IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v26y2017i8p1052-1066.html

Measuring Socioeconomic Inequality in Obesity: Looking Beyond the Obesity Threshold

Author

Listed:
  • Marcel Bilger
  • Eliza J. Kruger
  • Eric A. Finkelstein

Abstract

We combine two of the most widely used measures in the inequality and poverty literature, the concentration index and Foster–Greer–Thorbecke metric to the analysis of socioeconomic inequality in obesity. This enables us to describe socioeconomic inequality not only in obesity status but also in its depth and severity. We apply our method to 1971–2012 US data and show that while the socioeconomic inequality in obesity status has now almost disappeared, this is not the case when depth and severity of obesity are considered. Such socioeconomic gradient is found to be greatest among non‐Hispanic whites, but decomposition analysis also reveals an inverse relationship between income and obesity outcomes among Mexican Americans once the effect of immigrant status has been accounted for. The socioeconomic gradient is also greater among women with marital status further increasing it for severity of obesity while the opposite is true among men. Overall, the socioeconomic gradient exists as poorer individuals lie further away from the obesity threshold. Our study stresses the need for policies that jointly consider obesity and income to support those who suffer from the double burden of poverty and obesity‐related health conditions. © 2016 The Authors. Health Economics Published by John Wiley & Sons Ltd.

Suggested Citation

  • Marcel Bilger & Eliza J. Kruger & Eric A. Finkelstein, 2017. "Measuring Socioeconomic Inequality in Obesity: Looking Beyond the Obesity Threshold," Health Economics, John Wiley & Sons, Ltd., vol. 26(8), pages 1052-1066, August.
  • Handle: RePEc:wly:hlthec:v:26:y:2017:i:8:p:1052-1066
    DOI: 10.1002/hec.3383
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.3383
    Download Restriction: no

