Obesity and socioeconomic status in developing countries: a systematic review

Multidimensional analysis of health in Mexico: implementation of fuzzy sets

BACKGROUND

The national health and nutrition survey allows to know the state of health of the Mexican population, it provides data for the analysis of different factors and / or indicators of health, diseases and nutritional conditions, such as chronic degenerative diseases and depressive symptoms, which, in turn, if both occur simultaneously, they will have a negative impact on health. This article studies the four factors involved in the overall health of the population in Mexico: excess weight, diabetes, high blood pressure, and depressive symptoms, which are used to conduct a multidimensional characterization and analysis.

METHODS

Two methodological resources are applied, a descriptive statistical characterization and the construction of a multidimensional health index with the use of fuzzy sets, through the National Health and Nutrition Survey (ENSANUT 2018-19 - for its acronym in Spanish) in Mexico.

RESULTS

The results reveal a growing percentage of individuals who experience detriments to their health, that is, the factors being studied have had a negative impact and tend to follow international projections. The construction of a multidimensional index enables the interaction between the factors being studied, thus allowing for an adequate modeling for the identification of health in Mexico.

CONCLUSION

This study aims to elucidate the current state of health throughout the population in Mexico by using the most current data provided by the autonomous public body of statistics and geography to build a multidimensional panorama using four elementary public health indicators (diabetes, obesity, high blood pressure, and depressive symptoms).

Individual- and community-level factors associated with underweight and overweight among women of reproductive age in Bangladesh: a multilevel analysis

The co-existence of under- and overweight at population level around the globe is well documented. However, this has yet to be explored using suitable statistical techniques in the context of Bangladesh. This study aimed to examine the prevalence and risk factors for being underweight and overweight or obese compared with normal weight in ever-married non-pregnant women aged 15-49 years in Bangladesh using data from the most recent Bangladesh Demographic and Health Survey conducted in 2014. Multilevel multinomial logistic regression (MLMLR) and quantile regression models were fitted to examine the associations of socioeconomic and individual-, household- and community-level factors on the nutritional status of women as measured by BMI. Overall, the prevalences of underweight, normal weight, overweight and obese women were 19%, 58%, 19% and 4%, respectively, in 2014. The MLMLR analysis revealed that women of young age, widowed/divorced/separated, having a larger family size and children aged ≤5 years in the household, currently amenorrhoeic and members of non-government organizations were at significantly increased risk of being underweight; those of older age, having higher parity, more educated, frequently watched TV and non-poor were more likely to be overweight or obese relative to normal BMI. Women from more affluent communities and urban areas were more likely to be overweight or obese relative to normal BMI than their counterparts from less-affluent and rural communities. Women's nutritional status was found to be heterogeneous across the regions of the country. The findings indicate that, along with individual-level factors, community-level characteristics are also important in explaining women's BMI in Bangladesh. The issue of under- and overweight or obesity among women in Bangladesh requires the immediate adoption of a public health policy for its mitigation. When developing intervention programmes, important determinants and uniform development of regions should be taken into consideration to combat the dual burden of under- and overweight among women in Bangladesh.

Links Between Mortality and Socioeconomic Characteristics, Disease Burden, and Biological and Physical Functioning in the Aging Chinese Population

OBJECTIVES

Determinants of mortality may depend on the time and place where they are examined. China provides an important context in which to study the determinants of mortality at older ages because of its unique social, economic, and epidemiological circumstances. This study uses a nationally representative sample of persons in China to determine how socioeconomic characteristics, early-life conditions, biological and physical functioning, and disease burden predict 4-year mortality after age 60.

METHODS

We used data from the China Health and Retirement Longitudinal Study. We employed a series of Cox proportional hazard models based on exact survival time to predict 4-year all-cause mortality between the 2011 baseline interview and the 2015 interview.

RESULTS

We found that rural residence, poor physical functioning ability, uncontrolled hypertension, diabetes, cancer, a high level of systemic inflammation, and poor kidney functioning are strong predictors of mortality among older Chinese.

DISCUSSION

The results show that the objectively measured indicators of physical functioning and biomarkers are independent and strong predictors of mortality risk after accounting for several additional self-reported health measures, confirming the value of incorporating biological and performance measurements in population health surveys to help understand health changes and aging processes that lead to mortality. This study also highlights the importance of social and historical context in the study of old-age mortality.

Association between parental socioeconomic status and offspring overweight/obesity from the China Family Panel Studies: a longitudinal survey

OBJECTIVE

To examine the association between parental socioeconomic status (SES) and the risk of offspring overweight/obesity and the changes of the association that occur as children grow older.

DESIGN

We used data from the nationally representative longitudinal survey of the China Family Panel Studies of 2010 and its three follow-up waves in 2012, 2014 and 2016.

PARTICIPANTS

A total of 6724 children aged 0-15 years old were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

Average household income and paternal and maternal education levels were used as SES indicators. Logistic regression model for panel data was used to examine the associations between SES indicators and child overweight/obesity. A restricted cubic spline linear regression model was used to estimate body mass index (BMI) trajectories with child growth across parental SES levels.

RESULTS

Compared with the lowest education level (primary school or less), the ORs for fathers who had completed junior high school, senior high school and junior college or higher were 0.85 (95% CI 0.75 to 0.97), 0.77 (95% CI 0.64 to 0.92) and 0.72 (95% CI 0.55 to 0.93), respectively. The corresponding ORs for mothers were 0.76 (95% CI 0.67 to 0.86), 0.59 (95% CI 0.47 to 0.72) and 0.45 (95% CI 0.34 to 0.60), respectively. A negative association between parental education and offspring overweight/obesity was observed in the first 10 years but not in children 11-15 years old. BMI differences across parental education levels emerged from birth and widened before 6-7 years old, but decreased before adolescence. High average household income was related to a low risk of offspring overweight/obesity but not when parental education level was adjusted for.

CONCLUSION

High parental education levels were associated with a low risk of offspring overweight/obesity, especially before adolescence. Effective approaches need to be adopted in early childhood to reduce socioeconomic differences in overweight/obesity.

The Effect of Schooling on Women's Overweight and Obesity: A Natural Experiment in Nigeria

An extensive social scientific literature has documented the importance of schooling in preventing overweight and obesity among women. However, prior quasi-experimental studies investigating the causal effect of schooling on women's overweight and obesity have focused almost exclusively on high-income countries (HICs). Schooling effects may differ in low- or middle-income countries (LMICs), where information about the harms of being overweight is often sparse and where larger body sizes can be socially valued. Here I evaluate the causal impact of schooling on women's probability of being overweight or obese in an LMIC, Nigeria, using data from the 2003, 2008, and 2013 Demographic Health Surveys. In 1976, the Nigerian government abolished primary school fees and increased funding for primary school construction, creating quasi-random variation in access to primary school according to an individual's age and the number of newly constructed schools in their state of residence. I exploit both sources of variation and use a two-stage instrumental variables approach to estimate the effect of increased schooling on the probability of being overweight or obese. Each additional year of schooling increased the probability of being overweight or obese by 6%, but this effect estimate was not statistically different from zero. This finding differs from the protective effect of schooling documented in several HICs, suggesting that contextual factors play an important role calibrating the influence of additional schooling on overweight or obesity. Furthermore, my findings contrast markedly with the positive correlation between schooling and overweight/obesity identified in previous studies in Nigeria, suggesting that studies failing to account for selection bias overestimate the causal effect of schooling. More robust causal research is needed to examine the effect of schooling on overweight and obesity in LMIC contexts.

Urban-rural differences in overweight and obesity among 25-64 years old Myanmar residents: a cross-sectional, nationwide survey

OBJECTIVES

To investigate whether urban-rural location and socioeconomic factors (income, education and employment) are associated with body mass index (BMI) and waist-hip ratio (W/H-ratio), and to further explore if the associations between urban-rural location and BMI or W/H-ratio could be mediated through variations in socioeconomic factors.

DESIGN

Cross-sectional, WHO STEPS survey of non-communicable disease risk factors.

SETTING

Urban and rural areas of Myanmar.

PARTICIPANTS

A total of 8390 men and women aged 25 to 64 years included during the study period from September to December 2014. Institutionalised people (Buddhist monks and nuns, hospitalised patients) and temporary residents were excluded.

