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The Financial Correlates of Midlife Obesity

  • Joseph D. Wolfe
    Correspondence
    Address correspondence to: Joseph D. Wolfe, PhD, Department of Sociology, College of Arts and Sciences, The University of Alabama at Birmingham, 460A Heritage Hall Building, 1401 University Boulevard, Birmingham AL 35233.
    Affiliations
    Department of Sociology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, Alabama
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      Introduction

      This study explored the associations between midlife obesity and an array of common financial stressors related to wealth loss, debt, and bankruptcy.

      Methods

      The analysis was conducted in 2022 with data from the National Longitudinal Survey of Youth 1979. The final sample included 36,122 observations on 8,059 respondents as they aged from ages 31‒39 years in 1996 to ages 51‒59 in 2016. Associations between obesity and financial stressors were estimated with logistic regression models adjusting for a comprehensive set of relevant control variables.

      Results

      The analysis found significant relationships between obesity and multiple types of financial stressors, including property debt, unsecured debt, and bankruptcy. Property debt and unsecured debt increased the odds of obesity by 29% and 20%, respectively, and bankruptcy increased the odds of obesity by 43%. Average Marginal Effects (AMEs) in combination with model fit statistics confirmed that these stressors—unsecured debt, property debt, and bankruptcy—were important financial correlates of midlife obesity among the National Longitudinal Survey of Youth 1979 cohort.

      Conclusions

      The financial correlates of obesity included multiple financial stressors, but the magnitude of associations varied substantially across types of financial stressors. Results suggest that future interventions aimed at reducing obesity disparities should target populations with high levels of debt and bankruptcy.

