Accounting for the multidimensional nature of the relationship between adult obesity and socio-economic status : the French second National Individual Survey on Food Consumption (INCA 2) dietary survey (2006–07)

The objective was to study the multidimensional nature of the relationship between adult obesity (OB) and socio-economic status (SES),
using comprehensive indices of SES taken separately or synthesised in an overall index. A nationally representative sample of adults aged
18–79 years was taken from the French second National Individual Survey on Food Consumption (INCA 2) dietary survey (2006–07).
Weight and height were measured and OB defined as BMI $ 30 kg/m². SES variables were reported in questionnaires and included
occupation, education and characteristics of household wealth. Composite indices of SES (household wealth and overall SES indices)
were computed by correspondence analysis, and relationships with OB were investigated with logistic regression analysis. In total, 11·8
(95% CI 10·1, 13·4) % of French adults were obese, without significant difference by sex. While no significant relationship was observed
in men, all SES indicators were inversely correlated to OB in women. Both education and the household wealth index were retained in the
stepwise multivariate model, confirming that different socio-economic variables are not necessarily proxies of each other regarding the OB
issue. On the other hand, ‘controlling for SES’ while including several measures of SES in multivariate models may lead to collinearity, and
thus over-adjustment. A more integrative approach may be to derive a synthetic index by including the SES factors available in a given
study. Beyond this methodological perspective, understanding how OB is related to the different dimensions of SES should help to
target the more vulnerable groups and increase the effectiveness of prevention.

The neighborhood social environment and body mass index among youth : a mediation analysis

Background

This study aimed to examine associations between aspects of the neighborhood social environment and body mass index (BMI) in youth both cross-sectionally and prospectively; and whether this association was mediated by physical activity, screen-time and sedentary time.
Methods

Data were collected in 2004 and 2006 in high and low socio-economic areas of Melbourne, Australia. In 2004, 185 children aged 8-9 years (47% boys) and 359 children aged 13-15 years (45% boys) participated. Parents reported their perceptions of aspects of the social environment (i.e. social networks and social trust/cohesion), and physical activity (i.e. time spent outdoors by their children; and their younger children's walking and cycling trips) and screen-time (i.e. TV viewing, computer use). The older children self-reported their walking and cycling trips and their screen-time. All children wore an accelerometer to objectively assess outside-school hours moderate- to-vigorous physical activity and sedentary time. BMI was calculated from height and weight measured in 2004 and 2006. Multilevel linear regression analyses were conducted to examine associations between the social environment and BMI. Mediation analyses using the products of coefficient method were conducted to determine whether associations between the social environment and BMI were mediated by the time spent in a range of physical activity and sedentary behaviors.
Results

Cross-sectional and prospective regression analyses showed that a more positive social network and higher social trust/cohesion was related to lower BMI among children. There was no evidence that time spent in physical activity or sedentary behaviors mediated this relation, despite significant associations between social networks and screen-time and between screen-time and BMI.
Conclusions

The findings suggest that the neighborhood social environment may be important for preventing overweight and obesity in children. Further research investigating the mechanisms through which the neighborhood social environment exerts its effect on BMI is needed.

Economic implications of obesity among people with atherothrombotic disease

Objective: The purpose of this study was to ascertain the impact of obesity on the cost of disease management in people with or at high risk of atherothrombotic disease from a governmental perspective using a bottom-up approach to cost estimation. In addition, the aim was also to explore the causes of any differences found.

Method: The health-care costs of obesity were estimated from 2819 participants recruited into the nationwide Australian REACH Registry with established atherothrombotic disease or at least three risk factors for atherothrombosis. Enrollment was in 2004, through primary care general practices. Information was collected on the use of cardiovascular drugs, hospitalizations and ambulatory care services. Bottom-up costing was undertaken by assigning unit costs to each health-care item, based on Australian Government-reimbursed figures 2006-2007. Linear-mixed models were used to estimate associations between direct medical costs and body mass index (BMI) categories.

