Overweight primarily a problem among wealthier women in low- to middle-income countries

A new study from the Harvard School of Public Health (HSPH) finds that high body mass index (BMI) in developing countries remains primarily a problem of the rich. The findings suggest that the shift towards overweight and obesity among the poor that has already happened in wealthier countries has not yet happened in developing countries.

The study appears in an advance online edition of the American Journal of Clinical Nutrition and will appear in an upcoming print edition.

“Previous research on the increasing overweight and obesity burden in developing countries has assumed that the burden is shared by everybody within these countries; however, we found that the social patterning of weight continues to closely resemble the unequal distribution of income and other resources,” said S V Subramanian, lead author of the paper and associate professor in the department of society, human development, and health at HSPH.

Subramanian and his colleagues analyzed data from nationally representative samples of 538,140 women ages 15 to 49 drawn from Demographic and Health Surveys conducted in 54 low- to middle-income countries between 1994 and 2008. They looked at BMI, education, household wealth, and the per capita Gross Domestic Product (pcGDP) from the women's home countries. The researchers found an association between BMI and wealth in every country except Moldova and Kazakhstan. Globally, a 25% increase on the measure of wealth index was associated with a 54% increase in BMI and a 33% increase in overweight. Similar patterns were observed in urban and rural areas within countries. There were no strong associations found between weight and either education or pcGDP.

The researchers theorize that these findings could be due to a number of factors, including that women in higher income groups are more likely to have diets richer in animal fats than lower-income women. Also, cultural norms in developing countries may favor fatty body shapes among wealthier women. Richer women are also less likely than poor women to engage in regular physical labor.

While increasing BMI and overweight prevalence are important public health concerns in many of these countries, their distribution among socioeconomic groups needs to be a central consideration in drafting policies for improving the nutritional status of populations in developing countries, according to the researchers.

“Our findings have serious policy implications,” Subramanian said. “If being overweight is primarily concentrated among the rich, should precious public resources be targeted to reducing overweight or should they be devoted to policies that improve nutritional outcomes among the poor?” He added, “The fact that the burden of overweight and underweight is concentrated largely in two distinct socioeconomic groups actually is a good thing from a policy perspective, with the challenge being how to balance the emphasis in terms of priorities.”

No direct funding source supported this study. Macro International Inc. provided access to the Demographic and Health Surveys. Subramanian is supported by a career development grant from the U.S. National Heart, Lung, and Blood Institute.

“Weight of nations: a socioeconomic analysis of women in low- to middle-income countries.” S.V. Subramanian, Jessica M. Perkins, Emre Özaltin, and George Davey Smith. American Journal of Clinical Nutrition, online November 10, 2010.

Visit the HSPH website for the latest news, press releases and multimedia offerings.

Harvard School of Public Health ( http://www.hsph.harvard.edu ) is dedicated to advancing the public's health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children's health to quality of care measurement; from health care management to international health and human rights.