K. Hert, M.G. Wagner, L. Myers, J. Levine*, T. Heck, Y. Rhee

1. Anthropometric Measurements Differ among Overweight and Obese Adults of Varying Socioeconomic Status but no Differences in Fruit and Vegetable Intake K. Hert, M.G. Wagner, L. Myers, J. Levine*, T. Heck, Y. Rhee Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, *Family Nutrition Sciences, Concordia College, Moorhead, MN

2. ABSTRACT Background: Individuals of lower socioeconomic status (SES) tend to have higher rates of obesity and eat poorer quality diets than their counterparts of higher SES. Purpose: To determine if fruit and vegetable (F/V) intake and anthropometric measurements differ among overweight and obese adults of varying SES. Methods: The study was a cross-sectional design that included 38 adults from the Midwestern United States with a body mass index (BMI) of >25 kg/m2.The study looked at education level, personal income, and household income separately to assess SES. Weight, height, body fat percentage, and waist circumference were measured and BMI was calculated. Intake of F/V was measured by averaging daily intakes from three-day food records. Results: The results showed that F/V intake did not vary significantly among those of varying SES but BMI and body fat percentage did. Individuals with higher education levels as well as higher personal incomes had a significantly lower BMI and body fat percentage. Also, those with higher household incomes had a significantly lower body fat percentage. Discussion:Overweight and obesity appear to be more prevalent among those of lower SES, which is why nutrition intervention is important for this population. However, focus should be on barriers to eating higher quality diets, other than affordability, such as taste, availability, and motivation to make changes.

3. INTRODUCTION • Less than 25% of adults in the United States consume the recommended servings of fruit and vegetable (F/V) daily with individuals of lower socioeconomic status (SES) eating less F/V1,2 • Increased consumption of F/V has been shown to have a positive effect on obesity and chronic disease3 • From 1980-2008, obesity rates doubled for adults and tripled for children4 • Individuals of lower SES tend to have higher rates of obesity5

4. PURPOSE • Todetermine if overweight and obese adults of lower SES have lower intakes of F/V than their counterparts of higher SES • To determine if overweight and obese individuals of lower SES have greater rates of obesity than those of higher SES

5. METHODS Design • Cross-sectional • Part of a larger study, which was a randomized, controlled trial that consisted of three phases • Pre-testing • Intervention • Post-testing • Data from pre-testing were used for the current study

6. METHODS Participants • Adults aged 18 years and older • Exclusion criteria • BMI <25 kg/m2 • Persons with a history of bariatric surgery • Current smokers • Pregnant or lactating

7. METHODS • Socioeconomic status was measured by self-reported: • Education level • <college degree, bachelor’s degree, graduate degree • Personal annual income • <$30,000, $30,000-<70,000, ≥$70,000 • Household annual income • <$50,000, $50,000-<90,000, ≥$90,000

8. METHODS • Fruit and vegetable intake was measured by three-day food records from two weekdays and one weekend day • Analyzed using The Food Processor® (ESHA Research, Salam, OR) • All food records were entered by the same person to ensure consistency

9. METHODS Anthropometric Measurements • Height • Stadiometer(HR-200, Tanita Corporation of America, Inc., Arlington Heights, IL) • Weight and body fat percentage • Tanita Body Composition Analyzer (TBF-300A, Tanita Corporation of America, Inc., Arlington Heights, IL) • Waist circumference • Fabric tape measure • BMI • Calculated from height and weight measurements from weight and height measurements

10. METHODS Statistical Analysis • SAS (version 9.2; SAS Institute Inc., Cary, NC) • Significance level p<0.05 • Descriptives • Frequencies • Analysis of Variance

11. RESULTS

12. DEMOGRAPHICS • 38 adults • Age: 48.0 (±10.4) years • Body mass index: 33.9 (±6.6) kg/m2

13. SOCIOECONOMIC STATUS DISTRIBUTION

14. FRUIT AND VEGETABLE INTAKE BY EDUCATION LEVEL *No significant differences seen between groups

15. FRUIT AND VEGETABLE INTAKE BY PERSONAL ANNUAL INCOME n= 20 *No significant differences seen between groups

16. FRUIT AND VEGETABLE INTAKE BY HOUSEHOLD ANNUAL INCOME n= 20 *No significant differences seen between groups

17. BODY MASS INDEX BY SOCIOECONOMIC STATUS ^Significant differences seen between groups, p=0.04 and 0.01 respectively

18. BODY FAT PERCENTAGE BY SOCIOECONOMIC STATUS ^Significant differences seen between groups, p=0.049, 0.02, and 0.03 respectively

19. DISCUSSION • Intake of F/V did not differ significantly among adults of varying SES looking specifically at education and income levels • BMI and body fat percentage were significantly higher among those with lower education levels and lower personal annual incomes • Body fat percentage was also significantly higher among those with lower household annual incomes • It appears that overweight and obesity are more prevalent among those of low SES

20. LIMITATIONS • Participants were self-selected • Conducted during September in the Midwest, fresh F/V are more available and cheaper during this month than winter months • Small sample size • Majority of participants had post-secondary education

21. CONCLUSION • Future interventions should target on individuals of lower SES, but should focus on barriers to eating F/V other than affordability • Other barriers to consider include taste, availability, and motivation to make changes

22. REFERENCES Thomson, C.A. & Ravia, J. (2011). A systematic review of behavioral interventions to promote intake of fruit and vegetables. Journal of the American Dietetic Association, 111, 1523-1535. Lallukka, T., Pitkaniemi, J., Rahkonen, T., Roos, E., Laaksonen, M, & Lahelma, E. (2010). The association of income with fresh fruit and vegetable consumption at different levels of education. European Journal of Clinical Nutrition, 64, 324-327. Crujeiras, A.B., Goyenechea, E., & Martinez, J.A. (2009). Fruit, vegetables, and legumes consumption: Role in preventing and treating obesity. In Bioactive Foods in Promoting Health (Chapter 24). Retrieved from ScienceDirect database. Centers for Disease Control and Prevention. (2011). About BMI for adults. Retrieved from http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html Baum II, C.L. & Ruhm, C. J. (2009). Age, socioeconomic status, and obesity growth. Journal of Health Economics, 28, 635-648.