Advertisement

Canadian Journal of Public Health

, Volume 100, Issue 1, pp 18–23 | Cite as

The Geography of Overweight in Quebec: A Multilevel Perspective

  • Alexandre LebelEmail author
  • Robert Pampalon
  • Denis Hamel
  • Marius Thériault
Quantitative Research

Abstract

Objectives

Explore the contextual aspects of overweight in Québec through multilevel modelling, using a purposely designed set of spatial units and a few area-based characteristics.

Methods

Data came from the Canadian Community Health Survey (CCHS Cycle 2.1). Multilevel logistic regressions were performed to test for the presence of an independent contextual effect on overweight and obesity (BMI >-25 kg/m2), separately for men and women. Modelling considered individual attributes, including some lifestyle aspects, and contextual characteristics. A geographic grid integrating spatial elements related to overweight and obesity in the literature was developed. Also, an area-level residuals analysis was carried out to identify spatial units presenting higher or lower odds of being overweight.

Results

After accounting for individual and area-level characteristics, there remain significant geographic variations in overweight in Québec. Although this contextual effect is small for men and women, many spatial units differ significantly from the provincial average. There are differences between the geography of overweight in men and women which suggest that socio-economic mechanisms and land use patterns underlying overweight might be different between genders. Also, there is considerable variability within rural and urban areas.

Conclusion

A complex geography of overweight is revealed. Small-scale studies, as well as methodological and data developments, are needed to deepen our understanding of this geography.

Key words

Overweight obesity Québec medical geography multilevel analysis population health 

Résumé

Objectifs

Explorer l’aspect contextuel de l’excès de poids au Québec avec une modélisation multiniveau basée sur un cadre de référence spatial adapté à la thématique.

Méthodes

Les données analysées proviennent de l’Enquête sur la santé dans les collectivités canadiennes (cycle 2.1). Afin de vérifier la présence d’un effet contextuel indépendant sur l’excès de poids (IMC >-25 kg/m2), nous avons réalisé une série de régressions logistiques multiniveaux séparément pour les hommes et les femmes. La modélisation comprend des caractéristiques individuelles, incluant certaines habitudes de vie, et contextuelles. Nous avons développé un cadre de référence spatial qui considère des éléments de l’espace qui sont habituellement associés à l’excès de poids dans la littérature. De plus, une analyse des résidus de second niveau nous a permis d’identifier les unités spatiales qui présentent les plus fortes et les plus faibles valeurs de risque d’excès de poids.

Résultats

Après avoir considéré les caractéristiques individuelles et contextuelles, une part significative des variations géographiques reste inexpliquée. Bien que cette part soit faible, plusieurs unités spatiales diffèrent de la moyenne provinciale. Des différences entre la géographie de l’excès de poids des hommes et de femmes suggèrent que certains mécanismes socioéconomiques et d’utilisation du sol diffèrent entre les sexes. De plus, nous avons observé qu’il existe une importante variabilité à l’intérieur des milieux ruraux et des milieux urbains.

Conclusion

La géographie de l’excès de poids est complexe. Des analyses locales et des développements méthodologiques sont nécessaires pour mieux comprendre cette géographie.