Results: Annual pharmaceutical costs per person increased with increasing BMI category, even after adjusting for gender, age, living place, formal education, smoking status, hypertension and diabetes. Adjusted annual pharmaceutical costs of overweight and obese participants were higher (7 (P0.004) and 144 (0.001), respectively) than those of the normal weight participants. This was due to participants in higher BMI categories receiving more pharmaceuticals than normal weight participants. There was no significant change across the BMI categories in annual ambulatory care costs and annual hospital costs.

Conclusion: In these participants with or at high risk of atherothrombotic disease, annual pharmaceutical costs were greater in participants of higher BMI category, but there was not such a gradient in the annual hospital or ambulatory care costs. The greater cardiovascular pharmaceutical costs for participants of higher BMI categories remained even after adjusting for a range of demographic factors and comorbidities. Our results suggest that these costs are explained by the higher number of drugs used among people with atherothrombotic disease. Further investigation is needed to understand the reasons for this level of drug use.

Sitting time and socio-economic differences in overweight and obesity

Objectives: To examine (1) the inter-relationships between socio-economic status (SES), physical activity, three different domains of sitting time (weekday, weekend day and leisure-time sitting), and being overweight or obese (body mass index25 kg/m2); and (2) the potential mediation effects of sitting time in the relationship between socio-economic factors and being overweight or obese in working Australian adults.

Design: Observational epidemiological study.

Subjects: One thousand forty eight working adults. Using a multistage sampling design on neighbourhood SES, participants were from high and low SES neighbourhoods of an Australian capital city.

Measurements: Neighbourhood SES was assessed using census data; individual SES was based on self-reported educational attainment and household income. There were three sitting time variables: sitting time on weekdays, weekend days and in leisure time. Overweight and obesity were determined using self-reported body weight and height.

Results: Gender, age, neighbourhood SES, education, working hours and physical activity were independently associated with weekday, weekend day and leisure-related sitting time. With the exception of education and working hours, these variables were also independently associated with being overweight or obese. Leisure-time sitting was found to be a mediator in the relationships between gender, education and being overweight or obese.

Conclusion: Strategies to promote less sitting in leisure time are required to combat overweight and obesity in Australian adults, especially among those from low SES neighbourhoods, and among those with high levels of education and income who work long hours.

Developing Abu Dhabi's solid waste sustainability index (ADSWMI)

Fast urbanization and population and economic growth led to increased solid waste generation in Abu Dhabi in the last decades. Abu Dhabi generates 5.8 kg of municipal waste per day per person. This is well above the world average of 1.2 kg per day per person. Treatment and destination of the municipal solid waste is also problematic. Only 3.5% of the total municipal solid waste generation is recycled, and the remaining waste is disposed in landfills which are technically not adequate. In this context, sustainability indicators can play an important role in supporting decision makers in planning and managing the solid waste system. In this study, the waste management system in Abu Dhabi Emirate was analyzed through the implementation of a set of proposed sustainability indicators. The DSR Driving force-State-Response approach was used as the methodology to develop a framework for the context of Abu Dhabi. Twenty indicators, based on literature review and benchmarking, were divided into five categories: quantity & composition, environmental controls & resource management, construction & demolition waste, financial sustainability, and governances & policies. These indictors can be a baseline to assist decision makers to develop an integrated waste management system able to meet the high international standards and target in the field.

