Elsevier

Public Health

Volume 120, Issue 10, October 2006, Pages 946-952
Public Health

ORIGINAL RESEARCH
Trends in overweight and obesity in Portuguese conscripts from 1986 to 2000 in relation to place of residence and educational level

https://doi.org/10.1016/j.puhe.2006.05.023Get rights and content

Summary

Objective

The aim of this study was to analyse changes in the prevalence of overweight and obesity between 1986 and 2000 in Portuguese conscripts, and to examine the role of place of residence and educational level.

Study design

Cross-sectional study.

Methods

Data sets from the cross-sectional annual surveys of all 18-year-old Portuguese males born between 1966 and 1981 and examined between 1986 and 2000 (850 081 subjects) were used in this study. Height and weight were measured and body mass index was calculated. Data on educational level (4, 6, 9, 11 and 12+ years) and residence (urban, semi-urban and rural) were collected.

Results

The prevalence of overweight increased from 10.5% in 1986 to 21.3% in 2000, and the prevalence of obesity increased from 0.9% to 4.2% in the same period (P<0.001). After adjustment for year of examination, the odds ratio (OR) for being overweight increased with educational level (reference 4–6 years: 1.19; 9 years: 1.30; 11 years: 1.47; 12+ years: 2.41) and place of residence (reference urban–semi-urban: 1.04; rural: 1.06). The prevalence of obesity increased with educational level (reference 4–6 years: 1.27; 9 years: 1.79; 11 years: 1.83; 12+ years: 2.66) and decreased with place of residence, i.e. those who lived in rural areas had a lower risk of becoming obese (OR: 0.94).

Conclusions

Despite the low prevalence of obesity in young males in Portugal compared with other European countries, the sharp increase in recent years indicates that public health strategies are needed to prevent obesity.

Introduction

An increased prevalence of overweight and obesity has been reported in many developed countries over the past decades.1, 2, 3, 4, 5, 6, 7, 8 Moreover, there is growing evidence that excess weight is causally related to chronic diseases and all-cause mortality.[9] Obesity is associated with an increased risk of hypertension, non-insulin-dependent diabetes mellitus, hyperlipidaemia and other chronic diseases.10, 11, 12

Several studies have shown that obesity in young adults has an adverse effect on morbidity and mortality. Many countries have reported an increase in the prevalence of obesity during the last few decades, and a serious increase in the associated health problems is anticipated.[13] Obesity is a multifactorial problem and its development is due to multiple interactions between genes and the environment.[14]

Portugal has the highest stroke mortality rate in Western Europe, and cardiovascular diseases cause around 40% of deaths in Portugal.15, 16 The only study of time trends in the prevalence of overweight and obesity used a selected sample of young males, from the District of Lisbon, at the time of military examination, and showed an increase in the percentage of males with body mass index (BMI) >25 kg/m2 from 8.1% in 1960 to 18.0% in 1990.[17] Another Portuguese study with a random sample of 1436 residents of Porto, aged 18–90 years, found that obese subjects showed a significantly higher prevalence of hypertension, hypertriglyceridaemia, diabetes and high-density-lipoprotein cholesterol concentration compared with subjects of normal weight.[18]

Obesity-related costs have been estimated to represent approximately 7% of the total healthcare expenditure in the USA, 1–5% in Europe and 3.5% in Portugal.13, 19, 20

This paper reports the first national study of overweight and obesity in 18-year-old Portuguese males. The aims were: (i) to analyse time trends in BMI distribution and the prevalence of overweight and obesity from 1986 to 2000; and (ii) to examine the influence of place of residence and educational level on the prevalence of overweight and obesity.

Section snippets

Study population

Data were obtained from medical examination records at the Portuguese district recruiting centres. Military service is compulsory in Portugal. All males born in a given year are examined by military physicians during their registration visit, which lasts for 3 days. The sample can thus be regarded as representing all regions of the country and all the social strata. All 18-year-old Portuguese males born between 1966 and 1981 and examined between 1986 and 2000 (850 081 subjects) were included.

Sociodemographic and health characteristics

Table 1 summarizes the evolution of sociodemographic and health system characteristics in Portugal during the 20th Century.22, 23 From 1920 to 1990, birth rate, percentage of young people (<15 years), infant mortality rate and postneonatal mortality rate all showed a strong decrease. Simultaneously, the percentage of old people (⩾65 years), life expectancy in both sexes, and adult literacy increased. The Portuguese health system also showed large changes. Between 1960 and 1990, the number of

Discussion

Trends in the prevalence of obesity in European countries are available for several countries including England, Sweden, Finland, Germany, Spain and The Netherlands.[24] The prevalence of obesity has increased by approximately 10–40% in the majority of European countries over the past 15 years. The most dramatic increase has been reported in the UK, where the prevalence of obesity has doubled in the past 15 years.

The present findings are of national relevance because they give a unique picture

Acknowledgements

The author thanks the Portuguese Army High Command (Estado Maior do Exército) for their kindness in providing all the raw data.

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