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Socioeconomic gradient in body size and obesity among women: the role of dietary restraint, disinhibition and hunger in the Whitehall II study

International Journal of Obesity volume 28, pages 262–268 (2004)Cite this article

Abstract

OBJECTIVE: To examine the associations between three psychological eating behaviour variables—restraint, hunger and disinhibition—and body weight and size, and to assess their explanatory power for the employment grade gradients in body measurement.

DESIGN: Cross-sectional analysis of self-report and clinical data.

SUBJECTS: In all, 1470 women (aged 45–68 y, mean 56.3, s.d. 6.0 y), body mass index (BMI) 26.3 (4.8) kg/m2 at phase 5 (1997–98) of the Whitehall II study.

MEASUREMENTS: Employment grade was measured in six bands ranging from clerical (lowest) to administrative (highest). Five measures of body size were examined: BMI, weight in kilograms, waist and hip measurement in centimetres and waist-hip ratio. The eating behaviour variables were measured using Stunkard and Messick's (1985) Three-Factor Eating Questionnaire (TFEQ).

RESULTS: Disinhibition and hunger scores were strongly and directly associated with all measures of body weight and size. Restraint score was not directly associated with body size and weight. An interaction between restraint and disinhibition scores was found. The low-restraint–high-disinhibition group (based on median score splits) were the heaviest (BMI 28.5 kg/m2) and largest (waist 85.8 cm), while the low-restraint–low-disinhibition group were the lightest (BMI 24.2 kg/m2) and smallest (waist 76.3 cm). Employment grade gradients in body weight and size remained largely unchanged after adjustment for dietary restraint. Moderate attenuations were found for disinhibition scores (3.6–15.0%) and hunger (4.8–19.9%) on the five body-size measures.

CONCLUSION: Among middle-aged women high scores on hunger and disinhibition, as measured by the TFEQ, are associated with greater body size. Restraint relates to body size through its interaction with disinhibition. Individuals with high disinhibition and any level of restraint are heavier and larger than those with low levels of disinhibition. High disinhibition coupled with low levels of restraint is associated with the greatest weight and size. Hunger and disinhibition explain a moderate amount of the gradient in body size across employment grade and may be useful concepts for future work on the socio-economic gradient in obesity and overweight.

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Acknowledgements

We thank Amanda Sacker for statistical advice and Caroline Mulvihill for her assistance with the literature review. This study was supported by the Economic and Social Research Council's Health Variations programme. The Whitehall II study has been supported by grants from the Medical Research Council, British Heart Foundation, Health and Safety Executive, Department of Health, National Heart, Lung and Blood Institute (HL36310), National Institute on Aging (AG13196), Agency for Health Care Policy Research (HS06516), and the John D and Catherine T MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health. We also thank all participating civil service departments and their welfare, personnel and establishment officers; the Occupational Health and Safety Agency; the Council of Civil Service Unions and all participating civil servants in the Whitehall study. We acknowledge the input of all past and present members of the Whitehall II study team, particularly Daryth Stallone and Michael Kimpton.

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Authors and Affiliations

  1. Department of Epidemiology and Public Health, Royal Free and University College London Medical School, London, UK

    J Dykes, E J Brunner, P T Martikainen & J Wardle

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  1. J Dykes
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  2. E J Brunner
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  3. P T Martikainen
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  4. J Wardle
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Correspondence to E J Brunner.

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Ethical approval for the Whitehall II study was obtained from the Royal Free and University College London Medical School Committee on the ethics of human research.

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Dykes, J., Brunner, E., Martikainen, P. et al. Socioeconomic gradient in body size and obesity among women: the role of dietary restraint, disinhibition and hunger in the Whitehall II study. Int J Obes 28, 262–268 (2004). https://doi.org/10.1038/sj.ijo.0802523

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