Longitudinal analysis of lifestyle habits in relation to body mass index,onset of overweight and obesity: Results from a large population-based cohort in Sweden

Abstract

Aims: It is currently unknown whether the prevalence of obesity is increasing or has levelled off in Sweden and other Westernised countries. Given the major importance of lifestyle habits on weight status, we aimed to explore associations of longitudinal changes in lifestyle habits with changes in body mass index (BMI), and the onset of overweight and obesity. Methods: Participants (aged 18–84 years at baseline) were included from the Stockholm Public Health Cohort 2002–2010 (n=23,108). Weight status was from self-reported height and weight. Investigated lifestyle habits were leisure-time physical activity, and fruit, alcohol and smoking habits. We estimated associations of stable, improving or worsening lifestyle habits with longitudinal changes in BMI and onset of overweight or obesity between 2002 and 2010. Results: Both men and women increased in weight during the eight years of follow-up. Incidence of obesity was lower in men who increased their leisure-time physical activity (Relative Risk [RR]=0.58, 95% confidence interval 0.42–0.81) than in inactive individuals; the same applied to women (RR=0.37, 0.25–0.54), and similar patterns were identified for overweight and BMI in both genders. Smoking cessation was associated with onset of obesity for men (RR=1.69, 1.15–2.50) and women (RR=1.99, 1.39–2.85). Stable low alcohol intake or decreasing alcohol intake and daily fruit intake was associated with less weight gain, but only in men. Conclusions: Improving physical activity in both men and women, and alcohol habits and fruit intake in men, prevents excess weight gain among adult people in Sweden. Such an improvement might diminish weight gain after smoking cessation.

Keywords

Physical activity alcohol intake fruit intake overweight obesity cohort study epidemiology

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References

Ogden

Carroll

Kit

. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 2014;311:806–14.

Doak

Wijnhoven

Schokker

. Age standardization in mapping adult overweight and obesity trends in the WHO European Region. Obes Rev 2012;13:174–91.

Rokholm

Baker

Sorensen

. The levelling off of the obesity epidemic since the year 1999 – a review of evidence and perspectives. Obes Rev 2010;11:835–46.

Sundquist

Johansson

Sundquist

. Levelling off of prevalence of obesity in the adult population of Sweden between 2000/01 and 2004/05. BMC Public Health 2010;10:119.

Folkhälsan i Sverige: Årsrapport 2012 [Public Health in Sweden: Annual report 2012]. Socialstyrelsen.se: Folkhälsoinstitutet and Socialstyrelsen, 2012.

Ledoux

Hingle

Baranowski

. Relationship of fruit and vegetable intake with adiposity: a systematic review. Obes Rev 2011;12:e143–50.

Suter

Hasler

Vetter

. Effects of alcohol on energy metabolism and body weight regulation: is alcohol a risk factor for obesity? Nutr Rev 1997;55:157–71.

Fogelholm

Kukkonen-Harjula

. Does physical activity prevent weight gain – a systematic review. Obes Rev 2000;1:95–111.

Finucane

Stevens

Cowan

. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 2011;377:557–67.

10.

Svensson

Fredlund

Laflamme

. Cohort profile: the Stockholm public health cohort. Int J Epidemiol 2012; doi: 10.1093/ije/dys126.

11.

Orsini

Bellocco

Bottai

. Reproducibility of the past year and historical self-administered total physical activity questionnaire among older women. Eur J Epidemiol 2007;22:363–8.

12.

Becker

. Indikatorer för bra matvanor – resultat från intervjuundersökningar 2005 och 2006 [Indicators of good food habits. Results of interviews 2005 and 2006]. Uppsala, Sweden: Livsmedelsverket (National Food Administration), 2007.

13.

Romelsjo

Leifman

Nystrom

. A comparative study of two methods for the measurement of alcohol consumption in the general population. Int J Epidemiol 1995;24:929–36.

14.

Connor Gorber

Schofield-Hurwitz

Hardt

. The accuracy of self-reported smoking: a systematic review of the relationship between self-reported and cotinine-assessed smoking status. Nicotine Tob Res 2009;11:12–24.

15.

McLaren

. Socioeconomic status and obesity. Epidemiol Rev 2007;29:29–48.

16.

Lindstrom

Hanson

Ostergren

. Socioeconomic differences in leisure-time physical activity: the role of social participation and social capital in shaping health related behaviour. Soc Sci Med 2001;52:441–51.

17.

Johansson

. Overweight and obesity in Sweden. A five year follow-up, 2004–2008. Scand J Public Health 2010;38:803–9.

18.

Neovius

Teixeira-Pinto

Rasmussen

. Shift in the composition of obesity in young adult men in Sweden over a third of a century. Int J Obes (Lond) 2008;32:832–6.

19.

Neovius

Janson

Rossner

. Prevalence of obesity in Sweden. Obes Rev 2006;7:1–3.

20.

Ekelund

Besson

Luan

. Physical activity and gain in abdominal adiposity and body weight: prospective cohort study in 288,498 men and women. Am J Clin Nutr 2011;93:826–35.

21.

Williams

. Maintaining vigorous activity attenuates 7-yr weight gain in 8340 runners. Med Sci Sports Exerc 2007;39:801–9.

22.

Bergmann

Schutze

Steffen

. The association of lifetime alcohol use with measures of abdominal and general adiposity in a large-scale European cohort. Eur J Clin Nutr 2011;65:1079–87.

23.

Sayon-Orea

Martinez-Gonzalez

Bes-Rastrollo

. Alcohol consumption and body weight: a systematic review. Nutr Rev 2011;69:419–31.

24.

Mozaffarian

Hao

Rimm

. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med 2011;364:2392–404.

25.

Cornfield

Haenszel

Hammond

. Smoking and lung cancer: recent evidence and a discussion of some questions. 1959. Int J Epidemiol 2009;38:1175–91.

26.

Audrain-McGovern

Benowitz

. Cigarette smoking, nicotine, and body weight. Clin Pharmacol Ther 2011;90:164–8.

27.

Lawman

Wilson

. Associations of social and environmental supports with sedentary behavior, light and moderate-to-vigorous physical activity in obese underserved adolescents. Int J Behav Nutr Phys Act 2014;11:92.

28.

Schaap

Kunst

Leinsalu

. Effect of nationwide tobacco control policies on smoking cessation in high and low educated groups in 18 European countries. Tob Control 2008;17:248–55.

29.

Lieberman

Golden

Earp

. Structural approaches to health promotion: what do we need to know about policy and environmental change? Health Educ Behav 2013;40:520–5.

30.

Gorber

Tremblay

Moher

. A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev 2007;8:307–26.