Economic development, urbanization, technological change and overweight: what do we learn from 244 Demographic and Health Surveys?

The hidden cost of sophistication: economic complexity and obesity

Obesity has become a global health crisis, affecting people of all ages, regions, and socio-economic backgrounds. While individual behaviour and genetic factors contribute to obesity, the role of economic complexity in the evolution of obesity rates has not yet been empirically studied. Using a large panel of 110 countries over the period 1976-2015, this article estimates the linear and non-linear links between obesity and economic complexity. According to baseline results, an improvement in economic complexity will lead to an increase in obesity up to a certain threshold. Beyond this turning point, any further increase in economic complexity will significantly contribute to obesity reduction. The issue of simultaneity is tackled using the two-stage instrumental variable method. Our findings support the Obesity Kuznets Curve (OKC) pattern, which suggests that economic progress and obesity have an inverted U-shaped relationship. Our results suggest that greater embeddedness of knowledge in the products produced and exported by a country increases the likelihood of obesity in society, at least up to a threshold. From these results, some important policy implications are discussed.

Updating the association between socioeconomic status and obesity in low-income and lower-middle-income sub-Saharan African countries: A literature review

Globally, the literature tends to emphasize negative associations between socioeconomic status (SES) and bodyweight in countries improving their economic development. However, little is known about the social distribution of obesity in sub-Saharan Africa (SSA) where economic growth has been highly heterogeneous the last decades. This paper reviews an exhaustive set of recent empirical studies examining its association in low-income and lower-middle-income countries in SSA. Although there is evidence of a positive association between SES and obesity in low-income countries, we found mixed associations in lower-middle-income countries, potentially providing evidence of a social reversal of the obesity burden.

Examining obesity kuznets curve in the United States from the perspective of globalization and biocapacity

Given the recent rise in the adult obesity prevalence in the United States, the central and state-level governments and health agencies in the country are considering appropriate measures. Further motivation for this investigation stems from the United Nations Sustainable Development Goals (UNSDG-3, 8, and 13), that highlights the need for sustainable health for all, sustainable decent economic growth amidst environmental sustainability. Driven by this motivation, this study investigates the validity of Obesity Kuznets curve (OKC) in the United States over the experimental period of 1975-2016. In addition, this study illustrates the (mediating) role of globalisation and biocapacity in controlling the prevalence of obesity in the United States. While the study established the validity of obesity Kuznets curve, especially in the short run, it found an inverted U-shaped relationship between globalisation and obesity for the United States. This interprets that a significant reduction in wealth-related health issues is achievable with increased (socioeconomic and political) globalisation policy amidst improved (socioeconomic) welfare of the Americans. Moreover, biocapacity showed a desirable impact on obesity since the short- and long-run relationship with a respective elasticity of 0.02 and 1.86 is negative and statistically significant. In general, this study puts forward policy from the perspective of socioeconomic and political globalisation and domestic welfare measures across the country.

Effects of social determinants of health on obesity among urban women of reproductive age

Obesity is a major global public health problem. It is spreading very fast in low- and middle-income countries and has reached world record levels in some of them. In Ghana, it has increased by over 65% among urban women in the past three decades. This study investigated the effects of social determinants of health on obesity among women in urban Ghana. The study analyzed the Ghana demographic and health survey data. These are nationally representative data collective every five years across low- and middle-income countries. A total of 1,204 urban women were included in the analysis. Body mass index was the outcome variable of interest. We used logistic regression to model the effects of the various social determinants of health on obesity. The results showed that 40% (95% confidence interval (CI) = 25.4, 57.0) and 36.7% (95% CI = 25.6, 49.3) of women who had higher education and those whose partners had higher education suffered from obesity, respectively. Women living in rich households had a five times higher prevalence of obesity than those in poor households (28.8% vs 5.7%). Further, 33.4% (95% CI = 18.5, 19.3) of women who occupied managerial positions were obese. The results from the multivariable logistic regression analysis suggested that compared to women in poor households, those in rich households were 3.4 times (95% CI = 1.31, 8.97) more likely to suffer from obesity. Women whose main occupation was agriculture were 81% (aOR = 0.19; 95% CI = 0.034, 0.99) less likely to suffer from obesity compared to those with no occupation. The results suggest that the various social determinants of health (SDH) included in the analysis significantly influence obesity outcomes. Women and partner education levels, occupying a managerial position, and living in rich households increase the risk of obesity. Interventions to address the rising obesity in urban Ghana should have specific packages targeted at these sub-groups.

Re-examining the reversal hypothesis: A nationwide population-based study of the association between socioeconomic status, and NCDs and risk factors in China

Background

According to the reversal hypothesis, as a country's economic and social development progresses, the burden of NCDs and risk factors shifts from rich to poor. The aim of this research is to examine the reversal hypothesis in the Chinese setting.

Methods

Using data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015, we explored whether the reversal hypothesis applies at the subnational level. Participants aged 45 years and older in 2015 were included. We examined five risk factors (smoking, heavy drinking, physical inactivity, overweight, and obesity) and three objectively measured NCDs (diabetes, hypertension, dyslipidemia). Binary logistic regressions were performed to examine outcomes across people of differing SES in provincial level, in urban and rural areas, and across generations.

Results

Nationally, SES is positively associated with heavy drinking, obesity, diabetes and dyslipidemia, whereas it is negatively associated with physical inactivity. The association between SES and smoking and hypertension was not statistically significant. Except in the cases of diabetes and dyslipidemia, we found that risk factors of all kinds were more concentrated among richer people in rural than in urban areas. Across provinces with increasing GDP per capita, a downward trend in risk factors among those with high SES compared to those with low SES could be interpreted, while the opposite trend could be interpreted with respect to the metabolic syndrome conditions. Obesity and overweight exhibited slight downward trends (in line with those for risk factors) and upward trends (in line with those for metabolic syndrome conditions), respectively.

Conclusion

We conclude that China is at a relatively early stage of 'reversal', visible with respect to risk factors. If these patterns persist over time, the trend will likely feed through to metabolic disorders which will increasingly become diseases of the poor.

How does urbanization affect public health? New evidence from 175 countries worldwide

Urbanization is an essential indicator of contemporary society and a necessary historic stage in the industrialization of all countries. Thus, we explore the impact of urbanization on public health using the OLS estimation and a two-way fixed effect model based on annual panel data from 175 countries from 2000 to 2018. This paper also addresses potential endogeneity issues and identifies causal relationships using the coefficient stability tests, system GMM, and instrumental variable method. The results demonstrate that urbanization positively affects public health. Furthermore, we find that the impact of urbanization on public health can be mediated through living standards, and nations with higher living standards reduce the effect of urbanization on public health. An increase in the urbanization rate can promote public health by improving residents' living standards. Our results have significant real-world implications for the research of urbanization and the formulation of public health policy.

Urban living and chronic diseases in the presence of economic growth: Evidence from a long-term study in southeastern China

High-speed urban development has brought about an increase in per capita income in low- and middle-income countries (LMICs) as well as the high prevalence rate of chronic diseases. Based on a study of chronic diseases from 2011 to 2021 in southeastern China, we used multivariate adjusted logistic regression method to analyze the effect of urban living on the incidence of typical chronic diseases and the trend of such effect with the improvement of public healthcare system. We adopted potential mediating risk factors of urban lifestyles including body mass index (BMI), frequency of dining out, sedentary time, and psychological distress in the adjusted estimation. Baseline results indicate a positive relationship between living in urban areas and the prevalence of type 2 diabetes, hyperlipidemia, and hypertension. Regarding the mediating factors, psychological distress had the highest positive coefficient (Cr) on type 2 diabetes, hyperlipidemia, and hypertension (Cr: 0.4881-0.7084), followed by BMI (Cr: 0.1042-0.1617) and frequency of dining out (Cr: 0.0311-0.0478), and finally, sedentary time (Cr: 0.0103-0.0147). However, regression results on the follow-up survey reveal that trend in the impact of living in urban areas on chronic disease diminished as the level of the healthcare system improved. Additionally, urban living was more positively correlated with the incidence of metabolic disease than with the incidence of cardiovascular disease and cancer. Our findings provide empirical evidence that future urban health planning in LMICs should pay sustained attention to upgrading the level of public health infrastructure covering urban residents as well as rural-to-urban migrants, constructing a long-term dynamic system of chronic disease prevention and control, and regularly monitoring the mental health problems of residents in order to interrupt the process of urban chronic disease prevalence in an early stage.