RESULTS

The prevalence of overweight and obesity was higher in the urban areas and increased with increasing socioeconomic status (SES) score. Mean BMI was higher among urban residents (ß=2.49 kg/m²; 95% CI 2.28 to 2.70; p<0.001), individuals living above poverty line, that is, ≥US$1.9/day (ß=0.74 kg/m²; 95% CI 0.43 to 1.05; p<0.001), and those with high education attainment (ß=1.48 kg/m²; 95% CI 1.13 to 1.82; p<0.001) when adjusting for potential confounders. Similarly, greater W/H-ratio was observed in participants living in an urban area, among those with earnings above poverty line, and among unemployed individuals. The association between urban-rural location and BMI was found to be partially mediated by a composite SES score (9%), income (17%), education (16%) and employment (16%), while the association between urban-rural location and W/H-ratio was found to be partially mediated by income (12%), education (6%) and employment (6%).

CONCLUSION

Residents living in urban locations had higher BMI and greater W/H-ratio, partially explained by differences in socioeconomic indicators, indicating that socioeconomic factors should be emphasised in the management of overweight and obesity in the Myanmar population. Furthermore, new national or subnational STEPS surveys should be conducted in Myanmar to observe the disparity in trends of the urban-rural differential.

Determinants of dietary diversity and its relationship with the nutritional status of pregnant women

There is little information regarding factors that determine dietary diversity among pregnant women in Ghana. The present study, therefore, sought to assess the independent predictors of dietary diversity and its relationship with nutritional status of pregnant women in the Northern Region of Ghana. The present study was an analytical cross-sectional survey involving 423 pregnant women in different stages of gestation. The 24-h dietary recall method was used to assess minimum dietary diversity for women (MDD-W), and nutritional status was assessed using mid-upper arm circumference (MUAC) measurements. Binary logistic regression was performed to assess the association between maternal dietary diversity and maternal thinness and a P value of <0⋅05 was considered statistically significant. Of the 423 women, 79⋅9 % (95 % CI 76⋅1, 83⋅7) met the MDD-W and the prevalence of undernutrition among the pregnant women was 26⋅0 %. The analysis showed that women of low household wealth index were 48 % less likely (AOR 0⋅52, CI 0⋅31, 0⋅88) of meeting the MDD-W, whereas women from households of poor food insecurity were 88 % less likely (AOR 0⋅12, CI 0⋅05, 0⋅27) of achieving the MDD-W. Women of low household size were three times more likely of meeting the MDD-W (AOR 3⋅07, CI 1⋅13, 8⋅39). MDD-W was not associated with maternal underweight during pregnancy. In conclusion, the results of the present study showed that food insecurity and not low MDD-W, associated with mothers' thinness (underweight) during pregnancy in peri-urban setting of Northern Ghana.

Nutritional and weight status of Indian mother-child dyads experienced by a natural disaster

Natural disasters have detrimental effects not only on local infrastructure in an affected population but may also have an impact on the human biological condition, particularly during critical periods of life. This study aimed to assess the nutritional and weight status of women and their children who had experienced cyclone Aila prenatally and postnatally in comparison with a non-affected neighbouring group. The study sample involved N = 597 dyads consisting of mothers and their prepubertal children prenatally or postnatally (during infancy) exposed to a natural disaster and a control group from a neighbouring region (West Bengal, India). The analysed anthropometric indices involved body mass index (BMI) and mid-upper arm circumference (MUAC). Moreover, several socioeconomic characteristics were collected (mother's and father's education, family size and family income). Analyses revealed that the group factor (Aila-exposed or non-exposed groups) had the highest impact on both children's and their mothers' BMI and MUAC (p < 0.001) in comparison with socioeconomic variables. Surprisingly, both mothers and their children revealed deteriorated nutritional and relative weight status several years after the occurrence of cyclone Aila, which is in opposition to the results obtained in developed countries, where prenatal maternal stress caused by the natural disaster led to the subsequent higher risk of excessive weight in affected children.

[Mediating effect of milk intake between family socioeconomic status and body mass index of children and adolescents]

OBJECTIVE

To examine the association between family socioeconomic status (SES) and body mass index (BMI) z-score of children and adolescents, and the mediating effect of milk intake in this association.

METHODS

In the study, 2 496 students and their parents were selected from 16 schools (4 urban middle schools, 4 rural middle schools, 4 urban primary schools, and 4 rural primary schools) using a stratified cluster sampling method. The frequency and amount of weekly milk intake from the 7-day Food Records reported by the students were extracted. The parents' education and household income were the indicators of family SES. The mediating effect of milk intake between family SES and BMI z-score of children and adolescents were tested using the PROCESS add-on SPSS software.

RESULTS

Parents' education level and household income were positively correlated with BMI z-score of children and adolescents (P=0.001 and 0.038, respectively). The overall average daily intake of milk was (0.92±0.84) servings, and the frequency was (4.43±2.70) days per week. The students of primary school, in urban areas, with higher parents' education level, with higher household income, and being non-obese were likely to have higher frequency and amount of milk intake. Milk intake was one of the mediating factors in the relationship between family SES and BMI z-score of children and adolescents. Specifically, the mediating effect of the frequency of milk intake accounted for -6.57% and -10.21% of the total effects of the association between the parents' education and the household income with BMI z-score of children and adolescents, respectively. The mediating effect of the daily intake of milk accounted for -3.63% and -5.86% of the total effects of the association between the parents' education and the household income with BMI z-score of children and adolescents, respectively.

CONCLUSION

The milk intake of Chinese children and adolescents still needs to be improved. High family SES was found to contribute to high BMI z-score, mediated by the milk intake which was the protective factors of BMI z-score. Further research is needed to study other dietary or physical exercise behaviors that mediate the relationship between family SES and BMI z-score of children and adolescents in order to adopt more targeted interventions.

[Mediating effect of milk intake between family socioeconomic status and body mass index of children and adolescents]

OBJECTIVE

To examine the association between family socioeconomic status (SES) and body mass index (BMI) z-score of children and adolescents, and the mediating effect of milk intake in this association.

METHODS

In the study, 2 496 students and their parents were selected from 16 schools (4 urban middle schools, 4 rural middle schools, 4 urban primary schools, and 4 rural primary schools) using a stratified cluster sampling method. The frequency and amount of weekly milk intake from the 7-day Food Records reported by the students were extracted. The parents' education and household income were the indicators of family SES. The mediating effect of milk intake between family SES and BMI z-score of children and adolescents were tested using the PROCESS add-on SPSS software.

RESULTS

Parents' education level and household income were positively correlated with BMI z-score of children and adolescents (P=0.001 and 0.038, respectively). The overall average daily intake of milk was (0.92±0.84) servings, and the frequency was (4.43±2.70) days per week. The students of primary school, in urban areas, with higher parents' education level, with higher household income, and being non-obese were likely to have higher frequency and amount of milk intake. Milk intake was one of the mediating factors in the relationship between family SES and BMI z-score of children and adolescents. Specifically, the mediating effect of the frequency of milk intake accounted for -6.57% and -10.21% of the total effects of the association between the parents' education and the household income with BMI z-score of children and adolescents, respectively. The mediating effect of the daily intake of milk accounted for -3.63% and -5.86% of the total effects of the association between the parents' education and the household income with BMI z-score of children and adolescents, respectively.

CONCLUSION

The milk intake of Chinese children and adolescents still needs to be improved. High family SES was found to contribute to high BMI z-score, mediated by the milk intake which was the protective factors of BMI z-score. Further research is needed to study other dietary or physical exercise behaviors that mediate the relationship between family SES and BMI z-score of children and adolescents in order to adopt more targeted interventions.

The association between sleep duration and excess body weight of the American adult population: a cross-sectional study of the national health and nutrition examination survey 2015-2016

BACKGROUND

We intend to explore whether sleep duration is associated with overweight and obesity among the adult American population. Furthermore, we stratified the study population by age and sex in the subgroup analysis to investigate the potential disparities between adults and older adults, and men and women.

METHODS

In total, 2459 individuals from the 2015-2016 National Health and Nutrition Examination Survey cycle were included for analysis in this study. Sleep duration was assessed by the Sleep Disorders Questionnaire. Classification of the short-sleep, normal-sleep, and long-sleep group was based on the recommendation of the National Sleep Foundation. Bodyweight was measured during the physical examination. Multivariate logistic regression models were implemented.

