title: Educational inequalities in obesity and gross domestic product: evidence from 70 countries.
abstract: BACKGROUND
  We test the reversal hypothesis, which suggests that the relationship between obesity and education depends on the economic development in the country; in poor countries, obesity is more prevalent in the higher educated groups, while in rich countries the association is reversed-higher prevalence in the lower educated.
  
  
  METHODS
  We assembled a data set on obesity and education including 412,921 individuals from 70 countries in the period 2002-2013. Gross domestic product (GDP) per capita was used as a measure of economic development. We assessed the association between obesity and GDP by education using a two-stage mixed effects model. Country-specific educational inequalities in obesity were investigated using regression-based inequality indices.
  
  
  RESULTS
  The reversal hypothesis was supported by our results in men and women. Obesity was positively associated with country GDP only among individuals with lower levels of education, while this association was absent or reduced in those with higher levels of education. This pattern was more pronounced in women than in men. Furthermore, educational inequalities in obesity were reversed with GDP; in low-income countries, obesity was more prevalent in individuals with higher education, in medium-income and high-income countries, obesity shifts to be more prevalent among those with lower levels of education.
  
  
  CONCLUSIONS
  Obesity and economic development were positively associated. Our findings suggest that education might mitigate this effect. Global and national action aimed at the obesity epidemic should take this into account.
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
authors.forename: Jonas Minet
authors.initials: JM
authors.lastname: Kinge
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway Department of Community Medicine, University of Oslo, Oslo, Norway.
authors.forename: Bjørn Heine
authors.initials: BH
authors.lastname: Strand
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Stein Emil
authors.initials: SE
authors.lastname: Vollset
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway Columbia Aging Center, Columbia University, New York, New York, USA.
authors.forename: Vegard
authors.initials: V
authors.lastname: Skirbekk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003431:Cross-Cultural Comparison; D019049:Developed Countries / Q000191:economics* / Q000706:statistics & numerical data; D003906:Developing Countries / Q000191:economics* / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D059066:Gross Domestic Product / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D009765:Obesity / Q000191:economics / Q000453:epidemiology*; D015995:Prevalence; D017678:Sex Distribution; D012923:Social Class
keywords: EDUCATION; Health inequalities; INTERNATIONAL HLTH; MULTILEVEL MODELLING; OBESITY