title: Socioeconomic status, financial hardship and measured obesity in older adults: a cross-sectional study of the EPIC-Norfolk cohort.
abstract: BACKGROUND
  Socioeconomic status is strongly associated with obesity. Current economic circumstances are also independently associated with self-reported weight status in Finnish civil servants. We aimed to examine three types of financial hardship in relation to measured general and central obesity in a general population of older adults, while considering conventional socioeconomic indicators.
  
  
  METHODS
  Data from 10,137 participants (≥50 years) in the EPIC-Norfolk cohort who responded to a postal Health and Life Experiences Questionnaire (1996-2000) and attended a clinical assessment (1998-2002). Multivariable logistic regression models assessed likelihood of general obesity (BMI ≥30 kg/m²) and central obesity (women: ≥88 cm; men: ≥102 cm) calculated from measured anthropometrics.
  
  
  RESULTS
  Obesity prevalence was consistently patterned by standard socioeconomic indicators, with over-50s in the lowest social class being twice as likely to be obese than those in the highest class (women OR 2.10 [CI95: 1.41-3.13]; men OR 2.36 [1.44-3.87]). After adjustment for socioeconomic status, reporting having less than enough money for one's needs (compared to more than enough) was associated with obesity in women (OR 2.04 [1.54-2.69]) and men (OR 1.83 [1.34-2.49]). Similar associations were demonstrated between obesity and always or often not having enough money for food/clothing (women OR 1.40 [1.03-1.90]; men OR 1.81 [1.28-2.56]), compared to reporting this never occurred. The strongest independent associations were seen for obesity and reported greatest level of difficulty paying bills (women OR 2.20 [1.37-3.55]; men 2.40 [1.38-4.17]), compared to having no difficulties. Findings for central obesity were slightly higher in women and lower in men.
  
  
  CONCLUSIONS
  Obesity in British over-50s was more likely in study participants who reported greater financial hardship, even after education, social class and home ownership were taken into account. Public health policies need to consider the hitherto neglected role of financial hardship in older people, especially difficulty paying bills, as part of strategies to prevent or reduce obesity.
authors.forename: Annalijn I
authors.initials: AI
authors.lastname: Conklin
authors.forename: Nita G
authors.initials: NG
authors.lastname: Forouhi
authors.forename: Marc
authors.initials: M
authors.lastname: Suhrcke
authors.forename: Paul
authors.initials: P
authors.lastname: Surtees
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.affiliation: UK Clinical Research Collaboration Centre for Diet and Activity Research (CEDAR), Institute of Public Health, Forvie Site, Robinson Way, Box 296, Cambridge CB2 0SR, UK. pm491@medschl.cam.ac.uk.
authors.forename: Pablo
authors.initials: P
authors.lastname: Monsivais
mesh_terms: D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000209:etiology; D011203:Poverty / Q000706:statistics & numerical data*; D015995:Prevalence; D012306:Risk; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires