Life-course socioeconomic status and obesity: scoping review – Population Health Metrics

Report on the Influence of Life-Course Socioeconomic Status on Weight Status and Obesity in the Context of Sustainable Development Goals

Executive Summary: Socioeconomic Disparities and Health Outcomes

An analysis of 45 studies demonstrates a significant relationship between life-course socioeconomic status (SES) and obesity. These findings directly impact the achievement of several Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 10 (Reduced Inequalities), and SDG 1 (No Poverty). The research identifies persistent links between socioeconomic disadvantage at various life stages and an increased likelihood of obesity, highlighting how inequality creates significant barriers to public health. Methodological approaches used to establish these links include:

• Sensitive Periods Analysis
• Social Mobility Analysis
• Risk Accumulation Analysis

Detailed Findings on Socioeconomic Determinants of Health

Sensitive Periods: Early Life Disadvantage and Long-Term Health

The “sensitive periods” approach reveals that socioeconomic conditions during specific life stages, especially childhood, have a lasting impact on health, undermining SDG 3. Low SES during childhood, a challenge related to SDG 1 (No Poverty) and SDG 4 (Quality Education), is a strong predictor of obesity in later life.

Key Socioeconomic Indicators and Their Impact:

1. Childhood SES Indicators: Parental occupation, education level, household income, and socioeconomic class were used to measure early life conditions. Low status in these areas was consistently linked to adverse weight outcomes.
2. Adulthood SES Indicators: An individual’s own occupation, education, income, marital status, and socioeconomic class were assessed. Disadvantage in adulthood compounded the risks established in childhood.
3. Weight Status Indicators:
   • Body Mass Index (BMI): 23 studies found an inverse association between low SES and high BMI across childhood, adulthood, and late adulthood. This demonstrates a life-long health burden stemming from socioeconomic inequality, a core issue for SDG 10.
   • Central Obesity Indicators (WC, HC, WHR): Low life-course SES was associated with higher waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR), indicating increased risk for non-communicable diseases.
   • Obesity Incidence: Children experiencing poverty before age two were found to have a higher likelihood of developing obesity by age 15.5, illustrating a critical window for intervention to achieve health equity.

A critical finding relates to SDG 5 (Gender Equality), as women with consistently low life-course SES demonstrated a significantly higher and more consistent likelihood of obesity and central obesity compared to men, for whom the association was less constant.

Social Mobility: The Health Implications of Socioeconomic Trajectories

The social mobility approach examines how changes in socioeconomic position over a lifetime affect health. Downward mobility or persistent disadvantage is linked to poor health outcomes, reinforcing the importance of SDG 10 (Reduced Inequalities) and SDG 11 (Sustainable Cities and Communities) in creating environments that support health and upward mobility.

Analysis of Trajectories:

• Individual SES Trajectories: A disadvantaged socioeconomic trajectory over the life course was inversely associated with BMI and linked to a high probability of obesity.
• Neighborhood and Environmental Trajectories:
  • Living in socioeconomically deprived neighborhoods over time was associated with higher BMI and increased obesity risk. This highlights the role of community infrastructure, a focus of SDG 11.
  • Factors such as crime levels and the availability of green space were directly associated with children’s BMI trajectories.
  • Food environments are also critical. A shift towards unhealthful eating patterns, often dictated by socioeconomic constraints, increased the risk of obesity, linking to SDG 2 (Zero Hunger), which encompasses nutrition.

Again, gender disparities were evident. Women from disadvantaged socioeconomic trajectories consistently showed the highest likelihood of obesity, underscoring the gendered nature of health inequalities and the need for targeted interventions to meet SDG 5.

Risk Accumulation: The Compounding Effect of Lifelong Disadvantage

The risk accumulation model assesses the cumulative burden of exposure to socioeconomic and environmental disadvantages. This approach shows that prolonged exposure to poverty and deprivation has a compounding negative effect on health, making it a significant obstacle to achieving SDG 3 and SDG 10.

Key Findings from Risk Accumulation Models:

1. Cumulative Individual Disadvantage: The accumulation of personal socioeconomic disadvantages (e.g., low income, low education) over a lifetime is strongly associated with a higher BMI.
2. Cumulative Neighborhood Disadvantage: Long-term exposure to deprived neighborhoods is linked to higher BMI, adverse gestational weight gain patterns, and increased risk of abdominal obesity. This reinforces the need for policies that promote equitable and healthy communities as envisioned in SDG 11.
3. Gender-Specific Impacts: Cumulative socioeconomic disadvantage was found to lead to higher BMI trajectories, particularly in older women. This further emphasizes the vulnerability of women to the long-term health consequences of inequality, a direct concern for SDG 5.

Analysis of Sustainable Development Goals (SDGs) in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article primarily discusses the relationship between life-course socioeconomic status and health outcomes, specifically obesity. This analysis connects to several Sustainable Development Goals that focus on health, poverty, inequality, education, gender, and sustainable communities.