      INTRODUCTION

      In response to concerning trends in the economic well-being of aging adults, researchers across social and health sciences have sought to better understand the impact of financial stressors on population health.
      • Yilmazer T
      • Babiarz P
      • Liu F
      The impact of diminished housing wealth on health in the United States: evidence from the Great Recession.
      • Wolfe JD
      • Baker EH
      • Uddin J
      • Kirkland S
      Varieties of financial stressors and midlife health problems, 1996-2016.
      • Boen C
      • Yang YC
      The physiological impacts of wealth shocks in late life: evidence from the Great Recession.
      • Pool LR
      • Needham BL
      • Burgard SA
      • Elliott MR
      • de Leon CFM
      Negative wealth shock and short-term changes in depressive symptoms and medication adherence among late middle-aged adults.
      • Pool LR
      • Burgard SA
      • Needham BL
      • Elliott MR
      • Langa KM
      • Mendes de Leon CF
      Association of a negative wealth shock with all-cause mortality in middle-aged and older adults in the United States.
      Financial stressors include a range of negative financial events such as large wealth losses (or wealth shocks), indebtedness (negative net worth or simply debt), and bankruptcy.
      • Wolfe JD
      • Baker EH
      • Uddin J
      • Kirkland S
      Varieties of financial stressors and midlife health problems, 1996-2016.
      Current research on financial stressors generally provides evidence of a negative association between financial stressors and health,
      • Sun AR
      • Houle JN
      Trajectories of unsecured debt across the life course and mental health at midlife.
      • O'Rand AM
      • Hamil-Luker J
      Landfall after the perfect storm: cohort differences in the relationship between debt and risk of heart attack.
      • Sweet E
      • Nandi A
      • Adam EK
      • McDade TW
      The high price of debt: household financial debt and its impact on mental and physical health.
      • Addo FR
      Seeking relief: bankruptcy and health outcomes of adult women.
      but less is known about the associations between financial stressors and midlife obesity.
      A prominent explanation for the association between financial stressors and adult health emphasizes the impact of stress on the body, which has implications for midlife obesity.
      • Boen C
      • Yang YC
      The physiological impacts of wealth shocks in late life: evidence from the Great Recession.
      ,
      • Sun AR
      • Houle JN
      Trajectories of unsecured debt across the life course and mental health at midlife.
      ,
      • Kahn JR
      • Pearlin LI
      Financial strain over the life course and health among older adults.
      Stressful experiences or social conditions (stressors) get under the skin by triggering a hormonal response (stress) capable of increasing one's chances of health problems and obesity.
      • Lupien SJ
      • McEwen BS
      • Gunnar MR
      • Heim C
      Effects of stress throughout the lifespan on the brain, behaviour and cognition.
      • Tomiyama AJ
      Stress and obesity.
      Stress is a known catalyst of unhealthy behaviors with established links to obesity, for example, problematic alcohol use and emotional eating.
      • Hermes G
      • Fogelman N
      • Seo D
      • Sinha R
      Differential effects of recent versus past traumas on mood, social support, binge drinking, emotional eating and BMI, and on neural responses to acute stress.
      • Spinosa J
      • Christiansen P
      • Dickson JM
      • Lorenzetti V
      • Hardman CA
      From socioeconomic disadvantage to obesity: the mediating role of psychological distress and emotional eating.
      • Stephens MAC
      • Wand G
      Stress and the HPA axis: role of glucocorticoids in alcohol dependence.
      Given the established links between financial well-being, stress, and weight gain, a growing body of research has begun examining the financial correlates of obesity.
      • Wolfe JD
      • Baker EH
      • Uddin J
      • Kirkland S
      Varieties of financial stressors and midlife health problems, 1996-2016.
      ,
      • Wolfe JD
      • Baker EH
      • Scarinci IC
      Wealth and obesity among U.S. adults entering midlife.
      • Münster E
      • Rüger H
      • Ochsmann E
      • Letzel S
      • Toschke AM
      Over-indebtedness as a marker of socioeconomic status and its association with obesity: a cross-sectional study.
      • Kuroki M
      Obesity and bankruptcy: evidence from U.S. counties.
      This study extends this line of research by identifying which specific financial stressors have the largest and most robust associations with midlife obesity. To this end, the analysis explored variation in the associations between common types of financial stressors and midlife obesity in the National Longitudinal Surveys of Youth 1979 (NLSY79). The NLSY79 is a cohort of baby boomers, born in 1957‒1964,
      • Dimock M
      Defining generations: where Millennials end and Generation Z begins.
      who transitioned into middle adulthood during the Great Recession of 2007‒2009. This cohort thus experienced multiple types of wealth loss, debts, and bankruptcies with relationships to stress and poor health outcomes in later adulthood.
      Wealth shocks denote large drops in net worth, the value of one's total assets minus their total debts. Wealth shocks have significant associations with mental health and mortality risk.
      • Boen C
      • Yang YC
      The physiological impacts of wealth shocks in late life: evidence from the Great Recession.
      • Pool LR
      • Needham BL
      • Burgard SA
      • Elliott MR
      • de Leon CFM
      Negative wealth shock and short-term changes in depressive symptoms and medication adherence among late middle-aged adults.
      • Pool LR
      • Burgard SA
      • Needham BL
      • Elliott MR
      • Langa KM
      • Mendes de Leon CF
      Association of a negative wealth shock with all-cause mortality in middle-aged and older adults in the United States.
      However, wealth loss can occur within any one of the components of net worth. For example, housing-related financial problems such as a large drop in the value of one's primary residence can be a stressful experience with multiple implications for individuals’ later financial, emotional, and physical well-being.
      • Yilmazer T
      • Babiarz P
      • Liu F
      The impact of diminished housing wealth on health in the United States: evidence from the Great Recession.
      ,
      • Desmond M
      • Kimbro RT
      Eviction’s fallout: housing, hardship, and health.
      ,
      • Downing J
      The health effects of the foreclosure crisis and unaffordable housing: a systematic review and explanation of evidence.
      Although homeownership is the most common source of wealth, one's net worth can also drop owing to a loss in one's savings or in the value of other properties such as vehicles, real estate (beyond one's primary residence), and businesses or farms. Recent studies suggest that these components of net worth as well as large drops in their value can have independent associations with health and longevity,
      • Wolfe JD
      • Baker EH
      • Scarinci IC
      Wealth and obesity among U.S. adults entering midlife.
      ,
      • Boen C
      • Keister L
      • Aronson B
      Beyond net worth: racial differences in wealth portfolios and Black–White health inequality across the life course.
      ,
      • Wolfe JD
      • Thomeer MB
      Divorce, economic resources, and survival among older Black and White women.
      but research has not considered whether this finding extends to obesity.
      Debt is not necessarily bad for health,
      • Dwyer RE
      • McCloud L
      • Hodson R
      Youth debt, mastery, and self-esteem: class-stratified effects of indebtedness on self-concept.
      but among midlife and older adults, the stress of debt—especially indebtedness—is consistently associated with mental and physical health problems.
      • O'Rand AM
      • Hamil-Luker J
      Landfall after the perfect storm: cohort differences in the relationship between debt and risk of heart attack.
      • Sweet E
      • Nandi A
      • Adam EK
      • McDade TW
      The high price of debt: household financial debt and its impact on mental and physical health.
      ,
      • Zurlo KA
      • Yoon W
      • Kim H
      Unsecured consumer debt and mental health outcomes in middle-aged and older Americans.
      ,
      • Richardson T
      • Elliott P
      • Roberts R
      The relationship between personal unsecured debt and mental and physical health: a systematic review and meta-analysis.
      Debt can be disaggregated by its relationship to asset ownership.
      • Dwyer RE
      Credit, debt, and inequality.
      Secured debts are linked to material assets such as real estate or vehicles, whereas unsecured (or noncollateralized) debts are not tied to any physical asset. In general, secured debts are related to financial investments such as homeownership and have lower interest rates than unsecured debts, but even secured debts can become financial stressors under certain conditions. For example, small-business owners can easily find themselves with large amounts of debt while trying to keep a struggling business afloat. Unsecured debt is typically created by, for example, credit card use, medical expenses, or high-interest loans used to supplement low wages. In other words, unsecured debt typically denotes a financial liability and a future drain on resources among those with few resources to spare.
      • Sun AR
      • Houle JN
      Trajectories of unsecured debt across the life course and mental health at midlife.
      ,
      • Berger LM
      • Collins JM
      • Cuesta L
      Household debt and adult depressive symptoms in the United States.
      Bankruptcy offers debt relief but at an apparent price for health.
      • Kuroki M
      Obesity and bankruptcy: evidence from U.S. counties.
      ,
      • Dobbie W
      • Goldsmith-Pinkham P
      • Yang CS
      Consumer bankruptcy and financial health.
      Filing for bankruptcy prohibits creditors from collecting outstanding debts, but filers generally find that their financial troubles continue. Bankruptcy carries a stigma in both social and financial networks, highlighting a person's previous financial problems and casting doubt on their credit worthiness.
      • Maroto M
      The scarring effects of bankruptcy: cumulative disadvantage across credit and labor markets.
      Therefore, bankruptcy can cause problems in the housing and labor markets, often leaving those who file for bankruptcy with many of the same financial strains that the bankruptcy process was supposed to alleviate.
      • Addo FR
      Seeking relief: bankruptcy and health outcomes of adult women.
      Multiple types of bankruptcy exist, with debtors generally filing Chapters 7 or 13 bankruptcy.
      • Dobbie W
      • Goldsmith-Pinkham P
      • Yang CS
      Consumer bankruptcy and financial health.
      Chapter 7 bankruptcies lead to an immediate repossession of assets, and Chapter 13 bankruptcies reorganize debt into a repayment plan wage-earning debtors can afford to pay off over time. Paying one's debt down and holding onto assets might reduce stress and lower anxiety or potentially become a recurring strain on limited resources.
      • Addo FR
      Seeking relief: bankruptcy and health outcomes of adult women.
      In summary, this study extends research by identifying which specific financial stressors are associated with obesity among a cohort of baby boomers entering midlife. Given the established relationships of multiple financial stressors with poor health and obesity, the analysis considered an array of stressors related to wealth loss, debt, and bankruptcy. Although this analysis is exploratory in nature, mapping the relative associations between multiple financial stressors and obesity provides useful information for future research and public policies, for example, future attempts to reduce obesity disparities should target populations with high levels of debt and bankruptcy.

