Neighborhood socioeconomic status and BMI differences by immigrant and legal status: Evidence from Utah

We build on recent work examining the BMI patterns of immigrants in the US by distinguishing between legal and undocumented immigrants. We find that undocumented women have relative odds of obesity that are about 10 percentage points higher than for legal immigrant women, and their relative odds of being overweight are about 40 percentage points higher. We also find that the odds of obesity and overweight status vary less across neighborhoods for undocumented women than for legal immigrant women. These patterns are not found among immigrant men: undocumented men have lower rates of obesity (by about 6 percentage points in terms of relative odds) and overweight (by about 12 percentage points) than do legal immigrant men, and there is little variation in the impact of neighborhood context across groups of men. We interpret these findings in terms of processes of acculturation among immigrant men and women.     

Physical activity and the risk of becoming overweight or obese in middle-aged and older women

Although public health campaigns stress leisure time physical activity (LTPA) as essential for obesity prevention, few epidemiological studies have focused on the association of specific types and intensities of LTPA and the clinical endpoints of overweight and obesity. Therefore, we prospectively assessed whether moderate- and vigorous-intensity as well as total LTPA were associated with the risk of becoming either overweight or obese using a prospective cohort design of 19,003 women enrolled in the Women's Health Study (WHS). Women reported their participation in walking and LTPA at baseline. During a median follow-up of 11.6 years, 7,865 women became overweight or obese. In multivariable-adjusted models that included demographic, lifestyle, and dietary factors, both vigorous-intensity and total LTPA showed a modest inverse relationship with the development of overweight/obesity. The hazard ratios (HR) and 95% confidence interval (CI) for the highest categories of vigorous-intensity LTPA (>2,000 kcal/week) and total LTPA (>3,000 kcal/week) compared with no LTPA were 0.79 (0.71-0.89) and 0.87 (0.78-0.96), respectively. In addition, a greater percentage of total LTPA spent performing vigorous intensity activities was associated with a lower risk of overweight/obesity (multivariable HR 0.93, 95% CI 0.87-0.98 for performing >50% compared with <50% of activity as vigorous). In conclusion, higher amounts of total LTPA should be encouraged to prevent obesity. Among those willing to participate in vigorous LTPA, and for whom such activities are not contraindicated, vigorous LPTA should be encouraged.     

Overweight,Obesity, and Binge Eating in a Non‐clinical Sample of Five Brazilian Cities

Objective: To investigate the relationship between obesity/overweight and binge eating episodes (BEEs) in a large nonclinical population. Research Methods and Procedures: Consumers at shopping centers in five Brazilian cities (N = 2858) who participated in an overweight prevention program were interviewed and had weight and height measured to calculate BMI. Results: Prevalence of overweight (BMI = 25 to 29.9 kg/m²) was 46.6% for men and 36.6% for women. Obesity (BMI ≥ 30 kg/m²) was about two‐thirds of the prevalence of overweight. BEEs (subjects who binged one or more times per week over the last 3 months) in normal‐weight individuals was 1.4% for men and 3.9% for women, whereas in overweight/obese, these prevalences were 6.5% and 5.5%, respectively (p < 0.01). After adjustment for age, socioeconomic variables, and childhood obesity, those who reported BEEs had an odds ratio of being overweight/obese of 3.31 (95% confidence interval: 1.11 to 9.85) for men and 1.73 (95% confidence interval: 1.05 to 2.84) for women. Discussion: These findings indicate a strong association between episodes of binge eating and overweight/obesity, mainly among men.     