RESULTS

We observed a significantly higher overweight incidence in the short-sleep group compared to the normal-sleep group (OR = 1.825, 95%CI: 1.251-2.661, P = 0.004). Short-sleep (OR = 1.832, 95%CI: 1.215-2.762, P = 0.007) duration and long-sleep duration (OR = 1.370, 95%CI: 1.043-1.800, P = 0.027) were associated with higher prevalence of obesity. When stratified by age, short-sleep also increased the overweight and obese incidence 1.951 and 1.475 times in the adult group. In the sex-stratified subgroup analysis, the short-sleep group showed 2.49 times higher overweight incidence among females. The prevalence of obesity was 2.59 times higher in the short-sleep group and 1.698 times higher in the long-sleep group in the female population.

CONCLUSIONS

Sleep duration is associated with the occurrence of overweight and obesity, with sleep duration less than 7 h increase the overweight and obesity rate nearly 2 folds comparing to sleep 7-9 h.

Early childhood factors associated with obesity at age 8 in Vietnamese children: The Young Lives Cohort Study

Background

Over recent decades, Vietnam has experienced rapid economic growth, a nutrition transition from the traditional diet to highly-processed and calorie-dense foods and beverages, and an increasing prevalence of childhood overweight/obesity (ow/ob). The goal of this study is to describe the patterns of ow/ob in a longitudinal sample of Vietnamese children from ages 1 to 8, and the sociodemographic and behavioral factors associated with ow/ob at age 8.

Methods

This study is a secondary data analysis of a geographically-representative, longitudinal cohort of 1961 Vietnamese children from the Young Lives Cohort Study from 2002 to 2009. Thirty-one communities were selected with oversampling in rural communities, and children age 1 were recruited from each community using simple random sampling. Surveys of families and measurements of children were collected at child ages 1, 5, and 8. Our specified outcome measure was childhood ow/ob at age 8, defined by the World Health Organization’s thresholds for body-mass-index (BMI) for age Z-scores. Associations between early and concurrent socio-behavioral factors, childhood nutrition and physical activity variables were analyzed using STATA 15. Bivariate and multivariable analyses were completed utilizing logistic regression models.

Results

The prevalence of ow/ob increased from 1.1% in both sexes at age 1 to 7% in females and 13% in males at age 8. Bivariate analyses show greater likelihood of ow/ob at age 8 was significantly associated with early life sociodemographic factors (at age 1), male sex (OR = 2.2, 1.6–3.1), higher wealth (OR = 1.1–1.4), and urban residence (OR = 4.3, 3–6). In adjusted analyses, ow/ob at age 8 was associated with early nutrition practices at age 5, including frequent consumption of powdered milk (OR = 2.8, 1.6–4.6), honey/sugar (OR = 2.7, 1.8–4.1), prepared restaurant/fast foods (OR = 4.6, 2.6–8.2), and packaged sweets (OR = 3.4, 2.3–4.9). In addition, breastfeeding for 6 months or longer was protective against obesity at age 8 (OR = 0.3, 0.1–0.9).

Conclusions

We found that increased consumption of powdered milk, honey/sugar, packaged sweets, and prepared restaurants/fast foods are associated with childhood ow/ob. In contrast, breastfeeding for 6 months or longer was protective against childhood ow/ob. These findings suggest that public health programs and campaigns aimed to prevent childhood ow/ob in Vietnam should target early feeding practices.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10292-z.

Prevalence and associated factors of overweight/obesity among type2 diabetic outpatients in Southwest Ethiopia

PURPOSE

Type 2 diabetes mellitus is a major global health threat worldwide. Obesity and overweight is major risk factor for its development. This study aimed to assess the prevalence and associated factors of overweight/obesity among diabetic outpatients at Jimma Medical Center, Southwest Ethiopia.

METHODS

Hospital-based, cross-sectional study was conducted during March 02 to June 30, 2020 among systematically selected participants at the study area. Bivariable and multivariable binary logistic regression were used to identify the factors associated with outcome variable. Variables with a p value of<0.25 on bivariable logistic regression were considered candidates for multivariable regression. On multivariable logistic regression variables with p-value of <0.05 were considered as significantly associated with overweight/obesity.

RESULTS

A total of 334 participants with mean age of 51.42 ± 13.33 years were included in the study. The prevalence of overweight/obesity among the study population was 36.2%. According to multivariable logistic regression analysis, residence (AOR = 1.8, 95%CI:1, 3), higher income tercile (AOR = 3.4, 95%CI:1.8, 6.7), family history of overweight and obesity (AOR = 1.9, 95%CI:1.1,3.4), comorbid hypertension (AOR = 2.4, 95%CI:1.4,4) and physical inactivity (AOR = 2.1, 95%CI:1.2,3.5) were significantly associated with overweight/obesity.

CONCLUSION

There was a high prevalence of overweight/obesity among study participants. It was found that higher income tercile, residence, family history of overweight and obesity, comorbid hypertension and physical inactivity were significantly associated with overweight/obesity.

Prevalence of overweight and obesity and associated factors among women of childbearing age in Brazil

OBJECTIVE

To assess the factors associated with overweight and obesity among women of childbearing age in Brazil.

DESIGN

Cross-sectional study.

SETTING

Using the National Health Survey (PNS) database, from the year 2013. The socio-economic and demographic factors analysed were age, race/skin colour, region, marital status, education level, employment and family income. Concerning health history, diagnoses of hypertension, diabetes mellitus, high cholesterol, heart attack, stroke, chronic kidney disease, menarche, parity and depression were evaluated. For lifestyle information, health status, alcoholic beverage consumption, smoking and physical activity were included. The outcomes were obesity and overweight. The association of excess weight with socio-economic and demographic factors, health history and lifestyle characteristics was investigated according to the appropriate theoretical-conceptual model for the topic.

PARTICIPANTS

The sample size was 17 109 women aged 18-49 years.

RESULTS

The prevalence of women with excess weight was 55·20 %, with 33·26 % being overweight and 21·94 % with obesity. The factors associated with excess weight were age, non-white skin colour, having a partner, family income of up to two minimum wages, menarche before the age of 12, multiparity, diabetes mellitus, depression, hypertension, high cholesterol, stroke and heart attack.

CONCLUSION

The results showed an association between excess weight and socio-demographic factors, both determinants of general and reproductive health history. Implementation of effective public health policies is necessary to prevent unfavourable outcomes related to the health of women of childbearing age with excess weight.

Associations of Socioeconomic Status and Physical Activity With Obesity Measures in Rural Chinese Adults

Background: Although independent association of socioeconomic status (SES) or physical activity (PA) with obesity has been well-documented in urban settings, their independent and joint associations on obesity measures are limited in rural regions.

Methods: Almost 38,000 (n = 37,922) individuals were included from the Henan Rural Cohort Study. The International Physical Activity Questionnaire (IPAQ) was used to evaluate PA. Obesity was reflected by body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body fat percentage (BFP), and visceral fat index (VFI). The independent and interactive effects of SES and PA on obesity were analyzed by logistic regression models and generalized linear regression models, respectively.

Results: Compared with high education level, the OR (95%CI) of obesity defined by BMI with low education level was 1.466 (1.337, 1.608), 1.064 (0.924, 1.225), and 1.853 (1.625, 2.114) in total population, men and women, respectively. Besides, the OR (95%CI) of obesity defined by BMI associated with per capita monthly income were 1.089 (1.015, 1.170), 1.192 (1.055, 1.347), 1.038 (0.951, 1.133) in total population, men and women, respectively. Similar results had been observed in other obesity measures. Negative interactive association of low education level and PA on obesity measures were observed only in women (all P < 0.05).

Conclusions: This study suggests that women are more susceptible to obesity concerning low SES and that adequate PA may be a potential target for mitigating the negative effect of low SES on obesity in women.

Clinical Trial Registration: The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699) http://www.chictr.org.cn/showproj.aspx?proj=11375.

Association of Socioeconomic Status and Overweight/Obesity in Rural-to-Urban Migrants: Different Effects by Age at Arrival

This study aims to investigate the association between socioeconomic status and overweight/obesity in rural-to-urban Yi migrants in China, and to explore whether the association varied by the age at arriving urban areas. The cross-sectional population-based data from the Yi Migrants Study in 2015 was used, which included 1,181 Yi migrants aged 20–80 years. Socioeconomic status was evaluated by education level, personal annual income, and a composited variable (socioeconomic status index, SESI). Measured weight and height were used to calculate BMI and to define overweight/obesity (BMI ≥ 24 kg/m²). The results suggested that the association of income and SESI with overweight/obesity was not significant when age at arrival (two groups, <20 and ≥20 years) was considered as a covariate. In the stratification analysis, reversed association was observed in the two groups of age at arrival. In migrants of <20 years of age at arrival, higher level of education and SESI were related to decreased risk of overweight/obesity. In contrary, in those of ≥20 years at arrival, higher socioeconomic status level was found to be related to increased risk. Our findings suggest that the effect of socioeconomic status on overweight/obesity was modified by the age at arrival in Yi migrants. Especially, the association between socioeconomic status and overweight/obesity was negative when migration before 20 years of age, and transfer to positive after 20 years.

