Why does the social gradient in health not apply to overweight?

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by Stefan Kuhle and Paul J. Veugelers



In developed countries, there is a negative association between socioeconomic status (SES) and a variety of health outcomes, known as the social gradient in health. This is contrasted by a weak, absent or even positive gradient for overweight. The objective of this study was to investigate why overweight does not follow the social gradient. 

Data and methods

Data from adult respondents to the 2004 Canadian Community Health Survey (cycle 2.2) were used.  A series of multivariate models regressing overweight and determinants of overweight on household education and household income were performed, stratified by gender.   


Except for education among women, negative associations between SES measures and overweight emerged.  Respondents from higher household income groups reported more meals away from home, compared with those from lower household income groups.  In addition, adults in higher-education households were more likely than those in lower-education households to have quit smoking.


Differences in food consumption patterns and smoking cessation between SES groups may have contributed to the lack of a clear negative association between household education and income and overweight in the CCHS. 


body weight, dietary habits, education, income, nutrition, physical activity, smoking, socio-economic factors


One of the paradigms of public health is that in developed countries, individuals of lower socio-economic status (SES) tend to have poorer health. Numerous studies have demonstrated a higher prevalence of risk factors for cardiovascular diseases and type 2 diabetes, a higher incidence of cardiovascular disease and some cancers, and higher allcause, cardiovascular and cancer mortality in lower SES groups. [Full text]


Stefan Kuhle and Paul J. Veugelers (780-492-9095; paul.veugelers@ualberta.ca) are with the School of Public Health, University of Alberta, 650 University Terrace, Edmonton, Alberta, T6G 2T4

What is already known on this subject?

  • Individuals of lower socio-economic status (SES) tend to have poorer health, a phenomenon commonly referred to as the social gradient of health. 
  • Associations between SES and overweight/obesity are less consistent and show gender differences.
  • The lifestyle factors related to SES that may underlie this observation have not been investigated.

What does this study add?

  • Differences between SES groups in food consumption patterns and smoking cessation may be associated with the lack of a strong negative association between SES measures and overweight.