{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T07:44:48Z","timestamp":1782719088588,"version":"3.54.5"},"reference-count":39,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T00:00:00Z","timestamp":1782518400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Obesity is a major public health concern and shows a clear social gradient, with higher prevalence among individuals with lower socioeconomic position. Educational level is a key indicator of socioeconomic status, but the extent to which lifestyle factors explain its association with obesity remains unclear. Objective: To examine the association between educational level and obesity in a working-age population and to evaluate how adjustment for lifestyle factors influences the magnitude of the association between educational level and obesity. Methods: A cross-sectional study was conducted among 3108 working-age adults undergoing occupational health assessments in Spain. Educational level was categorised into three groups (higher, intermediate, and primary or none). Obesity was defined as a body mass index \u226530 kg\/m2. Lifestyle variables included smoking status, physical activity assessed using the International Physical Activity Questionnaire (IPAQ-SF), and adherence to the Mediterranean diet evaluated with the MEDAS-14 score. Sequential logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CI), with progressive adjustment for demographic, behavioural, and clinical factors. Results: The overall prevalence of obesity was 16.6%, with a clear gradient across educational levels (11.5% in higher education vs. 19.8% in primary or no education). In crude analyses, individuals with the lowest educational level had higher odds of obesity (OR 1.89; 95% CI 1.46\u20132.45). Adjustment for age and sex attenuated the association (OR 1.72; 95% CI 1.32\u20132.24), with further reduction after inclusion of lifestyle factors (OR 1.63; 95% CI 1.24\u20132.13). In the fully adjusted model, the association remained statistically significant (OR 1.61; 95% CI 1.18\u20132.21), indicating that adjustment for lifestyle factors attenuated the association between educational level and obesity, although the association remained statistically significant. Conclusions: Lower educational level is associated with a higher risk of obesity. Adjustment for lifestyle factors attenuated this association, although a statistically significant relationship remained. These findings support the role of education as a fundamental determinant of health and highlight the need for strategies addressing broader social and structural determinants of obesity.<\/jats:p>","DOI":"10.3390\/medsci14030351","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T05:49:33Z","timestamp":1782712173000},"page":"351","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Educational Inequalities and Obesity: Association and Attenuation After Lifestyle Adjustment in a Cross-Sectional Working-Age Population"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3071-5897","authenticated-orcid":false,"given":"Mar\u00eda Te\u00f3fila","family":"Vicente-Herrero","sequence":"first","affiliation":[{"name":"ADEMA University School, University of the Balearic Islands, 07009 Palma, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5222-5784","authenticated-orcid":false,"given":"Pedro J.","family":"T\u00e1rraga L\u00f3pez","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Castilla La Mancha, 02008 Albacete, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9367-2137","authenticated-orcid":false,"given":"Carla","family":"Busquets-Cort\u00e9s","sequence":"additional","affiliation":[{"name":"ADEMA University School, University of the Balearic Islands, 07009 Palma, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3848-687X","authenticated-orcid":false,"given":"Lluis","family":"Rodas Ca\u00f1ellas","sequence":"additional","affiliation":[{"name":"ADEMA University School, University of the Balearic Islands, 07009 Palma, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7439-8117","authenticated-orcid":false,"given":"\u00c1ngel Arturo","family":"L\u00f3pez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"ADEMA University School, University of the Balearic Islands, 07009 Palma, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6887-4562","authenticated-orcid":false,"given":"Jos\u00e9 Ignacio","family":"Ram\u00edrez-Manent","sequence":"additional","affiliation":[{"name":"ADEMA University School, University of the Balearic Islands, 07009 Palma, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,27]]},"reference":[{"key":"ref_1","first-page":"e984","article-title":"Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association","volume":"143","author":"Poirier","year":"2021","journal-title":"Circulation"},{"key":"ref_2","unstructured":"World Health Organization (2024). Obesity and Overweight, WHO. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/obesity-and-overweight."