      METHODS

      Study Sample

      To assess the association between financial stressors and health, data from the NLSY79 was used. The NLSY79 is a nationally representative, longitudinal study of U.S. adults that began in 1979 with 12,686 respondents between the ages of 14 and 22 years. The National Longitudinal Surveys (NLSs) is a program of the U.S. Bureau of Labor Statistics with data collection provided by the Center for Human Resource Research, a multidisciplinary research organization affiliated with The Ohio State University. The NLS data are available to the public and can be downloaded for free at www.nlsinfo.org.
      The analysis only used the 1996, 2000, 2004, 2008, 2012, and 2016 survey years for 2 reasons. First, 1996 was the baseline because it represents the first year of the NLS in which all respondents were in their 30s (ages 31‒39 years). Second, the analysis relied on 4-year intervals because the NLSY79 began collecting wealth data every 4 years in 2000. The analysis excluded the 1998 survey to ensure that results were not an artifact of change in the interval length between measurements of wealth.
      The final analysis sample included 36,122 observations of 8,059 NLSY79 respondents. In 1990, the NLS dropped 3 supplemental samples from data collection (n=2,700), reducing the total sample from 12,686 to 9,986 respondents. To arrive at the final analysis sample, another 1,927 respondents were dropped owing to missingness (n=1,065) or attrition (n=862). To ensure that listwise deletion did not substantively impact results, a supplemental analysis was conducted using respondents’ BMI as the outcome with full information maximum likelihood linear regression.
      • Allison P
      Listwise deletion: it’s NOT evil.
      ,
      • Allison PD
      MissingData.
      This supplemental analysis with 54,744 observations of 9,124 respondents (862 respondents who did not participate in any survey from 1996 to 2016 were dropped) yielded the same overall conclusions as the analysis of obesity presented in this study.

