Kristina Lindvall

The obesity epidemic slows among the middle-aged population in Sweden while the socioeconomic gap widens

Background: Obesity prevalence has continuously increased in Northern Sweden as elsewhere. A cohort effect has been shown and an increasing proportion of the middle-aged population is maintaining body weight. Objective: To test the hypothesis that the obesity epidemic continues but at different speeds that are dependent on socioeconomic status. Design: Cross-sectional (103,940 adults) and longitudinal (26,872 adults) data from the Västerbotten Intervention Program 1990–2007 were included. All adults in Västerbotten County are invited to a health examination at the ages of 40, 50, and 60 years. Body mass index (BMI) and socioeconomic status, assessed by residence location, marital status, and education were evaluated. Results: BMI increased in all groups but was greater among men. During 1990–1995 and 2002–2007, mean BMIs were 25.9 and 26.8 among men and 25.2 and 25.9 among women. The trend of increasing BMI slowed around the year 2000 (p<0.001), but this was only observed among the highly educated adults in the most urbanized area. The difference between educational groups increased throughout the study period (men p=0.014, women p=0.002). Longitudinal data for both sexes showed a twofold higher baseline prevalence of obesity among individuals with basic compared to high education and it nearly doubled in all groups during the 10-year follow-up. Low education, living in a rural environment, and living alone were independent predictors of obesity development. The overall cumulative 10-year incidence was 9.4% in men, 9.1% in women, and twofold higher among those with basic and mid-level education who live in rural areas compared to those with high education who live in cities. Conclusion: The trend of increasing obesity has slowed in this middle-aged Northern Sweden population, but this trend shift occurred primarily among those with high education who live in an urban environment. Greater efforts to combat obesogenic environments are needed and should take socioeconomic and sociocultural aspects into account.

Who is maintaining weight in a middle-aged population in Sweden? A longitudinal analysis over 10 years

BackgroundObesity has primarily been addressed with interventions to promote weight loss and these have been largely unsuccessful. Primary prevention of obesity through support of weight maintenance may be a preferable strategy although to date this has not been the main focus of public health interventions. The aim of this study is to characterize who is not gaining weight during a 10 year period in Sweden.MethodsCross-sectional and longitudinal studies were conducted in adults aged 30, 40, 50 and 60 years during the Västerbotten Intervention Programme in Sweden. Height, weight, demographics and selected cardiovascular risk factors were collected on each participant. Prevalences of obesity were calculated for the 40, 50 and 60 year olds from the cross-sectional studies between 1990 and 2004. In the longitudinal study, 10-year non-gain (lost weight or maintained body weight within 3% of baseline weight) or weight gain (≥ 3%) was calculated for individuals aged 30, 40, or 50 years at baseline. A multivariate logistic regression model was built to predict weight non-gain.ResultsThere were 82,927 adults included in the cross-sectional studies which had an average annual participation rate of 63%. Prevalence of obesity [body mass index (BMI) in kg/m2 ≥ 30] increased from 9.4% in 1990 to 17.5% in 2004, and 60 year olds had the highest prevalence of obesity. 14,867 adults with a BMI of 18.5–29.9 at baseline participated in the longitudinal surveys which had a participation rate of 74%. 5242 adults (35.3%) were categorized as non-gainers. Older age, being female, classified as overweight by baseline BMI, later survey year, baseline diagnosis of diabetes, and lack of snuff use increased the chances of not gaining weight.ConclusionEducational efforts should be broadened to include those adults who are usually considered to be at low risk for weight gain – younger individuals, those of normal body weight, and those without health conditions (e.g. diabetes type 2) and cardiovascular risk factors – as these are the individuals who are least likely to maintain their body weight over a 10 year period. The importance of focusing obesity prevention efforts on such individuals has not been widely recognized.

Self-rated health does not predict 10-year weight change among middle-aged adults in a longitudinal population study

BackgroundThere is a worldwide obesity epidemic, but lack of a simple method, applicable for research or clinical use, to identify individuals at high risk of weight gain. Therefore, the relationship of self-rated health and 10-year percent weight change was evaluated to determine if self-rated health would predict weight change.MethodsFrom 1990 to 2008, adults aged 30, 40, 50 and 60 years were invited to health surveys that included self-rated health and measured weight and height. ANOVA was used to evaluate the relationship of 10-year percent weight change and self-rated health.ResultsThe study population consisted of 29,207 participants (46.5% men). There was no relationship between baseline self-rated health and 10-year percent weight change for middle-aged men or women.ConclusionsSelf-rated health is not able to predict weight change over a 10-year period in this age group.

Primary weight maintenance: an observational study exploring candidate variables for intervention

BackgroundPrevious studies have focused on weight maintenance following weight loss, i.e. secondary weight maintenance (SWM). The long-term results of SWM have been rather modest and it has been suggested that preventing initial weight gain, i.e. primary weight maintenance (PWM), may be more successful. Therefore, developing a prevention strategy focused on PWM, enabling normal weight or overweight individuals to maintain their weight, would be of great interest. The aim of this study was to identify attitudes, strategies, and behaviors that are predictive of PWM in different age, sex and BMI groups in Northern Sweden.MethodsA questionnaire was mailed to 3497 individuals in a Swedish population that had two measured weights taken ten years apart, as participants in the Västerbotten Intervention Programme. Subjects were between 41–63 years of age at the time of the survey, had a baseline BMI of 20–30, and a ten year percent change in BMI greater than -3%. The respondents were divided into twelve subgroups based on baseline age (30, 40 and 50), sex and BMI (normal weight and overweight). Analysis of variance (ANOVA), correlation, and linear regression were performed to identify independent predictors of PWM.ResultsOf the 166 predictors tested, 152 (91.6%) were predictive of PWM in at least one subgroup. However, only 7 of these 152 variables (4.6%) were significant in 6 subgroups or more. The number of significant predictors of PWM was higher for male (35.8) than female (27.5) subgroups (p=0.044). There was a tendency (non significant) for normal weight subgroups to have a higher number of predictors (35.3) than overweight subgroups (28.0). Adjusted R-squared values ranged from 0.1 to 0.420.ConclusionsThe large number of PWM predictors identified, and accompanying high R-squared values, provide a promising first step towards the development of PWM interventions. The large disparity in the pattern of significant variables between subgroups suggests that these interventions should be tailored to the person’s demographic (age, sex and BMI). The next steps should be directed towards evaluation of these predictors for causal potential.

Adapting the T0-T4 implementation science model to occupational health and safety in agriculture, forestry, and fishing : A scoping review

BACKGROUND Despite much research to develop life-saving innovations for the agriculture, forestry, and fishing workforce, these populations continue to face the highest fatal and non-fatal injury rates in the United States, as many of these solutions are not fully adopted. METHODS A scoping review was conducted to provide an overview of research to practice efforts in this field. The language used to describe these initiatives, the utility of the NIH T0-T4 model, and the progress along the research to practice continuum were examined. RESULTS Fourteen eligible references demonstrated that progress in implementation science is lacking and that there is little consistency in how researchers apply the T0-T4 model; thus, a new model is presented. CONCLUSIONS Researchers in this field face several challenges when moving from research to practice. While some challenges are addressed with the proposed model, additional resources and infrastructure to support such initiatives are necessary.