Brazilian Reference Percentiles for Bioimpedance Phase Angle of Healthy Individuals

Objectives

The present study was designed to estimate phase angle percentile curves for a broad age range of healthy individuals.

Methods

This is a cross-sectional study of healthy Brazilian individuals aged five to 80. InBodyS10 was used to assess phase angle. Reference curves were stratified by sex and estimated using Generalized additive models for location, scale, and shape as a continuous function of age. The phase angle determinants analyzed were physical activity, age, BMI, and SES variables.

Results

Data were analyzed from 2,146 individuals, 1,189 (55.2%) of whom were female. In both sexes, the phase angles showed a similar pattern (an increasing trend from childhood to the teenage phase, followed by stabilization during adult ages and a decrease in old adults). In female, the relationship between phase angle and age were associated with BMI and family income. In the male, the relationship between phase angle and age were associated with skin color and family income.

Conclusions

To the best of our knowledge, it is the first attempt to apply the GAMLSS technique to estimate phase angle percentiles in a healthy population covering most of the life cycle. We also showed that there are different phase angle determinants according to sex.

Nutritional status and adequacy of feeding Practices in Infants and Toddlers 0-23.9 months living in the United Arab Emirates (UAE): findings from the feeding Infants and Toddlers Study (FITS) 2020

BACKGROUND

Infant and young child feeding practices (IYCF) impact the early and later health status of the population. Limited data is available regarding IYCF in the United Arab Emirates (UAE). This study aimed to evaluate the nutritional status and adequacy of feeding practices, energy, food, and nutrient intakes of UAE infants and toddlers ages 0-23.9 months.

METHODS

This study is a population-based cross-sectional survey of 276 infants and toddlers aged 0-23.9 months of which 180 were nationals and 96 were Arab non-nationals living in the UAE. Data were collected from the three major emirates: Abu Dhabi, Dubai, and Sharjah. Anthropometry was collected and assessed using WHO Anthro-Survey Analyzer, and a multicomponent age-specific questionnaire was used to evaluate IYCF and sociodemographic characteristics. Usual intake of energy, micronutrients, and macronutrients, including supplements, were collected using multiple-pass 24-h dietary recall and analyzed using the PC-side software. IYCF practices were assessed using the WHO indicators.

RESULTS

Overall, 4% of children were malnourished, 8% wasted, 15% stunted, 18% at risk of overweight, and 7% overweight and obese. 95% of infants were ever breastfed and 37% exclusively breastfed at 6 months. Around 98% of infants had a timely introduction of complementary food. Macronutrient intake exceeded AMDR for fat, carbohydrates, and protein for 27%, 8% and 2% of toddlers respectively. As for the percentage of those exceeding the ESPGHAN cut-off for free sugars set at 5% of energy intake, 28.6% had excessive intakes overall, 10% in 0-5.9, 21.9% in 6-11.9 and 56.7% in 12-23.9 month. Usual iron intake was below the Estimated Average Requirement (EAR) in 47% of infants 6-11.9 months. Above 12 months, the usual intake of iron and vitamin D were below EAR in 11% and 49% of toddlers respectively. Usual intake exceeded the tolerable upper intake levels (UL) for vitamin A (14 to 18%) and zinc (11 to 22%) across all ages. Approximately 93% of toddlers ages 12-23.9 months did not meet food groups' recommendations for vegetables, 87% for fruits, 48% for milk/dairy, 54% for lean meat and beans, and 33% for grains.

CONCLUSIONS

This study revealed that a high percentage of infants and toddlers aged 0-23.9 m suffer from a double burden of malnutrition, which is the coexistence of both undernutrition, and overweight and obesity in the same population. In addition to suboptimal feeding practices and inadequate/overconsumption of various nutrients. The findings highlight the need for the development of culturally specific programs aiming to improve the nutritional status of infants and toddlers in the UAE.

Built environment as a risk factor for adult overweight and obesity: Evidence from a longitudinal geospatial analysis in Indonesia

Indonesia has nearly doubled its urban population in the past three decades. In this period, the prevalence of overweight and obesity in Indonesia has also nearly doubled. We examined 1993-2014 panel data from the Indonesian Family Life Survey (IFLS) to determine the extent to which the increase in one's built environment contributed to a corresponding increase in adult overweight and obesity during this period. We estimated longitudinal regression models for body mass index (BMI) and being overweight or obese using novel matched geospatial measures of built-up land area. Living in a more built-up area was associated with greater BMI and risk of being overweight or obese. The contribution of the built environment was estimated to be small but statistically significant even after accounting for individuals' initial BMI. We discuss the findings considering the evidence on nutritional and technological transitions affecting food consumption patterns and physical activity levels in urban and rural areas.

Contribution of economic and nutritional context to overweight/obesity dynamics in Indian women from 1998 to 2016: a multilevel analysis of national survey data

BACKGROUND

Overweight/obesity increased dramatically among Indian women since 2000. We evaluated the independent contributions of economic and nutrition context to the changing distribution of overweight/obesity among women from 1998 to 2016 across India.

METHODS

Individual-level data from 473 912 ever married Indian women aged 18-49 in the National Family Health Surveys (1998-1999, 2005-2006, 2015-2016) were merged with year-matched state-level economic and nutrition context indicators. Cross-classified generalised linear mixed models were estimated to quantify associations of contextual characteristics with overweight/obesity (body mass index ≥25 kg/m²) across survey rounds.

RESULTS

Between 1998 and 2016, age-standardised prevalence of overweight/obesity increased from 13.9% to 27.5% nationally at an annual growth rate of 0.8%. After accounting for a woman's age, parity and social class, the adjusted OR (aOR) for overweight/obesity was 2.02 times higher for every unit of state log per capita gross domestic product (GDP) (95% credible interval (CrI) 2.00 to 2.03). Yet, the association of state GDP with overweight/obesity generally decreased over survey round. Women in states with higher per capita daily oil (aOR 1.02 per gram; 95% CrI 1.01 to 1.03) and sugar (aOR 1.05 per gram; 95% CrI 1.04 to 1.05) consumption were more likely to be overweight/obese, while women in states with higher cereal consumption were less likely to be overweight/obese (aOR 0.93 per 10 gram; 95% CrI 0.93 to 0.93).

CONCLUSIONS

Indicators of state economic development and nutrition transition were independently associated with a woman's likelihood of being overweight/obese. The impact of state wealth waned over survey round, suggesting that risks for overweight/obesity may be increasingly shaped by individual factors as economic development expands in India.

Transitioning to an obese India: Demographic and structural determinants of the rapid rise in overweight incidence

India, which has long suffered from undernutrition, has seen a rapid rise in overweight incidence in the last decade and a half. These changes are characterized by significant within-country differences in overweight incidence that vary by gender and regional development levels. In this paper, we provide an integrative framework, linking the income-gradient hypothesis of obesity with biological, obesogenic, and environmental factors to provide an explanation on the emergence of within-country differences in overweight patterns. We utilize measured body mass index (BMI), along with individual- and household-level data of over 800,000 men and women surveyed in the National Family Health Surveys of 2005-06 and 2015-16 to identify correlates of within-country differences in overweight incidence. A decomposition analysis reveals that among women, in addition to increasing access to obesogenic technologies, biological factors are associated with overweight incidence. Among men, obesogenic factors related to technology use and health behaviors are associated with the rise in overweight incidence, but biological factors are not. At lower levels of regional development, overweight incidence is associated with greater access to obesogenic technology such as motorized transport, which reduces physical activity among men at higher rates than women. At higher levels of economic development, obesogenic behaviors, such as watching more television and reducing smoking, are associated with overweight incidence. Our results corroborate the call by public health experts for group-specific policies to stem the rise of overweight incidence in developing countries.

Social inequalities in obesity and overweight: secular changes in Poland between 1983 and 2020

BACKGROUND

Human development is strongly influenced by environmental factors, including the socioeconomic status (SES) of the family. The aim of this study is to analyze the prevalence of excess body weight among Polish children and adolescents from families of varying SES examined in 1983 and 2020.