A prospective study of overweight, physical activity, and depressive symptoms in young women

This study examined the prospective associations of BMI, physical activity (PA), changes in BMI, and changes in PA, with depressive symptoms. Self-reported data on height, weight, PA, selected sociodemographic and health variables and depressive symptoms (CESD-10) were provided in 2000 and 2003 by 6,677 young adult women (22-27 years in 2000) participating in the Australian Longitudinal Study on Women's Health (ALSWH). Results of logistic regression analyses showed that the odds of developing depressive symptoms at follow-up (2003) were higher in women who were overweight or obese in 2000 than in healthy weight women, and lower in women who were active in 2000 than in sedentary women. Changes in BMI were significantly associated with increased odds of depressive symptoms at follow-up. Sedentary women who increased their activity had lower odds of depressive symptoms at follow-up than those who remained sedentary. Increases in activity among initially sedentary young women were protective against depressive symptoms even after adjusting for BMI changes. These findings indicate that overweight and obese young women are at risk of developing depressive symptoms. PA appears to be protective against the development of depressive symptoms, but does not attenuate the depressive symptoms associated with weight gain. However, among initially sedentary young women, even small increases in PA over time may reduce the odds of depressive symptoms, regardless of weight status.     

Occupational physical activity and risk of coronary heart disease among active and non-active working-women of North Dakota: a Go Red North Dakota Study

Currently less than half of the US adults meet physical activity (PA) recommendations, yet many more are sedentary in their occupations. Sedentary workers may therefore be at elevated risk for coronary heart disease (CHD). Therefore, the objective of the study is to examine the relationship of CHD risk with occupational PA (OCPA) and leisure time PA (LTPA) among working-women. The 10-year CHD risk and relative risk scores were calculated for 642 working-women. Self-report questionnaire determined levels of OCPA and LTPA. Biometric data were directly collected on all women. No direct relationship for OCPA and 'high risk' of CHD was determined. Insufficient LTPA was significantly associated with greater prevalence of 'high risk' of CHD. No dose response relationship was determined with PA and CHD risk. The odds of being 'high risk' were significantly greater for sedentary workers with insufficient LTPA compared to sufficient LTPA. The odds for being 'high risk' were similar among moderately active or heavy working women completing insufficient LTPA compared to women doing sufficient LTPA. For women with sedentary occupations, a sufficient amount of LTPA is essential to reduce CHD risk. Women in moderate to heavy working occupations may be acquiring adequate amounts of PA to minimize CHD risk.     

Trends in obesity and associations with education and urban or rural residence in Thailand

Objective: To measure trends in the prevalence of overweight and obesity and the relationship with urban or rural residence and education in Thailand. Research Methods and Procedures: Data were from two nationally representative surveys of 38,323 individuals ≥18 years old (19,156 were 18 to 59 years old) in 2004 and 3375 individuals 18 to 59 years old in 1997. Overweight and obesity were defined using the World Health Organization's Asian criteria. Results: Among those ≥18 years old in 2004, 17.8% of men (95% confidence interval, 16.6% to 19.0%) were overweight, 18.4% (17.3% to 19.5%) had Class I obesity, 4.8% (4.1% to 5.5%) had Class II obesity, and 15.9% (14.6% to 17.1%) had abdominal obesity. In women, 18.2% (17.1% to 19.2%) were overweight, 26.1% (24.9% to 27.3%) had Class I obesity, 9.3% (8.6% to 10.0%) had Class II obesity, and 37.3% (35.3% to 39.2%) had abdominal obesity. In those 18 to 59 years old, the prevalence of Class I obesity in men and all four categories in women significantly increased between 1997 and 2004. There was an inverse relationship in women but a positive relationship in men between education and the odds of being overweight or obese. In 2004, there were significantly lower odds of being overweight or obese in rural compared with urban men but similar odds between urban and rural women. Discussion: The prevalence of overweight and obesity in Thailand is high and increasing. Although the transition of overweight and obesity to those of lower socioeconomic status is not complete, it is well on the way.     

Prevalence of Overweight and Obesity and Weight Loss Practice among Beijing Adults, 2011

Objective

This study aims to determine the up-to-date prevalence of overweight and obesity, the distributions of body weight perception and weight loss practice in Beijing adults.

Methods

A cross-sectional study was conducted in 2011. A total of 2563 men and 4088 women aged 18–79 years from the general population were included. Data were obtained from questionnaire and physical examination.