1. SDG 3: Good Health and Well-being

   This is the most central SDG, as the article’s main focus is on weight status, obesity, and related health risks like cardiovascular issues (“high left ventricular (LV) mass index”) and Type 2 Diabetes. The research investigates the determinants of these health conditions.

2. SDG 10: Reduced Inequalities

   The article is fundamentally about inequality. It explores how disparities in socioeconomic status—measured by income, education, and occupation across a person’s life—lead to unequal health outcomes. It explicitly examines “social inequity in obesity” and how “disadvantaged socioeconomic trajectory was associated with a high likelihood of obesity.”

3. SDG 1: No Poverty

   Poverty is identified as a key component of socioeconomic disadvantage. The article mentions “household income” and directly links poverty to health outcomes, stating that “children who experienced poverty before two years of age were more likely to develop obesity.”

4. SDG 4: Quality Education

   Education level is repeatedly used as a primary indicator of socioeconomic status. The article notes that studies used “education level” of both parents and individuals to measure socioeconomic status, which in turn correlates with weight status.

5. SDG 5: Gender Equality

   The article consistently highlights a significant gender dimension in its findings. It repeatedly states that the association between low socioeconomic status and obesity is stronger and more consistent for women. For example, “all the studies showed that women with low socioeconomic status throughout their life-course have a higher likelihood of obesity. For men, associations not as constant.”

6. SDG 11: Sustainable Cities and Communities

   The analysis extends beyond individual factors to include the living environment. The article discusses “neighborhood socioeconomic trajectories,” “neighborhood deprivation,” and the influence of the “built environment,” including the “presence of green space” and “level of crime in their neighborhood,” on health outcomes.

2. What specific targets under those SDGs can be identified based on the article’s content?

• SDG 3: Good Health and Well-being

  • Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment. The article’s focus on obesity, a major risk factor for non-communicable diseases like diabetes and cardiovascular conditions, directly relates to this target. The research aims to understand the social determinants of obesity to inform prevention strategies.

• SDG 10: Reduced Inequalities

  • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status. The article’s core finding—that low socioeconomic status throughout life is linked to poor health outcomes—is a clear example of health inequality based on economic status, which this target aims to address.

• SDG 1: No Poverty

  • Target 1.2: By 2030, reduce at least by half the proportion of men, women and children of all ages living in poverty in all its dimensions. The article identifies “poverty” and “household income” as critical factors influencing obesity, demonstrating how poverty has health dimensions that go beyond just a lack of income.

• SDG 5: Gender Equality

  • Target 5.1: End all forms of discrimination against all women and girls everywhere. The article provides evidence of a gender-specific health inequality, where women from disadvantaged backgrounds are disproportionately affected by obesity. This highlights a systemic issue where socioeconomic factors have a more severe health impact on women, which can be seen as a consequence of broader gender inequalities.

• SDG 11: Sustainable Cities and Communities

  • Target 11.7: By 2030, provide universal access to safe, inclusive and accessible, green and public spaces. The article directly supports this target by finding associations between health indicators (BMI) and environmental factors like the “presence of green space in the neighborhood” and the “level of crime,” which affects the safety and accessibility of public spaces.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article is rich with specific indicators used in the reviewed studies to measure both socioeconomic status and health outcomes.

• Indicators for Health Status (Relating to SDG 3)

  • Body Mass Index (BMI): Mentioned as the “main indicator used to study the relationships.”
  • Waist Circumference (WC), Hip Circumference (HC), and Waist-to-Hip Ratio (WHR): Used to measure abdominal obesity.
  • Incidence of Obesity: The article mentions studying the “first incidence of obesity.”
  • Body Mass Index Trajectories: Used to track weight changes over time.
  • Gestational Weight Gain (GWG): An indicator for maternal health.

• Indicators for Socioeconomic Status and Inequality (Relating to SDGs 1, 4, 10)

  • Occupation: Used to measure socioeconomic status in childhood and adulthood.
  • Education Level: A key measure of parental and individual socioeconomic status.
  • Household Income: A direct measure of economic status.
  • Socioeconomic Class: A composite measure of social standing.
  • Poverty Status: Specifically, “children who experienced poverty.”
  • Social Mobility Trajectories: Measuring upward or downward movement in socioeconomic status over a lifetime.
  • Neighborhood Socioeconomic Deprivation: An indicator of community-level disadvantage.

• Indicators for Gender Disparities (Relating to SDG 5)

  • Sex-disaggregated data on obesity likelihood: The article’s primary indicator for gender inequality is the repeated finding that associations between low socioeconomic status and obesity are strong and consistent for women but “not as constant” for men.

• Indicators for Community Environment (Relating to SDG 11)

  • Presence of green space: Directly mentioned as a neighborhood characteristic associated with BMI.
  • Level of crime in a neighborhood: Mentioned as an environmental factor influencing children’s BMI.

4. Summary Table of SDGs, Targets, and Indicators

Source: pophealthmetrics.biomedcentral.com