    File URL: https://libkey.io/10.1002/hec.3383?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Duan, Naihua, et al, 1983. "A Comparison of Alternative Models for the Demand for Medical Care," Journal of Business & Economic Statistics, American Statistical Association, vol. 1(2), pages 115-126, April.
    2. Hai Zhong, 2010. "The impact of missing data in the estimation of concentration index: a potential source of bias," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(3), pages 255-266, June.
    3. Costa-Font, Joan & Gil, Joan, 2008. "What lies behind socio-economic inequalities in obesity in Spain A decomposition approach," Food Policy, Elsevier, vol. 33(1), pages 61-73, February.
    4. Finkelstein, Eric A. & Zhen, Chen & Bilger, Marcel & Nonnemaker, James & Farooqui, Assad M. & Todd, Jessica E., 2013. "Implications of a sugar-sweetened beverage (SSB) tax when substitutions to non-beverage items are considered," Journal of Health Economics, Elsevier, vol. 32(1), pages 219-239.
    5. Wagstaff, Adam & van Doorslaer, Eddy & Watanabe, Naoko, 2003. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Journal of Econometrics, Elsevier, vol. 112(1), pages 207-223, January.
    6. Andrew M. Jones (ed.), 2012. "The Elgar Companion to Health Economics, Second Edition," Books, Edward Elgar Publishing, number 14021.
    7. Foster, James & Greer, Joel & Thorbecke, Erik, 1984. "A Class of Decomposable Poverty Measures," Econometrica, Econometric Society, vol. 52(3), pages 761-766, May.
    8. Ruhm Christopher J, 2007. "Current and Future Prevalence of Obesity and Severe Obesity in the United States," Forum for Health Economics & Policy, De Gruyter, vol. 10(2), pages 1-28, September.
    9. Lakdawalla, Darius & Philipson, Tomas, 2009. "The growth of obesity and technological change," Economics & Human Biology, Elsevier, vol. 7(3), pages 283-293, December.
    10. Robert A. Pollak, 2005. "Bargaining Power in Marriage: Earnings, Wage Rates and Household Production," NBER Working Papers 11239, National Bureau of Economic Research, Inc.
    11. Bilger, Marcel & Carrieri, Vincenzo, 2013. "Health in the cities: When the neighborhood matters more than income," Journal of Health Economics, Elsevier, vol. 32(1), pages 1-11.
    12. Dean Jolliffe, 2004. "Continuous and robust measures of the overweight epidemic: 1971–2000," Demography, Springer;Population Association of America (PAA), vol. 41(2), pages 303-314, May.
    13. repec:wbk:wbpubs:6896 is not listed on IDEAS
    14. Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income‐related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 629-647, July.
    15. Shelly J. Lundberg & Robert A. Pollak & Terence J. Wales, 1997. "Do Husbands and Wives Pool Their Resources? Evidence from the United Kingdom Child Benefit," Journal of Human Resources, University of Wisconsin Press, vol. 32(3), pages 463-480.
    16. Cawley, John & Meyerhoefer, Chad, 2012. "The medical care costs of obesity: An instrumental variables approach," Journal of Health Economics, Elsevier, vol. 31(1), pages 219-230.
    17. Manning, Willard G. & Mullahy, John, 2001. "Estimating log models: to transform or not to transform?," Journal of Health Economics, Elsevier, vol. 20(4), pages 461-494, July.
    18. Jolliffe, Dean, 2011. "Overweight and poor? On the relationship between income and the body mass index," Economics & Human Biology, Elsevier, vol. 9(4), pages 342-355.
    19. David Madden, 2012. "A profile of obesity in Ireland, 2002–2007," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 175(4), pages 893-914, October.
    20. Kakwani, Nanok C, 1977. "Measurement of Tax Progressivity: An International Comparison," Economic Journal, Royal Economic Society, vol. 87(345), pages 71-80, March.
    21. repec:wbk:wbpubs:2306 is not listed on IDEAS
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Clarke, Philip & Erreygers, Guido, 2020. "Defining and measuring health poverty," Social Science & Medicine, Elsevier, vol. 244(C).
    2. Nancy Kong & Weina Zhou, 2021. "The curse of modernization? Western fast food and Chinese children's weight," Health Economics, John Wiley & Sons, Ltd., vol. 30(10), pages 2345-2366, September.
    3. Bénédicte Apouey & David Madden, 2023. "Health poverty," Chapters, in: Jacques Silber (ed.), Research Handbook on Measuring Poverty and Deprivation, chapter 19, pages 202-211, Edward Elgar Publishing.
    4. Nie, P. & Ding, L. & Jones, A.M., 2020. "Inequality of opportunity in bodyweight among middle-aged and older Chinese: a distributional approach," Health, Econometrics and Data Group (HEDG) Working Papers 20/14, HEDG, c/o Department of Economics, University of York.
    5. Sinha, Kompal & Davillas, Apostolos & Jones, Andrew M. & Sharma, Anurag, 2021. "Do socioeconomic health gradients persist over time and beyond income? A distributional analysis using UK biomarker data," Economics & Human Biology, Elsevier, vol. 43(C).
    6. Mohamad Khaled & Paul Makdissi & Myra Yazbeck, 2018. "On the importance of the upside down test in absolute socioeconomic health inequality comparisons," Working Papers 180003, Canadian Centre for Health Economics.
    7. Athina Raftopoulou & Joan Gil Trasfi, 2024. "Income-related inequality in obesity and its determinants in Spain: What happens beyond the obesity threshold?," International Journal of Health Economics and Management, Springer, vol. 24(1), pages 135-153, March.
    8. French, Declan & Vigne, Samuel, 2019. "The causes and consequences of household financial strain: A systematic review," International Review of Financial Analysis, Elsevier, vol. 62(C), pages 150-156.
    9. Mujica, Fiorella Parra & Candio, Paolo, 2024. "Taking a health economic perspective in monitoring health inequalities: A focus on excess weight," Health Policy, Elsevier, vol. 148(C).
    10. Ousmane Traoré, 2021. "The relationship between health poverty and income poverty in Sub-Saharan African countries: evidence from index correlations," SN Business & Economics, Springer, vol. 1(10), pages 1-19, October.
    11. Hudomiet, Péter & Hurd, Michael D. & Rohwedder, Susann, 2021. "Forecasting mortality inequalities in the U.S. based on trends in midlife health," Journal of Health Economics, Elsevier, vol. 80(C).