Results

The prevalence of overweight (BMI 24–27.9 kg/m²) and obesity (BMI≥28 kg/m²) was 42.1% and 20.3% in men and 35.6% and 17.1% in women, respectively. Age was inversely associated with overweight in both sexes, and obesity in women. Education level was negatively associated with overweight and obesity in women but not in men. Only 49.1% men and 58.3% women had a correct perception of their body weight. Underestimation of body weight was more common than overestimation, especially in men, the older people, and those with low education level. The percentage of taking action to lose weight was inversely associated with men and old age, and positively associated with higher education level, higher BMI, and self-perception as “fat” (OR = 3.78 in men, OR = 2.91 in women). Only 26.1% of overweight/obese individuals took action to lose weight. The top two weight loss practices were to reduce the amount of food intake and exercise.

Conclusion

Overweight and obesity were highly prevalent with high incorrect body weight perceptions in the general adult population in Beijing. Weight loss practice was poor in overweight and obese individuals. Actions at multiple levels are needed to slow or control this overweight and obesity epidemic.     

Associations of visceral and liver fat with the metabolic syndrome across the spectrum of obesity: the AGES-Reykjavik study

Visceral adipose tissue (VAT) is a key pathogenic fat depot in the metabolic syndrome (MetS), but liver fat (LF) may also play an important role. We evaluated associations of VAT and LF with MetS in normal weight, overweight, and obese men and women (BMI <25, 25-29.9, and ≥30 kg/m2, respectively). This analysis included 2,495 participants from the Age, Gene/Environment Susceptibility (AGES)-Reykjavik study with computed tomography measurements for VAT and LF. MetS was defined by ≥3 of the following: larger abdominal circumference, hypertension, elevated triglyceride (TG), low high-density lipoprotein (HDL), impaired fasting glucose (IFG), and microalbuminuria. We estimated the odds of MetS per 1-s.d. increase in VAT and LF, adjusting for key covariates. VAT was associated with an increased odds of MetS in normal weight, overweight, and obese women (odds ratios (OR) = 2.78, 1.63, and 1.43, respectively; all P < 0.01) that diminished in magnitude with increasing BMI (VAT × BMI class interaction P < 0.001). In men, VAT was related to MetS only among the overweight (OR = 1.69, P < 0.01). LF was associated with MetS in the overweight and obese groups in women (OR = 1.38 and 1.45; both P < 0.001) and in men (OR = 1.38, P = 0.01; and OR = 1.27, P = 0.10), but not in the normal weight groups. These BMI-specific relationships persisted when both fat depots were included in the model. VAT and LF were associated with MetS independently of each other, and these relationships were modified by BMI class such that, VAT was the more important depot at lower levels of obesity and LF at higher levels. Importantly, fatty liver may be a novel metabolic risk factor in overweight and obese individuals.     

First nationwide survey of prevalence of overweight, underweight, and abdominal obesity in Iranian adults

Objective: The goal was to estimate the prevalence of overweight, obesity, underweight, and abdominal obesity among the adult population of Iran. Research Methods and Procedures: A nationwide cross‐sectional survey was conducted from December 2004 to February 2005. The selection was conducted by stratified probability cluster sampling through household family members in Iran. Weight, height, and waist circumference (WC) of 89,404 men and women 15 to 65 years of age (mean, 39.2 years) were measured. The criteria for underweight, normal‐weight, overweight, and Class I, II, and III obesity were BMI <18.5, 18.5 to 24.9, 25 to 29.9, 30 to 34.9, 35 to 39.9, and ≥40 (kg/m²), respectively. Abdominal obesity was defined as WC ≥102 cm in men and ≥88 cm in women. Results: The age‐adjusted means for BMI and WC were 24.6 kg/m² in men and 26.5 kg/m² in women and 86.6 cm in men and 89.6 cm in women, respectively. The age‐adjusted prevalence of overweight or obesity (BMI ≥25) was 42.8% in men and 57.0% in women; 11.1% of men and 25.2% of women were obese (BMI ≥30), while 6.3% of men and 5.2% of women were underweight. Age, low physical activity, low educational attainment, marriage, and residence in urban areas were strongly associated with obesity. Abdominal obesity was more common among women than men (54.5% vs. 12.9%) and greater with older age. Discussion: Excess body weight appears to be common in Iran. More women than men present with overweight and abdominal obesity. Prevention and treatment strategies are urgently needed to address the health burden of obesity.     

