Trends in group inequalities and interindividual inequalities in BMI in the United States, 1993-2012.
BACKGROUND
Marked increases in mean body mass index (BMI) and prevalence of obesity and overweight in the United States are well known. However, whether these average increases were accompanied by changing dispersion (or SD) remains understudied.


OBJECTIVE
We investigated population-level changes in the BMI distribution over time to understand how changes in dispersion reflect between-group compared with within-group inequalities in weight gain in the United States.


METHODS
Using data from the Behavioral Risk Factor Surveillance System survey (1993-2012), we analyzed associations between mean, SD, and median BMI and BMI at the 5th and 95th percentiles for 3,050,992 non-Hispanic white, non-Hispanic black, and Hispanic men and women aged 25-64 y.


RESULTS
Overall, an increase of 1.0 in mean BMI (in kg/m²) was associated with an increase of 0.70 (95% CI: 0.67, 0.73) in the SD of BMI. A change of 1.0 in median BMI was associated with a change of 0.18 (95% CI: 0.14, 0.21) in the BMI value at the 5th percentile compared with a change of 2.94 (95% CI: 2.81, 3.07) at the 95th percentile. Quantile-quantile plots showed unequal changes in the BMI distribution, with pronounced changes at higher percentiles. Similar patterns were observed in subgroups stratified by sex, race-ethnicity, and education with non-Hispanic black women and women with less than a high school education having highest mean BMI, SD of BMI, and BMI values at the 5th and 95th percentiles.


CONCLUSIONS
Mean BMI and the percentage of overweight and obese individuals do not fully describe population changes in BMI. Increases in within-group inequality in BMI represent an underrecognized characteristic of population-level weight gain. Crucially, similar increases in dispersion within groups suggest that growing inequalities in BMI at the population level are not driven by these socioeconomic and demographic factors. Future research should focus on understanding factors driving inequalities in weight gain between individuals.
From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (AK and SVS); the Department of Medicine, University of Toronto, Toronto, Canada (FR); the Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada (FR); the Harvard Center for Population and Development Studies. Boston, MA (FR); Laval University, Quebec, Canada (AL); the Quebec Heart and Lung Institute Research Center, Quebec, Canada (AL); and the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (GDS).
Aditi
A
Krishna
From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (AK and SVS); the Department of Medicine, University of Toronto, Toronto, Canada (FR); the Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada (FR); the Harvard Center for Population and Development Studies. Boston, MA (FR); Laval University, Quebec, Canada (AL); the Quebec Heart and Lung Institute Research Center, Quebec, Canada (AL); and the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (GDS).
Fahad
F
Razak
From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (AK and SVS); the Department of Medicine, University of Toronto, Toronto, Canada (FR); the Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada (FR); the Harvard Center for Population and Development Studies. Boston, MA (FR); Laval University, Quebec, Canada (AL); the Quebec Heart and Lung Institute Research Center, Quebec, Canada (AL); and the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (GDS).
Alexandre
A
Lebel
From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (AK and SVS); the Department of Medicine, University of Toronto, Toronto, Canada (FR); the Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada (FR); the Harvard Center for Population and Development Studies. Boston, MA (FR); Laval University, Quebec, Canada (AL); the Quebec Heart and Lung Institute Research Center, Quebec, Canada (AL); and the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (GDS).
George Davey
GD
Smith
From the Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (AK and SVS); the Department of Medicine, University of Toronto, Toronto, Canada (FR); the Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada (FR); the Harvard Center for Population and Development Studies. Boston, MA (FR); Laval University, Quebec, Canada (AL); the Quebec Heart and Lung Institute Research Center, Quebec, Canada (AL); and the School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom (GDS).
S V
SV
Subramanian
D000328:Adult; D001741:Black or African American; D040343:Behavioral Risk Factor Surveillance System; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D054624:Health Status Disparities; D019456:Health Transition; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000453:epidemiology* / Q000208:ethnology; D050177:Overweight / Q000453:epidemiology* / Q000208:ethnology; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D015430:Weight Gain; D044465:White People
BRFSS; Behavioral Risk Factor Surveillance System; body mass index; distributional change; health inequalities; obesity; socioeconomic status