      Measures

      Obesity was constructed by taking the most recently reported height and respondents’ self-reported weight in each survey to create each respondents’ BMI (kg/m2), with BMI ≥30 kg/m2 coded as a 1, and all others as 0. Although measured height and weight are preferable, research indicates that self-reports are a reasonable proxy for measured height and weight.
      • Stommel M
      • Schoenborn CA
      Accuracy and usefulness of BMI measures based on self-reported weight and height: findings from the NHANES & NHIS 2001-2006.
      ,
      • Craig BM
      • Adams AK
      Accuracy of body mass index categories based on self-reported height and weight among women in the United States.
      The BMI of women was set to missing if they reported a pregnancy.
      Wealth shocks included large drops in net worth and the value of assets including savings, housing, and other properties. The NLSY79 collected information on the market value of respondents’ homes; savings, stocks, investments, and bonds; businesses and farms; and vehicles, in addition to the value of debts related to homes, cars, real estate, and businesses. Net worth denotes the total value of assets minus total debts. Savings refers to the total amounts in savings and checking accounts. Property wealth denotes the total market value of vehicles, real estate (other than primary residence), businesses, and farms. Shocks denote a 75% or larger drop in assets since the respondent's last survey (yes=1, no=0).
      • Pool LR
      • Needham BL
      • Burgard SA
      • Elliott MR
      • de Leon CFM
      Negative wealth shock and short-term changes in depressive symptoms and medication adherence among late middle-aged adults.
      ,
      • Pool LR
      • Burgard SA
      • Needham BL
      • Elliott MR
      • Langa KM
      • Mendes de Leon CF
      Association of a negative wealth shock with all-cause mortality in middle-aged and older adults in the United States.
      For example, if a respondent reported a 75% drop in the value of their savings from their 1992 to 1996 interview, they would be given a 1, indicating a savings shock.
      Debts included indebted, housing debt, property debt, and unsecured debt. Indebtedness was operationalized using information collected from respondents about their financial situation if they were to pay off all outstanding debts. Respondents could reply that they would have money left over, would break even, or would be in debt. With this information, a binary indicator of indebtedness was created by combining those who reported having money left over or breaking even into a single reference group (coded 0).
      • Sweet E
      • Nandi A
      • Adam EK
      • McDade TW
      The high price of debt: household financial debt and its impact on mental and physical health.
      Indicators of housing and property debt were created by taking the difference in the property's market worth and the debt owed on it and creating binary indicators of negative net housing and property wealth. Unsecured debt was measured as a binary indicator of respondents who reported a debt of more than $500 because of credit cards, educational loans, or medical debts.
      Bankruptcies were operationalized with 3 binary variables that identified whether respondents had filed for any type of bankruptcy, a Chapter 7 bankruptcy, or a Chapter 13 bankruptcy. In 2004 and then from 2008 to 2016, the NLSY79 collected information on respondents’ experiences with bankruptcy. This information includes whether the respondents have ever declared bankruptcy, the type of bankruptcy, and the date it occurred. To operationalize bankruptcy, a binary variable for each year was created in the analysis period that respondents experienced a personal bankruptcy of any type. Likewise, binary indicators were created denoting the type of bankruptcy (Chapters 7 or 13).
      The analysis adjusted for several known socioeconomic and sociodemographic correlates of health and financial stressors (Table 1).
      • Wolfe JD
      • Baker EH
      • Uddin J
      • Kirkland S
      Varieties of financial stressors and midlife health problems, 1996-2016.
      ,
      • Wolfe JD
      The effects of socioeconomic status on child and adolescent physical health: an organization and systematic comparison of measures.
      Socioeconomic controls included average family income, average wealth, education, employment, job loss, work hours, and health insurance. To normalize the distributions of income and wealth, the analysis used the natural log of a rolling average. Education was measured as a categorical variable denoting respondents with <12, 12, 13‒15 years, and ≥16 years of schooling. The analysis also controlled for current employment status and work hours in the previous year (none, part time, or full time). Demographic controls included sex (male/female), race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, or other race/ethnicity), age (in years), and marital status (married, previously married, or never married).
      Table 1Descriptive Information for Analysis Variables at 1996 Baseline
      Variable namesDescriptionMin, MaxMean or %
      Outcomes
      ObesityBMI≥30 kg/m2 is 1, otherwise is 00, 124%
      Wealth shocks
      Net worth shock75% or larger drop in net worth0, 112%
      Savings shock75% or larger drop in savings0, 121%
      Housing shock75% or larger drop in home wealth0, 15%
      Property shock75% or larger drop in property wealth0, 111%
      Debts
      IndebtedNegative net worth0, 114%
      Housing debtNegative net home wealth0, 12%
      Property debtNegative net property wealth0, 16%
      Unsecured debtUnsecured debt of more than $5000, 137%
      Bankruptcies
      BankruptFiled for bankruptcy0, 13%
      Chapter 7Filed for a Chapter 7 bankruptcy0, 12%
      Chapter 13Filed for a Chapter 13 bankruptcy0, 11%
      Socioeconomic controls
      WealthNatural log of average wealth0, 13.878.38
      IncomeNatural log of average of income0, 13.7910.24
      EducationCompleted years of schooling0, 3
      <12 years13%
      12 years43%
      13‒15 years24%
      ≥16 years20%
      EmployedCurrently, employed0, 181%
      Work hoursHours worked in the previous year0, 2
      NoneZero hours worked14%
      Part time<2,080 hours29%
      Full time≥2,080 hours57%
      Demographic controls
      AgeAge in years31, 3934.55
      FemaleWomen=1, men=00, 149%
      Race/ethnicity0, 3
      WhiteNon-Hispanic, White48%
      BlackNon-Hispanic, Black29%
      Hispanic19%
      OtherAll other races/ethnicities4%
      Marital status0, 2
      Married57%
      Previously marriedDivorced, separated, or widowed20%
      Never married23%
      Max, maximum; Min, minimum.