Sex,Race/Ethnicity,Socioeconomic Status,and BMI in Relation to Self‐Perception of Overweight

Objective: To compare the self‐perception of overweight in the study population according to sex, race/ethnicity, and socioeconomic status and to compare the self‐perception of overweight among individuals classified as normal weight, overweight, and obese. Research Methods and Procedures: Data from 5440 adults who participated in the 1994 to 1996 Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey conducted by the U.S. Department of Agriculture were analyzed. Data for analysis included self‐perceived weight status, self‐reported weight and height, and demographic and socioeconomic data. Underweight individuals, defined as those with a body mass index <18.5 kg/m², were excluded from the analysis. Results: Self‐perception of overweight was more common in women compared with men and in whites compared with blacks or Hispanics. Both the correct and incorrect perception of overweight was more common in normal weight and overweight white women compared with black women. More overweight and obese white men correctly perceived their overweight status compared with black men. Multiple logistic regression showed that the odds ratio of perceived overweight was significantly higher in women, whites, and individuals with higher body mass index, higher income, and higher education. Discussion: Self‐perceived overweight varied by sex, race/ethnicity, and socioeconomic status. Erroneous perception of body weight may have important health and behavioral implications. In particular, a considerable proportion of overweight men may be at risk of obesity if they continue to perceive themselves as having normal weight.     

Geography of underweight and overweight among women in India: A multilevel analysis of 3204 neighborhoods in 26 states

We investigated the geographic distribution and the relationship with neighborhood wealth of underweight and overweight in India. Using multilevel modeling techniques, we calculated state-specific smoothed shrunken state residuals of overweight and underweight, neighborhood and state variation of nutritional status, and the relationships between neighborhood wealth and nutritional status of 76,681 women living in 3204 neighborhoods in 26 Indian states. We found a substantial variation in overweight and underweight at the neighborhood and state levels, net of what could be attributed to individual-level factors. Neighborhood wealth was associated with increased levels of overweight and decreased levels of underweight, and was found to modify the relationship between personal living standard and nutritional status. These findings suggest that interventions to address the double burden of undernutrition and overnutrition in India must take into account state and neighborhood characteristics in order to be successful.     

Stigmatized Students: Age,Sex, and Ethnicity Effects in the Stigmatization of Obesity

Objective: To assess the stigmatization of obesity relative to the stigmatization of various disabilities among young men and women. Attitudes across ethnic groups were compared. In addition, these findings were compared with data showing severe stigmatization of obesity among children. Research Methods and Procedures: Participants included 356 university students (56% women; mean age, 20.6 years; mean BMI, 23.3 kg/m²; range, 14.4 to 45.0 kg/m²) who ranked six drawings of same‐sex peers in order of how well they liked each person. The drawings showed adults with obesity, various disabilities, or no disability. These rankings were compared with those obtained through a similar procedure with 458 fifth‐ and sixth‐grade children. Results: Obesity was highly stigmatized relative to physical disabilities. African‐American women liked obese peers more than did African‐American men, white men, or white women [F (1, 216) = 4.02, p < 0.05]. Overweight and obese participants were no less stigmatizing of obesity than normal weight participants. Adults were more accepting than children of their obese peers [t (761) = 9.16, p < 0.001]. Discussion: Although the stigmatization of obesity was high among participants overall, African‐American women seemed to have more positive attitudes toward obesity than did white women, white men, or African‐American men. Participants’ weight did not affect their stigmatization of obesity: obese and overweight adults were as highly stigmatizing of obesity as non‐overweight adults. Such internalized stigmatization could help to explain the low self‐esteem and poor body image among obese young adults. However, adults seemed to have more positive attitudes about obesity than children. An understanding of the factors that limit the stigma of obesity among African‐American women could help efforts to reduce stigma.     

