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The Geography of Overweight in Quebec: A Multilevel Perspective

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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.

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.

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Authors and Affiliations

  1. Centre de recherche en aménagement et développement, Université Laval, Pavillon Félix-Antoine-Savard, room 1636, Quebec City, QC, G1K 7P4, Canada

    Alexandre Lebel & Marius Thériault PhD

  2. Institut national de santé publique du Québec, Québec, QC, Canada

    Alexandre Lebel, Robert Pampalon PhD & Denis Hamel MSc

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  1. Alexandre Lebel
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  2. Robert Pampalon PhD
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  3. Denis Hamel MSc
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  4. Marius Thériault PhD
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Correspondence to Alexandre Lebel.

Additional information

Acknowledgements: This research could not have been carried out without the financial support of the Quebec Population Health Research Network (QPHRN), the Quebec Inter-University Centre for Social Statistics (QICSS), and the Fonds de la recherche en santé du Québec (FRSQ). The Institut national de santé publique du Québec (INSPQ) and the Natural Science and Engineering Research Council of Canada (NSERCC) also contributed to this study. Finally, we thank William Pederson and Pierre Masson for their revision of an earlier version of this manuscript, as well as Philippe Gamache and Patricia Lamontagne, both from INSPQ, for their valuable advice.

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Lebel, A., Pampalon, R., Hamel, D. et al. The Geography of Overweight in Quebec: A Multilevel Perspective. Can J Public Health 100, 18–23 (2009). https://doi.org/10.1007/BF03405486

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