Temporal trend of overweight and obesity prevalence among Brazilian adults, according to sociodemographic characteristics, 2006-2019

OBJETIVO

To analyze the temporal trend of overweight and obesity prevalence rates among adults in the Brazilian state capitals and Federal District between 2006 and 2019.

METHODS

This was a time series study using data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey, 2006-2019 (n=730,309). Prevalence of overweight and obesity for each of the years was analyzed, according to combined sex, age, and schooling. Temporal variation trend was analyzed using Prais-Winsten regression.

RESULTS

Variations in overweight prevalence were observed, mainly among males 18-24 years old with up to 8 years of schooling (3.17%/year) and among women between 18-24 years old with more than 12 or more years of schooling (6.81% /year). Variations in obesity prevalence were found mainly among women 18-24 years old with more than 12 years of schooling (10.79%/year).

CONCLUSION

There was an increase in overweight and obesity in most of the socio-demographic strata studied, especially among more educated young people.

Prevalence of overweight and obesity in Brazilian children and adolescents: a systematic review

abstract It is important to know about overweight and obesity situation of Brazilian children and adolescents. The present study aims to update scientific production, through a systematic review, on the prevalence and factors associated with overweight and obesity in Brazilian children and adolescents. Nine databases were verified, and 1,316 references were examined from 2018 to 2019. The electronic search was conducted by three independent researchers. All review steps followed a strategy based on PRISMA. 40 studies were included in this systematic review. Most studies use the World Health Organization classification criteria. The prevalence of overweight in Brazilian children and adolescents varies from 8.8% to 22.2% (boys: 6.2% to 21%; girls: 6.9% to 27.6%). The prevalence of obesity varied from 3.8% to 24% (boys: 2.4% to 28.9%; girls: 1.6% to 19.4%). It was observed that the socioeconomic factors (sex, skin color, economic level, region, mother's educational level, living in a rented house and without access to the internet), hereditary/genetic (family history of dyslipidemia and overweight and rs9939609 genotype) and behavioral (physical activity, screen time, eating habits, perceived body weight, health vulnerability, presence of a result close to home, alcoholic beverages, cigarette consumption) were associated with the outcome. It is concluded that the prevalence of overweight and obesity among Brazilian children and adolescents are worrisome and most of the factors associated with the outcomes are subject to change from the adoption of a healthy lifestyle.

Life course socioeconomic position and body composition in adulthood: a systematic review and narrative synthesis

INTRODUCTION

Multiple systematic reviews have investigated the relation between socioeconomic position (SEP) and body mass index (BMI) throughout the life course. However, BMI does not capture quantity and distribution of fat and muscle, which are better indicators of obesity than BMI, and have been independently linked to adverse health outcomes. Less is known about the relation between SEP and body composition, and the literature has not been reviewed. We therefore systematically reviewed the literature on the association between life course SEP and body composition in adulthood.

METHODS

A protocol was registered on PROSPERO (CRD42019119937), and the review followed PRISMA guidelines. An electronic search of three databases (MEDLINE, Embase Classic + Embase and SPORTDiscus) was conducted. Original studies in the English language were included that examine the association between any recognised measure of SEP at any age and body composition (fat mass, fat-free mass, ratio and distribution) in adulthood, measured using a direct technique, i.e., not an anthropometric measure. A narrative synthesis was conducted.

RESULTS

A total of 47 papers were included in the final review, none were from low-income countries (LICs). Greater advantage in childhood and adulthood was associated with lower fat levels in high-income countries (HICs). Associations in the opposite direction were found exclusively in middle-income countries (MICs). No studies in MICs reported associations for childhood SEP. For measures of lean mass, the majority of papers reported no association, or greater advantage in adulthood associated with higher lean mass, with little variation between HICs and MICs. Associations in HICs are more often observed in women than men.

CONCLUSION

The results indicate that fat measures follow similar patterns to those seen for BMI, and that women in HICs are more likely to experience inequalities in both fat and lean measures. Further research in LICs and MICs is needed.

The effect of pre-pregnancy body mass index on breastfeeding initiation, intention and duration: A systematic review and dose-response meta-analysis

Overweight and obesity not only are major risk factors for number of chronic diseases, but also a risk factor for pregnancy complications in women. The present study aims to investigate the association between pre-pregnancy BMI and the persistence and duration of BF. The electronic databases including Medline (PubMed), Scopus, Embase, Web of Science and Google Scholar were searched for papers with titles and/or abstracts including one of our keywords and published up to 15 April 2019. For dose-response relationship, the two-stage random-effects meta-analysis was performed using the “dosresmeta” function in R software. Thirty-two studies with the effect of pre-pregnancy BMI on BF initiation, intention and duration were included in the present study. Based on crude and adjusted OR models, the risk of BF cessation increased by 4% (OR = 1.04; 95% CI: 1.02–1.05) with an increase in a unit of BMI. In addition, based on crude and adjusted RR models, the risk of BF cessation increases by 2% and 1% (crude RR = 1.02; 95% CI: 1.01–1.03 and adjusted RR = 1.01; 95% CI: 0.99–1.02) with an increase in one unit of BMI. Based on the result, the health care professionals and other key stakeholders should be aware of the impact excess weight, and that women who are overweight or obese should be encouraged with continued access to guidance, counseling and support, starting from conception, to maximize BF outcomes.

Acting against obesity: a cross-cultural analysis of prevention models in Spain, Argentina and Brazil

This article analyses and compares preventive models for obesity in Spain, Argentina and Brazil through an examination of the respective measures adopted to counter it in those countries. Based on a qualitative study of the main actions carried out since 2004, the aim is to delineate the conceptual framework and reflect on the reasons for their relative effectiveness. The results show that in contexts where prevalence has increased rapidly, sociocultural causes acquire greater explanatory power as opposed to biological and/or behavioral factors. These models premise worsening diets and sedentary lifestyles as being the main culprits, and assume that contemporary societies generate obesogenic and toxic environments. The international health bodies have developed specific strategies to control and prevent obesity based on this diagnosis, and these have been supported by member states such as Spain, Argentina and Brazil. Although the measures reflect certain particularities, they conform to a common pattern organized from platforms promoting so-called "healthy lifestyles" and articulated mainly around the twin axes of a balanced diet and regular physical exercise. The discussion suggests that the excessive emphasis on individual responsibility and the underplaying of the role of food as a complex practice, as well as changing structural factors and the differential distribution of this disease, might largely explain the limited impact of these strategies.

Interaction between the place of residence and wealth on the risk of overweight and obesity in Bangladeshi women

BACKGROUND

The prevalence of overweight and obesity in women has increased significantly over the last few decades in Bangladesh, a rapidly urbanising developing country. However, little is known regarding the association between the interaction of the place of residence and household wealth with overweight and obesity, particularly in women from developing countries.

OBJECTIVE

The objective of this study is to find the association between the interaction of the place of residence and wealth with overweight and obesity among Bangladeshi women.

METHODS

This study utilised data from the four Bangladesh Demographic Health Surveys conducted in 2004, 2007, 2011 and 2014 with a total of 54337 women aged 15-49 years. Multivariate logistic regression was used for the analyses.

RESULTS

The prevalence of overweight and obesity among women aged 15-49 years in Bangladesh has considerably increased from 9.96% in 2004 to 24.43% in 2014. The interaction between wealth and place of residence has been found to be associated with obesity. Urban wealthy and richest women were 4.23 (OR: 4.23, 95% CI: 1.25-14.34) and 5.99 (OR: 5.99, 95% CI: 1.91-18.74) times more likely to be obese compared to their rural counterparts in the period 2004. Urban richest were 2.94 times (OR: 2.94, 95% CI: 1.20-7.24) more likely to be obese against their rural counterparts for the survey year 2014.

CONCLUSIONS

The place of residence is not associated with obesity, but its interaction with wealth is significant.

