Cross-National Comparisons of Socioeconomic Differences in Overweight and Obesity

Overweight and obesity have become increasingly common in the past decades. Overweight affects 30–80% of adults in Europe. The World Health Organization estimates that 150 million adults in Europe will be obese by 2010. The associated costs with overweight, obesity and related diseases are gargantuan, both from a societal and a financial point of view. One 2002 estimate indicated that the total direct and indirect annual costs of obesity in 15 EU countries may have been as high as € 32.8 billion. Obesity and its associated risks may kill 320 000 men and women annually in Western Europe. The effects on quality of life are more difficult to quantify but are manifold. This raises the question what can be done about it, and how this can be done most effectively. The immediate cause of obesity and overweight is an energy imbalance between calories consumed on one hand, and calories expended on the other hand. But it is overly simplistic to regard overweight and obesity as the result of an imbalance between energy intake and expenditure. Biological susceptibility interacts with a changing environment that includes more sedentary lifestyles and increased dietary abundance. The heritability of obesity is estimated at 40-70 %. However, genetic factors alone can not explain the rapid increase in the prevalence of overweight and obesity in the recent few decades. A twin study showed that identical twins living apart had greater discordance in relative body weight gain, compared with identical twins living together. Household or physical environment accounted for about 50 % of the variation in adolescent overweight. Two environmental patterns are important in this context. There is a shift in diet towards increased intake of energy-dense foods that are high in fat and sugars but low in vitamins, minerals and other micronutrients. Meanwhile, there is a trend towards decreased physical activity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization. However, important as they are, these direct factors are just one element of the explanation.

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