1. Alexandre Lebel (CRAD) The Geography of Overweight in Québec Robert Pampalon (INSPQ) Denis Hamel (INSPQ) Marius Thériault (CRAD) Halifax June 2 nd, 2008 CPHA 2008 Annual Conference

2.  Background  Objective et methodology  Results and analyses Presentation plan Why obesity is a public health concern? Why geography should be considered? Why obesity is a public health concern? Why geography should be considered? Main concepts Multilevel analysis Main concepts Multilevel analysis

3. Linked to a large number of chronic diseases Coronary artery disease Stroke Breast cancer Colorectal cancer Hyperlipidemia Ostéo-arthrite Endometrial cancer Type 2 diabetes Pulmonary embolism Hypertension Gallbladder disease 20% Are directly attribuable to obesity Birmingham et al. (1999) Life expectancy going down ? Background: 1) Why obesity is a public health concern?

4. Main associations with overweight: individual characteristics Sex Age Marital status Income Education Race Other genetic factors Smoking Diet Physical activity Lots of associations Many interventions Few results 2) Why geography is important?

5. Contextual characteristics Urban design Land use Transport system Rural Security Socioeconomic characteristics Few associations! Inconsistent results Different methodologies Hard to compare Geography given low importance (Region definition, scale)

6. Sources : diverses Geographic differences in obesity prevalence In the World

7. In Canada Source : CCHS, 2003 (in Mongeau, 2005) Obesity prevalence by province

8. In Québec Source : CCHS, 2003 (in Mongeau, 2005) Overweight prevalance by health region Québec 47 %

9. General objective: To explore the spatial distribution of overweight in the Québec population while taking into consideration individuals’ characteristics, contextual indicators and an appropriate spatial frame of reference. Objective and Methodology

10. Spatial frame of reference 51 units

11. Multilevel Analysis

13. Sample CCHS 2003 (cycle 2.1) 20 000 Adults Living in Québec Dependant variable: BMI ≥ 25 No pregnant women No individuals with BMI < 18,5 Self-reported information

14. ResultsMen 51 regions 9 522 adults

15. Men

16. ResultsWomen 51 regions 10 927 adults

17. Women

18. As a summary, we found that: Independent of individual characteristics known to be associated with overweight, many regions present significantly higher or lower odds of overweight. These differences are not randomly distributed through space. The geographical patterns are different between genders. There is an important variability within rural as well as urban areas. The contextual effect is stronger for women. Consequently: Geography is important Studying at local scale

19. Financial support And other partners ÉSAD We hope to publish details of this research in 2008 in The Canadian Journal of Public Health