Explaining the SES/Overweight and Obesity Relationship

描述（由申请人提供）：肥胖发生在社会经济地位较低（SES）的妇女不成比例，特别是在工业化国家。肥胖率的上升与男性和女性的心血管疾病、癌症、糖尿病和其他慢性和危及生命的疾病的发病率较高有关。中年妇女（30-50岁）体重增加是经常发生的，特别令人关切，因为这对以后的健康产生影响，而且这些妇女在家庭中发挥着重要作用。在西班牙裔美国人中，较高的肥胖率与较高的社会经济地位有关，这与历史上较贫穷国家的情况类似。大多数基于个人行为改变的肥胖预防计划在实现长期健康体重方面并不成功。注意力正在转向更复杂的环境和社会因素对肥胖的影响，包括中枢性肥胖，以帮助确定多层次和多原因的途径，并针对高危人群进行干预。需要进一步了解已确立的体重指数（BMI）增加的风险因素沿着SES梯度（白人为反向，西班牙裔为正）起作用的机制。该项目的主要目的是更好地理解和评估中年女性SES和BMI之间的假定因果关系。来自该项目的数据将有助于减少干预渠道的数量，并提供如何接触这些妇女及其家庭成员的线索，以通过调解社会经济地位在肥胖风险方面的差异的机制来影响体重变化。最终，超重是由能量不平衡引起的，热量输入高于输出。然而，为什么这种情况会根据社会经济地位的不同而以不同的比率发生，目前还不清楚。我们将根据Mackenbach的概念模型，在一个主要城市地区对1000名30-50岁女性进行过度抽样，在基于人口的队列中测试SES和超重/肥胖关系的关键解释。1 -3通过增加招聘来提高西班牙裔女性的代表性，我们将能够在非西班牙裔白色人群中进行分析，并在西班牙裔人群中单独进行分析。具体目标如下：1.评估a）物质资源（例如，邻近地区的可步行性，健康食品的可获得性;食品的成本）; B）社会心理背景（例如，身体形象、家庭和文化规范）;以及c）压力过程（例如，情绪，睡眠障碍，皮质醇）之间的关系SES，体重相关的行为（体力活动和饮食模式）和体重指数在中年妇女2。评估SES与体重变化之间的关系，为期3年。纵向研究物质资源、心理社会背景和应激过程在中年女性SES、BMI与中心性肥胖关系中的中介作用。

DESCRIPTION (provided by applicant): Obesity occurs disproportionately in women of lower socioeconomic status (SES), especially in industrialized countries. Rising rates of obesity have been linked to higher rates of cardiovascular disease, cancer, diabetes, and other chronic and life threatening diseases in both men and women. Weight gain in women during middle age (age 30-50) is frequent and of particular concern because of the consequences for later health and because of the important role these women play in their households. Among Hispanics, higher rates of obesity are associated with higher SES, similar to what has been found in poorer countries, historically. Most obesity prevention programs based on individual behavior change have not been successful in achieving long-term healthy weight. Attention is shifting to more complex environmental and societal contributions to adiposity, including central adiposity, to help identify multi-level and multi-causal pathways and to target interventions to high risk groups. Improved understanding is needed of the mechanisms by which established risk factors for increased body mass index (BMI) operate along the SES gradient (inverse for Caucasians, and positive for Hispanics). The main aim of this project is to better understand and evaluate the putative causal pathways between SES and BMI in middle-age women. Data from this project would assist in reducing the number of intervention channels and provide clues on how to reach these women and their household members to influence weight change through the mechanisms that mediate the SES disparities in risk of obesity. Ultimately, excess weight is caused by energy imbalance, with higher caloric input than output. However why this should occur at different rates according to different levels of SES is not known. We shall test key explanations for the SES and overweight/obesity relationship in a population-based cohort of 1000 women age 30-50, with oversampling of Hispanic women in a major urban area, based on a conceptual model by Mackenbach.1-3 By augmenting the recruitment to enhance the representation of women of Hispanic ethnicity, we will be able to conduct analyses within the group who are non-Hispanic white and separately, within the group who are of Hispanic origin. Specific aims are as follows: 1. To evaluate the mediating cross-sectional effects of a) material resources (e.g., walkability of neighborhood, availability of healthy foods; cost of food); b) psychosocial context (e.g., body image, norms of family and culture);and c) stress process (e.g., mood, sleep disturbance, cortisol) in the relationship between SES, weight-related behaviors (physical activity & eating patterns) and BMI in middle-age women 2. To evaluate the relationship between SES and change in weight over a 3-year period 3. To evaluate longitudinally the mediating effects of material resources, psychosocial context, and the stress process in the relationship between SES, BMI and central adiposity in middle aged women.