Do adult obesity rates in England vary by insecurity as well as by inequality? An ecological cross-sectional study

OBJECTIVE: Geographical variations in adult obesity rates have been attributed in part to variations in social and economic inequalities. Insecurity is associated with obesity at the cross-national level, but there is little empirical evidence to show that insecurity contributes to the structuring of adult obesity rates at the subnational level. This is examined in this study across local authorities in England, using a recently developed social classification for the British population. SETTING: Modelled obesity rates from the Health Survey for England 2006–2008 were related to social class (as estimated from the BBC’s Great British Class Survey of 2011 and a nationally representative sample survey), across 320 local authorities in England. PRIMARY AND SECONDARY OUTCOME MEASURES: Comparisons of mean obesity rates across Z score categories for seven latent social classes were carried out using one-way analysis of variance. Pooled ordinary least square regression analyses of obesity rates by local authorities according to the proportion of different social classes within each of them were performed to determine the extent of geographical variations in obesity rates among the classes that were more greatly based on insecurity (emergent service workers, precariat), and those more closely based on inequality (elite, established middle class, technical middle class, new affluent workers, traditional working class). RESULTS: Adult obesity rates vary negatively across local authorities according to the proportion of people in the elite (F=39.06, p<0.001) and technical middle class (F=8.10, p<0.001) and positively with respect to the proportion of people of the established middle class (F=26.36, p<0.001), new affluent workers (F=73.03, p<0.001), traditional working class (F=23.00, p<0.001) and precariat (F=13.13, p<0.001). Social classes more closely based on inequality show greater association with adult obesity rates across local authorities than social classes more closely based on insecurity. CONCLUSIONS: Both insecurity and inequality are associated with the geographical patterning of adult obesity rates across England.