Aitsi-Selmi, A; (2013) Is the social gradient of female obesity in lower income settings reversing and why? An investigation into the association between wealth, education and obesity. Doctoral thesis , UCL (University College London).

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Abstract

Female levels of obesity in low- and middle-income countries (LMICs) are rising. Obesity prevalence has been the greatest in high socio-economic status (SES) groups, but recent evidence suggests a changing pattern with the prevalence of obesity rising rapidly among lower SES groups and exceeding the former - a reversal of the social gradient of obesity. However, inconsistencies in the gradient by SES indicator have put the reversal into question. Using nationally representative surveys, the thesis: 1) examines the time variation in the SES-obesity association splitting SES into two components; and 2) tests the hypothesis that education protects against the obesogenic effects of improved material circumstances through cognitive skills and their influence on media exposure and dietary behaviour. Egypt (~40% female obesity prevalence) is investigated using Demographic and Health Surveys data. Changes in the SES-obesity association over the period 1992-2008 are examined including the separate and joint effects of education and material circumstances on obesity. Then, Egypt is compared with countries of different levels of economic development: Benin, Nigeria, India, Jordan, Peru, Colombia (DHS data) and China (Four-Provinces survey data). Finally, literacy, TV exposure and sweet snack use are investigated as mediators. All estimates are adjusted for age group, area of residence, and number of children using multivariate logistic regression. The findings showed variation over time and by country consistent with the reversal of the social gradient. Education significantly modified the association between material circumstances and obesity at middle levels of country income. There was evidence that literacy and TV exposure may mediate this inter-relationship but the study power limited inferences on dietary behaviour. The findings support the possibility that education drives the reversal of the social gradient of female obesity and that cognitive skills may be more important than material circumstances in preventing female obesity. Thus, investments in education could be viewed as preventive medicine.

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