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This study examines country-specific differences in obesity risk factors between Sweden and Canada.

June 4, 2026Open Access

Country-specific differences in the association between obesity risk factors in two high-income countries: a cross-sectional analysis from the Prospective Urban Rural Epidemiology (PURE) study

Puntos clave

This study examines country-specific differences in obesity risk factors between Sweden and Canada.
Cross-sectional analysis utilizing data from the Prospective Urban Rural Epidemiology (PURE) study.
Included 9,790 adults aged 34–60 from Canada and Sweden.
Used the Boruta algorithm and logistic regression to analyze obesity associations with risk factors.
26% of Canadians vs. 16% of Swedes were classified as obese (p<0.001).
Highest UPF intake significantly associated with obesity in Canada (OR=2.31) and Sweden (OR=2.83).
Socioeconomic factors showed stronger obesity associations in Sweden than Canada, particularly among women.

Resumen

Abstract Background Although Sweden and Canada are high-income countries with similar social structures, obesity prevalence is significantly higher in Canada. This study explored country-specific differences in the association between socioeconomic and behavioural risk factors for obesity in Sweden and Canada, using data from the Prospective Urban Rural Epidemiological (PURE) study. Methods This cross-sectional study included 9 790 adults aged 34–60 years from Canada ( n = 6 652, 55% women) and Sweden ( n = 3 138, 54% women). The Boruta algorithm was used to identify relevant factors that were associated with obesity among individual with normal weight (body mass index BMI: 18.5- 30 kg/m 2 ). Logistic regression models with 95% confidence intervals (CI) estimated odds ratios (OR) of obesity by country in relation to selected risk factors for obesity. Results More Canadians than Swedes had obesity (26 vs. 16%, p-value: <0.001). Ultra-processed food (UPF) and the Alternative Healthy Eating Index (AHEI-2010) score were identified as the main drivers of obesity risk. The highest UPF intake group was strongly associated with obesity in both Canada (OR = 2.31 CI = 1.57–3.37) and Sweden (OR = 2.83 CI = 2.30–3.49). Canadian men had higher UPF intake and were found to have a significantly higher risk of obesity (p for interaction: 0.032 and 0.021 for middle and highest tertiles), compared to Swedish males. Among women, low socioeconomic status (rural residence (OR = 2.30 CI = 1.66–3.17 vs. OR = 1.42 CI = 1.19–1.70), low income (OR = 4.75 CI = 2.71–8.95 vs. OR = 2.62 CI = 2.16–3.18), not working (OR = 2.24 CI = 1.51–3.29 vs. OR = 1.32 CI = 1.07–1.63), and unskilled occupation (OR = 5.08 CI = 3.05–8.45 vs. OR = 1.78 CI = 1.38–2.28) was more strongly associated with obesity in Sweden than in Canada. Conclusions This study highlights important differences in obesity-related risk factors between Sweden and Canada. UPF consumption, the AHEI-2010 score and socioeconomic disadvantage emerged as key drivers of obesity, with notable sex- and country-specific patterns. These findings underscore the importance of tailored, context-specific public health strategies to address obesity in different national settings.

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