Socioeconomic inequalities in the prevalence of underweight, overweight, and obesity among women aged 20\u201349 in low- and middle-income countries

Ursula Reyes Matos,Marilia Arndt Mesenburg,Cesar G Victora

doi:10.1038/s41366-019-0503-0

Ursula Reyes Matos, Marilia Arndt Mesenburg + Show 1 more

Open Access

https://doi.org/10.1038/s41366-019-0503-0

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Abstract

ObjectiveTo analyze socioeconomic inequalities in the prevalence of underweight and overweight or obesity in women from low and middle-income countries (LMICs).MethodsUsing the last available Demographic Health Survey between 2010 and 2016 from 49 LMICs, we estimated the prevalence of underweight (BMI < 18.5 kg/m2) and overweight or obesity combined (BMI ≥ 25 kg/m2) for women aged 20–49 years. We used linear regression to explore the associations between the two outcomes and gross national income (GNI). We assess within-country socioeconomic inequalities using wealth deciles. The slope index of inequality (SII) and the inequality pattern index (IPI) were calculated for each outcome. Negative values of the latter express bottom inequality (when inequality is driven by the poorest deciles) while positive values express top inequality (driven by the richest deciles).ResultsIn total, 931,145 women were studied. The median prevalence of underweight, overweight or obesity combined, and obesity were 7.3% (range 0.2–20.5%), 31.5% (8.8–85.3%), and 10.2% (1.9–48.8%), respectively. Pearson correlation coefficients with log GNI were −0.33 (p = 0.006) for underweight, 0.72 (p < 0.001) for overweight or obesity, and 0.66 (p < 0.001) for obesity. For underweight, the SII was significantly negative in 38 of the 49 countries indicating a higher burden among poor women. There was no evidence of top or bottom inequality. Overweight or obesity increased significantly with wealth in 44 of the 49 countries. Top inequality was observed in low-prevalence countries, and bottom inequality in high-prevalence countries.ConclusionUnderweight remains a problem among the poorest women in poor countries, but overweight and obesity are the prevailing problem as national income increases. In low-prevalence countries, overweight or obesity levels are driven by the higher prevalence among the richest women; as national prevalence increases, only the poorest women are relatively preserved from the epidemic.

Highlights

The spectrum of malnutrition includes both undernutrition and overweight or obesity [1]
In addition to the persisting problem of underweight, many low- and middle-income countries (LMICs) are showing the increasing prevalence of overweight or obesity among adults, similar to what is observed in high-income countries [3]
In addition to describing the magnitude of socioeconomic inequalities using summary indices, we report on the inequality pattern index, that is, on whether such inequalities are being primarily driven by the poorest or richest groups of women [17]

Summary

Introduction

The spectrum of malnutrition includes both undernutrition (for example, low body mass index or BMI) and overweight or obesity [1]. * Ursula Reyes Matos reyes.ursula@gmail.com 1 International Center for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, Pelotas, Rio Grande do Sul, Brazil the conditions representing these two extremes of the malnutrition spectrum vary according to socioeconomic position in women living in low- and middle-income countries (LMICs). Underweight affects around 462 million adults [1], representing a serious problem among reproductive age women for their own health and for the health and nutrition of their offspring. In addition to the persisting problem of underweight, many LMICs are showing the increasing prevalence of overweight or obesity among adults, similar to what is observed in high-income countries [3].

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