title: Determinants of geographical variations in body mass index (BMI) and obesity in Spain.
abstract: OBJECTIVE
  To identify the factors associated with geographic variations in Body Mass Index (BMI) and obesity in Spain.
  
  
  METHODS
  Cross-sectional, ecological analysis using data on illiteracy rate (per 1000 population), energy intake (kcal/person/d), sedentary population (%), smoking population (%), alcohol consumption (g/person/d), and percentage of population aged 65 y or over, for Spain's 50 provinces.
  
  
  METHODS
  Non-institutionalized population aged 16y or over.
  
  
  METHODS
  Median BMI and percentage of population with obesity, defined as BMI > 30 kg/m2.
  
  
  RESULTS
  There was a clear geographical pattern, with some areas in the south and north-west of the country registering the highest BMI and prevalence of obesity and a north-south pattern on illiteracy per 1000 population. Multivariate regression analysis showed that illiteracy, sedentary lifestyle and energy intake explain 35% and 14% of the variation in BMI and obesity, respectively. Illiteracy proved to be the variable most associated with both BMI (regression coefficient (beta = 0.01; P = 0.005) and obesity (beta = 0.05; P = 0.013). Sedentary lifestyle showed a statistically significant relationship with BMI (beta = 0.01; P = 0.03), but not with obesity (beta = 0.03; P = 0.581). Energy intake exhibited a relationship with BMI (beta < 0.01 P = 0.03) that lost statistical significance when adjusted for age.
  
  
  CONCLUSIONS
  Geographical variations in BMI in Spain are partly explained by illiteracy, sedentary lifestyle and, to a lesser extent, energy intake, whereas regional variations in obesity are related only to the educational level of the population.
authors.affiliation: Department of Preventive Medicine and Public Health, Autonomous University of Madrid, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Gutiérrez-Fisac
authors.forename: F
authors.initials: F
authors.lastname: Rodríguez Artalejo
authors.forename: P
authors.initials: P
authors.lastname: Guallar-Castillon
authors.forename: J R
authors.initials: JR
authors.lastname: Banegas Banegas
authors.forename: J
authors.initials: J
authors.lastname: del Rey Calero
mesh_terms: D000428:Alcohol Drinking; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004522:Educational Status; D002149:Energy Intake; D015444:Exercise; D006801:Humans; D008019:Life Style; D009765:Obesity / Q000453:epidemiology*; D011897:Random Allocation; D012907:Smoking; D012923:Social Class; D013030:Spain / Q000453:epidemiology