      Statistical Analysis

      To correctly identify the most influential financial stressors in terms of adult obesity among the NLSY79 cohort, the analysis examined statistical significance, coefficient magnitude, and model fit. The analysis thus proceeded in 3 steps. First, to test statistical significance, the analysis regressed obesity on each type of wealth loss, debt, and bankruptcy using logistic regression with socioeconomic and demographic controls. To address the nonindependence among observations of individuals over time, the analysis estimated the SEs with the clustered sandwich estimator, allowing for intragroup correlation by relaxing the usual requirement that the observations be independent. In other words, the analysis assumes that observations are independent across respondents but not necessarily within respondents over time.

      StataCorp. Stata Base reference manual release 17. College Station, TX: StataCorp. https://www.stata.com/manuals/r.pdf. Published 2021. Accessed April 7, 2022.

      To further improve the accuracy of parameter estimates, the analysis also included lagged obesity as a control variable in all statistical models.
      • Wilkins AS
      To lag or not to lag?: re-evaluating the use of lagged dependent variables in regression analysis.
      ,
      • Gius MP
      The prevalence of obesity and overweight among young adults: an analysis using the NLSY.
      The second step of analysis used the logistic coefficients from the first step to estimate the average marginal effects (AMEs) of each financial stressor on midlife obesity. AMEs denote the differences in the probability of midlife obesity between those who experienced a particular financial stressor and those who did not experience the stressor, holding all other variables at their observed values in the data. AMEs reveal the relative magnitude of the associations between stressors and obesity. Although ORs offer a useful way of presenting patterns in significance, examining predicted probabilities such as AMEs is a critically important step when working with logistic regression.
      • Long JS
      • Mustillo SA
      Using predictions and marginal effects to compare groups in regression models for binary outcomes.
      ,
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      • Freese J
      Regression Models for Categorical Dependent Variables Using Stata.
      The third and final step of the analysis compared the differences in model fit between (1) a model of health with controls but no financial stressors and (2) models of health with controls and a single stressor. Model fit is measured with the Akaike Information Criteria (AIC). Lower AIC values indicate better fitting models.
      • Burnham KP
      • Anderson DR
      Multimodel inference: understanding AIC and BIC in model selection.
      Model fit was measured with the AIC because the Bayesian Information Criteria penalizes model complexity and because the goal of the analysis was identifying which financial stressor provided the best improvement in fit regardless of model complexity. All data preparation and statistical estimation was done in Stata 17.
      StataCorp
      Stata Statistical Software: Release 17.