METHODS

The study group included 3-15-year olds from two cross-sectional surveys (1983 and 2020) conducted in kindergartens and schools. The 1983 cohort consisted of 3394 individuals and the one from 2020-of 1253 children and adolescents. Body height and weight were measured and body mass index was calculated. Inclusion into underweight, normal weight and overweight/obese categories was based on Cole's cutoff points. SES was established based on the place of the parents' birth, parents', education status and the number of children in the family, which were self-reported in a questionary by the parents of the examined individuals.

RESULTS

The mean overall SES was higher in the 2020 cohort, in comparison to the one examined in 1983. This change was also reflected by the changing prevalence of excess body weight, which, in 1983 was the greatest in the high socioeconomic category. On the other hand, in 2020 overweight/obesity was the most prevalent among individuals from families of low SES.

CONCLUSIONS

The present results confirm the findings obtained in other countries, which suggest that changing the level of socioeconomic development modifies the changes regarding the prevalence of excess body weight. It is an important observation because a study of this type has not yet been conducted in the Polish population.

Perceptions and behaviors related to noncommunicable diseases in Palau: a qualitative study

The increasing burden of noncommunicable diseases (NCDs) is a major public health concern in Palau. This study aims to identify social and psychological factors related to NCDs among Palauan people using a qualitative approach. We conducted eight key informant interviews and eight focus group discussions, which were audio-recorded, transcribed and translated into English. Ideas of the respondents were extracted and labeled, and the labels were analyzed using an inductive multistage approach referred to as qualitative content analysis. Three themes emerged: (1) home education, (2) traditional local community, and (3) modernization and westernization of lifestyle. Respondents believed that the influence of the family on lifestyle was significant, but that disciplining children at home had become difficult. They considered that the traditional lifestyle was mostly healthy, and were reluctant to abandon certain unhealthy customs, such as serving abundant food to guests as a sign of fraternity. They also thought that they overate because of their stressful modernized lifestyle. This is the first qualitative study to analyze perception and behavior of the Palauan people in relation to NCDs. We found that the increase in NCDs was related to two concurrent trends: preserving certain traditional customs unfavorable to good health, and abandoning time-consuming healthy traditional lifestyle to adopt a modernized one. We also found that Palauan people were not confident in their ability to prevent NCDs. Therefore, health promotion activities should be designed to empower people to make positive changes.

Are we speaking the same language? Call for action to improve theory application and reporting in behaviour change research

Inconsistencies are evident in definitions and interpretations of theory, application of theory, and reporting of theory use within the behaviour change field impeding cumulative knowledge advancement. Standardised frameworks and methods are needed to support the definition, application, and reporting of theory, and to assist researchers in understanding how theory should be applied to build cumulative knowledge over time. Progress is being made with the development of ontologies, taxonomies, methods for mapping interventions, and coding schemes; however, consolidation is needed to improve levels and quality of theory use, and to facilitate the translation of theory-driven research in practice. This paper discusses the importance of rigorous theory application and reporting in health-related behaviour change research and outlines the need for a standardised framework that supports both researchers and practitioners in designing, implementing, and evaluating theory-driven interventions in a concrete and consistent manner. To this end, several recommendations are provided to facilitate the development of a standardised framework that supports theory application and reporting in the behaviour change field. Concrete and consistent theory application and reporting will permit critical appraisal within and across studies, thereby advancing cumulative knowledge of behaviour change over time.

Is night-time light intensity associated with cardiovascular disease risk factors among adults in early-stage urbanisation in South India? A cross-sectional study of the Andhra Pradesh Children and Parents Study

OBJECTIVES

To explore associations of night-time light intensity (NTLI), a novel proxy for continuous urbanisation levels, with mean systolic blood pressure (SBP), body mass index (BMI), fasting serum low-density lipoprotein (LDL) and fasting plasma glucose (FPG), among adults in early-stage urbanisation in Telangana, South India.

DESIGN

Cross-sectional analysis of the third wave of the Andhra Pradesh Children and Parents Study cohort.

SETTING

28 villages representing a continuum of urbanisation levels, ranging from rural settlement to medium-sized town in Telangana, South India.

PARTICIPANTS

Data were available from 6944 participants, 6236 of whom were eligible after excluding pregnant women, participants younger than 18 years of age and participants missing data for age. Participants were excluded if they did not provide fasting blood samples, had implausible or missing outcome values, were medicated for hypertension or diabetes or had triglyceride levels invalidating derived LDL. The analysis included 5924 participants for BMI, 5752 participants for SBP, 5287 participants for LDL and 5328 participants for FPG.

RESULTS

Increasing NTLI was positively associated with mean BMI, SBP and LDL but not FPG. Adjusted mean differences across the range of village-level NTLI were 1.0 kg/m2 (95% CI 0.01 to 1.9) for BMI; 4.2 mm Hg (95% CI 1.0 to 7.4) for SBP; 0.3 mmol/L (95% CI -0.01 to 0.7) for LDL; and -0.01 mmol/L (95% CI -0.4 to 0.4) for FPG. Associations of NTLI with BMI and SBP were stronger in older age groups.

CONCLUSION

The association of NTLI with cardiovascular disease (CVD) risk factors identify NTLI as a potentially important tool for exploring urbanisation-related health. Consistent associations of moderate increases in urbanisation levels with important CVD risk factors warrant prevention strategies to curb expected large public health impacts from continued and rapid urbanisation in India.

Double Burden of Malnutrition among Chinese Women of Reproductive Age and Their Social Determinants

This study aimed to examine the impact of a wide range of demographic, socioeconomic, and community factors on the double burden of malnutrition among women of reproductive age using longitudinal data. We used data about 11,348 women of reproductive age who participated in the China Health and Nutrition Survey (CHNS), a longitudinal survey, between 1989 and 2015. Nutritional outcomes were categorized into four groups, namely underweight, normal weight, overweight, and obesity, with normal weight as reference. A multinomial logit model was fitted due to geographic clustering and repeated observations of individuals. The prevalence of underweight decreased over time from 1991 but has tended to rise again since 2004, while the prevalence of overweight/obesity continued to rise between 1991 and 2015. Improved individual factors, socioeconomic status, and community urbanization reduced the risk of underweight but elevated the risk of overweight and obesity. The medium levels, rather than the highest levels, of household income and community urbanization are associated with a higher risk of overweight and obesity. The notable increase in underweight prevalence is a cause for concern to be addressed along with efforts to curb the rising tide of overweight. In order to enhance the nutritional status of women of reproductive age, it is essential to improving the community environment, levels of education, and living environment from a wider context. Long-term and targeted plans are urgently needed for nutrition improvements among the different populations.

Does greater unemployment make people thinner in Brazil?

The study seeks to analyze the impact of macroeconomic conditions on weight measures, such as BMI, overweight, obesity, and severe obesity in Brazil. We examine this relationship in the specific context of a middle-income country that differs in many aspects from the high-income countries usually considered in the literature. The study uses the microdata of VIGITEL in the period from 2006 to 2014 and the state unemployment rate as a proxy for macroeconomic conditions. The results showed that the relationship is robust and presents a procyclical pattern-increases in the unemployment rate reduce BMI, and this reduction is observed throughout the entire distribution, with statistically significant effects for measures of overweight, obesity, and severe obesity. These results agree with the findings for the United States but contradict the results found for Finland and Canada.

Factors associated with underweight, overweight, and obesity in reproductive age Tanzanian women

BACKGROUND

Underweight, overweight, and obesity are major public health challenges among reproductive-age women of lower- and middle-income countries (including Tanzania). In those settings, obesogenic factors (attributes that promote excessive body weight gain) are increasing in the context of an existing high burden of undernutrition. The present study investigated factors associated with underweight, overweight, and obesity among reproductive age women in Tanzania.

METHODS

This study used 2015-16 Tanzania Demographic and Health Survey data (n = 11735). To account for the hierarchical nature of the data (i.e., reproductive age women nested within clusters), multilevel multinomial logistic regression models were used to investigate the association between individual-level (socioeconomic, demographic and behavioural) and community-level factors with underweight, overweight, and obesity.

