Place of Residence and Obesity in 1,578,694 Young Swedish Men Between 1969 and 2005

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Abstract
Objective: To compare prevalence of overweight and obesity in young adult men from rural areas with those from urban areas of Sweden over three decades.Methods and Procedures: Eighty‐two percent of the Swedish male population at military conscription age between 1969 and 2005 (n = 1,578,694; 18.3 ± 0.4 years) was grouped by urban, semiurban, and rural place of residence. BMI was calculated from measured height and weight. Comparisons were made with and without adjustments for parental education, socioeconomic position (SEP), and intelligence quotient (IQ).Results: During the study period, the prevalence of obesity more than quintupled from 0.9–5.1%, while overweight tripled from 7.1–20.5% (P < 0.0001). An urban–rural gradient was observed within all socioeconomic and education strata. After adjustment for SEP, IQ, parental education level, and testing year, the odds ratios (ORs) were 1.28 (1.23–1.34) and 1.20 (1.18–1.22) for obesity and overweight, respectively, in a rural compared to an urban area. The corresponding ORs for semiurban place of residence were 1.16 (1.13–1.19) and 1.11 (1.10–1.12), respectively. Significant effect modification by time was seen, with evidence of an increasing gradient until the early 1990s (P < 0.001).Discussion: A strong and persisting gradient of increasing overweight and obesity from urban to rural areas was observed that could not be explained by individual or family‐related factors such as IQ, parental education level, or SEP. These results indicate the presence of strong environmental or contextual obesogenic factors affecting the energy balance of people in rural areas more negatively than those in urban communities.