Factors associated with overweight and obesity in adults using structural equation model: mediation effect of physical activity and dietary pattern

PURPOSE

This study aimed to determine the indirect effect of risk factors associated with overweight and obesity through physical activity (PA) and dietary pattern (DP), using structural equation model in the adults' population.

METHODS

This cross-sectional study was conducted on 10,000 adults from baseline data of Ravansar Non Communicable Disease cohort study, in the west region of Iran in 2018. Structural equation modeling was used to assess the causal effects of associated factors on obesity and overweight as the outcome.

RESULTS

In general, the population at higher economic level was significantly more dependent on the healthy DP. The direct effect of socioeconomic status (SES) on overweight and obesity was - 0.070, the indirect effect was 0.127, and the total effect was 0.057. When stratified by gender, in women, SES had a weak direct effect (β = 0.024) and indirectly, through the variables of PA and DP, had a significant effect (β = 0.088) on the outcome. The same situation has been observed in men. That is a weak direct effect of SES (β = 0.070) and a significantly indirect effect, through three variables such as PA, DP, and smoking status, on the outcome.

CONCLUSION

Factors associated with overweight and obesity not only by direct effect, but also can indirectly and through mediators (such as DP and PA as two important mediation variables) cause this outcome. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Obesity: a Ghost at the Feast of the Sustainable Development Goals

PURPOSE OF REVIEW

Despite its rapidly rising global prevalence, obesity is not featured in any of the Sustainable Development Goals (SDGs). This review highlights the multiple points at which obesity is affected by the Goals.

RECENT FINDINGS

At least 14 out of the 17 thematic SDG targets play a role in driving the obesity epidemic, including health, food, education, water quality, land and ocean quality, urbanisation and employment. Although the SDGs recognise the need to reduce 'malnutrition in all its forms', the Goals underplay the role of urbanisation and unregulated markets on dietary health. Furthermore, adherence to the SDGs may be weak and compromised by conflicted interests. Nonetheless, governments have shown that they can, when pressed, respond to health challenges, and we anticipate how the rise in the numbers of people experiencing excess bodyweight may itself lead to greater demand for collective responsibility to ensure our environments are fully health-creating.

Association of macro-level determinants with adolescent overweight and suicidal ideation with planning: A cross-sectional study of 21 Latin American and Caribbean Countries

BACKGROUND

Adolescents and young people (10-24 years old) in the Latin America and the Caribbean (LAC) region represent approximately 25% of the region's population. Since the 2008 global economic crisis, the pace of reduction in poverty and income inequality in the LAC region has stalled. The region is characterised by high levels of inequities and is also vulnerable to many natural disasters. Food systems are changing with increased availability and marketing of packaged and fast foods and sugar-sweetened drinks. Adolescence is a formative phase of the life course with multiple physical, emotional and social changes which can make them vulnerable to health problems. We assess the potential impact of macro-determinants, human and economic development as well as income inequality, on 2 top-ranking regional priorities for adolescent nutrition and mental health, using measures of overweight and suicidal ideation and planning which some have shown to be associated.

METHODS AND FINDINGS

The Global School-based Health Survey (GSHS) is a nationally representative self-administered, school-based survey. We examined overweight/obesity and suicidal ideation with planning by gross domestic product (GDP) per capita or human development index (HDI) in 10-19-year-old adolescents from 21 LAC countries between 2009 and 2013. Sample sizes varied from 943 in Anguilla to 27,988 in Argentina. A total of 55,295 adolescents had a measure of overweight/obesity status, and 59,061 adolescents reported about suicidal ideation with planning. There was equal representation by sex in the surveys (52% girls and 48% boys). A total of 28.8% of boys and 28.1% of girls had overweight/obesity, and 7.5% of boys and 17.5% of girls reported suicidal ideation with planning over the last 12 months. Adjusted for individual socioeconomic and risk behaviours, and relative to the highest GDP per capita tertile, the middle tertile was associated with 42% (95% confidence interval (CI) 59% to 17%, p = 0.003) and 32% (95% CI 60% to 5%, p = 0.023), and the lowest tertile with 40% (95% CI 55% to 19%, p = 0.001) and 46% (95% CI 59% to 29%, p < 0.001) lower chances of overweight/obesity for girls and boys, respectively. A similar positive effect was seen with HDI, with lowest chances of overweight in the lowest tertile compared with the highest tertile for both sexes. Overweight/obesity was positively related with suicidal ideation with planning for girls (odds ratio (OR) 1.12, 95% CI 1.02 to 1.22, p = 0.009) and weakly related for boys (OR 1.09, 95% CI 0.96 to 1.24, p = 0.182). In contrast to overweight/obesity status, suicidal ideation with planning was not related to macro-level indices despite both outcomes sharing common individual socioeconomic and risk behaviour correlates. Limitations include the dominance of Argentinians in the sample (40%), the exclusion of vulnerable adolescents who dropped out of school, and reporting bias due to stigma of mental health-related issues.

CONCLUSIONS

This study shows that economic and human development were positively associated with adolescent overweight/obesity but not with suicidal ideation with planning. We also observed an interconnectedness between overweight/obesity and suicide ideation with planning among girls. These findings highlight the importance of strategies that engage with both upstream and downstream determinants to improve adolescent nutrition and mental health.

Socioeconomic Status and Childhood Obesity: a Review of Literature from the Past Decade to Inform Intervention Research

PURPOSE OF REVIEW

This is a review of the patterns, conceptualization, and suggested mechanisms underlying the relationship of socioeconomic status (SES) to obesity in childhood and the implications of these data for interventions going forward.

RECENT FINDINGS

Adiposity and SES are negatively associated in high-income countries and positively associated in medium to low-income countries. Several mechanisms, such as early introduction of solid food and parental behaviors, which may explain the association of SES and adiposity, have been identified. Parental education and adiposity and early pediatric nutrition appear to be particularly salient SES-related effectors on adiposity. There is a clear association of SES and adiposity which is affected by population affluence. Evaluation of the relationship of SES and obesity in children are complicated by the complexity of SES and lack of common definition. A number of SES-related interventional targets have been identified. Intervention research should ensure they are addressing SES-associated issues in the study population.

Sex difference in the association of obesity with personal or social background among urban residents in Japan

The development of obesity is influenced by genetic and environmental factors and is associated with a variety of health problems. To gain insight into environmental factors that contribute to obesity, we analyzed the relation of personal or social background to obesity in men and women separately with the use of data from a community-based questionnaire survey of 5425 residents aged 20 to 64 years of Kobe, a representative large city in Japan. Obesity and normal weight were defined as a body mass index (BMI) of ≥25 and of ≥ 18.5 and < 25 kg/m2, respectively, according to the diagnostic criteria of the Japan Society for the Study of Obesity. The personal or social background factors examined included marital status, family structure, employment, household income, residence type, welfare enrollment, economic conditions of current life, educational level, extracurricular activity in school, living conditions at 15 years of age, and childhood adversity. We found that the prevalence of obesity was 27.2% and 10.6% in men and women, respectively. Among women, unmarried status, a low household income, welfare enrollment, difficult current economic conditions, a low educational level, and childhood adversity were associated with obesity, whereas none of the personal or social background factors examined were associated with obesity in men. Our results suggest that the development of obesity in women is strongly influenced by personal or social background, and such factors should be taken into consideration in the management of this condition in women.

Complementary feeding practices and their association with adiposity indicators at 12 months of age

Nutrition during the first 1000 days of life represents a window of opportunity to reduce the risk of metabolic dysfunctions later in life. Exclusive breastfeeding (EBF) and adequate introduction of solid foods are essential to promote metabolic and nutritional benefits. We evaluated the association of infant feeding practices from birth to 6 months (M) with adiposity indicators at 12 M. We performed a secondary analysis of 106 healthy term infants born from a cohort of healthy pregnant women. Type of breastfeeding (exclusive or nonexclusive), the start of complementary feeding (CF) (before (<4 M) or after (≥4 M)), and adiposity (body mass index - BMI, body mass index-for-age - BMI/A, waist circumference - WC, and waist circumference-length ratio - WLR) were evaluated at 12 M using descriptive statistics, mean differences, X2, and linear regression models. During the first 6 M, 28.3% (n = 30) of the infants received EBF. Early CF (<4 M) was present in 26.4% (n = 28) of the infants. Children who started CF < 4 M were less breastfed, received added sugars as the most frequently introduced food category, and showed higher BMI, BMI/A, WC, and WLR; those who consumed added sugars early (<4 M) had a higher WC. Starting CF < 4 M was the main factor associated with a higher WC at 12 M. Unhealthy infant feeding practices, such as lack of EBF, early CF, and early introduction of sugars, may be associated with higher adiposity at 12 M.