RESULTS

Reproductive age women who were informally employed (relative risk ratio [RRR] = 0.79; 95% confidence interval [CI]: 0.64, 0.96), those who were currently married (RRR = 0.59; 95% CI: 0.43, 0.82) and those who used contraceptives (RRR = 0.70; 95% CI: 0.54, 0.90) were less likely to be underweight. Reproductive age women who attained secondary or higher education (RRR = 1.48; 95% CI: 1.11, 1.96), those who resided in wealthier households (RRR = 2.31; 95% CI: 1.78, 3.03) and those who watched the television (RRR = 1.26; 95% CI: 1.06, 1.50) were more likely to be overweight. The risk of experiencing obesity was higher among reproductive age women who attained secondary or higher education (RRR = 1.79; 95% CI: 1.23, 2.61), those who were formally employed (RRR = 1.50; 95% CI: 1.14, 1.98), those who resided in wealthier households (RRR = 4.77; 95% CI: 3.03, 7.50), those who used alcohol (RRR = 1.43; 95% CI: 1.12, 1.82) and/or watched the television (RRR = 1.70; 95% CI: 1.35, 2.13).

CONCLUSION

Our study suggests that relevant government jurisdictions need to identify, promote, and implement evidence-based interventions that can simultaneously address underweight and overweight/obesity among reproductive age women in Tanzania.

Trends and determinants of underweight and overweight/obesity among urban Ethiopian women from 2000 to 2016

BACKGROUND

Nutritional, epidemiological and demographic transitions have been associated with the emergence of the double burden of malnutrition globally. In Ethiopia, there has been no nationally representative investigation of trends and determinants of both underweight and overweight/obesity among urban women. This study examined the trends and determinants of underweight and overweight/obesity in urban Ethiopian women from 2000 to 2016.

METHODS

Trends in the prevalence of underweight and overweight/obesity were investigated based on a series of the Ethiopia Demographic and Health Survey (EDHS) data for the years 2000 (n = 2559), 2005 (n = 1112), 2011 (n = 3569), and 2016 (n = 3106). Multivariable multinomial logistic regression was used to investigate the association between socioeconomic, demographic, behavioural, and community-level factors with underweight and overweight/obesity.

RESULTS

The prevalence of underweight in urban Ethiopian women reduced significantly from 23.2% (95% confidence interval [CI]: 20.3, 26.3%) in 2000 to 14.8% (95% CI: 13.1, 16.7%) in 2016, while overweight/obesity increased significantly from 10.9% (95% CI: 9.1, 13.0%) in 2000 to 21.4% (95% CI: 18.2, 25.1%) in 2016. Urban women from rich households and those who had never married were less likely to be underweight. Urban women who were from wealthy households and those who attained at least secondary education were more likely to be overweight/obese. Women who were informally employed and listened to the radio were less likely to be overweight/obese compared to those who were unemployed and did not listen to the radio, respectively.

CONCLUSION

The prevalence of overweight/obesity increased from 2000 to 2016, with a concurrent reduction in the prevalence of underweight. Interventions aiming to reduce overweight and obesity should target urban women with higher education, those who resided in wealthier households and those who watched the television.

Education and prevalence of overweight and obesity among reproductive age group women in Ethiopia: analysis of the 2016 Ethiopian demographic and health survey data

Background

Globally, the prevalence of overweight and obesity is escalating, particularly among women and wealthier people. In many developed countries, overweight and obesity are more prevalent in persons with lower socioeconomic status. In contrast, studies in developing countries have reported a higher prevalence rate of overweight and obesity among women with higher educational status. Hence, this study aimed to assess the association between education and the prevalence of overweight and obesity among reproductive age group women in Ethiopia.

Methods

This cross-sectional study was done based on the 2016 Ethiopian demographic and health survey (EDHS) data. From the total 15,683 women participants of the 2016 EDHS, 2848 reproductive age group women aged 15–49 years old who had a complete response to all variables of interest were selected and retained for analysis. Data were analyzed using SPSS version 20 software program. Both descriptive and logistic regression models were used for analysis.

Results

The prevalence of overweight and obesity among the study participants was 11.5 and 3.4% respectively. The combined prevalence of overweight and obesity was 14.9%. From the total participants who are overweight and, or obese, majority, 83.3% were urban dwellers and the remaining 16.7% were rural dwellers. Education was positively associated with overweight and obesity among women. Besides, increased age, region, living in urban areas, being in rich quintile, increased frequency of watching television, and frequency of using internet were significantly associated with the odds of being overweight and obese among reproductive age group women in Ethiopia.

Conclusions

The prevalence of overweight and obesity among reproductive age group women in Ethiopia is increasing compared to previous studies. Education was found to be a risk factor for overweight and obesity among women. Hence, context based interventions on the prevention and control methods of overweight and obesity are required.

How does socioeconomic development in Brazil shape social inequalities in diabetes?

Many countries, including Brazil, are facing growing social inequalities in diabetes prevalence. The different states in Brazil represent different levels of development and by comparing diabetes inequalities across states we aim to get a better understanding of how educational inequalities in diabetes are linked to social development. We use the latest cross-sectional national health survey of Brazil - PNS-2013 (N = 60,202) and analyse the disparities in diabetes as well as the differential exposure and susceptibility to the effect of obesity across states for men and women. Among women in high-HDI states the prevalence of diabetes is 11.7 percentage units (CI: 9.3; 14.0) higher among the lowest compared to the highest educated. In less-developed states the disparity is smaller. Among men, there is no social gradient found for diabetes, but obesity is positively associated with education. The association between obesity and diabetes is stronger among the low educated particularly for men in high-HDI states. Here the interaction effect between low education and obesity is 11.7 (CI 8.1; 15.4) percentage units. The fact that economic development is associated with increasingly unequal levels of diabetes and with unequal levels of exposure and susceptibility to obesity indicates that other interacting determinants are important for the development of the diabetes epidemic in Brazil.

Dietary patterns and their associations with gestational weight gain in the United Arab Emirates: results from the MISC cohort

Background

Suboptimum weight gain during pregnancy may carry long term health consequences for the infant or mother. Nutritional imbalances are well recognized as a determinant of gestational weight gain. Few studies examined the effect of dietary patterns on gestational weight gain, especially in countries undergoing nutrition transition, such as the United Arab Emirates.

Objectives

To characterize dietary patterns among pregnant women living in the UAE and examine their associations with gestational weight gain and gestational weight rate.

Methodology

Data were drawn from the Mother-Infant Study Cohort, a two-year prospective cohort study of pregnant women living in the United Arab Emirates, recruited during their third trimester (n = 242). Weight gain during pregnancy was calculated using data from medical records. The Institute of Medicine’s recommendations were used to categorize gestational weight gain and gestational weight gain rate into insufficient, adequate, and excessive. During face-to-face interviews, dietary intake was assessed using an 89-item culture-specific semi-quantitative food frequency questionnaire that referred to usual intake during pregnancy. Dietary patterns were derived by principal component analysis. Multiple logistic regression analyses were used to evaluate the associations of derived dietary patterns with gestational weight gain/gestational weight gain rate.

Results

Two dietary patterns were derived, a “Diverse” and a “Western” pattern. The “Diverse” pattern was characterized by higher intake of fruits, vegetables, mixed dishes while the “Western” pattern consisted of sweets and fast food. The “Western” pattern was associated with excessive gestational weight gain (OR:4.04,95% CI:1.07–15.24) and gestational weight gain rate (OR: 4.38, 95% CI:1.28–15.03) while the “Diverse” pattern decreased the risk of inadequate gestational weight gain (OR:0.24, 95% CI:0.06–0.97) and gestational weight gain rate (OR:0.28, 95% CI:0.09–0.90).

Conclusion

The findings of this study showed that adherence to a “Diverse” pattern reduced the risk of insufficient gestational weight gain/gestational weight gain rate, while higher consumption of the “Western” pattern increased the risk of excessive gestational weight gain/gestational weight gain rate. In view of the established consequences of gestational weight gain on the health of the mother and child, there is a critical need for health policies and interventions to promote a healthy lifestyle eating through a life course approach.

