Shifting educational gradients in body mass index trajectories of Indonesians: an age period cohort analysis

Abstract

Background Globally, the number of obese adults has increased rapidly in many developing countries. The links between increased educational attainment and lower risks of overweight/obesity have been studied in a number of high-income contexts. However, educational attainment can have a different association with obesity at different levels of economic development and different stages of the nutritional transition, and these associations may vary by period and cohort. This study aims to provide evidence on the shifting of educational gradients in overweight/obesity in Indonesia, a low middle income country. Methods Using five waves of Indonesian Family Life Survey (IFLS), this study examines the Body Mass Index (BMI) trajectories of 14,810 individuals from 1993 to 2014. This study analyses how educational gradients in BMI have shifted over time and across cohorts using a hierarchical age-period-cohort (HAPC) model to account for the effects of age and the changes in historical periods (social and environmental contexts). Results In older generations, higher educational attainment is associated with higher BMI, but the gap between educational groups shrinks in more recently-born cohorts. The BMI of lower educational groups is catching up with that of the tertiary educated, leading to an increased risk of overweight/obesity among low educated individuals. Having tertiary education lowers the risk of weight gain (-0.04 point) among recently-born cohort of women, but it still increases the risk (+ 0.04 point) for men. Conclusion Changes in access to education and the ongoing nutritional transition in Indonesia are leading to a shifting of educational gradients in overweight/obesity over time. The rising trends in BMI among low-educated and younger individuals are of substantial concern for Indonesian public health due to their implications for the risk of communicable and non-communicable diseases in the future.

Educational attainment and offspring birth weight: A bidirectional Mendelian randomization study

“…This approach additionally assumes that all selected IVs must be conditionally independent of the outcome, given all exposures and confounders ( Sanderson et al, 2019 ). Studies have found the associations between EA and body mass index (BMI) ( Liwin, 2022 ; Zhang et al, 2022 ; Zhao et al, 2022 ), alcoholic drinks per week ( Liu et al, 2019 ; Treur et al, 2021 ; Zhou et al, 2021 ). In addition, BMI of parents is well-established influencing factor for offspring birth weight according to both clinical observational and genetic association studies ( Vogelezang et al, 2020 ; Chen S. et al, 2021 ; Thompson et al, 2021 ; Aydogan Mathyk et al, 2022 ; Gootjes et al, 2022 ).…”

Body Mass Index Asian Populations category and stroke and heart disease in the adult population: A longitudinal study of The Indonesia Family Life Survey (IFLS) 2007 and 2014

“…In addition, a previous study in Indonesia suggested that higher education, and white scholar workers were associated with higher BMI [18]. The reasons for this might be in Indonesia, higher education is related to better socioeconomic status [17]; however, socioeconomic level was not significantly influenced by self-reported health status [48], and people with higher socioeconomic status are more likely to experience health issues like obesity and hypertension [49, 50]. Furthermore, greater BMI in the middle age category has been linked to an increase in stroke and myocardial infraction [51], the highest association with incident heart failure among CVD subtypes [52], and may increase the risk of heart disease [41], which is in line with our findings.…”

“…In Indonesia, a previous study using IFLS data found that between 1993 and 2014, the prevalence of overweight people doubled from 17.1% to 33.0%, and the younger generations have higher BMIs than the older generations [17]. The mean BMI also increased from 21.4 kg/m 2 in 1993 to 23.85 kg/m 2 in 2014 [17, 18]. Furthermore, based on the BMI Asian populations classification, in Indonesia, overweight and obesity were more common in women than men.…”

“…Furthermore, based on the BMI Asian populations classification, in Indonesia, overweight and obesity were more common in women than men. The trend has increased over time, with 61.1% and 42.4% in women and men respectively [17].…”

Changing socioeconomic and geographic gradients in cardiovascular disease risk factors in India – Evidence from nationally representative household surveys

“…16 to 2019-21, the largest absolute increase in prevalence occurred for unhealthy weight (overweight or obesity: 3•4 percentage points, 95% CI: 3•0, 3•8; obesity: 1•2 percentage points, 95% CI 1•0, 1•3) followed by diabetes (0•3 percentage points, 95% CI 0•2, 0•5) (Table2). While the absolute changes appear small, these increasing trends corresponded to pronounced relative changes when compared to the baseline NFHS-4 values: overweight or obesity increased by 17% (95% CI 14•7, 19•3) from a baseline prevalence of 20% (95% CI 19•7; 20•3), obesity by 28•4% (95% CI 23•7, 33•2) from a baseline prevalence of 4•1% (95% CI 4•0, 4•2), and diabetes by 9•5% (95% CI 4•4, 14•7) from a baseline prevalence of 3•3% (95% CI 3•2, 3•4).…”