},{"key":"ref_3","first-page":"44","article-title":"The Impact of Fast Food Consumption on the Development of General and Central Obesity","volume":"39","author":"Naghizadeh","year":"2024","journal-title":"Acad. J. Health Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1016\/S0140-6736(16)32380-7","article-title":"Socioeconomic status and the 25 \u00d7 25 risk factors as determinants of premature mortality: A multicohort study and meta-analysis of 1\u00b77 million men and women","volume":"389","author":"Stringhini","year":"2017","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e140","DOI":"10.1016\/S2468-2667(19)30248-8","article-title":"Association between socioeconomic status and the development of mental and physical health conditions in adulthood: A multi-cohort study","volume":"5","author":"Batty","year":"2020","journal-title":"Lancet Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"120697","DOI":"10.1016\/j.atherosclerosis.2026.120697","article-title":"The relation between socioeconomic status and societal development with cardiovascular disease\u2014A systematic review and meta-analysis on global data","volume":"415","author":"Khatami","year":"2026","journal-title":"Atherosclerosis"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e077750","DOI":"10.1136\/bmjopen-2023-077750","article-title":"Life-course socioeconomic status and obesity: A scoping review protocol","volume":"14","author":"Adamou","year":"2024","journal-title":"BMJ Open"},{"key":"ref_8","unstructured":"World Health Organization (2024). Social Determinants of Health, WHO. Available online: https:\/\/www.who.int\/health-topics\/social-determinants-of-health#tab=tab_1."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"m693","DOI":"10.1136\/bmj.m693","article-title":"Health equity in England: The Marmot review 10 years on","volume":"368","author":"Marmot","year":"2020","journal-title":"BMJ"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1093\/ajcn\/87.5.1107","article-title":"Does social class predict diet quality?","volume":"87","author":"Darmon","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1111\/j.1467-789X.2009.00658.x","article-title":"A systematic review of studies on socioeconomic inequalities in dietary intakes associated with weight gain and overweight\/obesity conducted among European adults","volume":"11","author":"Giskes","year":"2010","journal-title":"Obes. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1186\/1479-5868-9-116","article-title":"Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: A systematic review","volume":"9","author":"Beenackers","year":"2012","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_13","first-page":"92","article-title":"Influence of tobacco consumption on the values of different cardiometabolic risk scales in 418,343 spanish workers","volume":"39","author":"Paublini","year":"2024","journal-title":"Acad. J. Health Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2166","DOI":"10.1161\/CIRCULATIONAHA.117.029652","article-title":"Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions","volume":"137","author":"Schultz","year":"2018","journal-title":"Circulation"},{"key":"ref_15","first-page":"48","article-title":"Cardiometabolic risk level in 43074 Spanish office workers: Associated variables","volume":"39","author":"Tosoratto","year":"2024","journal-title":"Acad. J. Health Sci."},{"key":"ref_16","first-page":"112","article-title":"Influence of sociodemographic variables and healthy habits on the values of cardiometabolic risk scales in 386924 spanish workers","volume":"39","author":"Vallejos","year":"2024","journal-title":"Acad. J. Health Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"593","DOI":"10.2147\/CLEP.S520772","article-title":"SEPLINE: Socioeconomic Position in Epidemiological Research-A National Guideline on Danish Registry Data","volume":"17","author":"Hjorth","year":"2025","journal-title":"Clin. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e2445309","DOI":"10.1001\/jamanetworkopen.2024.45309","article-title":"Prevalence of Cardiovascular-Kidney-Metabolic Syndrome Stages by Social Determinants of Health","volume":"7","author":"Zhu","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_19","first-page":"91","article-title":"Multimetric assessment of obesity in manual workers: The impact of age, smoking, diet, and physical activity","volume":"40","year":"2025","journal-title":"Acad. J. Health Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4063","DOI":"10.1093\/eurheartj\/ehae508","article-title":"Obesity and cardiovascular disease: An ESC clinical consensus statement","volume":"45","author":"Koskinas","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1001\/jama.2022.0395","article-title":"Treatment of Tobacco Smoking: A Review","volume":"327","author":"Rigotti","year":"2022","journal-title":"JAMA"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Meh, K., Jurak, G., Sori\u0107, M., Rocha, P., and Sember, V. (2021). Validity and Reliability of IPAQ-SF and GPAQ for Assessing Sedentary Behaviour in Adults in the European Union: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18094602"},{"key":"ref_23","first-page":"509","article-title":"Evaluation of adherence to the Mediterranean diet after a nutritional dietary intervention from primary care","volume":"43","author":"Rider","year":"2025","journal-title":"Nutr. Hosp."