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（SES）的妇女中不成比例地发生，特别是在工业化国家。在男性和女性中，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升高有关。中年妇女（30-50岁）体重增加很常见，尤其令人担忧，因为这对她们以后的健康造成了影响，也因为这些妇女在家庭中发挥着重要作用。在西班牙裔人群中，较高的肥胖率与较高的社会地位有关，这与历史上在较贫穷国家发现的情况相似。大多数基于个人行为改变的肥胖预防计划都未能成功地达到长期健康的体重。人们的注意力正转向更复杂的环境和社会因素对肥胖的影响，包括中心性肥胖，以帮助确定多层次和多原因的途径，并针对高风险群体进行有针对性的干预。我们需要更好地理解身体质量指数（BMI）增加的危险因素沿社会经济地位梯度的机制（白种人为负，西班牙裔为正）。该项目的主要目的是更好地理解和评估中年妇女SES和BMI之间的推定因果途径。该项目的数据将有助于减少干预渠道的数量，并为如何接触这些妇女及其家庭成员提供线索，通过调节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，为什么根据不同的社会经济地位水平，这种情况会以不同的比率发生尚不清楚。我们将测试关键解释SES和超重/肥胖关系1000年以人群为基础的队列,年龄30 ~ 50岁的女性,过采样的西班牙裔妇女在主要城市地区,基于概念模型通过Mackenbach.1-3增加招聘来提高妇女的代表的西班牙裔种族,我们将能够在集团内从事分析非西班牙裔白人,另外,在西班牙裔的人。具体目标如下：1。评估a)物质资源（例如，社区的可步行性、健康食品的可获得性、食品成本）的中介横截面效应；B)社会心理环境（如身体形象、家庭规范和文化）；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（体育活动和饮食模式）和BMI之间的关系评估3年内社会经济地位与体重变化之间的关系。纵向评价物质资源、社会心理环境和应激过程在中年女性SES、BMI与中枢性肥胖的关系中的中介作用。随着时间的推移，身高体重增加的梯度随着社会经济地位的不同而不同，对这一观察结果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，在中年白人和西班牙裔女性中，研究包括社会、心理和生物学因素在内的机制，以及这些因素的交集，以解释所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重点的数量，并为如何通过调节肥胖风险的社会经济差异的机制影响这些妇女及其家庭成员的体重变化提供线索。

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.