Explaining the SES/Overweight and Obesity Relationship

描述(由申请人提供)：肥胖在社会经济地位较低的女性中发生的比例不成比例，特别是在工业化国家。肥胖率的上升与心血管疾病、癌症、糖尿病和其他慢性和危及生命的疾病的发病率上升有关，无论是男性还是女性。妇女在中年(30-50岁)体重增加的现象很常见，尤其令人担忧，因为这会对以后的健康产生影响，而且这些妇女在家庭中扮演着重要的角色。在拉美裔美国人中，肥胖率越高，SES就越高，这与历史上在较贫穷国家发现的情况类似。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。人们的注意力正在转向更复杂的环境和社会因素对肥胖症的影响，包括中心性肥胖症，以帮助确定多水平和多原因的途径，并针对高危群体进行干预。需要更好地了解已确定的体重指数(BMI)增加的危险因素沿着SES梯度(高加索人相反，西班牙裔人为正)起作用的机制。该项目的主要目的是为了更好地了解和评估中年女性SES和BMI之间可能的因果关系。该项目的数据将有助于减少干预渠道的数量，并提供线索，说明如何接触到这些妇女及其家庭成员，通过调节SES在肥胖风险方面的差异的机制来影响体重变化。归根结底，超重是由能量失衡造成的，卡路里输入高于输出。然而，为什么这种情况会根据不同的社会经济水平而以不同的速度发生，这一点尚不清楚。我们将根据Mackenbach1-3的概念模型，在基于人口的1000名年龄在30-50岁之间的女性队列中测试对SES和超重/肥胖关系的关键解释，在主要城市地区对西班牙裔女性进行过度抽样。1-3通过扩大招募以提高西班牙裔女性的代表性，我们将能够在群体内进行非西班牙裔白人的分析，并在群体中单独进行西班牙裔女性的分析。具体目标如下：1.评估a)物质资源(例如，社区的可步行程度、健康食品的可获得性、食物的价格)；b)心理社会背景(例如，身体形象、家庭和文化规范)的中介横截面效应；C)压力过程(如情绪、睡眠障碍、皮质醇)在中年女性SES、体重相关行为(体力活动和饮食模式)与BMI之间的关系2.评估SES与3年体重变化的关系3.纵向评估物质资源、心理社会背景以及压力过程在SES、BMI与中心性肥胖关系中的中介作用。公共卫生相关性对于观察到身高体重随时间增加的梯度因社会经济地位不同而不同的可能解释尚不清楚，可能因种族或其他社会文化因素而不同。我们建议，在中年高加索和西班牙裔女性中，研究包括社会、心理和生物因素在内的机制，以及这些因素的交集，以解释观察到的肥胖风险与社会经济地位的关联。该项目的数据将有助于减少干预焦点的数量，并提供线索，说明如何接触到这些妇女及其家庭成员，通过调节肥胖风险的社会经济差异的机制来影响体重变化。

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. PUBLIC HEALTH RELEVANCE Possible explanations for the observation that gradients over time in increased weight for height differ according to socioeconomic status are not well understood, and may differ by ethnicity or other socio- cultural factors. We propose, in middle aged Caucasian and Hispanic women, to study mechanisms including social, psychological, and biological factors, and the intersection of these factors in explaining the observed associations of obesity risk with socioeconomic status. Data from this project would assist in reducing the number of intervention foci and provide clues on how to reach these women and their household members to influence weight change through the mechanisms that mediate the socioeconomic disparities in risk of obesity.