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Virginia W. Chang, MD, PhD; Diane S. Lauderdale, PhD

Arch Intern Med. 2005;165:2122-2128.

Background  Although obesity is frequently associated with poverty, recent increases in obesity may not occur disproportionately among the poor. Furthermore, the relationship between income and weight status may be changing with time.

Methods  We use nationally representative data from the National Health and Nutrition Examination Surveys (1971-2002) to examine (1) income differentials in body mass index (calculated as weight in kilograms divided by the square of height in meters) and (2) change over time in the prevalence of obesity (body mass index, 30) at different levels of income.

Results  Over the course of 3 decades, obesity has increased at all levels of income. Moreover, it is typically not the poor who have experienced the largest gains. For example, among black women, the absolute increase in obesity is 27.0% (1.05% per year) for those at middle incomes, but only 14.5% (0.54% per year) for the poor. Among black men, the increase in obesity is 21.1% (0.77% per year) for those at the highest level of income, but only 4.5% (0.06% per year) for the near poor and 5.4% (0.50% per year) for the poor. Furthermore, all race-sex groups show income differentials on body mass index, but patterns show substantial variation between groups and consistency and change within groups over time. For example, white women consistently show a strong inverse gradient, while a positive gradient emerges in later waves for black and Mexican American men.

Conclusion  The persistence and emergence of income gradients suggests that disparities in weight status are only partially attributable to poverty and that efforts aimed at reducing disparities need to consider a much broader array of contributing factors.

Author Affiliations: Center for Health Equity Research and Promotion, Philadelphia VAMC, Department of Medicine, University of Pennsylvania School of Medicine, and Department of Sociology, Population Studies Center, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Dr Chang); and Department of Health Studies, The University of Chicago, Chicago, Ill (Dr Lauderdale).

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