Elevated C-Reactive Protein in Children from Risky Neighborhoods: Evidence for a Stress Pathway Linking Neighborhoods and Inflammation in Children

Background

Childhood socioeconomic status is linked to adult cardiovascular disease and disease risk. One proposed pathway involves inflammation due to exposure to a stress-inducing neighborhood environment. Whether CRP, a marker of systemic inflammation, is associated with stressful neighborhood conditions among children is unknown.

Methods and Results

The sample included 385 children 5–18 years of age from 255 households and 101 census tracts. Multilevel logistic regression analyses compared children and adolescents with CRP levels >3 mg/L to those with levels ≤3 mg/L across neighborhood environments. Among children living in neighborhoods (census tracts) in the upper tertile of poverty or crime, 18.6% had elevated CRP levels, in contrast to 7.9% of children living in neighborhoods with lower levels of poverty and crime. Children from neighborhoods with the highest levels of either crime or poverty had 2.7 (95% CI: 1.2–6.2) times the odds of having elevated CRP levels when compared to children from other neighborhoods, independent of adiposity, demographic and behavioral differences.

Conclusions

Children living in neighborhoods with high levels of poverty or crime had elevated CRP levels compared to children from other neighborhoods. This result is consistent with a psychosocial pathway favoring early development of cardiovascular risk that involves chronic stress from exposure to socially- and physically-disordered neighborhoods characteristic of poverty.     

Obesity and Receipt of Clinical Preventive Services in Veterans

Although obese individuals utilize health care at higher rates than their normal weight counterparts, they may be less likely to receive certain preventive services. We conducted a retrospective cohort study of veterans with visits to 136 national Veterans Affairs (VA) outpatient clinics in the United States in the year 2000. The cohort included 1,699,219 patients: 94% men, 48% white, and 76% overweight or obese. Overweight and obese patients had higher adjusted odds of receiving each of the targeted clinical preventive services as recommended over 5 years compared with normal weight patients. The odds for receiving vaccinations increased linearly with BMI category: influenza (men: odds ratio (OR) = 1.13 for overweight to OR = 1.42 for obese class 3; women: OR = 1.15 for overweight to OR = 1.61 for obese class 3) and pneumococcus (men: OR = 1.02 for overweight to OR = 1.15 for obese class 3; women: OR = 1.08 for overweight to OR = 1.28 for obese class 3). The odds for receiving the cancer screening services typically peaked in the mild‐moderately obese categories. The highest OR for prostate cancer screening was in obese class 2 (OR = 1.29); for colorectal cancer, obese class 1 (men: OR = 1.15; women OR = 1.10); for breast cancer screening, obese class 2 (OR = 1.19); and for cervical cancer screening, obese class 2 (OR = 1.06). In a large national sample, obese patients received preventive services at higher, not lower, rates than their normal weight peers. This may be due to the VA health service coverage and performance directives, a more homogeneous patient demographic profile, and/or unmeasured factors related to service receipt.     

Sedentary behavior, recreational physical activity, and 7-year weight gain among postmenopausal U.S. women

Objective: To assess the relationship among recreational physical activity (PA), non‐occupational sedentary behavior, and 7‐year weight gain among postmenopausal U.S. women 40 to 69 years old. Research Methods and Procedures: In 1992 and 1999, 18,583 healthy female participants from the Cancer Prevention Study II Nutrition Cohort completed questionnaires on anthropometric characteristics and lifestyle factors. The associations between recreational PA [in metabolic equivalent (MET) hours per week] and non‐occupational sedentary behavior (in hours per day) at baseline and risk for 7‐year weight gain (5 to 9 or ≥10 vs. ±4 pounds) were assessed using multivariate logistic regression analysis. Results: Neither PA nor sedentary behavior was associated with a 5‐ to 9‐pound weight gain. Among women who were not overweight at baseline (BMI <25.0), the odds of ≥10‐pound weight gain were 12% lower (odds ratio, 0.88; 95% confidence interval, 0.77 to 0.99) for those in the highest category of recreational PA (≥18 MET h/wk) compared with >0 to <4 MET h/wk; odds were 47% higher (odds ratio, 1.47; 95% confidence interval, 1.21 to 1.79) for non‐overweight women who reported ≥6 h/d of non‐occupational sedentary behavior compared with <3 h/d. Neither PA nor sedentary behavior were associated with risk of ≥10‐pound weight gain weight among women who were overweight at baseline (BMI ≥25.0). Discussion: Both recreational PA and non‐occupational sedentary behavior independently predicted risk of ≥10‐pound weight gain among postmenopausal women who were not overweight at baseline. Public health messages to prevent weight gain among normal‐weight postmenopausal women may need to focus on decreasing time spent in sedentary behaviors and increasing the amount of time spent on PA.     

