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The impact of economic, political and social globalization on overweight and obesity in the 56 low and middle income countries.

ABSTRACT: Anecdotal and descriptive evidence has led to the claim that globalization plays a major role in inducing overweight and obesity in developing countries, but robust quantitative evidence is scarce. We undertook extensive econometric analyses of several datasets, using a series of new proxies for different dimensions of globalization potentially affecting overweight in up to 887,000 women aged 15-49 living in 56 countries between 1991 and 2009. After controlling for relevant individual and country level factors, globalization as a whole is substantially and significantly associated with an increase in the individual propensity to be overweight among women. Surprisingly, political and social globalization dominate the influence of the economic dimension. Hence, more consideration needs to be given to the forms of governance required to shape a more health-oriented globalization process.

SUBMITTER: Goryakin Y

PROVIDER: S-EPMC4416723 | biostudies-literature | 2015 May

REPOSITORIES: biostudies-literature

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The impact of economic, political and social globalization on overweight and obesity in the 56 low and middle income countries.

Goryakin Yevgeniy Y Lobstein Tim T James W Philip T WP Suhrcke Marc M

Social science & medicine (1982) 20150314

Anecdotal and descriptive evidence has led to the claim that globalization plays a major role in inducing overweight and obesity in developing countries, but robust quantitative evidence is scarce. We undertook extensive econometric analyses of several datasets, using a series of new proxies for different dimensions of globalization potentially affecting overweight in up to 887,000 women aged 15-49 living in 56 countries between 1991 and 2009. After controlling for relevant individual and countr ...[more]

PMID: 25841097

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Project description:ObjectiveTo analyze socioeconomic inequalities in the prevalence of underweight and overweight or obesity in women from low and middle-income countries (LMICs).MethodsUsing the last available Demographic Health Survey between 2010 and 2016 from 49 LMICs, we estimated the prevalence of underweight (BMI < 18.5 kg/m2) and overweight or obesity combined (BMI ≥ 25 kg/m2) for women aged 20-49 years. We used linear regression to explore the associations between the two outcomes and gross national income (GNI). We assess within-country socioeconomic inequalities using wealth deciles. The slope index of inequality (SII) and the inequality pattern index (IPI) were calculated for each outcome. Negative values of the latter express bottom inequality (when inequality is driven by the poorest deciles) while positive values express top inequality (driven by the richest deciles).ResultsIn total, 931,145 women were studied. The median prevalence of underweight, overweight or obesity combined, and obesity were 7.3% (range 0.2-20.5%), 31.5% (8.8-85.3%), and 10.2% (1.9-48.8%), respectively. Pearson correlation coefficients with log GNI were -0.33 (p = 0.006) for underweight, 0.72 (p < 0.001) for overweight or obesity, and 0.66 (p < 0.001) for obesity. For underweight, the SII was significantly negative in 38 of the 49 countries indicating a higher burden among poor women. There was no evidence of top or bottom inequality. Overweight or obesity increased significantly with wealth in 44 of the 49 countries. Top inequality was observed in low-prevalence countries, and bottom inequality in high-prevalence countries.ConclusionUnderweight remains a problem among the poorest women in poor countries, but overweight and obesity are the prevailing problem as national income increases. In low-prevalence countries, overweight or obesity levels are driven by the higher prevalence among the richest women; as national prevalence increases, only the poorest women are relatively preserved from the epidemic.

Project description: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.

Dataset Information

The impact of economic, political and social globalization on overweight and obesity in the 56 low and middle income countries.

Publications

The impact of economic, political and social globalization on overweight and obesity in the 56 low and middle income countries.

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