The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation

To assess the clinical effectiveness and cost-effectiveness of bariatric surgery for obesity. Seventeen electronic databases were searched [MEDLINE; EMBASE; PreMedline In-Process & Other Non-Indexed Citations; The Cochrane Library including the Cochrane Systematic Reviews Database, Cochrane Controlled Trials Register, DARE, NHS EED and HTA databases; Web of Knowledge Science Citation Index (SCI); Web of Knowledge ISI Proceedings; PsycInfo; CRD databases; BIOSIS; and databases listing ongoing clinical trials] from inception to August 2008. Bibliographies of related papers were assessed and experts were contacted to identify additional published and unpublished references. Two reviewers independently screened titles and abstracts for eligibility. Inclusion criteria were applied to the full text using a standard form. Interventions investigated were open and laparoscopic bariatric surgical procedures in widespread current use compared with one another and with non-surgical interventions. Population comprised adult patients with body mass index (BMI) > or = 30 and young obese people. Main outcomes were at least one of the following after at least 12 months follow-up: measures of weight change; quality of life (QoL); perioperative and postoperative mortality and morbidity; change in obesity-related comorbidities; cost-effectiveness. Studies eligible for inclusion in the systematic review for comparisons of Surgery versus Surgery were RCTs. For comparisons of Surgery versus Non-surgical procedures eligible studies were RCTs, controlled clinical trials and prospective cohort studies (with a control cohort). Studies eligible for inclusion in the systematic review of cost-effectiveness were full cost-effectiveness analyses, cost-utility analyses, cost-benefit analyses and cost-consequence analyses. One reviewer performed data extraction, which was checked by two reviewers independently. Two reviewers independently applied quality assessment criteria and differences in opinion were resolved at each stage. Studies were synthesised through a narrative review with full tabulation of the results of all included studies. In the economic model the analysis was developed for three patient populations, those with BMI > or = 40; BMI > or = 30 and < 40 with Type 2 diabetes at baseline; and BMI > or = 30 and < 35. Models were applied with assumptions on costs and comorbidity.

Trends in body mass index according to educational attainment for urban Australian adults between 1980 and 2007

BackgroundWe have previously demonstrated that between the years 1980 and 2000, the mean body mass index (BMI) of the urban Australian population increased, with greater increases observed with increasing BMI. The current study aimed to quantify trends over time in BMI according to education between 1980 and 2007.MethodsWe compared data from the 1980, 1983 and 1989 National Heart Foundation Risk Factor Prevalence Studies, 1995 National Nutrition Survey, 2000 Australian Diabetes, Obesity and Lifestyle Study and the 2007 National Health Survey. For survey comparability, analyses were restricted to urban Australian residents aged 25-64 years. BMI was calculated from measured height and weight. The education variable was dichotomised at completion of secondary school. Four age-standardised BMI indicators were compared over time by sex and education: mean BMI, mean BMI of the top five percent of the BMI distribution, prevalence of obesity (BMI⩾30 kg/m(2)), prevalence of class II(+) obesity (BMI⩾35 kg/m(2)).ResultsBetween 1980 and 2007, the mean BMI among men increased by 2.5 kg/m(2) and 1.7 kg/m(2) for those with low and high education levels, respectively, corresponding to increases in obesity prevalence of 20(from 12% to 32%) and 11(10% to 21%) %-points. Among women mean BMI increased by 2.9 kg/m(2) and 2.4 kg/m(2) for those with low and high education levels respectively, corresponding to increases in obesity prevalence of 16(12% to 28%) and 12(7% to 19%) %-points. The prevalence of class II(+) obesity among men increased by 9(1% to 10%) and 4(1% to 5%) %-points for those with low and high education levels, and among women increased by 8(4% to 12%) and 4(2% to 6%) %-points. Absolute and relative differences between education groups generally increased over time.ConclusionsEducational differences in BMI have persisted among urban Australian adults since 1980 without improvement. Obesity prevention policies will need to be effective in those with greatest socio-economic disadvantage if we are to equitably and effectively address the population burden of obesity and its corollaries.International Journal of Obesity accepted article preview online, 16 March 2015. doi:10.1038/ijo.2015.27.

The association between socio-economic position and diet quality in Australian adults

Objective: We aimed to investigate the association between multiple measures of socio-economic position (SEP) and diet quality, using a diet quality index representing current national dietary guidelines, in the Australian adult population. Design: Cross-sectional study. Linear regression analyses were used to estimate the association between indicators of SEP (educational attainment, level of income and area-level disadvantage) and diet quality (measured using the Dietary Guideline Index (DGI)) in the total sample and stratified by sex and age (≤55 years and >55 years). Setting: A large randomly selected sample of the Australian adult population. Subjects: Australian adults (n 9296; aged ≥25 years) from the Australian Diabetes, Obesity and Lifestyle Study. Results: A higher level of educational attainment and income and a lower level of area-level disadvantage were significantly associated with a higher DGI score, across the gradient of SEP. The association between indicators of SEP and DGI score was consistently stronger among those aged ≤55 years compared with their older counterparts. The most disadvantaged group had a DGI score between 2 and 5 units lower (depending on the marker of SEP) compared with the group with the least disadvantage. Conclusions: A higher level of SEP was consistently associated with a higher level of diet quality for all indicators of SEP examined. In order to reduce socio-economic inequalities in diet quality, healthy eating initiatives need to act across the gradient of socio-economic disadvantage with a proportionate focus on those with greater socio-economic disadvantage.