Body mass index of women in Bangladesh: comparing Multiple Linear Regression and Quantile Regression

This study explored the association between socio-demographic factors and the body mass index (BMI) of women of reproductive age (15–49 years) in Bangladesh. Data from the 2014 Bangladesh Demographic and Health Survey (BDHS-14) were analysed using Multiple Linear Regression (MLR) and Quantile Regression (QR) analyses. The study sample comprised 15,636 non-pregnant women aged 15–49. The mean BMI of the women was 22.35±4.12 kg/m2. Over half (56.75%) had a BMI in the normal range (18<BMI<25 kg/m2), and 18.50%, 20.00% and 4.75% were underweight (BMI≤18 kg/m2), overweight (25≤BMI<30 kg/m2) and obese (BMI≥30 kg/m2), respectively. The results of the MLR found that age, wealth index, urban/rural place of residence, geographical division, womenʼs educational status, husbandʼs educational status, womenʼs working status and total number of children ever born were significantly (p<0.001) associated with respondents’ mean BMI. The QR results showed different associations between socio-demographic factors and mean BMI, as well as a different conditional distribution of mean BMI. Overall, the results indicated that women with uneducated husbands, with little or no education and from less-affluent households from rural areas tended to be more underweight compared with women in other groups. The inter-relationship between the study womenʼs mean BMI and associated socio-demographic factors was assessed using QR analysis to identify the most vulnerable cohorts of women in Bangladesh.

Economic Growth and Weight of Children and Adolescents in Urban Areas: A Panel Data Analysis on Twenty-Seven Provinces in China, 1985-2014

Background: With the rapid economy development of China, the overweight and obesity rates of school-age children and adolescents in China have been on the rise. The purpose of this study is to explore how powerful an influence economic growth has on the weight of children and adolescents and examine the relationship between China's macroeconomic development and weight of children and adolescents in the past 30 years using provincial panel data collected from more than 1 million children and adolescents. Methods: Panel data from seven longitudinal surveys (1985, 1991, 1995, 2000, 2005, 2010, and 2014) of the Chinese National Surveys on Students' Constitution and Health, which include students, ages 7-22 years, from 27 provinces, were analyzed. Fixed-effects models were used to estimate the associations. Results: (1) For every 1% increase in per capita disposable income, the average weight of male and female students increased by ∼0.035% (p < 0.01) and 0.039% (p < 0.01), respectively. (2) Linear relationships were found between economic growth and weight of both boys and girls during the 30 years of the survey. The positive effect of the Chinese economy on weight of children and adolescents has been gradually increasing persistently. Conclusion: Linear relationships exist between economic growth and weight status of children and adolescents. The significant positive effect of the Chinese economy on weight of children and adolescents has been gradually and persistently increasing.

The effect of economic growth on obesity for the most obese countries: new evidence from the obesity Kuznets curve

In this study, the relationship between obesity and economic growth has been examined within the framework of the obesity Kuznets curve (OKC) for the top 20 obese countries from 1991 to 2016 using bounds test based on ARDL. Multiple models were used in the study, including unemployment variable instead of single model. The bounds test results show that there is a cointegration between the variables in all countries except Bahamas, Fiji, Mexico, New Zealand, Tunisia, and UK. The long-run coefficients show that OKC hypothesis is valid for Oman, Saudi Arabia, Turkey and the United Arab Emirates. The main finding of this study is that countries should improve the welfare of individuals to encourage healthy lifestyles and reduce obesity risks.

The overweight and obesity transition from the wealthy to the poor in low- and middle-income countries: A survey of household data from 103 countries

BACKGROUND

In high-income countries, obesity prevalence (body mass index greater than or equal to 30 kg/m2) is highest among the poor, while overweight (body mass index greater than or equal to 25 kg/m2) is prevalent across all wealth groups. In contrast, in low-income countries, the prevalence of overweight and obesity is higher among wealthier individuals than among poorer individuals. We characterize the transition of overweight and obesity from wealthier to poorer populations as countries develop, and project the burden of overweight and obesity among the poor for 103 countries.

METHODS AND FINDINGS

Our sample used 182 Demographic and Health Surveys and World Health Surveys (n = 2.24 million respondents) from 1995 to 2016. We created a standard wealth index using household assets common among all surveys and linked national wealth by country and year identifiers. We then estimated the changing probability of overweight and obesity across every wealth decile as countries' per capita gross domestic product (GDP) rises using logistic and linear fixed-effect regression models. We found that obesity rates among the wealthiest decile were relatively stable with increasing national wealth, and the changing gradient was largely due to increasing obesity prevalence among poorer populations (3.5% [95% uncertainty interval: 0.0%-8.3%] to 14.3% [9.7%-19.0%]). Overweight prevalence among the richest (45.0% [35.6%-54.4%]) and the poorest (45.5% [35.9%-55.0%]) were roughly equal in high-income settings. At $8,000 GDP per capita, the adjusted probability of being obese was no longer highest in the richest decile, and the same was true of overweight at $10,000. Above $25,000, individuals in the richest decile were less likely than those in the poorest decile to be obese, and the same was true of overweight at $50,000. We then projected overweight and obesity rates by wealth decile to 2040 for all countries to quantify the expected rise in prevalence in the relatively poor. Our projections indicated that, if past trends continued, the number of people who are poor and overweight will increase in our study countries by a median 84.4% (range 3.54%-383.4%), most prominently in low-income countries. The main limitations of this study included the inclusion of cross-sectional, self-reported data, possible reverse causality of overweight and obesity on wealth, and the lack of physical activity and food price data.

CONCLUSIONS

Our findings indicate that as countries develop economically, overweight prevalence increased substantially among the poorest and stayed mostly unchanged among the wealthiest. The relative poor in upper- and lower-middle income countries may have the greatest burden, indicating important planning and targeting needs for national health programs.

Double burden of underweight and overweight among women of reproductive age in Bangladesh

OBJECTIVE

Bangladesh, like many emerging economies of South-East Asia, has started to experience a double burden of continuing high rates of undernutrition and increasing rates of overweight and obesity. A lack of assessment of the nutritional shift leaves a gap in current policies: the growing overweight and obesity is yet to be addressed. The present paper investigates the change in nutritional status, particularly the shift in BMI, of Bangladeshi women of reproductive age (15-49 years) and characterizes the vulnerable households for both underweight and overweight status during a period of 10 years (2004-2014).

DESIGN

Generalized linear mixed-effect models were fitted for both urban and rural residents to assess underweight and overweight status.

SETTING

Bangladesh Demographic and Health Surveys.

PARTICIPANTS

Women aged 15-49 years (n 53 077).

RESULTS

The proportion of overweight increased during 2004-2014 from 10·7 to 25·1 % and the proportion of underweight decreased from 32·6 to 18·2 %. Prevalence of underweight status remained high in rural areas and prevalence of overweight increased rapidly in both rural and urban areas, creating a double burden. The significant contributors to this double burden were the change in women's level of education, increased household wealth, divisional location and rapid urbanization.

CONCLUSIONS

The findings indicate that specific cohort- or area-based intervention policy studies in line with the UN Decade of Action on Nutrition are required to address the nutritional double burden in Bangladesh.

Seasonality of physical activity and its association with socioeconomic and health factors among urban-dwelling adults of Kaunas, Lithuania

BACKGROUND

Physical activity (PA) has been declining dramatically over time in many countries worldwide. The decrease of PA levels affects a person's health and quality of life as it is a significant risk factor for many noncommunicable diseases. Understanding the factors that determine PA is particularly important in promoting greater PA in adults and reducing the risk of diseases associated with physical inactivity. This study investigated associations of seasonal PA levels with socioeconomic and health factors among adults.

METHODS

A cross-sectional study included 1111 participants of Kaunas city, Lithuania who completed a questionnaire about PA and mobility behaviour, socioeconomic, health and demographic factors. Commuting PA and sufficient PA (sPA) on weekdays and weekends in the summer and winter seasons was investigated in this study. Data on daily commuting duration and forms of transportation were collected using a questionnaire survey. Daily commuting was categorized into two categories: 1) using motorized transportation or walking or cycling 0 to 29 min, 2) and walking or cycling for 30 min or more.

RESULTS

Our findings showed significant seasonal impact on PA levels. The results revealed that employment status was significantly associated with PA. Unemployed individuals were 2 times more likely to engage in sPA in winter and almost 3 times in summer compared to workers.