      RESULTS

      The analytic sample included 8,059 participants, who contributed a total of 36,122 observations between 1996 and 2016. The characteristics of the sample at baseline (1996) are presented in Table 1. Table 2 shows the percentage of obesity and financial stressors in the sample, by survey year. Obesity ranged from 24% in 1996 to 41% in 2016. Financial stressors related to savings losses and unsecured debt were most common. Nearly a quarter of the sample experienced a savings loss in 1996 and 2012, and approximately half of the sample reported unsecured debts of $500 or more from 2004 to 2016. Even financial stressors that occurred less frequently, such as housing debt and Chapter 13 bankruptcy, were still reported by about 1% of the sample each year.
      Table 2Percentage of the Sample Who Experienced Obesity or Financial Stressors, by Year (N=8,059; observations=36,122)
      Years
      Variable names1996, %2000, %2004, %2008, %2012, %2016, %
      Outcome
      Obesity243032363941
      Wealth shocks
      Net worth shock121115141913
      Savings shock211620212217
      Housing shock568896
      Property shock111415121413
      Debts
      Indebted141111121513
      Housing debt211121
      Property debt665544
      Unsecured debt373850535048
      Bankruptcies
      Bankrupt344331
      Chapter 7232211
      Chapter 13122111
      Table 3 presents the ORs of interest from 13 models of obesity, including 11 models that adjust for a single financial stressor and 2 models, Models 12 and 13, that estimate the association between obesity and multiple financial stressors simultaneously. Although not shown, all statistical models included control for lagged obesity,
      • Kuroki M
      Obesity and bankruptcy: evidence from U.S. counties.
      ,
      • Gius MP
      The prevalence of obesity and overweight among young adults: an analysis using the NLSY.
      age, age squared,
      • Frongillo EA
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      • Ritchie LD
      • et al.
      Community policies and programs to prevent obesity and child adiposity.
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      • Utz RL
      • Robinson W
      • Li G
      What is a cohort effect? Comparison of three statistical methods for modeling cohort effects in obesity prevalence in the United States, 1971-2006.
      and the socioeconomic and demographic controls listed in Table 1.
      Table 3ORs From Logistic Regression Models Predicting Obesity, 1996‒2016 (N=8,059; observations=36,122)
      VariablesModels
      12345678910111213
      Net worth shock0.97 (0.04)0.96 (0.04)
      Savings shock1.00 (0.03)1.00 (0.04)
      Housing shock0.94 (0.05)0.94 (0.05)
      Property shock0.95 (0.04)0.95 (0.04)
      Indebted1.05 (0.05)1.05 (0.05)
      Housing debt1.00 (0.13)0.97 (0.13)
      Property debt1.33 (0.09)1.29 (0.08)
      Unsecured debt1.21 (0.04)1.20 (0.04)
      Bankruptcy1.43 (0.11)1.43 (0.11)
      Chapter 71.44 (0.15)1.44 (0.15)
      Chapter 131.40 (0.17)1.41 (0.17)
      Model fit
      AIC33,18833,18833,18733,18633,18733,18833,16833,14633,16733,17533,18033,16933,119
      AIC0 – AICM−2−2−10−1−21940201161867
      Note: Boldface indicates statistical significance (p<0.05 [2-tailed tests]).
      Robust SEs are in parentheses. Every model included lagged obesity, age, age squared, and the socioeconomic and demographic controls listed in Table 1. AIC0–AICM denotes the differences between a model that excludes all financial stressors (AIC0) and models with a single financial stressor included (AICM).
      AIC, Akaike Information Criteria.
      After controlling for socioeconomic and demographic variables, a loss of 75% or more in net worth was not significantly associated with an increase in the odds of obesity by a factor of 1.06 (p>0.05) in Model 1. In terms of significance, this result held for every type of wealth loss, including savings, housing, and property shocks. In terms of debt, only property and unsecured debts were significantly associated with obesity (p<0.001), whereas bankruptcy and its 2 component types, Chapters 7 and 13 bankruptcy, were all significantly related to obesity (p<0.001 for bankruptcy and Chapter 7 and p<0.01 for Chapter 13).
      Models 12 and 13 in Table 3 considered multiple stressors in a single model to assess whether any significant associations between financial stressors and obesity were because of a correlation with another financial stressor. In Models 12, the analysis considered overall measures of wealth shock, debt, and bankruptcy in a single model. In Model 13, the analysis examined the multiple types of wealth shocks, debts, and bankruptcies in a single model. Even after adjusting for other, related financial stressors, the results were the same in terms of statistical significance. In Model 12, bankruptcy remained the only financial stressors related to obesity, and in Model 13, property debt, unsecured debt, and Chapters 7 and 13 were all significantly related to obesity.
      Table 3 also includes the AIC statistic for model fit. The analysis used a model to assess the improvement in fit provided by adding each of the varieties of financial stressors to a new model with AICM. The change in fit is denoted by AIC0–AICM, where AIC0 represents a model without a financial stressor. A difference of 10 or more indicates strong support for AICM, a difference of 4‒9 provides moderate support for AICM, and a difference ≤3 indicates little to no improvement in fit from AIC0.
      • Burnham KP
      • Anderson DR
      Multimodel inference: understanding AIC and BIC in model selection.
      Unsecured debt provided the largest improvement in fit, a difference of 40. Property debt and bankruptcy provided the next best improvements in fit, a difference of 19 and 20, respectively. Although relatively smaller improvements in fit, the AIC statistics still suggested strongly to moderate support for models that included Chapters 7 and 13 bankruptcy.
      To compare the magnitude of the associations between financial stressors and obesity, Figure 1 presents the differences in the predicted probability of obesity. AMEs are the expected increase in the probability of obesity for those who experienced a financial stressor. If the CIs include 0, then the AME is not significant at the 0.05 significance level. The largest AMEs were related to unsecured debts, property debts, and bankruptcy, which had AMEs ranging in size from approximately 0.03 (unsecured debt) to 0.05 (bankruptcy). The magnitude of AMEs related to wealth shocks was all relatively small and not statistically significant. When considered together, the ORs, AMEs, and model fit indices all confirmed that unsecured debts, property debts, and bankruptcy were the principal financial correlates of obesity during the transition to middle adulthood for the NLSY79 cohort.
      Figure 1
      Figure 1AMEs of financial stressors on midlife obesity with 95% CIs (N=8,059; observations=36,122).
      Note: AMEs (x-axis) were calculated from logistic regression estimates (). If an AME is positive and its CIs do not overlap 0, then the probability of midlife obesity was significantly larger among those who experienced the financial stressor.
      AME, Average marginal effect.

