Is the burden of overweight shifting to the poor across the globe? Time trends among women in 39 low- and middle-income countries (1991–2008)

Abstract

Background Overweight prevalence has increased globally; however, current time trends of overweight by social class in lower income countries are unknown. Methods We used repeated cross-sectional, nationally representative data from the Demographic and Health Surveys on women aged 18–49 with young children (n=421,689) in 39 lower income countries. We present overweight (body mass index ≥25) prevalence at each survey wave, prevalence difference and prevalence growth rate for each country over time is presented separately by wealth quintile and educational attainment. We present the correlation between nation wealth and differential overweight prevalence growth by wealth and education was estimated. Results In the majority of countries the highest wealth and education groups still have the highest prevalence of overweight and obesity. However, in a substantial number of countries (31% when wealth is used as the indicator of SES and 54% for education) the estimated increases in overweight prevalence over time have been greater in the lowest compared to the highest wealth and education groups. Gross Domestic Product per capita was associated with a higher overweight prevalence growth rate for the lowest wealth group compared to the highest (Pearson’s correlation coefficient: 0.45). Conclusions Higher (versus lower) wealth and education groups had higher overweight prevalence across most developing countries. However, some countries show a faster growth rates in overweight in the lowest (versus highest) wealth and education groups, indicative of an increasing burden of overweight among lower wealth and education groups in lower income countries.

Education Modifies the Association of Wealth with Obesity in Women in Middle-Income but not Low-Income Countries: an Interaction Study using Seven National Datasets, 2005–10.

“…No empirical studies have focused on investigating the relationship between different indicators or how these associations diverge by level of economic development for different indicators, although in a previous study, we have demonstrated an interaction between education and occupation in older Chinese women [31]. The findings in this study corroborate the existence of a changing SES-obesity association dependent on a country's level of economic development [3,4,5,6]. However, two studies claim that DHS data do not provide any evidence of an SESoverweight/obesity reversal [7,8].…”

“…Accessed 2013 Jan 1) are a key source of data for studies on obesity [4,5,6,7,8,17,18,19]. They are a worldwide project funded by the United States Agency for International Development aiming to provide data on demographics and health outcomes, mainly for women and young children.…”

“…The model used in this study is based on the literature of multicountry studies examining SES-obesity association and includes a relatively small number of variables [4,5,7,17,19]. Body mass index (BMI in kg/m 2 ) was calculated as (weight/height 2 ) and the cut off for obesity was defined as a BMI$30 kg/m 2 .…”

“…It is arguably the most complex to address and presents a potentially intractable epidemic in itself [2]. Crosscountry comparisons have played a central role in understanding the association between socio-economic status (SES) and obesity in relation to country levels of economic development [3,4,5,6]. Most of this research suggests that obesity is a problem of the elites in poorer countries, with a process of gradual reversal occurring as countries develop, and it becomes a problem of the poor in advanced economies.…”

The nutrition transition and indicators of child malnutrition

“…While overweight and obesity in developing countries are positively associated with income, poor population segments are also increasingly affected (Jones- Smith et al, 2012;Roemling and Qaim, 2012). These effects of the nutrition transition on body weight have primarily been observed in adult populations.…”