CONCLUSIONS

Our findings suggest the importance of considering environmental, socioeconomic and health factors when assessing PA. Promoting PA through active commuting is an important part of a healthy lifestyle and strategies to support the implementation of health-promoting policies and practices are needed.

Stratification of BMI categories among older adults within and across countries

OBJECTIVE

Within- and across-country nutritional disparities were examined among older adults in six different countries at varying levels of development.

DESIGN

Cross-sectional study.

PARTICIPANTS

Older adults (aged 50 years or over) in China, Ghana, India, Mexico, Russia and South Africa using the Study on global AGEing and adult health (SAGE).

RESULTS

While the distribution of BMI categories varied by country, development-related characteristics were generally related to BMI category in a similar way: urban-living, educated and wealthier individuals were typically more likely to be in a higher BMI category. However, there were some exceptions that corroborate findings in more developed countries. Indeed, a pooled partial proportional odds model which included gross domestic product per capita interactions made the case for intertwining processes of development and the nutrition transition.

CONCLUSIONS

Population segments to be targeted by nutrition policy and programme implementation might need to change over the course of development.

Predicting nationwide obesity from food sales using machine learning

The obesity epidemic progresses everywhere across the globe, and implementing frequent nationwide surveys to measure the percentage of obese population is costly. Conversely, country-level food sales information can be accessed inexpensively through different suppliers on a regular basis. This study applies a methodology to predict obesity prevalence at the country-level based on national sales of a small subset of food and beverage categories. Three machine learning algorithms for nonlinear regression were implemented using purchase and obesity prevalence data from 79 countries: support vector machines, random forests and extreme gradient boosting. The proposed method was validated in terms of both the absolute prediction error and the proportion of countries for which the obesity prevalence was predicted satisfactorily. We found that the most-relevant food category to predict obesity is baked goods and flours, followed by cheese and carbonated drinks.

Inequality in body mass indices across countries: Evidence from convergence tests

This study examines the long-term inequality in body mass index (BMI) based on convergence tests applied to a database of 172 countries recently published by the NCD Risk Factor Collaboration. First, we find that countries converge in clubs, which indicates that country disparities in BMIs will persist over time. Second, there are three and six convergence clubs in BMIs for female and male individuals, respectively. That is, we would not observe a single convergence pattern in body weights as the nutrition transition theory and the dietary convergence hypothesis seem to suggest. Females have only one healthy club (18.5 ≤ BMI < 25) and two overweight clubs (BMI ≥ 25). Males have three healthy clubs and three overweight clubs. Third, the analysis of club convergence indicates that BMI inequality has increased due to the BMI growth observed in club 1 (the one with the highest average BMI and led by the US) in each gender group. Finally, potential determinants of BMI such as globalization, human capital, income, and urbanization are relevant to understand differences across clubs. We interpret the club convergence as the result of a heterogeneous integration of countries into the global economy, which is probably related to strong domestic preferences, policies designed to manage the impacts of globalization, and shifts in productive structures.

What is driving global obesity trends? Globalization or "modernization"?

BACKGROUND

Worldwide obesity has more than doubled since 1980. Researchers have attributed rising obesity rates to factors related to globalization processes, which are believed to contribute to obesity by flooding low-income country markets with inexpensive but obesogenic foods and diffusing Western-style fast food outlets (dependency/world systems theory). However, alternative explanations include domestic factors such as increases in unhealthy food consumption in response to rising income and higher women's labor force participation as countries develop economically ("modernization" theory). To what extent are processes of globalization driving rising global overweight/obesity rates versus domestic economic and social development processes? This study evaluates the influence of economic globalization versus economic development and associated processes on global weight gain.

RESULTS

Using two-way fixed-effects OLS regression with a panel dataset of mean body weight for 190-countries over a 30-year period (1980-2008), we find that domestic factors associated with "modernization" including increasing GDP per capita, urbanization and women's empowerment were associated with increases in mean BMI over time. There was also evidence of a curvilinear relationship between GDP per capita and BMI: among low income countries, economic growth predicted increases in BMI whereas among high-income countries, higher GDP predicted lower BMI. By contrast, economic globalization (dependency/world systems theory) did not significantly predict increases in mean BMI and cultural globalization had mixed effects. These results were robust to different model specifications, imputation approaches and variable transformations.

DISCUSSION

Global increases in overweight/obesity appear to be driven more by domestic processes including economic development, urbanization and women's empowerment, and are less clearly negatively impacted by external globalization processes suggesting that the harms to health from global trade regimes may be overstated.

Sugar-sweetened beverage affordability and the prevalence of overweight and obesity in a cross section of countries

Background

A key component of ‘obesogenic environments’ is the ready availability of convenient, calorie-dense foods, in the form of hyper-palatable and relatively inexpensive ultra-processed products. Compelling evidence indicates that the regular consumption of soft drinks, specifically carbonated and non-carbonated sugar-sweetened beverages (SSBs), has a significant impact on the prevalence of overweight and obesity. However, to implement country-level effective prevention programmes we need to supplement this evidence with quantitative knowledge of the relationships between overweight/obesity and the main determinants of SSB consumption, notably SSB prices and consumers’ disposable income.

Method

Affordability considers the simultaneous effects of both price and disposable income on the buying decision. The purpose of this study was to investigate the effect of SSB affordability on the consumers’ purchasing behaviour and weight-related health outcomes. Our study was divided into three parts. First, we computed SSB consumption and affordability for approximately 150 countries worldwide. Second, we estimated a demand function for SSBs to assess the impact of affordability on consumption at the country level. Third, we used a multivariate regression model and country data on the prevalence of overweight and obesity to test the role of SSB affordability in the current obesity epidemic.

Results

The analysis reveals that SSB affordability: 1) showed both a large variability across countries and a clear tendency to increase substantially with the level of economic development; 2) played a key role in determining cross-country differences in the amount of soft drink consumed per capita; and 3) was significantly associated with the prevalence rates of both overweight and obesity. Specifically, we show that a 10 % increase in SSB affordability was associated, on average, with approximately 0.4 more overweight/obese adults per 100 inhabitants.

Conclusions

By controlling for the main possible confounding factors, our results clearly indicate that affordability is a major driver of purchasing behaviours and is significantly associated with the prevalence rates of both overweight and obesity. We thus suggest a fiscal approach to curb SSB consumption based on the effectiveness of ‘soda taxes’ to affect the long-term dynamic of SSB affordability.

Electronic supplementary material

The online version of this article (10.1186/s12992-019-0474-x) contains supplementary material, which is available to authorized users.

Adult body weight trends in 27 urban populations of Brazil from 2006 to 2016: A population-based study

OBJECTIVE

We aimed to estimate trends in population-level adult body weight indicators in the 26 state capitals and the Federal District of Brazil.

METHODS

Self-reported weight and height data of 572,437 adults were used to estimate the mean body mass index (BMI), and the prevalence of BMI categories ranging from underweight to morbid obesity, in Brazil's state capitals and Federal District, from 2006 to 2016, by sex. All estimates were standardized by age.

RESULTS

From 2006 to 2016, the main findings showed that: (i) the overall mean BMI increased from 25.4 kg/m2 to 26.3 kg/m2 in men, and from 24.5 kg/m2 to 25.8 kg/m2 in women; (ii) the overall prevalence of overweight increased from 48.1% to 57.5% in men, and from 37.8% to 48.2% in women; (iii) the overall prevalence of obesity increased from 11.7% to 18.1% in men, and from 12.1% to 18.8% in women; (iv) in general, the largest increases in overweight and obesity prevalence were found in state capitals located in the north, northeast, and central-west regions of Brazil; (v) the prevalence of severe obesity surpassed the prevalence of underweight in 22 and 9 state capitals among men and women, respectively; and (vi) the mean BMI trend was stable only in Vitória state capital in men.

CONCLUSIONS

The policies for preventing and treating obesity in Brazil over the past years were not able to halt the increase in obesity prevalence either in the state capitals or the Federal District. Thus, a revision of policies is warranted. Furthermore, although policies are necessary in all state capitals, our results suggest that policies are especially necessary in the north, northeast, and central-west regions' state capitals, where, in general, the largest increases in overweight and obesity prevalence were experienced.