},{"key":"ref_24","first-page":"107","article-title":"Association between sociodemographic variables, healthy habits and stress with insulin resistance risk scales","volume":"40","year":"2025","journal-title":"Acad. J. Health Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1146\/annurev-publhealth-032315-021402","article-title":"Mediation Analysis: A Practitioner\u2019s Guide","volume":"37","author":"VanderWeele","year":"2016","journal-title":"Annu. Rev. Public Health"},{"key":"ref_26","first-page":"681","article-title":"Mediation Analysis in Medical Research","volume":"120","author":"Schlesinger","year":"2023","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1093\/eurpub\/ckr058","article-title":"Social inequalities in obesity and overweight in 11 OECD countries","volume":"23","author":"Devaux","year":"2013","journal-title":"Eur. J. Public Health"},{"key":"ref_28","unstructured":"Loring, B., and Robertson, A. (2014). Obesity and Inequities: Guidance for Addressing Inequities in Overweight and Obesity, WHO Europe. Available online: https:\/\/iris.who.int\/items\/a2b77bb0-064f-4c25-979b-574bd3cb005d."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"964236","DOI":"10.1155\/2014\/964236","article-title":"Overweight and obesity epidemic in developing countries: A problem with diet, physical activity, or socioeconomic status?","volume":"2014","author":"Bhurosy","year":"2014","journal-title":"Sci. World J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.puhe.2021.08.009","article-title":"The Dahlgren-Whitehead model of health determinants: 30 years on and still chasing rainbows","volume":"199","author":"Dahlgren","year":"2021","journal-title":"Public Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1002\/osp4.549","article-title":"Investigating socioeconomic inequalities in BMI growth rates during childhood and adolescence","volume":"8","author":"Killedar","year":"2021","journal-title":"Obes. Sci. Pract."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S36","DOI":"10.1111\/j.1753-4887.2009.00157.x","article-title":"Obesity, diets, and social inequalities","volume":"67","author":"Drewnowski","year":"2009","journal-title":"Nutr. Rev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s12963-025-00424-7","article-title":"Life-course socioeconomic status and obesity: Scoping review","volume":"23","author":"Adamou","year":"2025","journal-title":"Popul. Health Metr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1038\/s41430-024-01403-1","article-title":"The explanation of educational disparities in adiposity by lifestyle, socioeconomic and mental health mediators: A multiple mediation model","volume":"78","author":"Ksinan","year":"2024","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/S0140-6736(19)30310-1","article-title":"The global syndemic of obesity, undernutrition, and climate change","volume":"393","author":"Mendenhall","year":"2019","journal-title":"Lancet"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"daab030","DOI":"10.1093\/heapro\/daab030","article-title":"Promoting healthy eating in the community sport setting: A scoping review","volume":"37","author":"Westberg","year":"2022","journal-title":"Health Promot. Int."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1080\/17437199.2021.1923406","article-title":"Stress and eating behaviours in healthy adults: A systematic review and meta-analysis","volume":"16","author":"Hill","year":"2022","journal-title":"Health Psychol. Rev."},{"key":"ref_38","first-page":"9","article-title":"Variables associated with overweight and obesity in Spanish healthcare workers","volume":"40","year":"2025","journal-title":"Acad. J. Health Sci."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Coppi, F., Bucciarelli, V., Solodka, K., Selleri, V., Zanini, G., Pinti, M., Nasi, M., Salvioli, B., Nodari, S., and Gallina, S. (2024). The Impact of Stress and Social Determinants on Diet in Cardiovascular Prevention in Young Women. Nutrients, 16.","DOI":"10.3390\/nu16071044"}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/3\/351\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T06:50:38Z","timestamp":1782715838000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/3\/351"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,27]]},"references-count":39,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["medsci14030351"],"URL":"https:\/\/doi.org\/10.3390\/medsci14030351","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,27]]}}}