Multilevel Health Approach to Studying Obesity and Formulating Prevention Strategies

Social ecological models of health describe health issues in terms of the environment, and other interactive characteristics that influence the health outcome of an individual (Jacob & Jutka, 2015). Obesity is a public health issue that has nearly doubled in prevalence world wide in a 28 year period (1980-2008) (Jacob & Jutka, 2015). In the past, it was a condition most prevalent in wealthy countries, but in the past two decades there has been a dramatic increase in developing countries as well (Jacob & Jutka, 2015). The cause of the obesity epidemic is more complex than simply poor nutrition and lack of activity (Jacob & Jutka, 2015). It is a health condition that should be examined using a multilevel conceptual model so that the determinants of behaviours like nutrition and physical activity can be better understood (Jacob & Jutka, 2015).

An example of a study like this is one that was done in Spain, which has some of the highest rates of obesity in Europe, and also has had one of the greatest increases in the condition (Raftopoulou, 2017). Researchers found many determinants embedded in the obesity epidemic in Spain, including personal, socioeconomic, and geographical factors (Raftopoulou, 2017). The study found that net income was statistically significant, and had a negative association with BMI (Raftopoulou, 2017). Additionally, it found that individuals with lower education levels had higher BMI scores (Raftopoulou, 2017). The study also looked at the way specific regions interacted with BMI scores, and it was found that there was a higher chance of obesity in regions where green space was not accessible (Raftopoulou, 2017). Regional differences in violence had an impact on obesity rates as well, but only in women (Raftopoulou, 2017). It was found that in areas that were less secure, there was a 10% greater obesity rate in women (Raftopoulou, 2017).

A multilevel study on health outcomes in youth found something similar. Low socioeconomic status was associated with increased rates of obesity and asthma in youth, even in countries like Canada, where there is universal healthcare (Schreier & Chen, 2013). The study noted that a violent neighbourhood shaped parenting styles and parent mental health (Schreier & Chen, 2013). This was significant because mental health in parents and parenting behaviours were linked to health outcomes in their children (Schreier & Chen, 2013). It was found that more violent neighbourhoods contributed to post-traumatic stress in youth, behavioural problems, and depressive symptoms (Schreier & Chen, 2013). These psychological issues were associated with higher rates of obesity and asthma (Schreier & Chen, 2013). The study found that noise pollution, including traffic and aircraft noise affected youth quality of life and perceived stress, negatively (Schreier & Chen, 2013). Factors on different levels such as neighbourhood, family level and personal level influenced each other in dynamic ways (Schreier & Chen, 2013). Figure 1 from the study helps to illustrate this relationship.

“Figure 1. Proposed pathways between socioeconomic status and youth health outcomes (Schreier & Chen, pp. 608, 2013).”

In figure one, you can see that the neighbourhood and family, physical and social influences can be bidirectional feedback loops on each other that increase their impact on health (Schreier & Chen, 2013). For example, pollution in the environment, and lack of resources impacts parenting and stress within the family unit, and together they impact a child’s psychological state. As a result, that child has more barriers to face when trying to establish healthy behaviours such as good nutrition and exercise. The figure illustrates how all these factors can work synergistically to make a greater impact.

Consumption of food and what is purchased is influenced by many factors including price, culture, ethnicity and flavour (Jacob & Jutka, 2015). These factors influence each other, and exist on multiple levels of influence (Jacob & Jutka, 2015). Because there is not one single causal factor, it is unlikely that a single intervention will have any notable impact on obesity (Jacob & Jutka, 2015). A portfolio of continuous interventions, which rely less on education and personal responsibility, and more on reshaping societal norms and improving environmental factors is needed in the fight to prevent obesity (Jacob & Jutka, 2015).

References

Jacob C., S., & Jutka, H. (2015). The Global Burden of Obesity and the Challenges of Prevention. Annals of Nutrition and Metabolism, 7. https://0-doi-org.aupac.lib.athabascau.ca/10.1159/000375143

Raftopoulou, A. (2017). Geographic determinants of individual obesity risk in Spain: A multilevel approach. Economics and Human Biology, 24, 185–193. https://0-doi-org.aupac.lib.athabascau.ca/10.1016/j.ehb.2016.12.001

Schreier, H. M. C., & Chen, E. (2013). Socioeconomic Status and the Health of Youth: A Multilevel, Multidomain Approach to Conceptualizing Pathways. Psychological Bulletin, 139(3), 606–654. Retrieved from http://0-search.ebscohost.com.aupac.lib.athabascau.ca/login.aspx?direct=true&db=eric&AN=EJ1007099&site=eds-live