The obesity transition: stages of the global epidemic

The global prevalence of obesity has increased substantially over the past 40 years, from less than 1% in 1975, to 6-8% in 2016, among girls and boys, and from 3% to 11% among men and from 6% to 15% among women over the same time period. Our aim was to consolidate the evidence on the epidemiology of obesity into a conceptual model of the so-called obesity transition. We used illustrative examples from the 30 most populous countries, representing 77·5% of the world's population to propose a four stage model. Stage 1 of the obesity transition is characterised by a higher prevalence of obesity in women than in men, in those with higher socioeconomic status than in those with lower socioeconomic status, and in adults than in children. Many countries in south Asia and sub-Saharan Africa are presently in this stage. In countries in stage 2 of the transition, there has been a large increase in the prevalence among adults, a smaller increase among children, and a narrowing of the gap between sexes and in socioeconomic differences among women. Many Latin American and Middle Eastern countries are presently at this stage. High-income east Asian countries are also at this stage, albeit with a much lower prevalence of obesity. In stage 3 of the transition, the prevalence of obesity among those with lower socioeconomic status surpasses that of those with higher socioeconomic status, and plateaus in prevalence can be observed in women with high socioeconomic status and in children. Most European countries are presently at this stage. There are too few signs of countries entering into the proposed fourth stage of the transition, during which obesity prevalence declines, to establish demographic patterns. This conceptual model is intended to provide guidance to researchers and policy makers in identifying the current stage of the obesity transition in a population, anticipating subpopulations that will develop obesity in the future, and enacting proactive measures to attenuate the transition, taking into consideration local contextual factors.

Obesity Kuznets curve: international evidence

OBJECTIVES

The obesity epidemic has prevailed worldwide and is currently recognized as a global pandemic disease. Given the argument that various socio-economic features contribute to substantial differences in obesity rates across countries, economic development can also be considered a crucial factor of such variation. This study examines the relationship between economic development and each of three weight-related health statuses (rates of overweight, obesity, and morbid obesity).

STUDY DESIGN

This study uses panel data analysis.

METHODS

Using country-level panel data of 130 countries during the period from 1975 to 2010, we apply dynamic panel data analysis to mitigate possible endogeneity problems.

RESULTS

The main results show a clear pattern of the obesity Kuznets curve, i.e. a non-linear relationship between a country's income per capita and its weight-related health status, for both males and females. For low-income countries, as incomes increase, the weight-related health status deteriorates; thus, an increase in incomes raises the health risk. In contrast, for high-income countries, as incomes increase, the weight-related health status improves; thus, an increase in incomes reduces the health risk.

CONCLUSIONS

The policy implications from our analysis include the argument that a strong initiative for health policy targeting obesity prevention is required for middle-income countries, many of which are currently experiencing high economic growth.

Night light intensity and women's body weight: Evidence from Nigeria

The prevalence of overweight and obesity are increasing in many African countries and hence becoming regional public health challenges. We employ satellite-based night light intensity data as a proxy for urbanization to investigate the relationship between urbanization and women's body weight. We use two rounds of the Demographic and Health Survey data from Nigeria. We employ both nonparametric and parametric estimation approaches that exploit both the cross-sectional and longitudinal variations in night light intensities. Our empirical analysis reveals nonlinear relationships between night light intensity and women's body weight measures. Doubling the sample's average level of night light intensity is associated with up to a ten percentage point increase in the probability of overweight. However, despite the generally positive relationship between night light intensity and women's body weight, the strength of the relationship varies across the assorted stages of night light intensity. Early stages of night light intensity are not significantly associated with women's body weight, while higher stages of nightlight intensities are associated with higher rates of overweight and obesity. Given that night lights are strong predictors of urbanization and related economic activities, our results hint at nonlinear relationships between various stages of urbanization and women's body weight.

Integrating economics into the rationale for multisectoral action on obesity

Obesity is a compelling example of the challenges of championing and mobilizing a response that involves the whole of government and all of society. This paper discusses the need for economic rationales to strengthen the case for government intervention on obesity, with a view to better engaging the expertise and resources of nonhealth sectors. The paper also briefly reviews economic theory and evidence that could support an integrated multisectoral rationale for action, noting opportunities to expand the integration of economic evidence in the Americas.

Trends and determinants of weight gains among OECD countries: an ecological study

OBJECTIVES

Obesity has become a global issue with abundant evidence to indicate that the prevalence of obesity in many nations has increased over time. The literature also reports a strong association between obesity and economic development, but the trend that obesity growth rates may converge over time has not been examined. We propose a conceptual framework and conduct an ecological analysis on the relationship between economic development and weight gain. We also test the hypothesis that weight gain converges among countries over time and examine determinants of weight gains.

STUDY DESIGN

This is a longitudinal study of 34 Organisation for Economic Cooperation and Development (OECD) countries in the years 1980-2008 using publicly available data.

METHODS

We apply a dynamic economic growth model to test the hypothesis that the rate of weight gains across countries may converge over time. We also investigate the determinants of weight gains using a longitudinal regression tree analysis.

RESULTS

We do not find evidence that the growth rates of body weight across countries converged for all countries. However, there were groups of countries in which the growth rates of body weight converge, with five groups for males and seven groups for females. The predicted growth rates of body weight peak when gross domestic product (GDP) per capita reaches US$47,000 for males and US$37,000 for females in OECD countries. National levels of consumption of sugar, fat and alcohol were the most important contributors to national weight gains.

CONCLUSION

National weight gains follow an inverse U-shape curve with economic development. Excessive calorie intake is the main contributor to weight gains.

The Epidemiology and Economic Burden of Obesity and Related Cardiometabolic Disorders in the United Arab Emirates: A Systematic Review and Qualitative Synthesis

BACKGROUND

Noncommunicable diseases (NCDs) are considered as a global health problem and considered as a public health priority with the more considerable increasing trend of obesity and cardiometabolic disorders rates in the Middle Eastern countries. This systematic review aims at assessing the prevalence, incidence rates, and trends, as well as the cost of obesity and related cardiometabolic disorders in the United Arab Emirates (UAE).

METHODS

A highly sensitive strategy was used to retrieve original observational studies, addressing the epidemiology and cost of obesity and related cardiometabolic disorders in the UAE, irrespective of nationality (nationals and expatriates). The search was conducted on April 4, 2017, within numerous electronic databases and the grey literature. Standardized and validated methods were used for data extraction and analysis as well as quality assessment.

RESULTS

6789 records were retrieved, of which 36 were deemed eligible. High prevalence rates were reported for obesity, diabetes, hypertension, and metabolic syndrome in all studies. However, the definitions and methods employed by the studies were highly variable. The risk of bias in the epidemiological studies ranged between low and medium. Only one study reported the cost of illness for diabetes. In this study, the estimated cost per patient was $2,015 (adjusted to the year 2015), and it became twofold and sixfold higher in patients with microvascular and macrovascular complications, respectively.

CONCLUSIONS

Obesity and related cardiometabolic disorders are highly prevalent in the UAE, but quoting a precise prevalence for them is difficult given the methodological heterogeneity of the epidemiological studies addressing them. Nonetheless, we detected a 2-3-fold increase in the prevalence of overweight and obesity in the UAE between 1989 and 2017. It is hopeful that this systematic review will provide an insight into direct future studies, especially longitudinal studies exploring obesity and cardiometabolic risks and their costs.

Pathways of the association between maternal employment and weight status among women and children: Qualitative findings from Guatemala

The double burden of malnutrition, defined by the coexistence of undernutrition and overweight, is well documented in low- and middle-income countries. However, the mechanisms by which employment may be related to maternal and child weight status in low- and middle-income countries are not well understood. We conducted in-depth interviews among 20 mothers who participated in Project MIEL, a contemporary trial which evaluated the effects of an integrated micronutrient supplement and parenting intervention in rural Guatemala. We utilized semi-structured interviews to explore the pathways by which maternal employment might influence bodyweight. Interviews were structured to explore the factors that mothers considered when deciding whether or not to participate in the labor force and how mothers perceived the influence of employment on determinants of their own bodyweight and that of their children. Themes were used to develop a conceptual framework. Mothers described four pathways through which employment could lead to changes in weight status: changes in food purchasing; improved household well-being; changes in time allocation; and psychological effects. Mothers described purchasing increased quantities and more varied types of food, as well as the purchase of energy-dense foods. Less time to devote to food preparation resulted in mothers preparing quicker meals and relying on substitute childcare. Mothers also expressed feelings of worry and neglect in relation to being employed, and perceived that these feelings would affect weight. A better understanding of these mechanisms is important for developing policies and programs to support women in the workplace and also reducing maternal and child overweight in Guatemala.