      DISCUSSION

      This study extends past obesity research using the breadth of the NLSY79 data to create a detailed accounting of the financial stressors experienced by a cohort of baby boomers as they aged from ages 31‒39 years in 1996 to ages 51‒59 years in 2016. Results revealed that the magnitude of associations between financial stressors and midlife obesity varied significantly. Property debt, unsecured debt, and bankruptcy had significant and relatively large associations with midlife obesity, whereas wealth shocks as well as various types of wealth shocks were not significantly related to obesity. These results and their implications and limitations are discussed in more detail below.
      First, results confirmed that debt was among the more robust correlates of midlife obesity.
      • Addo FR
      Seeking relief: bankruptcy and health outcomes of adult women.
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      • Drentea P
      • Reynolds JR
      Where does debt fit in the stress process model?.
      ,
      • Drentea P
      • Reynolds JR
      Neither a borrower nor a lender be: the relative importance of debt and SES for mental health among older adults.
      Debt is a critically important topic in academic research as well as contemporary policy discussions, and results from this study provide further evidence that certain forms of debt—property debt and unsecured debt specifically—are associated with midlife obesity. Unsecured debt was the most common financial stressor considered and had a particularly robust association with midlife obesity compared with other financial stressors. Although the housing crisis and subsequent Great Recession of 2007 exacerbated problems with indebtedness in the U.S. population, consumer debt has been growing for decades as the traditional trappings of middle-class life, for example, a college degree and homeownership, became considerable financial undertakings that require large loans for the average person.
      • Dwyer RE
      Credit, debt, and inequality.
      Obesity appears to be an additional consequence of this unprecedented growth in consumer debt and financial distress among lower middle-class families during the early 21st century.
      Second, the analysis found evidence that bankruptcy and the various types of bankruptcy, Chapters 7 and 13, had nearly identical associations with midlife obesity—an approximately 5-point increase in the predicted probability of obesity. Although larger than those of other financial stressors, the AMEs for bankruptcy had notably wider CIs owing to the small sample of respondents who experienced bankruptcy. This was especially the case for Chapter 13, which had AMEs ranging from under 0.02 to more than 0.08. Furthermore, the AIC statistic suggested that models using bankruptcy as the single operationalization of financial stressor had a substantially poorer fit than models of obesity that included unsecured debt. Thus, bankruptcy appears to be an important—although rare—correlate of midlife obesity, whereas unsecured debt appears to be a more common but less influential correlate of midlife obesity.
      Third, wealth shocks had no association with obesity after adjusting for control variables. To ensure that this absence of a relationship was not because of recoding BMI into a binary indicator of obesity, the results were reproduced in a supplemental analysis using linear regression and BMI. The analysis using BMI came to the same conclusions, that is, wealth shocks had no significant relationship with BMI after controlling for past obesity, family income and wealth, education, employment, and other demographic characteristics. This finding suggests that the association between wealth shocks and obesity did not exist independently of other indicators of economic stability, for example, average income and wealth. Wealth shocks may represent more acute financial experiences than either debt or bankruptcy, which often act as long-term, chronic stressors.
      • Wolfe JD
      • Baker EH
      • Uddin J
      • Kirkland S
      Varieties of financial stressors and midlife health problems, 1996-2016.
      Finally, results from this study offer support to examining the distinct components of broad constructs such as wealth and debt.
      • Wolfe JD
      • Baker EH
      • Uddin J
      • Kirkland S
      Varieties of financial stressors and midlife health problems, 1996-2016.
      ,
      • Wolfe JD
      • Baker EH
      • Scarinci IC
      Wealth and obesity among U.S. adults entering midlife.
      ,
      • Wolfe JD
      • Thomeer MB
      Divorce, economic resources, and survival among older Black and White women.
      ,
      • Wolfe JD
      The effects of socioeconomic status on child and adolescent physical health: an organization and systematic comparison of measures.
      Researchers often use overall indicators of wealth and debt when studying health-related disparities.
      • Sweet E
      • Nandi A
      • Adam EK
      • McDade TW
      The high price of debt: household financial debt and its impact on mental and physical health.
      Using a single operationalization, for example, net worth, of wealth simplifies theoretical and statistical models but may conceal important relationships. By examining multiple types of debts, the analysis revealed a robust relationship between unsecured debt and obesity that did not exist for the overall measure of indebtedness.