Discrimination of Health Risk by Combined Body Mass Index and Waist Circumference

Objective: NIH Clinical Guidelines (1998) recommend the measurement of waist circumference (WC, centimeters) within body mass index (BMI, kilograms per square meter) categories as a screening tool for increased health risk. Research Methods and Procedures: The Canada Heart Health Surveys (1986 through 1992) were used to describe the prevalence of the metabolic syndrome in Canada and to test the use of the NIH guidelines for predicting metabolic risk factors. The sample included 7981 participants ages 20 to 74 years who had complete data for WC, BMI, high‐density lipoprotein‐cholesterol, triglycerides, diabetic status, and systolic and diastolic blood pressures. National Cholesterol Education Program Adult Treatment Panel III risk categories were used to identify the metabolic syndrome and associated risk factors. Logistic regression was used to test the hypothesis that WC improves the prediction of the metabolic syndrome, within overweight (25 to 29.9 kg/m²) and obese I (30 to 34.9 kg/m²) BMI categories. Results: The prevalence of the metabolic syndrome was 17.0% in men and 13.2% in women. The odds ratios (OR) for the prediction of the metabolic syndrome were elevated in overweight [OR, 1.85; 95% confidence interval (95%CI), 1.02 to 3.35] and obese (OR, 2.35; 95%CI, 1.25 to 4.42) women with a high WC compared with overweight and obese women with a low WC, respectively. On the other hand, WC was not predictive of the metabolic syndrome or component risk factors in men, within BMI categories. Discussion: In women already at increased health risk because of an elevated BMI, the additional measurement of WC may help identify cardiovascular risk.     

Health perceptions and demographic characteristics associated with underassessment of body weight

Objectives: To describe the relationship between BMI and perceived weight status and to determine how underassessment of weight status is associated with demographic characteristics, self‐reported general health, and perceived health risk in relation to one's body weight. Methods and Procedures: In the 2004 Styles surveys, 3,888 US adult participants described their current weight status (underweight, about right, slightly overweight, very overweight), which we compared with self‐reported BMI in order to determine concordance. We used multivariable logistic regression to evaluate associations between underassessment of body weight and characteristics of interest. Results: Among persons with a BMI ≥25, women were more likely than men to recognize their overweight status (slightly or very overweight; 93.0% of women vs. 73.5% of men) and the extent to which they were overweight: 70.4% of obese women vs. 49.5% of obese men described themselves as very overweight. Among the overweight and obese of both sexes, disagreement with regard to current weight as a health risk was associated with underassessment of weight. Additional factors associated with underassessment were education and race/ethnicity among overweight women; race/ethnicity among overweight men; household income and self‐rated health among obese women; and self‐rated health among obese men (P < 0.05). Discussion: While most of the obese participants recognized that they were overweight, many of them, particularly among the men, did not realize the extent to which they were overweight. Public health messages may be more effective if they are specifically tailored to target audiences, besides emphasizing the health risks associated with excess body weight.     