Nutrition label experience, obesity, high blood pressure, and high blood lipids in a cohort of 42,750 Thai adults

INTRODUCTION

Nutrition labels have been promoted for nearly two decades in Thailand to educate people about healthy eating and to combat nutrient-related non-communicable diseases (NCDs). But little is known about how nutrition labels are experienced and whether they are linked with better health. Our objective was to investigate the associations between nutrition label experience, obesity and nutrient-related NCDs in Thai consumers.

METHODS

A cross-sectional study was undertaken with a nationwide cohort of 42,750 distance learning Thai adult students enrolled in an Open University in 2013. We measured exposure as nutrition label experience (read, understand, use). Health outcomes were high blood pressure, high blood lipids, and high Body Mass Index (overweight at risk and obesity). Multivariate logistic regression was used to determine the association between nutrition label experience and health outcome adjusting for sociodemographic attributes, physical activity, smoking, and alcohol intake.

RESULTS

Frequent nutrition label use varied by cohort attributes and health outcomes and was least for those with low physical activity and high blood pressure. Being male, older, an urban resident or with low physical activity was associated with increasing high blood pressure and high blood lipids. Compared to those who read, understand and use nutrition labels, participants who did not (read, understand, and use), were more likely to report high blood pressure (Adjusted Odds Ratio 1.33; 1.17-1.51), high blood lipids (AOR 1.26; 1.14-1.39), and obesity (AOR 1.23; 1.13-1.33), but were not more likely to be overweight at risk (AOR 1.06; 0.97-1.16).

CONCLUSIONS

We found cross-sectional associations between low nutrition label experience and increased likelihood of high blood pressure, high blood lipids, and obesity among Thai adults. Nutrition label education should be promoted as part of a public health approach to appropriate food choices and better lifestyles to reduce obesity and nutrient-related NCDs.

Soft drink prices, sales, body mass index and diabetes: Evidence from a panel of low-, middle- and high-income countries

We take advantage of four different cross-country datasets containing data on 78 countries for the period 1999-2014, in order to assess the relationship of carbonated soft drinks' sales, as well as their prices, with body mass index (BMI), overweight, obesity and diabetes. Using an ecological study design and multivariate regression longitudinal estimation approaches, we find that carbonated soft drink sales were significantly positively related to BMI, overweight and obesity - but only in the low and lower-middle income countries. This finding was robust to a number of sensitivity and falsification checks. In this sub-sample, an increase in per capita soft drink sales by 1 litre per year was related to an increase of BMI by about 0.009 kg/m² (p < 0.1).. This is a small effect, implying that halving annual consumption per capita in this group of countries would result in a drop of BMI by only about 0.03 kg/m². Although soft drink prices were negatively related to weight-related outcomes in the sample of higher middle income and high income countries, this finding was not robust to falsification checks. The results thus suggest that sales restrictions to steer consumers away from soft drinks could indeed have a beneficial health effects in poorer countries, although the effect magnitude appears to be very small. However, given potential limitations of using ecological research design, results from individual level studies would be required to further ascertain the role of soft drink sales and prices in obesity and diabetes.

The weight of work: the association between maternal employment and overweight in low- and middle-income countries

Background

Maternal employment has increased in low-and middle-income countries (LMIC) and is a hypothesized risk factor for maternal overweight due to increased income and behavioral changes related to time allocation. However, few studies have investigated this relationship in LMIC.

Methods

Using cross-sectional samples from Demographic and Health Surveys, we investigated the association between maternal employment and overweight (body mass index [BMI] ≥ 25 kg/m²) among women in 38 LMIC (N = 162,768). We categorized mothers as formally employed, informally employed, or non-employed based on 4 indicators: employment status in the last 12 months; aggregate occupation category (skilled, unskilled); type of earnings (cash only, cash and in-kind, in-kind only, unpaid); and seasonality of employment (all year, seasonal/occasional employment). Formally employed women were largely employed year-round in skilled occupations and earned a wage (e.g. professional), whereas informally employed women were often irregularly employed in unskilled occupations and in some cases, were paid in-kind (e.g. domestic work). For within-country analyses, we used adjusted logistic regression models and included an interaction term to assess heterogeneity in the association by maternal education level. We then used meta-analysis and meta-regression to explore differences in the associations pooled across countries.

Results

Compared to non-employed mothers, formally employed mothers had higher odds of overweight (pooled odds ratio [POR] = 1.3; 95% Confidence Interval [CI] 1.2, 1.4) whereas informally employed mothers, compared to non-employed mothers, had lower odds of overweight (POR = 0.72; 95% CI: 0.64, 0.81). In 14 LMIC, the association varied by education. In these countries, the magnitude of the formal employment-overweight association was larger for women with low education (POR = 1.5; 95% CI: 1.1, 1.9) compared to those with high education (POR = 1.2; 95% CI: 1.0, 1.3).

Conclusions

Formally employed mothers in LMIC have higher odds of overweight and the association varies by educational attainment in 14 countries. This knowledge highlights the importance of workplace initiatives to reduce the risk of overweight among working women in LMIC.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0522-y) contains supplementary material, which is available to authorized users.

Simple vs. Complex Carbohydrate Dietary Patterns and the Global Overweight and Obesity Pandemic

Nowadays, obesity and being overweight are among the major global health concerns. Many, diet-related diseases impose high tangible and intangible costs, and threaten the sustainability of health-care systems worldwide. In this study, we model, at the macroeconomic level, the impact of energy intake from different types of carbohydrates on the population's BMI (body mass index). We proceed in three steps. First, we develop a framework to analyse both the consumption choices between simple and complex carbohydrates and the effects of these choices on people health conditions. Second, we collect figures for 185 countries (over the period 2012-2014) regarding the shares of simple (sugar and sweetener) and complex (cereal) carbohydrates in each country's total dietary energy supply. Third, we use regression techniques to: (1) estimate the impact of these shares on the country's prevalence of obesity and being overweight; (2) compute for each country an indicator of dietary pattern based on the ratio between simple and complex carbohydrates, weighted by their estimated effects on the prevalence of obesity and being overweight; and (3) measure the elasticity of the prevalence of obesity and being overweight with respect to changes in both carbohydrate dietary pattern and income per capita. We find that unhealthy eating habits and the associated prevalence of excessive body fat accumulation tend to behave as a 'normal good' in low, medium- and high-HDI (Human Development Index) countries, but as an 'inferior good' in very high-HDI countries.

The contribution of urbanization to non-communicable diseases: Evidence from 173 countries from 1980 to 2008

It is widely believed that the expanding burden of non-communicable diseases (NCDs) is in no small part the result of major macro-level determinants. We use a large amount of new data, to explore in particular the role played by urbanization - the process of the population shifting from rural to urban areas within countries - in affecting four important drivers of NCDs world-wide: diabetes prevalence, as well as average body mass index (BMI), total cholesterol level and systolic blood pressure. Urbanization is seen by many as a double-edged sword: while its beneficial economic effects are widely acknowledged, it is commonly alleged to produce adverse side effects for NCD-related health outcomes. In this paper we submit this hypothesis to extensive empirical scrutiny, covering a global set of countries from 1980-2008, and applying a range of estimation procedures. Our results indicate that urbanization appears to have contributed to an increase in average BMI and cholesterol levels: the implied difference in average total cholesterol between the most and the least urbanized countries is 0.40mmol/L, while people living in the least urbanized countries are also expected to have an up to 2.3kg/m² lower BMI than in the most urbanized ones. Moreover, the least urbanized countries are expected to have an up to 3.2p.p. lower prevalence of diabetes among women. This association is also much stronger in the low and middle-income countries, and is likely to be mediated by energy intake-related variables, such as calorie and fat supply per capita.