Mots clés

excès de poids obésité Québec géographie de la santé analyse multiniveau santé de la population 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Antipastis VJ, Gill TP. Obesity as a global problem. In: Björntorp P (Ed.), International Textbook of Obesity. Göteborg: John Wiley & Sons, Ltd, 2001;3–22.Google Scholar
  2. 2.
    Kim S, Popkin BM. Commentary: Understanding the epidemiology of overweight and obesity — a real global public health concern. Int J Epidemiol 2006;35(1):60–67.PubMedCrossRefGoogle Scholar
  3. 3.
    OMS. Obésité: Prévention et prise en charge de l’épidémie mondiale. Genève, Suisse: Organisation mondiale de la santé, 2003;894:300.Google Scholar
  4. 4.
    Commission des communautés européennes. Promouvoir une alimentation saine et l’activité physique: une dimension européenne pour la prévention des surcharges pondérales, de l’obésité et des maladies chroniques. Bruxelles: CCE, 2005;1–25.Google Scholar
  5. 5.
    International Obesity Task Force, European Association for the Study of Obesity. Obesity in Europe, The Case for Action. London, 2002; 1–30.Google Scholar
  6. 6.
    US Department of Health and Human Services. Healthy People 2010, Understanding and Improving Health. Washington, DC: US Government Printing Office, 2000; 1–64.Google Scholar
  7. 7.
    Secrétariat intersectoriel de promotion des modes de vie sains. La Stratégie pancanadienne intégrée en matière de mode de vie sains. Ottawa: Ministre de la Santé, 2005;1–55.Google Scholar
  8. 8.
    Brug J, van Lenthe FJ, Kremers SP. Revisiting Kurt Lewin: How to gain insight into environmental correlates of obesogenic behaviors. Am J Prev Med 2006;31(6):525–29.PubMedCrossRefGoogle Scholar
  9. 9.
    Chaix B, Chauvin P. Tobacco and alcohol consumption, sedentary lifestyle and overweightness in France: A multilevel analysis of individual and area-level determinants. Eur J Epidemiol 2003;18(6):531–38.PubMedCrossRefGoogle Scholar
  10. 10.
    Colchero MA, Bishai D. Effect of neighborhood exposures on changes in weight among women in Cebu, Philippines (1983-2002). Am J Epidemiol 2008;167(5):615–23.PubMedCrossRefGoogle Scholar
  11. 11.
    Colapinto CK, Fitzgerald A, Taper LJ, Veugelers PJ. Children’s preference for large portions: Prevalence, determinants, and consequences. J Am Diet Assoc 2007;107(7):1183–90.PubMedCrossRefGoogle Scholar
  12. 12.
    Dundas R, Leyland AH, Macintyre S, Leon DA. Does the primary school attended influence self-reported health or its risk factors in later life? Aberdeen Children of the 1950s Study. Int J Epidemiol 2006;35(2):458–65.PubMedCrossRefGoogle Scholar
  13. 13.
    Eid J, Overman H, Puga D, Turner M. Fat City: The Relationship Between Urban Sprawl and Obesity. Centre for Economic Performance, CEP Discussion Papers dp0758, 2007.Google Scholar
  14. 14.
    Ewing R, Schmid T, Killingsworth R, Zlot A, Raudenbush S. Relationship between urban sprawl and physical activity, obesity, and morbidity. Am J Health Promot 2003;18(1):47–57.PubMedCrossRefGoogle Scholar
  15. 15.
    Ewing R, Brownson RC, Berrigan D. Relationship between urban sprawl and weight of United States youth. Am J Prev Med 2006;31(6):464–74.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Glass TA, Rasmussen MD, Schwartz BS. Neighborhoods and obesity in older adults: The Baltimore Memory Study. Am J Prev Med 2006;31(6):455–63.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Hardy R, Wadsworth M, Kuh D. The influence of childhood weight and socioeco-nomic status on change in adult body mass index in a British national birth cohort. Int J Obesity Related Metabolic Disorders: J Int Assoc Study Obesity 2000;24(6):725–34.CrossRefGoogle Scholar
  18. 18.
    Inagami S, Cohen DA, Finch BK, Asch SM. You are where you shop: Grocery store locations, weight, and neighborhoods. Am J Prev Med 2006;31(1):10–17.PubMedCrossRefGoogle Scholar
  19. 19.
    Janssen I, Boyce WF, Simpson K, Pickett W. Influence of individual- and area-level measures of socioeconomic status on obesity, unhealthy eating, and physical inactivity in Canadian adolescents. Am J Clin Nutr 2006;83(1):139–45.PubMedCrossRefGoogle Scholar
  20. 20.
    Kim D, Subramanian SV, Gortmaker SL, Kawachi I. US state- and county-level social capital in relation to obesity and physical inactivity: A multilevel, multivariable analysis. Soc Sci Med 2006;63(4):1045–59.PubMedCrossRefGoogle Scholar
  21. 21.
    King T, Kavanagh AM, Jolley D, Turrell G, Crawford D. Weight and place: A multilevel cross-sectional survey of area-level social disadvantage and overweight/obesity in Australia. Int J Obesity 2006;30(2):281–87.CrossRefGoogle Scholar