    12. Khaled, Mohamad A. & Makdissi, Paul & Yazbeck, Myra, 2018. "Income-related health transfers principles and orderings of joint distributions of income and health," Journal of Health Economics, Elsevier, vol. 57(C), pages 315-331.
    13. Mohamad A. Khaled & Paul Makdissi & Myra Yazbeck, 2023. "On absolute socioeconomic health inequality comparisons," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(1), pages 5-25, February.
    14. Khalid Abu-Ismail & Verena Gantner & Paul Makdissi & Myra Yazbeck, 2020. "Socioeconomic inequalities in child malnutrition in Egypt," METRON, Springer;Sapienza Università di Roma, vol. 78(2), pages 175-191, August.
    15. Apostolos Davillas & Victor Hugo Oliveira & Andrew M. Jones, 2024. "A model of errors in BMI based on self-reported and measured anthropometrics with evidence from Brazilian data," Empirical Economics, Springer, vol. 67(5), pages 2371-2410, November.
    16. Mohamad A. Khaled & Paul Makdissi & Rami V. Tabri & Myra Yazbeck, 2018. "A framework for testing the equality between the health concentration curve and the 45‐degree line," Health Economics, John Wiley & Sons, Ltd., vol. 27(5), pages 887-896, May.
    17. Jay Dev Dubey, 2025. "Foster–Greer–Thorbecke Type Catastrophic Health Expenditure Measure: An Application to India," Journal of Quantitative Economics, Springer;The Indian Econometric Society (TIES), vol. 23(4), pages 1001-1032, December.
    18. Sarah Tougher & Kara Hanson & Catherine A. Goodman, 2021. "Does subsidizing the private for‐profit sector benefit the poor? Evidence from national antimalarial subsidies in Nigeria and Uganda," Health Economics, John Wiley & Sons, Ltd., vol. 30(10), pages 2510-2530, September.
    19. Cleary, Rebecca & Liu, Yizao & Carlson, Andrea C., 2022. "Differences in the Distribution of Nutrition Between Households Above and Below Poverty," 2022 Annual Meeting, July 31-August 2, Anaheim, California 322267, Agricultural and Applied Economics Association.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Athina Raftopoulou & Joan Gil Trasfi, 2024. "Income-related inequality in obesity and its determinants in Spain: What happens beyond the obesity threshold?," International Journal of Health Economics and Management, Springer, vol. 24(1), pages 135-153, March.
    2. Tavares, Lara Patrício & Zantomio, Francesca, 2017. "Inequity in healthcare use among older people after 2008: The case of southern European countries," Health Policy, Elsevier, vol. 121(10), pages 1063-1071.
    3. Sinha, Kompal & Davillas, Apostolos & Jones, Andrew M. & Sharma, Anurag, 2021. "Do socioeconomic health gradients persist over time and beyond income? A distributional analysis using UK biomarker data," Economics & Human Biology, Elsevier, vol. 43(C).
    4. Toni Mora & Joan Gil & Antoni Sicras-Mainar, 2012. "The Influence of BMI, Obesity and Overweight on Medical Costs: A Panel Data Approach," Working Papers 2012-08, FEDEA.
    5. Toni Mora & Joan Gil & Antoni Sicras-Mainar, 2015. "The influence of obesity and overweight on medical costs: a panel data perspective," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(2), pages 161-173, March.
    6. Jolliffe, Dean, 2011. "Overweight and poor? On the relationship between income and the body mass index," Economics & Human Biology, Elsevier, vol. 9(4), pages 342-355.
    7. Costa-Font, Joan & Mas, Núria, 2016. "‘Globesity’? The effects of globalization on obesity and caloric intake," Food Policy, Elsevier, vol. 64(C), pages 121-132.
    8. Olufunke Alaba & Lumbwe Chola, 2014. "Socioeconomic Inequalities in Adult Obesity Prevalence in South Africa: A Decomposition Analysis," IJERPH, MDPI, vol. 11(3), pages 1-20, March.
    9. Etile, Fabrice, 2014. "Education policies and health inequalities: Evidence from changes in the distribution of Body Mass Index in France, 1981–2003," Economics & Human Biology, Elsevier, vol. 13(C), pages 46-65.
    10. Eddy van Doorslaer & Owen O'Donnell, 2008. "Measurement and Explanation of Inequality in Health and Health Care in Low-Income Settings," WIDER Working Paper Series DP2008-04, World Institute for Development Economic Research (UNU-WIDER).
    11. Nübler, Laura & Busse, Reinhard & Siegel, Martin, 2022. "The role of consumer choice in out-of-pocket spending on health: A mixed-methods approach," EconStor Preprints 260395, ZBW - Leibniz Information Centre for Economics.
    12. McInerney, Melissa & Meiselbach, Mark K., 2020. "Distributional Effects of Recent Health Insurance Expansions on Weight-Related Outcomes," Economics & Human Biology, Elsevier, vol. 38(C).
    13. Davillas, Apostolos & Jones, Andrew M., 2020. "Regional inequalities in adiposity in England: distributional analysis of the contribution of individual-level characteristics and the small area obesogenic environment," Economics & Human Biology, Elsevier, vol. 38(C).
    14. Jones, A. & Lomas, J. & Rice, N., 2014. "Going Beyond the Mean in Healthcare Cost Regressions: a Comparison of Methods for Estimating the Full Conditional Distribution," Health, Econometrics and Data Group (HEDG) Working Papers 14/26, HEDG, c/o Department of Economics, University of York.
    15. Toni Mora & Joan Gil & Antoni Sicras-Mainar, 2012. "The Influence of BMI, Obesity and Overweight on Medical Costs: A Panel Data Approach," Working Papers 2012-08, FEDEA.
    16. Cawley, John, 2015. "An economy of scales: A selective review of obesity's economic causes, consequences, and solutions," Journal of Health Economics, Elsevier, vol. 43(C), pages 244-268.
    17. Dhingra, Aarushi & Gannon, Brenda & Connelly, Luke & Mishra, Gita, 2025. "Equity in use and financing of assisted reproductive technologies: Does income matter?," Economics & Human Biology, Elsevier, vol. 57(C).
    18. Andrew M. Jones & James Lomas & Nigel Rice, 2015. "Healthcare Cost Regressions: Going Beyond the Mean to Estimate the Full Distribution," Health Economics, John Wiley & Sons, Ltd., vol. 24(9), pages 1192-1212, September.
    19. Willard Manning, 2012. "Dealing with Skewed Data on Costs and Expenditures," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 44, Edward Elgar Publishing.
    20. Alberto Gago & Xavier Labandeira & Xiral L pez Otero, 2014. "A Panorama on Energy Taxes and Green Tax Reforms," Hacienda Pública Española / Review of Public Economics, IEF, vol. 208(1), pages 145-190, March.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:26:y:2017:i:8:p:1052-1066. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.