Association between obesity and education level among the elderly in Taipei, Taiwan between 2013 and 2015: a cross-sectional study

The inverse association between obesity and education level has been demonstrated in many developed countries; however, few studies have investigated obesity in geriatric populations. This cross-sectional analysis explored the association between geriatric obesity and education level, along with other demographic characteristics in Taipei, Taiwan between 2013 and 2015. Taipei citizens ≥ 65 years (aborigines ≥ 55 years) were recruited to participate in the elderly health examination programme. Logistic regression was applied to analyse the relationship between obesity (defined as body mass index ≥ 27 kg/m² in Taiwan) and education level among men and women after controlling for age, race, income status, and smoking status. A total of 28,092 men and 31,835 women were included in the final analysis. Compared to those with education years ≥ 16, older men and women with education years ≤ 12 had higher odds of being obese. The odds ratios increase as years of education decrease, and the trend is more pronounced among women. Aborigines had much higher chances of being obese among men and women, while there were no differences by income status. The results clarified the factors related to obesity in the elderly, and will be useful for authorities working to improve health outcomes among this population.

Overweight and obesity among women of reproductive age in Mali: what are the determinants?

Background

Existing evidence suggests that there has been a surge of overweight and obesity in low- and middle-income countries around the world. In this study we investigated the prevalence and factors associated with overweight and obesity among women in Mali.

Methods

We conducted the study among 5198 women using the 2018 Mali Demographic and Health Survey data. We used binary logistic regression for the analysis and pegged statistical significance at p<0.05.

Results

The prevalence of overweight and obesity was 26.9%. The likelihood of overweight and obesity was high among women 40–44 y of age (adjusted odds ratio [AOR] 5.94 [confidence interval {CI} 4.10 to 8.60]), those who were widowed/divorced/separated (AOR 1.59 [CI 1.04 to 2.43]), those with secondary education (AOR 1.41 [CI 1.13 to 1.75]), richest women (AOR 3.61 [CI 2.63 to 4.95]), those who watched television at least once a week (AOR 1.28 [CI 1.07 to 1.52]) and those who lived in the Kidal region (AOR 10.71 [CI 7.05 to 16.25]). Conversely, the likelihood of overweight and obesity was low among women who belonged to other religions compared with Muslims (AOR 0.63 [CI 0.43 to 0.92]).

Conclusions

This study found a predominance of overweight and obesity among women in Mali. The study showed that age, marital status, education, religion, region of residence, wealth status and frequency of watching television are associated with overweight and obesity among women in Mali. It is therefore critical for public health promotion programs in Mali to sensitize people to the negative effects associated with overweight and obesity. This implies that policies aimed at controlling overweight and obesity in Mali must take these factors into consideration.

Contrasting Anti-obesity Effects of Smectite Clays and Mesoporous Silica in Sprague-Dawley Rats

Porous colloids have been shown to exert unique bioactivities for mediating lipid (fat) metabolism and thereby offer significant potential as anti-obesity therapies. In this study, we compare the capacity for two classes of colloids, that is, smectite clays (Laponite XLG, LAP; montmorillonite, MMT) and mesoporous silica (SBA-15 ordered silica; MPS), to impede intestinal lipid hydrolysis and provoke lipid and carbohydrate excretion through adsorption within their particle matrices. A two-stage in vitro gastrointestinal lipolysis model revealed the capacity for both smectite clays and MPS to inhibit the rate and extent of lipase-mediated digestion under simulated fed state conditions. Each system adsorbed more than its own weight of organic media (i.e., lipid and carbohydrates) after 60 min lipolysis, with MMT adsorbing >10% of all available organics through the indiscriminate adsorption of fatty acids and glycerides. When co-administered with a high-fat diet (HFD) to Sprague-Dawley rats, treatment with MMT and MPS significantly reduced normalized rodent weight gain compared to a negative control, validating their potential to restrict energy intake and serve as anti-obesity therapies. However, in vitro-in vivo correlations revealed poor associations between in vitro digestion parameters and normalized weight gain, indicating that additional/alternate anti-obesity mechanisms may exist in vivo, while also highlighting the need for improved in vitro assessment methodologies. Despite this, the current findings emphasize the potential for porous colloids to restrict weight gain and promote anti-obesity effects to subjects exposed to a HFD and should therefore drive the development of next-generation food-grade biomaterials for the treatment and prevention of obesity.

[Preventing obesity in precarious contexts: local responses to global strategies]

The aim of this article is to analyze the conceptual structure underlying the models of obesity prevention implemented in Argentina, Brazil, and Spain. In their culturally distinct but epidemiologically similar contexts, the three countries have devised strategies that reproduce global diagnoses of the causes of obesity and replicate some of the measures proposed at the global level. While so-called "obesogenic environments" are considered primarily responsible for these tendencies, efforts to raise awareness about food and nutrition tend to promote self-monitoring and behavior rationalization as the main tools for achieving changes in diet and physical activity. Although a variety of measures have been proposed at the local level, they have been less diverse in terms of their nature and scope, barely taking into account the constraints that hinder the adoption of healthy lifestyles. In contexts of social and food precarity, this has meant neglecting the social groups with the highest prevalence of obesity.

Structural equation model analysis for the evaluation of factors associated with overweight and obesity in menopausal women in RaNCD cohort study

OBJECTIVE

Weight gain and increased body fat mass are among the common complications of menopause. In addition to hormonal changes, behavioral and environmental factors aggravate transition through this phase. This study uses a structural equation model (SEM) to evaluate factors associated with overweight and obesity in menopausal women.

METHODS

This is a cross-sectional study of 4,471 women (pre/perimenopausal 3,150, menopausal 1,321) from baseline data of the Ravansar Non-Communicable Disease (RaNCD) cohort study in the west region of Iran in 2018. Obesity and overweight were the outcome variables. SEM was used to examine the relationships, using IBM SPSS, AMOS version 23.

RESULTS

The mean body fat percentage and visceral fat area in menopausal women was significantly greater than among pre/perimenopause women. The direct association of higher socioeconomic status (SES) with a healthy dietary pattern was stronger among pre/perimenopausal women than among menopausal women (ß = 0.574 vs ß = 0.552). In both groups, less physical activity was associated with depression and musculoskeletal disorders, and this association was stronger in menopausal women (ß = -0.174 vs ß = -0.215; P > 0.05). Overweight and obesity were directly decreased (ß = -0.011, P > 0.05) and indirectly increased (ß = 0.013, P > 0.05) in pre/perimenopausal women by sleep duration, but they were directly and indirectly decreased in menopausal women.

CONCLUSIONS

The direct and indirect effects of well-known risk factors associated with overweight and obesity were found to be different in pre/perimenopausal and menopausal groups. Some risk factors showed stronger effects among menopausal women compared with the pre/perimenopausal women. Physical activity and healthy dietary pattern had a mediator impact in the two study groups.

Deprivation or discrimination? Comparing two explanations for the reverse income-obesity gradient in the US and South Korea

In high-income countries, poverty is often associated with higher average body mass index (BMI). To account for this reverse gradient, deprivation theories posit that declining economic resources make it more difficult to maintain a healthy weight. By contrast, discrimination theories argue that anti-fat discrimination in hiring and marriage sorts heavier individuals into lower-income households. This study assesses competing predictions of these theories by examining how household income in representative samples from South Korea (2007-2014, N=20,823) and the US (1999-2014, N=6395) is related to BMI in two key contrasting groups: (1) currently-married and (2) never-married individuals. As expected by anti-fat discrimination in marriage, the reverse gradient is observed among currently-married women but not among never-married women in both countries. Also consistent with past studies no evidence was found for a reverse gradient among men. These findings are consistent with anti-fat discrimination in marriage as a key cause of the reverse gradient and raise serious challenges to deprivation accounts as well as explanations based on anti-fat discrimination in labour markets.