  22. 22.
    Lee NE, De AK, Simon PA. School-based physical fitness testing identifies large disparities in childhood overweight in Los Angeles. J Am Diet Assoc 2006;106(1):118–21.PubMedCrossRefGoogle Scholar
  23. 23.
    Lopez R. Urban sprawl and risk for being overweight or obese. Am J Public Health 2004;94(9):1574–79.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Maddock J. The relationship between obesity and the prevalence of fast food restaurants: State-level analysis. Am J Health Promot 2004;19(2):137–43.PubMedCrossRefGoogle Scholar
  25. 25.
    Mobley LR, Root ED, Finkelstein EA, Khavjou O, Farris RP, Will JC. Environment, obesity, and cardiovascular disease risk in low-income women. Am J Prev Med 2006;30(4):327–32.PubMedCrossRefGoogle Scholar
  26. 26.
    Monteiro CA, Conde WL, Lu B, Popkin BM. Obesity and inequities in health in the developing world. Int J Obesity Related Metabolic Disorders: J Int Assoc Study Obesity 2004;28(9):1181–86.CrossRefGoogle Scholar
  27. 27.
    Moon G, Quarendon G, Barnard S, Twigg L, Blyth B. Fat nation: Deciphering the distinctive geographies of obesity in England. Soc Sci Med 2007;65(1):20–31.PubMedCrossRefGoogle Scholar
  28. 28.
    Morland K, Diez Roux AV, Wing S. Supermarkets, other food stores, and obesity: The atherosclerosis risk in communities study. Am J Prev Med 2006;30(4):333–39.PubMedCrossRefGoogle Scholar
  29. 29.
    Oliver LN, Hayes MV. Neighbourhood socio-economic status and the prevalence of overweight Canadian children and youth. Can J Public Health 2005;96(6):415–20.PubMedGoogle Scholar
  30. 30.
    Poortinga W. Perceptions of the environment, physical activity, and obesity. Soc Sci Med 2006;63(11):2835–46.PubMedCrossRefGoogle Scholar
  31. 31.
    Reijneveld SA, Schene AH. Higher prevalence of mental disorders in socioe-conomically deprived urban areas in The Netherlands: Community or personal disadvantage? J Epidemiol Community Health 1998;52(1):2–7.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Robert SA, Reither EN. A multilevel analysis of race, community disadvantage, and body mass index among adults in the US. Soc Sci Med 2004;59(12):2421–34.PubMedCrossRefGoogle Scholar
  33. 33.
    Ross NA, Tremblay S, Khan S, Crouse D, Tremblay M, Berthelot JM. Body mass index in urban Canada: Neighborhood and metropolitan area effects. Am J Public Health 2007;97(3):500–8.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Rundle A, Roux AV, Free LM, Miller D, Neckerman KM, Weiss CC. The urban built environment and obesity in New York City: A multilevel analysis. Am J Health Promot 2007;21(4 Suppl):326–34.PubMedCrossRefGoogle Scholar
  35. 35.
    Sundquist J, Malmstrom M, Johansson SE. Cardiovascular risk factors and the neighbourhood environment: A multilevel analysis. Int J Epidemiol 1999;28(5):841–45.PubMedCrossRefGoogle Scholar
  36. 36.
    Veugelers PJ, Fitzgerald AL. Prevalence of and risk factors for childhood overweight and obesity. CMAJ 2005;173(6):607–13.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Wilsgaard T, Jacobsen BK, Arnesen E. Determining lifestyle correlates of body mass index using multilevel analyses: The Tromso Study, 1979–2001. Am J Epidemiol 2005;162(12):1179–88.PubMedCrossRefGoogle Scholar
  38. 38.
    Zunzunegui MV, Forster M, Gauvin L, Raynault MF, Douglas WJ. Community unemployment and immigrants’ health in Montreal. Soc Sci Med 2006;63(2):485–500.PubMedCrossRefGoogle Scholar
  39. 39.
    Papas MA, Alberg AJ, Ewing R, Helzlsouer KJ, Gary TL, Klassen AC. The built environment and obesity. Epidemiol Rev 2007;29:129–43.PubMedCrossRefGoogle Scholar
  40. 40.
    Riva M, Gauvin L, Barnett TA. Toward the next generation of research into small area effects on health: A synthesis of multilevel investigations published since July 1998. J Epidemiol Community Health 2007;61(10):853–61.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Lupton R. ‘Neighbourhood effects’: Can we measure them and does it matter? London School of Economics, Center for Analysis of Social Exclusion, CASE Paper, 2003;73:27.Google Scholar
  42. 42.
    Pickett KE, Pearl M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: A critical review. J Epidemiol Community Health 2001;55(2):111–22.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Sampson RJ, Morenoff JD, Gannon-Rowley T. Assessing “neighborhood effects”: Social processes and new directions in research. Ann Rev Sociol 2002;28:443–78.CrossRefGoogle Scholar
  44. 44.
    Lebel A, Pampalon R, Villeneuve PY. A multi-perspective approach for defining neighbourhood units in the context of a study on health inequalities in the Quebec City region. Int J Health Geography 2007;6:27.CrossRefGoogle Scholar
