Dimensions of national culture associated with different trajectories of male and female mean body mass index in countries over 25 years

Abstract

Summary Cultural determinants of obesity prevalence have been little studied but could explain significant variations in body mass index (BMI) trajectories among countries. This ecological study quantified longitudinal associations between six dimensions of national culture and mean population BMI over 25 years. National mean male and female BMI data 1990 to 2014 provided dependent variables. National dimensions of culture (from the Hofstede database for up to 87 countries) were independent variables: Individualism, Uncertainty avoidance, Indulgence, Long‐term orientation, Power distance, and Masculinity. Analyses used mixed models for repeated measures for each dimension of national culture with male and female adult BMI trajectories, controlling for confounders. A higher mean BMI was significantly associated with higher Individualism, Uncertainty avoidance, Indulgence, and Masculine orientation and with lower Power distance (males only) and lower Long‐term orientation (males only). Overall, the national cultural dimensions explained 62.4% (males) and 53.5% (females) of the variance in mean BMI among countries. National cultural characteristics, especially Individualism and Uncertainty avoidance, are strongly related to obesity prevalence, explaining over half of the variance among countries. More research and theory development is needed to understand the pathways for these associations so that cultural contexts can be better accounted for in policies, social marketing messages, and community‐based actions for obesity prevention.

Ethnicity, Neighborhood and Individual Socioeconomic Status, and Obesity: The Singapore Multiethnic Cohort

“…Other relevant cultural factors may include traditional cuisines and hospitality traditions leading to the expectation that the host prepare and the guest consume an abundance of food (37). More recently, broader aspects of culture, such as the level of individualism, uncertainty avoidance, and indulgence, were shown to partly explain the variation in BMI among countries (5). In terms of countries of origin for Singapore ethnic groups, Malaysia scored higher on “indulgence” than India or China, and Malaysia and India scored lower on “long‐term orientation” than China (5).…”

“…More recently, broader aspects of culture, such as the level of individualism, uncertainty avoidance, and indulgence, were shown to partly explain the variation in BMI among countries (5). In terms of countries of origin for Singapore ethnic groups, Malaysia scored higher on “indulgence” than India or China, and Malaysia and India scored lower on “long‐term orientation” than China (5). Although “indulgence” and to a lesser degree “long‐term orientation” were associated with higher BMI in the cross‐country comparison (5), it is unclear whether these cultural differences between countries of origin contribute to ethnic differences within the Singapore setting.…”

“…In terms of countries of origin for Singapore ethnic groups, Malaysia scored higher on “indulgence” than India or China, and Malaysia and India scored lower on “long‐term orientation” than China (5). Although “indulgence” and to a lesser degree “long‐term orientation” were associated with higher BMI in the cross‐country comparison (5), it is unclear whether these cultural differences between countries of origin contribute to ethnic differences within the Singapore setting. Further longitudinal and qualitative studies are necessary to elucidate whether the ethnic variation in obesity can be explained by sociocultural norms and beliefs.…”

“…It has been suggested that the global increase in obesity prevalence is caused by worldwide drivers, such as ubiquitous food availability and marketing, and modified by local factors, such as economic development, the built environment, and sociocultural factors (4). One such modifying factor could be ethnicity and related cultural values, norms, and traditions (5).…”

Understanding the rise of cardiometabolic diseases in low- and middle-income countries

“…149 Combating obesity requires integrated governmental and societal action to protect population health. 150,151…”