Socio-economic accounting of inequalities in excess weight: a population-based analysis

Background: The prevalence of excess weight has been increasing globally in the last decades, affecting disproportionally adults from low socio-economic backgrounds and putting undue pressure on health systems and societal resources. In England, tackling unfair and unjust health inequalities is at the heart of national public health policy, and a prerequisite for enabling these decision makers to set policy priorities is an understanding of the prevalence and determinants of excess weight inequalities in their local population. Methods: We conducted both pooled (England) and regional-level (nine regions: North-East, North-West, Yorkshire and Humber, East Midlands, West Midlands, East of England, London, South East and South West) analyses of individual level data from a nationally representative sample of adults (N = 6,387). We used the Corrected Concentration Index (CCI) to measure absolute inequalities in excess weight across three dimensions of socio-economic deprivation: neighbourhood-level deprivation, occupational status and educational qualification. We used a Shapley decomposition method to evaluate their relative contribution to inequality. Results: At a national level, all three dimensions of socio-economic deprivation were found to be positively associated with excess weight across the adult population, as measured by the CCI, with educational qualification ranking first [CCI: -0.090, p < 0.01], closely followed by neighbourhood-level deprivation [CCI: -0.050, p < 0.01]. Large variation was found between regions and genders, with inequality being either considerably higher or exclusively patterned among women. The strongest independent factor contributing to excess weight inequalities was having a long-lasting limiting illness, especially among women and towards the right tail of the excess weight spectrum. Heterogeneous patterns of contribution across the excess weight spectrum were found, however age played a dominant role toward the left tail of the distribution. Conclusions: While socio-economic inequalities in excess weight exist in the English adult population, our findings underscore the importance of considering multiple dimensions of deprivation and the unique needs of different populations when developing policies to address overweight and obesity. Targeted interventions for adults with overweight and obesity with long-lasting illnesses and women can generate both short-term and long-term economic benefits, by reducing healthcare costs and increasing workforce productivity.