Urban Environments and Obesity in Southeast Asia: A Systematic Review, Meta-Analysis and Meta-Regression

Abstract

Many environmental factors contribute to the rise in prevalence of obesity in populations but one key driver is urbanization. Countries in Southeast (SE) Asia have undergone rapid changes in urbanization in recent decades. The aim of this study is to provide a systematic review of studies exploring the relationship between living in an urban or rural environment (urbanicity) and obesity in Southeast Asia. In particular, the review will investigate whether the associations are uniform across countries and ages, and by sex. The literature search was conducted up to June 2014 using five databases: EMBASE, PubMed, GlobalHealth, DigitalJournal and Open Grey. Forty-five articles representing eight of the eleven countries in SE Asia were included in the review. The review found a consistent positive association between urbanicity and obesity in countries of Southeast Asia, in all age groups and both genders. Regional differences between the associations are partly explained by gross national income (GNI). In countries with lower GNI per capita, the association between urbanicity and obesity was greater. Such findings have implications for policy makers. They imply that population level interventions need to be country or region specific, tailored to suit the current stage of economic development. In addition, less developed countries might be more vulnerable to the negative health impact of urbanization than more developed countries.

Social and Physical Determinants of Obesity in Adults

“…The results of this study demonstrated a positive relationship between obesity and urban living in south-east Asian countries. It was consistent with all age groups including both genders [14].…”

“…There were certain limitations to this study, first one being that this study compared the outcomes in rural and urban settings [14]. This may have missed the underlying factors that could have been potentially linked to obesity, such as the duration of stay in the area, economic diversity and commute to the workplace during the year.…”

“…Furthermore, another study was conducted to examine the relationship between obesity and urban environment in south-east Asia [14]. This study was a meta-analysis review, which was done in order to provide a review of studies that showed the positive association between obesity and urban living environment.…”

“…Future research should explore more into the underlying factors that could be important to confirm the relationship between obesity and urban living. Such factors could be the length of stay in the area, economic diversity and also the transport to work during the year [14].…”

Metrics in Urban Health: Current Developments and Future Prospects

“…In this category, we included studies that researched the impacts of general urban characteristics on health (3,46,108). However, three subcategories are specifically of interest to this review.…”