Energy imbalance: obesity, associated comorbidities, prevention, management and public health implications

The prevalence of obesity has been continually increasing, as have its associated comorbidities and health care costs. Effective management of obesity and early intervention measures are necessary to overcome this global issue. The responsibility for preventing and managing this global epidemic does not lie solely on an individual, but also on the entire health care system. Policy makers-nationally and globally-must play their roles to solve the issue. In this review article, we examine methods of controlling and managing obesity through interventions, such as a low caloric diet, physical exercise, pharmacological guidance, and bariatric surgical procedures. While health care professionals should educate patients about all available treatment options for severe obesity, bariatric surgical procedures have increased in popularity and are considered very beneficial with outcomes fruitful in managing severe obesity.

Overweight/obesity among 15- to 24-year-old women in Ghana: 21-year trend, future projections and socio-demographic correlates

Although developing countries are experiencing some of the fastest rises in the prevalence of adult overweight and obesity, little is known about the pace of the problem among young people in transition from adolescence to adulthood. This study examined the trend and associated socio-demographic predictors of overweight/obesity (BMI ≥25kg/m2) from 1993 to 2014 among women aged 15-24 years in Ghana and projected the future prevalence from 2019 to 2040. Descriptive statistics, the arithmetic linear change model, and binary logistic regression were applied to data on women aged 15-24 years from five nationally representative Ghana Demographic and Health Surveys conducted in 1993 (N=488), 1998 (N=517), 2003 (N=1832), 2008 (N=1693) and 2014 (N=1491). Overall, overweight/obesity among women aged 15-24 years almost tripled between the 1993 (6.8%; 95% CI=4.9-9.3) and 2014 (19.5%; 95% CI=17.3-21.2) surveys. Based on the arithmetic linear change model, overweight/obesity is projected to increase linearly to over 35% among the 15-24 year cohort of women by 2040. Age, educational level, wealth status, occupation, type of locality, ethnicity, frequency of viewing TV per week, parity and contraceptive use were found to be significant predictors of overweight/obesity among this sub-group of women. The trend of overweight/obesity demonstrated in this group of women could potentially provide momentum for further increases in the prevalence of overweight/obesity and associated health outcomes in the coming years in Ghana. This underscores the need for urgent national-level public health intervention efforts to curtail the problem.

How is obesity associated with happiness? Evidence from China

Happiness is a universal goal that people pursue. Studies of the relationship between obesity and happiness have shown mixed findings. It is uncertain whether an optimum BMI level exists and at what level obesity interferes or interacts with happiness. Guided by the Circle of Discontent Theory, we examined the relationship between obesity and happiness among Chinese residents using the 2014 China Family Panel Studies data. The results reveal an inverted U-shaped relationship between BMI and happiness, with obesity associated with happiness through physical appearance, health, and income. The socioeconomic conditions for the appropriate weight to achieve happiness are discussed.

Addressing Obesity to Promote Healthy Aging

The population worldwide is aging and prevalence of obesity in this population is increasing. The range of consequences that effect these at-risk patients include increased risk of falls, fractures, reduced quality of life, and cognitive decline. This article describes the epidemiology of obesity, risks and benefits of weight loss, and importance of treating obesity to help promote healthy aging. Health care professionals should encourage older adults with obesity to implement healthy lifestyle behaviors including exercise and diet routine. Treating obesity in older adults mitigates the significant public health crisis, and reduces health care utilization and risk of long-term adverse events.

Wage Penalties or Wage Premiums? A Socioeconomic Analysis of Gender Disparity in Obesity in Urban China

Global obesity as a major public health problem has increased at pandemic rate, with men often outpacing women. Survey data show that the overall prevalence of obesity is higher among women than men, yet in high-income developed countries, the prevalence of overweight is higher among men than women. The differential impact of different economic stages has prompted research in transition economies such as China. Using an instrumental variable approach based on a sample of 13,574 individuals from nine provinces in the Chinese Household Income Project (CHIP), we find a 7% excess-weight premium in wages for overweight men and a 4.6% penalty for overweight women, compared to their healthy-weight peers. We also find an inverse u-shaped association between the body mass index (BMI) and logarithm of monthly income for men, with an implied optimum above the threshold of obesity, while women are better off the slimmer they are. The excess-weight premium in wages for Chinese urban men might be associated with entrenched business practices of excessive dining and drinking associated with senior positions. Policies aimed at reducing obesity in China must be adapted to its unique sociocultural context in order to have gender-differentiated effects.

Overweight and obesity in Eastern Morocco: Prevalence and associated risk factors among high school students

BACKGROUND

Overweight and obesity in children and adolescents have become a major public health problem affecting most countries worldwide. The purpose of the study was to assess the prevalence and risk factors of overweight and obesity among public high school students in Eastern Morocco.

METHODS

A cross-sectional survey was conducted between February and May 2014 among a sample of 2271 students (1086 girls and 1185 boys). References from the International Obesity Task Force (IOTF) were used to determine the prevalence of overweight and obesity.

RESULTS

The prevalence of overweight and obesity reached 12.2% (14.2% in girls vs 10.4% in boys, P<0.01) and 3.0% (3.1% in girls vs 2.8% in boys), respectively. Risk factors associated with overweight and obesity were urban residence (OR=1.76; [1.18-2.63]; P<0.01), father's income≥5000MAD (OR=1.32; [1.02-1.70]; P<0.05), father's overweight (including obesity) (OR=1.87; [1.38-2.54]; P<0.001) and female sex (OR=1.31; [1.02-1.68]; P<0.05).

CONCLUSION

The prevalence of overweight/obesity has reached an alarming rate among high school students in the Eastern region of Morocco. The findings of the present study suggest an urgent need to set up a strategy to prevent and combat this epidemic.

Analysis of Publication Trends in Childhood Obesity Research in PubMed Since 1945

Background: Childhood obesity (CO) has become a true epidemic and a subject of increasing publications. The aim of this study was to assess if the number of publications in that field increases over time in proportion to the epidemic, and also according to socioeconomic factors. Methods: A PubMed search was carried out to extract articles related to CO published between 1945 and 2017. Data were downloaded from PubMed and processed through a dedicated parser. Socioeconomic data were collected from international organizations. Results: Overall, 36,554 articles were retrieved among 3329 journals, one-third of them being concentrated in 44 journals. The annual growth rate of publications on CO was on average 11.6% per year between 1990 and 2016, whereas the growth rate of articles on pediatrics or of the total articles indexed in MEDLINE was 2.6% and 4.4%, respectively. The most productive countries were the United States (37.80%), the United Kingdom (6.24%), and Italy (4.56%). There was a significant relationship between publications on CO in a country and prevalence of CO in that country (p = 0.002) and between evolution of the number of publications and evolution of the Human Development Index (p = 0.01). Following exponential growth, CO publications reached a plateau in 2013, whereas publications targeted on obesity in infants continue to increase. Conclusions: Research on CO has risen markedly in the last two decades, with a higher growth rate than biomedical research overall, as a result of the worldwide obesity epidemic and also due to specific socioeconomic factors.

Indicators of Absolute and Relative Changes in Skeletal Muscle Mass during Adulthood and Ageing

This study aimed to explore the set of variables related to skeletal muscle mass (SMM) in both sexes, and to create age- and sex-related models of changes in SMM, using the most representative indicator of muscular status. Body composition was assessed in 8733 subjects (♀ = 3370 and ♂ = 5363), allocated into subsamples according to age: 18–29.9, 30–39.9, 40–49.9, 50–59.9, 60–69.9, and 70.0–79.9 years. Nine variables were used: protein mass, protein percent, protein mass index, SMM, percent of SMM, SMM index, fat-free mass, fat-free mass index, and protein/fat index. Univariate and multivariate analysis of variance (ANOVA and MANOVA) were used to determine between- and within-sex difference in all variables by age. Correlation analysis established the relationship between age and muscularity variables. Principal Component Analysis extracted the variables that loaded highest in explaining muscularity, while regression analysis determined the linearity of association between the age and indicators of muscular status. Variables SMMI and PSMM were extracted as the most sensitive to age, with SMMI being gender-independent while showing the parabolic and sinusoidal form of change as function of ageing in males and females, respectively; and PSMM being sex-dependent while showing a linear trend of decrease in both sexes.