Age-variability in body shape associated with excess weight: the UK National Sizing Survey

Background: The health risks of obesity are disproportionately due to central abdominal adiposity; however, the extent to which age is associated with the body shape of obese adults is not known. Objective: Three‐dimensional (3D) data on body shape from the UK National Sizing Survey were analyzed to investigate age‐associated changes in body shape within the BMI bands <20, 20–24.99, 25–29.99 and ≥30 kg/m². Methods: Measurements of anthropometry (weight and height) and a 3D body scan were obtained in 4,344 men and 5,266 women recruited from eight British cities. Results: The body shape of men showed high consistency within BMI bands between early adulthood and old age. In contrast, the body shape of women altered within each BMI band with increasing age. In obese, overweight, and normal weight women, age was associated with decreased thigh girth, increased waist, and bust girth. Whereas young obese women maintained an hourglass shape, in old age the body shape of obese women converged on that of obese men. Discussion: The association of age with body shape is markedly different between the sexes, with the impact of obesity on shape strongly age‐dependent in women but not in men. The age delay in the association between obesity and high waist girth in women may contribute to the sex‐difference in life expectancy. The relationship between body shape change and cardiovascular risk merits longitudinal investigation within individuals.     

Evidence of a Double Burden of Malnutrition in Urban Poor Settings in Nairobi,Kenya

Background

Many low- and middle-income countries are undergoing a nutrition transition associated with rapid social and economic transitions. We explore the coexistence of over and under- nutrition at the neighborhood and household level, in an urban poor setting in Nairobi, Kenya.

Methods

Data were collected in 2010 on a cohort of children aged under five years born between 2006 and 2010. Anthropometric measurements of the children and their mothers were taken. Additionally, dietary intake, physical activity, and anthropometric measurements were collected from a stratified random sample of adults aged 18 years and older through a separate cross-sectional study conducted between 2008 and 2009 in the same setting. Proportions of stunting, underweight, wasting and overweight/obesity were dettermined in children, while proportions of underweight and overweight/obesity were determined in adults.

Results

Of the 3335 children included in the analyses with a total of 6750 visits, 46% (51% boys, 40% girls) were stunted, 11% (13% boys, 9% girls) were underweight, 2.5% (3% boys, 2% girls) were wasted, while 9% of boys and girls were overweight/obese respectively. Among their mothers, 7.5% were underweight while 32% were overweight/obese. A large proportion (43% and 37%%) of overweight and obese mothers respectively had stunted children. Among the 5190 adults included in the analyses, 9% (6% female, 11% male) were underweight, and 22% (35% female, 13% male) were overweight/obese.

Conclusion

The findings confirm an existing double burden of malnutrition in this setting, characterized by a high prevalence of undernutrition particularly stunting early in life, with high levels of overweight/obesity in adulthood, particularly among women. In the context of a rapid increase in urban population, particularly in urban poor settings, this calls for urgent action. Multisectoral action may work best given the complex nature of prevailing circumstances in urban poor settings. Further research is needed to understand the pathways to this coexistence, and to test feasibility and effectiveness of context-specific interventions to curb associated health risks.     

Work‐Related Physical Activity Is Not Associated with Body Mass Index and Obesity

Objective: To analyze the association of work‐related physical activity (WRPA) and leisure‐time physical activity (LTPA) with body mass index (BMI) and obesity in the Spanish adult population aged 20 to 60 years. Research Methods and Procedures: The data were taken from the 1993 Spanish National Health Survey. We analyzed a sample of 12,044 men and women representative of the Spanish population aged 20 to 60 years. BMI and frequency of obesity (BMI ≥ 30 kg/m²) were obtained from self‐reported weight and height. Multiple linear regression and logistic regression models were constructed, adjusting for the main confounding factors. WRPA and LTPA were measured by two questions to classify subjects into four categories of physical activity. Results: Neither mean BMI nor percentage of obesity varied significantly (p > 0.05) by WRPA. Mean BMI was significantly higher (p < 0.01) in those who were inactive in their leisure time (25.90 kg/m² in men and 24.43 kg/m² in women) than in those who reported vigorous activity (24.42 kg/m² and 22.97 kg/m² in men and women, respectively). The odds ration (OR) for obesity decreased with increasing level of LTPA in both men (OR of 0.64 for vigorous activity) and women (OR = 0.68), showing a statistically significant dose‐response relation in both men (for linear trend, p = 0.0021) and women (p = 0.0245). Discussion: These results raise questions about the association between WRPA and obesity and suggest the need to reexamine models of the obesity epidemic that point to automation of the workplace as one of the major explanatory factors.