  45. 45.
    Le Petit C, Berthelot J-M. L’obésité: un enjeu en croissance. Rapport sur la santé 2006;17(3):45–56.Google Scholar
  46. 46.
    Vanasse A, Demers M, Hemiari A, Courteau J. Obesity in Canada: Where and how many? Int J Obesity 2006;30(4):677–83.CrossRefGoogle Scholar
  47. 47.
    Huot I, Paradis G, Ledoux M. Factors associated with overweight and obesity in Quebec adults. Int J Obesity 2004;28(6):766–74.CrossRefGoogle Scholar
  48. 48.
    Pampalon R, Martinez J, Hamel D. Does living in rural areas make a difference for health in Quebec? Health & Place 2006;12(4):421–35.CrossRefGoogle Scholar
  49. 49.
    Shields M, Tjepkema M. Différences régionales en matière d’obésité. Rapport sur la santé 2007;17(3):65–74.Google Scholar
  50. 50.
    WHO. Physical Status: The use and interpretation of anthropometry. Geneva: World Health Organization, 1995.Google Scholar
  51. 51.
    Probert A. Desk Potatoes — The Importance of Occupational Physical Activity on Health. Canadian Public Health Association 2007 Annual Conference.Google Scholar
  52. 52.
    Pampalon R, Raymond G. A deprivation index for health and welfare planning in Quebec. Chron Dis Can 2000;21(3):104–13.Google Scholar
  53. 53.
    Diez Roux AV. A glossary for multilevel analysis. J Epidemiol Community Health 2002;56(8):588–94.PubMedCrossRefGoogle Scholar
  54. 54.
    Snijders T, Bosker R. Multilevel Analysis. London, UK: Sage Publication, 1999.Google Scholar
  55. 55.
    Gauvin L, Robitaille E, Riva M, McLaren L, Dassa C, Potvin L. Conceptualizing and operationalizing neighbourhoods: The conundrum of identifying territorial units. Can J Public Health 2007;98(Suppl 1):S18–S26.PubMedGoogle Scholar
  56. 56.
    Frank LD, Andresen MA, Schmid TL. Obesity relationships with community design, physical activity, and time spent in cars. Am J Prev Med 2004;27(2):87–96.PubMedCrossRefGoogle Scholar
  57. 57.
    McNiven C, Puderer H, Janes D. Zones d’influence des régions métropolitaines de recensement et des agglomérations de recensement (ZIM): une description de la méthodologie. Division de la géographie, Statistique Canada, 2000.Google Scholar
  58. 58.
    Statistics Canada. 2001 Census Dictionary. Minister of Industry. Ottawa, 2003.Google Scholar
  59. 59.
    Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295(13):1549–55.PubMedCrossRefGoogle Scholar
  60. 60.
    Apparicio P, Cloutier MS, Shearmur R. The case of Montreal’s missing food deserts: Evaluation of accessibility to food supermarkets. Int J Health Geography 2007;6:4.CrossRefGoogle Scholar
  61. 61.
    Pouliot N, Hamelin A-M. Disparities in fruit and vegetable supply: A potential health concern in the greater Québec City area. Public Health Nutr 2009;Under review.Google Scholar
  62. 62.
    Ramp W, Kulig J, Townshend I, McGowan V. Health in Rural Settings: Context for Action. Lethbridge: University of Lethbridge, 1999.Google Scholar
  63. 63.
    Aday LA, Quill BE, Reyes-Gibby CC. Equity in rural health and health care. In: Loue S, Quill BE (Eds.), Handbook of Rural Health. New York, NY: Kluwer Academic/Plenum Publisher, 2001.Google Scholar
  64. 64.
    Winkler E, Turrell G, Patterson C. Does living in a disadvantaged area mean fewer opportunities to purchase fresh fruit and vegetables in the area? Findings from the Brisbane food study. Health & Place 2006;12(3):306–19.CrossRefGoogle Scholar
  65. 65.
    Wrigley N, Warm D, Margetts B. Deprivation, diet, and food retail acess: Findings from the Leeds ‘Food Deserts’ Study. Environ Plan A 2002;34.Google Scholar
  66. 66.
    Richmond TK, Subramanian SV. School level contextual factors are associated with the weight status of adolescent males and females. Obesity (Silver Spring) 2008.Google Scholar
  67. 67.
    Mongeau L, Audet N, Aubin J, Baraldi R. L’excès de poids dans la population québécoise de 1987 à 2003. Institut national de santé publique du Québec, 2005;24.Google Scholar
  68. 68.
    Nolin B. Activité physique de loisir: codification et critères d’analyse, 2004. Québec: Institut national de santé publique du Québec, 2006.Google Scholar

Copyright information

© The Canadian Public Health Association 2009

Authors and Affiliations

  • Alexandre Lebel
    • 1
    • 2
    Email author
  • Robert Pampalon
    • 2
  • Denis Hamel
    • 2
  • Marius Thériault
    • 1
  1. 1.Centre de recherche en aménagement et développementUniversité LavalQuebec CityCanada
  2. 2.Institut national de santé publique du QuébecQuébecCanada

Personalised recommendations