title: Comparative appraisal of educational inequalities in overweight and obesity among adults in 19 European countries.
abstract: BACKGROUND
  In Western societies, a lower educational level is often associated with a higher prevalence of overweight and obesity. However, there may be important international differences in the strength and direction of this relationship, perhaps in respect of differing levels of socio-economic development. We aimed to describe educational inequalities in overweight and obesity across Europe, and to explore the contribution of level of socio-economic development to cross-national differences in educational inequalities in overweight and obese adults in Europe.
  
  
  METHODS
  Cross-sectional data, based on self-reports, were derived from national health interview surveys from 19 European countries (N = 127 018; age range = 25-44 years). Height and weight data were used to calculate the body mass index (BMI). Multivariate regression analysis was employed to measure educational inequalities in overweight and obesity, based on BMI. Gross domestic product (GDP) per capita was used as a measure of level of socio-economic development.
  
  
  RESULTS
  Inverse educational gradients in overweight and obesity (i.e. higher education, less overweight and obesity) are a generalized phenomenon among European men and even more so among women. Baltic and eastern European men were the exceptions, with weak positive associations between education and overweight and obesity. Educational inequalities in overweight and obesity were largest in Mediterranean women. A 10 000-euro increase in GDP was related to a 3% increase in overweight and obesity for low-educated men, but a 4% decrease for high-educated men. No associations with GDP were observed for women.
  
  
  CONCLUSIONS
  In most European countries, people of lower educational attainment are now most likely to be overweight or obese. An increasing level of socio-economic development was associated with an emergence of inequalities among men, and a persistence of these inequalities among women.
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands. albertjanroskam@hotmail.com
authors.forename: Albert-Jan R
authors.initials: AJ
authors.lastname: Roskam
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
authors.forename: Herman
authors.initials: H
authors.lastname: Van Oyen
authors.forename: Stefaan
authors.initials: S
authors.lastname: Demarest
authors.forename: Jurate
authors.initials: J
authors.lastname: Klumbiene
authors.forename: Enrique
authors.initials: E
authors.lastname: Regidor
authors.forename: Uwe
authors.initials: U
authors.lastname: Helmert
authors.forename: Florence
authors.initials: F
authors.lastname: Jusot
authors.forename: Dagmar
authors.initials: D
authors.lastname: Dzurova
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D019049:Developed Countries; D003906:Developing Countries; D004467:Economics; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology*; D015995:Prevalence; D017678:Sex Distribution