Social factors and overweight: evidence from nine Asian INDEPTH Network sites

Abstract

BackgroundOverweight/obesity increases the risk of morbidity and mortality from a number of chronic conditions, including heart disease, stroke, diabetes and some cancers. This study examined the distribution of body mass index (BMI) in nine Health and Demographic Surveillance System (HDSS) sites in five Asian countries and investigated the association between social factors and overweight.Data and methodsThis cross-sectional study was conducted in nine HDSS sites in Bangladesh, India, Indonesia, Thailand and Vietnam. The methodology of the WHO STEPwise approach to Surveillance with core risk factors (Step 1) and physical measurements for weight, height and waist circumference (Step 2) were included. In each site, about 2,000 men and women aged 25–64 years were selected randomly using the HDSS database. Weight was measured using electronic scales, height was measured by portable stadiometers and waist circumference was measured by measuring tape. Overweight/obesity was assessed by BMI defined as the weight in kilograms divided by the square of the height in metres (kg/m2).ResultsAt least 10% people were overweight (BMI ≥ 25) in each site except for the two sites in Vietnam and WATCH HDSS in Bangladesh where few men and women were overweight. After controlling for all the variables in the model, overweight increases with age initially and then declines, with increasing education, and with gender with women being heavier than men. People who eat vegetables and fruits below the recommended level and those who do high level of physical activity are, on the whole, less heavy than those who eat more and do less physical activity.ConclusionsAs the proportion of the population classified as being overweight is likely to increase in most sites and overweight varies by age, sex, and social and behavioural factors, behavioural interventions (physical exercise, healthy diet) should be developed for the whole population together with attention to policy around nutrition and the environment, in order to reduce the adverse effects of overweight on health.

Lifestyle factors associated with obesity in a cohort of males in the central province of Sri Lanka: a cross-sectional descriptive study

“…Similar to our findings, Katulanda et al and De Silva et al found a positive association between obesity and increasing income levels in Sri Lankan adults [20, 67]. India and Bangladesh similarly show an increase in obesity prevalence rates with increase in education levels and living standards [68, 69]. This may be attributed to nutrition transition, with increased availability of food as well as money to purchase food, which will increase energy intake leading to obesity.…”

How is Indonesia coping with its epidemic of chronic noncommunicable diseases? A systematic review with meta-analysis

“…Thirteen studies provided insight into the risk factor overweight/obesity [20, 21, 48, 67, 79, 80, 84, 97, 102, 139, 142, 143, 155]. National data estimate that 16–21% of all Indonesian men and 26–31% of all women were overweight; almost 5% of the whole population was obese [97, 139, 142, 143].…”

“…On average around 40% of all studies included some sort of socioeconomic indicator mirroring educational attainment [15, 17, 21–24, 32, 34, 35, 37–40, 42–44, 47, 48, 50, 55, 56, 60, 63, 66, 68, 69, 71, 73, 75, 76, 79, 81, 83–85, 91, 92, 95, 99, 101, 102, 104–108, 111, 112, 114, 122, 123, 125–127, 129, 131, 133, 135–138, 140, 142, 155, 156], income or wealth [15, 17, 20–22, 25, 28, 37, 39, 43, 47, 52, 55, 56, 60, 63, 66, …”

Women show a closer association between educational level and hypertension or diabetes mellitus than males: a secondary analysis from the Austrian HIS

“…Furthermore, prevalence rates of both overweight and obesity were highest in women with low incomes, though such a relationship was not characteristic of the male population in Europe [14]. However, the inverse relation between social class and obesity in women in wealthy countries contrasts with the findings in low-income countries [40,41]. Overweight increased with increases in education levels in poor rural populations in India, where overweight is also seen as sign of wealth and health [41].…”