Maternal Underestimation of Child's Weight at Pre-School Age and Weight Development between Age 5 and 12 Years: The ABCD-Study

Background: Healthcare monitoring of child growth reduces with age, which may increase parental influences on children’s weight development. This study aimed to examine the association between maternal underestimation of child’s weight at age 5/6 and weight development between 5 and 12 years. Methods: We performed univariate and multivariate linear regression analyses with data on maternal perception of child’s weight and weight development (∆SDS body-mass index; BMI) derived from the Amsterdam Born Children and their Development (ABCD) birth-cohort study. Underestimation was defined by comparing maternal perception of child’s weight with the actual weight status of her child. Associations were studied in two groups: children with overweight (n = 207) and children with normal weight (n = 1982) at baseline (children with underweight were excluded). Results: Underestimation was 5.5% in children with normal weight and 79.7% in children with overweight. Univariate analyses in children with normal weight and overweight showed higher weight development for children with underestimated vs. accurately estimated weights (respectively: β = 0.19, p < 0.01; β = 0.22, p < 0.05). After adjusting for child sex and baseline SDS BMI, the effect size became smaller for children with a normal weight (β = 0.15, p < 0.05) and overweight (β = 0.18, p > 0.05). Paternal and maternal BMI, ethnicity, and educational level explained the association further (remaining β = −0.11, p > 0.05 in children with normal weight; β = 0.06, p > 0.05 in children with overweight). Conclusions: The relationship between maternal underestimation of child’s weight and higher weight development indicates a need for promoting a realistic perception of child’s weight, this is also the case if the child has a normal weight.

Developmental trajectories of adolescent overweight/obesity in China: socio-economic status correlates and health consequences

OBJECTIVES

During recent decades, China has experienced a rapid growth in economy and also in prevalence of childhood obesity. Given the great importance of adolescence overweight/obesity for future health and given the relative lack of longitudinal studies on adolescent obesity in developing countries, particularly in China, in this study, we aimed to explore the potential growth trajectories of overweight/obesity among Chinese adolescents and to further examine socio-economic status predictors and health consequences of these growth trajectories.

STUDY DESIGN

This study is a longitudinal study.

METHODS

The data were from four waves of panel data from the China Family Panel Studies (CFPS 2010, 2012, 2014, and 2016). For the present study, children aged 10 to 12 years from the baseline 2010 sample were selected (N = 1685), among whom 1388 were reinterviewed in 2012, 1172 in 2014, and 941 in 2016. We retained a final sample of 800 who had at least three waves of body mass index (BMI) data (i.e. final N = 800). Generalized growth mixture modeling was used as the major analytical strategy.

RESULTS

We found three different types of overweight/obesity developmental trajectories for these Chinese adolescents, namely a stably normal class, a decreased risk class, and a chronically overweight/obese class. Moreover, we found that higher family income was associated with a lower probability of getting into the chronically overweight/obese class for urban adolescents but with a higher probability of getting into the same class for rural adolescents. Lastly, the adolescents classified in the chronically overweight/obese group reported significantly lower levels of self-rated health.

CONCLUSIONS

There were heterogeneous growth trajectories of adolescent overweight/obesity in China. Sustained overweight/obesity during adolescence was predicted by lower family income in urban China but by higher family income in rural China. More targeted and regionalized interventions for childhood overweight/obesity in China should be considered.

The independent role of deprivation in abdominal obesity beyond income poverty. A population-based household survey in Chinese adults

BACKGROUND

Individual-level deprivation takes into account the non-monetary aspects of poverty that neither income poverty nor socio-economic factors could fully capture; however, it has rarely been considered in existing studies on social inequality in obesity. Therefore, we examined the associations of deprivation, beyond income poverty, with both general and abdominal obesity.

METHODS

A territory-wide two-stage stratified random sample of 2282 community-dwelling Hong Kong adults was surveyed via face-to-face household interviews between 2014 and 2015. Deprivation was assessed by a Deprivation Index specific to the Hong Kong population. General obesity was defined as body mass index (BMI) ≥ 25 kg/m2, while abdominal obesity was defined as waist circumference (WC) ≥ 90 cm/80 cm for male/female. Multivariable binary logistic regressions were performed.

RESULTS

Deprivation was independently associated with abdominal obesity (odds ratios (OR) = 1.68; 95% confidence intervals (CI): 1.27-2.22); however, no significant association was found with general obesity (OR=1.03; CI: 0.77-1.38). After additional adjustment for BMI, deprivation remained strongly associated with abdominal obesity (OR=2.00; CI: 1.41-2.83); and after further adjustment for WC, deprivation had a marginal inverse association with general obesity (OR=0.72; CI: 0.51-1.01).

CONCLUSIONS

Deprivation is an important risk factor of abdominal obesity and plays a critical role in capturing the preferential abdominal fat deposition beyond income poverty.

Dyslipidemia and Associated Factors Among Adult Patients on Antiretroviral Therapy in Armed Force Comprehensive and Specialized Hospital, Addis Ababa, Ethiopia

Background

The development of antiretroviral drugs and subsequent access to combined antiretroviral therapy contributed to the decline in morbidity and mortality rates associated with acquired immune deficiency syndrome, resulting in an increased life expectancy and improved quality of life for people living with human immunodeficiency virus. However, a cluster of metabolic derangements such as dyslipidemia is increasing, especially for those on antiretroviral therapy. Limited studies were done on the prevalence of dyslipidemia and its associated factors among adult patients on antiretroviral therapy in Ethiopia which demand the conduct of the present investigation entitled on the prevalence of dyslipidemia and its associated factors among adult patients on antiretroviral therapy in Armed Force Comprehensive and Specialized Hospital Addis Ababa, Ethiopia, 2018.

Methods

Institution-based cross-sectional study design was employed between March and April 2018. Systematic sampling method was used to select 353 study participants. Pretested stepwise approach of the World Health Organization questionnaire (WHO Stepwise), document review, anthropometric measurements, and laboratory analysis were used to collect data on different variables under the study. Collected data were entered in Epidata version 3 and analyzed by SPSS version 21.

Results

The prevalence of dyslipidemia among study participants was 74.8%. Female participants were twice and half at risk of developing dyslipidemia compared to males (AOR= 2.38; 95% CI: 1.15, 3.66). Similarly, compared to those attended college level of education, not attended formal education (AOR=0.19; 95% CI: 0.05, 0.66), and having primary/secondary educational level (AOR= 0.33; 95% CI: 0.16, 0.66) showed lower odds to develop dyslipidemia. Furthermore, WHO clinical stage II (AOR= 0.35; 95% CI: 0.14,0.92), stage III (AOR=0.25; 95% CI:0.10,0.64), duration on ART (AOR= 1.01; 95% CI: 1.001,1.02), and BMI (AOR =1.13; 95% CI: 1.06,1.23) were significantly associated with dyslipidemia.

Conclusion

There exists a high prevalence of dyslipidemia among study participants. Sex, educational status, WHO clinical stage, duration on ART, and BMI were significantly associated factors for dyslipidemia. Intervention strategies including the identified factors are demanded in the setting.

Association between Maternal Depressive Symptoms with Overweight/Obesity among Children Aged 0-5 Years According to the 2016 Demographic and Family Health Survey

Background: Overweight and obesity among children under the age of 5 have become a public health problem. The worldwide prevalence is 4.9% and 6.0%, whereas in Peru it is 7.4% and 1.9%, respectively. The causes of these problems are multifactorial and must be studied to prevent the multiple consequences on children's health. Methods: Secondary data analysis of the 2016 Demographic and Family Health Survey (DHS). The sample size was 7935 children and their mothers. The dependent variable was childhood overweight/obesity, measured according to the Z-score of the BMI >2 standard deviation (SD), while the main independent variable consisted of the maternal depressive symptoms (DS) (Patient Health Questionnaire-9 score >10 points). The software STATA/MP 14.0 was used for statistical analysis. Results: The prevalence of overweight/obesity among children aged 0-5 years was 4.5% and the prevalence of moderate and severe maternal DS was 7.1%. No maternal depressive symptoms were found to be associated with the outcome [adjusted PR = 1.36 95% confidence interval (CI) = 0.59-3.09 p = 0.47]. An association was found between socioeconomic status (SES) Q3 (adjusted PR = 3.86 95% CI = 1.9-7.6 p < 0.0001), Q4 (adjusted PR = 5.53 95% CI = 2.76-11.1 p < 0.0001), Q5 (adjusted PR = 6.9 95% CI = 3.24-14.7 p = < 0.0001), maternal BMI (adjusted PR = 1.06 95% CI = 1.03-1.08 p < 0.0001), and cesarean delivery (adjusted PR = 1.42 95% CI = 1.01-1.99 p = 0.042). Conclusions: No association was found between maternal depressive symptoms and overweight/obesity among children aged 0-5 years. The upper SES quintiles, maternal BMI, and cesarean delivery were associated with the outcome.