Socioeconomic inequality in excessive body weight in Indonesia

Exploiting the Indonesian Family Life Survey (IFLS), this paper studies the transition of socioeconomic-related excess weight disparity, including overweight and obesity, from 1993 to 2014. First, we show that the proportions of overweight and obese people in Indonesia increased rapidly during the time period covered and that poorer groups exhibited a larger annual excess weight growth rate than richer groups (7.49 percent vs. 3.01 percent). Second, by calculating the concentration index, we confirm that the prevalence of obesity affected increasingly poorer segments of Indonesian society. Consequently, the concentration index decreased during the study period, from 0.287 to 0.093. Finally, decomposing the change in the concentration index of excess weight from 2000 to 2014, we show that a large part of the change can be explained by a decrease in the elasticity of wealth and improved sanitary conditions in poorer households. Overall, obesity in Indonesia no longer affects purely the wealthier segments of the population but the entire socioeconomic spectrum.     

The income body weight gradients in the developing economy of China

Existing theories predict the income gradient of individual body weight to change sign from positive to negative in process of economic development. However, there are only few empirical studies which test this hypothesis. This paper adds to the literature on that topic by investigating the case of China. Using individual and community data from 1991 to 2009 waves of the China Health and Nutrition Survey regression analyses suggest that after controlling for important confounding factors (1) higher income is positively related to future growth of individuals’ BMI in less developed areas (i.e. BMI growth is 0.7–1.5 percentage points higher when comparing the richest with the poorest individuals), but negatively related to BMI growth in more developed areas (i.e. BMI growth is 0.8–1.6 percentage points lower for the richest individuals), and (2) that concentrations of overweight are “trickling down” to lower income ranks as regions become more developed. Moreover, the reversal of the income gradient appears to happen at earlier stages of development for females.     

Transitioning to an obese India: Demographic and structural determinants of the rapid rise in overweight incidence

India, which has long suffered from undernutrition, has seen a rapid rise in overweight incidence in the last decade and a half. These changes are characterized by significant within-country differences in overweight incidence that vary by gender and regional development levels. In this paper, we provide an integrative framework, linking the income-gradient hypothesis of obesity with biological, obesogenic, and environmental factors to provide an explanation on the emergence of within-country differences in overweight patterns. We utilize measured body mass index (BMI), along with individual- and household-level data of over 800,000 men and women surveyed in the National Family Health Surveys of 2005–06 and 2015–16 to identify correlates of within-country differences in overweight incidence. A decomposition analysis reveals that among women, in addition to increasing access to obesogenic technologies, biological factors are associated with overweight incidence. Among men, obesogenic factors related to technology use and health behaviors are associated with the rise in overweight incidence, but biological factors are not. At lower levels of regional development, overweight incidence is associated with greater access to obesogenic technology such as motorized transport, which reduces physical activity among men at higher rates than women. At higher levels of economic development, obesogenic behaviors, such as watching more television and reducing smoking, are associated with overweight incidence. Our results corroborate the call by public health experts for group-specific policies to stem the rise of overweight incidence in developing countries.     

Urbanization and the spread of diseases of affluence in China

We quantify, track and explain the distribution of overweight and of hypertension across Chinese provinces differentiated by their degree of urbanicity over the period 1991–2004. We construct an index of urbanicity from longitudinal data on community characteristics from the China Health and Nutrition Survey and compute, for the first time, a rank-based measure of inequality in disease risk factors by degree of urbanicity. Prevalence rates of overweight and hypertension almost doubled between 1991 and 2004 and these disease risk factors became less concentrated in more urbanized areas. Decomposition analysis reveals that one-half of the urbanicity-related inequality in overweight is directly attributable to community level characteristics, while for hypertension the contribution of such characteristics increased from 20% in 1991 to 62% in 2004. At the individual level, lower engagement in physical activity and farming explain more than half of the urban concentration of overweight and a rising share (28%) of the greater prevalence of hypertension in more urbanized areas. Higher incomes explain around one-tenth of the urban concentration of both overweight and hypertension, while the education advantage of urban populations has a similar sized offsetting effect.