Economic freedom and productivity growth in resource-rich economies

The focus of this paper is to test whether free market institutions that protect property rights and support freedom of choice and voluntary exchange can change the curse of natural resources into a blessing. To examine the above question, this paper uses the Fraser Institute's economic freedom index and its five sub-indices, namely government size, property rights, access to sound money, freedom to trade, and setting proper regulations. Using data from 99 sample countries over the period 1970-2010, the system GMM estimates suggest that the negative growth effects of resource rents may turn positive in countries with greater economic freedom.

The economic feasibility of price discounts to improve diet in Australian Aboriginal remote communities

OBJECTIVE: To estimate the cost-effectiveness of fiscal measures applied in remote community food stores for Aboriginal Australians.

METHODS: Six price discount strategies on fruit, vegetables, diet drinks and water were modelled. Baseline diet was measured as 12 months' actual food sales data in three remote Aboriginal communities. Discount-induced changes in food purchases were based on published price elasticity data while the weight of the daily diet was assumed constant. Dietary change was converted to change in sodium and energy intake, and body mass index (BMI) over a 12-month period. Improved lifetime health outcomes, modelled for the remote population of Aboriginal and Torres Strait Islanders, were converted to disability adjusted life years (DALYs) saved using a proportional multistate lifetable model populated with diet-related disease risks and Aboriginal and Torres Strait Islander rates of disease.

RESULTS: While dietary change was small, five of the six price discount strategies were estimated as cost-effective, below a $50,000/DALY threshold.

CONCLUSION: Stakeholders are committed to finding ways to reduce important inequalities in health status between Aboriginal and Torres Strait Islanders and non-Indigenous Australians. Price discounts offer potential to improve Aboriginal and Torres Strait Islander health. Verification of these results by trial-based research coupled with consideration of factors important to all stakeholders is needed.

Invisible walls: Do psychological barriers really exist in stock index levels?

We investigate whether the levels of a stock market index contain any evidence of a behavioural bias depending on the proximity of the index level to 'psychological barriers'. These are certain index levels (usually in multiples of 100) at which the market tends to stick before breaking out either up or down. Extant behavioural finance literature has attributed this to investors' subjective perception of 'something special' about certain index levels where in fact no rational economic basis exists for such a perception. We carry out an empirical analysis of the NASDAQ Composite index and find that barrier effects are indeed present in that stock index. We employ simulation analysis to validate of our obtained results.

The importance of broadband for socio-economic development: a perspective from rural Australia

Advanced connectivity offers rural communities prospects for socio-economic development. Despite Australia’s national broadband infrastructure plans, inferior availability and quality of rural Internet connections remain persistent issues. This article examines the impact of limited connectivity on rural socio-economic opportunities, drawing from the views of twelve citizens from the Boorowa local government area in New South Wales. The available fixed wireless and satellite connections in Boorowa are slow and unreliable, and remote regions in the municipality are still without any Internet access. Participants identified four key areas in their everyday lives that are impacted by insufficient connectivity: business development, education, emergency communication, and health. Rural citizens often already face challenges in these areas, and infrastructure advancements in urban spaces can exacerbate rural-urban disparities. Participants’ comments demonstrated apprehension that failure to improve connectivity would result in adverse long-term consequences for the municipality. This article suggests that current broadband policy frameworks require strategic adaptations to account for the socio-economic and geographic contexts of rural communities. In order to narrow Australia’s rural-urban digital divide, infrastructure developments should be prioritised in the most underserved regions.