      Limitations

      Although the analysis found significant relationships between financial stressors for midlife obesity, the study has several limitations that should be noted and addressed by future work. First, the analysis controlled for race/ethnicity and sex but did not examine race or sex differences in the associations between financial stressors and obesity. Given the differences in obesity rates and experiences of financial stressors, a closer examination of these groups will be important. Second, even though the analysis considered a wide variety of financial stressors and controls, the results are still based on self-reports of weight, height, and wealth, which can be unreliable and thus introduce bias. Future research should consider extending this line of research with data that verify self-reports with medical records and tax information. Third, to compare results across an expansive set of financial stressors, the financial stressors were all recoded into binaries (i.e., either 0 or 1 values). This is the only option for bankruptcy and its types, but this meant collapsing the distributions of debt variables. Although supplemental analysis found that higher levels of unsecured debt had a similar association with obesity as the indicator of unsecured debt presented in this study, future research should still test whether the association changes significantly across the distribution of debt. Finally, reverse causality is always a possibility with observational data. Health conditions related to obesity could constrain economic attainment and thus increase one's chances of experiencing debt.
      • Wilkinson LR
      • Ferraro KF
      • Mustillo SA
      Wealth in middle and later life: examining the life course timing of women’s health limitations.
      Establishing causal relationships was not the aim of this study, but future research should extend the results of this study by testing whether the associations between debt, bankruptcy, and obesity are causal in nature.

      CONCLUSIONS

      Despite the limitations mentioned earlier, results found that a clearer picture of the relationship between financial stressors and obesity emerged when net worth, debt, and bankruptcy were disaggregated into their distinct components. More specifically, although shocks to net worth and indebtedness were not significantly associated with midlife obesity, unsecured debt and property debt were associated with midlife obesity. Results also revealed the need for obesity prevention interventions targeting populations experiencing financial difficulties related to debt and bankruptcy. As obesity inequalities persist and grow in the coming years, it is imperative that researchers should also explore the legal and political systems that help or hinder individuals from resolving financial problems.

      ACKNOWLEDGMENTS

      The author is especially grateful for the support of the Obesity and Health Disparities Research Center and the members of Obesity and Health Disparities Research Center who provided excellent feedback on previous drafts of this study.
      The content is solely the responsibility of the author and does not necessarily represent the official views of the NIH. No sponsor had a role in study design; collection, analysis, and interpretation of data; writing of the report; or the decision to submit the report for publication.
      Research reported in this manuscript was supported by the National Institute on Minority Health and Health Disparities of the NIH under Award Number U54MD000502.
      No financial disclosures were reported by the author of this paper.

      CRediT AUTHOR STATEMENT

      Joseph D. Wolfe: Conceptualization, Data curation, Methodology, Visualization, Writing - original draft.

      Appendix. SUPPLEMENTAL MATERIAL

      SUPPLEMENT NOTE

      This article is part of a supplement entitled Obesity-Related Health Disparities: Addressing the Complex Contributors, which is sponsored by the National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH), U.S. Department of Health and Human Services (HHS). The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of NIMHD, NIH, or HHS.

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