be determined by your weight, and not the
other way round. According to Puhl R, Brownell KD (2001), bias and
discrimination still exists towards the obese. You are less likely to be
promoted, or enjoy a healthy relationship with your colleagues if you are
obese, and this may prevent the obese getting high up in their profession.

Men:

Interestingly, most of the indicator’s associations with weight are seen less
when concerning men. This finding is similar to Sobal and Stunkard's results.
Different ideals amongst men and women can explain this. For example, a
larger body size is likely to be valued as a sign of physical dominance and
prowess by men, and this comes into play especially when concerning income
and occupation as indicators as males are the traditional ‘wage earners’
(Power, 1999). This throws off the normal SES-weight connection seen in
developed countries, reverting the patterns more commonly seen in
developing countries, where a strong direct relation is observed (high SES
groups having high levels of obesity).

Conclusion:

Seen throughout all the indicators discussed here, there are two sides of the
argument. On the one hand, ones weight could be reduced by the benefits
that come with living in an affluent area, having a large income or having a
good job. On the other, society may now be in a state where, unless you
already possess this reduced weight, then you will not experience living in the
nicer areas, receiving a larger income or having a better job, which in turn
leads to the obese not being able to break into the upper SES groups of
society. Although conclusions showing an inverse relationship between class
and weight were drawn up almost 20 years ago, it had always previously been
assumed that it was because your class affected your weight. It is now
however becoming a more predominant view, that it could be in fact quite the
other way round, and your weight may be determining your class.
 References

 Molarius, J.C. Seidell, S.Sans, J. Toumilehto and K. Kuulasmaa,

Educational level, relative body weight, and changes in their
association over 10 years; an international perspective from the WHO
MONICA Project, American Journal Of Public Health 90 (2000), 1260-
1268

 Baum and Ford, 2004 C.L. Baum and W.F. Ford, The wage effects of
obesity: a longitudinal study, Health Economics 13 (9 (September))
(2004), pp. 885–899

 Baum and Ruhm, 2009 C. Baum and C. Ruhm, Age, socioeconomic

status and obesity growth, Journal of Health Economics 28 (2009), pp.
635–648.

 Bourdieu P. The forms of capital. In: Handbook of theory and research

for the sociology of education—Richardson JH, ed. (1986) New York,
NY: Greenwood Press. 241–58

 Drewnowski A, Specter SE. Poverty and obesity: the role of energy

density and energy costs. Am J Clin Nutr (2004) 79:6–16

 K. Ball and D. Crawford, Socioeconomic status and weigh change in

adults: a review, Soc Sci Med 60 (2005), 1987–2010

 Kumar. P, Clark. M (2009): Kumar & Clark's Clinical Medicine 7th ed.
London: Saunders Elsevier, 228.

 McLaren L, Kuh D. Women's body dissatisfaction, social class, and

social mobility. Soc Sci Med (2004) 58:1575–84

 McLaren L. Socioeconomic status and obesity. Epidemiologic Review.

(2007) 29:29–48

 Obesity, Physical Activity and Diet, The information Centre, the NHS

o http://www.ic.nhs.uk/webfiles/publications/opan08/OPAD
%20Jan%202008%20final%20v7%20with%20links%20and
 %20buttons%20-%20NS%20logo%20removed
%2020112008.pdf (last accessed on the 10th December 2009)

 Parmenter K, Waller J, Wardle J. Demographic variation in nutrition

knowledge in England. Health Educ Res (2000) 15:163–74

 Power EM. An introduction to Pierre Bourdieu's key theoretical

concepts. J Study Food Soc (1999) 3:48–52.

 Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res

(2001) 9:788–805

 Roxanne Khamsi, New England Journal of Medicine (vol 357, 370-379,

2007)

 Sobal, & Stunkard (1989) J. Sobal and A.J. Stunkard, Socioeconomic

status and obesity: a review of the literature, Psychological Bulletin 105
(1989) (2), 260–275

 World Health Organization (1998) World Health Organization (WHO).

(1998). Obesity: prevention and managing the global epidemic. Report
of a WHO consultation on obesity, Geneva, 3–5 June 1997. Geneva:
World Health Organization

 World Health Organisation; Obesity

o http://www.who.int/topics/obesity/en/ (last accessed on the 7th

December 2009)
 Appendix 1

Table 1: Numbers of tests from methodologically stronger studies, that

supported study hypothesis (), alternative hypothesis (×), or suggested no
association (0)a. Ball and Crawford (2004)
 Appendix 2

Table 2: Adapted from - Associations between socioeconomic status (SES)

and body size among women, according SES indicator and the nature of the
SES-body size association (McLaren, 2007)
 Appendix 3

NATURE OF THE SES-BODY SIZE ASSOCIATION

SES POSITIVE NEGATIVE NON-SIGNIFICANT OR TOTAL

INDICATOR CURVILINEAR

No. of No. of No. of No. of

associations associations associations associations
% % % %

Area 0 0 10 71 4 29 14 2

Education 4 1 220 72 81 27 305 45

Employment 7 16 17 38 21 47 45 7

Income 9 6 69 49 64 45 142 21

Occupation 2 1 100 68 44 30 146 22

Other 1 6 4 22 13 72 18 3

Overall 23 3 420 63 227 34 670 100

Table 3: Adapted from - Associations between socioeconomic status (SES)

and body size among men, according SES indicator and the nature of the
SES-body size association (McLaren, 2007)
 Appendix 4

Table 4: Adapted from - Associations between socioeconomic status (SES)

and body size among both sexes combined, according SES indicator and the

NATURE OF THE SES-BODY SIZE ASSOCIATION

SES POSITIVE NEGATIVE NON-SIGNIFICANT OR TOTAL

INDICATOR CURVILINEAR

No. of No. of No. of No. of

associations associations associations associations
% % % %

Area 2
0 9
0 17
0 52
0 13
3 100
39 33
3 18
1

Education 14
1 2
6 126
31 65
50 114
16 33
45 254
48 50
27

Employment 0
3 0
9 1
2 13
6 28
7 88
85 33
8 6
4

Income 20
5 24
8 19
12 31
14 38
51 61 83
62 16
35

Occupation 1
7 4
6 16
49 59
39 10
70 37
56 126
27 25
15

Other 0 0 0
3 25
0 1
9 100
75 12
1 2
1

Overall 44
9 5
7 192
84 47
38 275
85 48
55 511
179 100

nature of the SES-body size association (McLaren, 2007)

 Appendix 5

Table 5: A table showing the responses to a questionnaire detailing the level

of education compared with the amount of obesity. (K. Parmenter, J. Waller
and J. Wardle, 2000)

Number of % Of
obese sample
Educational level people taken

No qualifications 431 42.5

O level/equivalent 281 27.7

A level/equivalent 169 16.7

Degree/higher degree 133 13.1