Abstract
BackgroundAs obesity increases, middle-income countries are undergoing a health-risk transition. We examine the association between socioeconomic status (SES) and emerging obesity in Thailand, and ascertain if an inverse relationship between SES and obesity has appeared.MethodsThe data derived from 87 134 individuals (54% female; median age, 29 years) in a national cohort of distance-learning Open University students aged 15–87 years and living throughout Thailand. We calculated adjusted odds ratios for associations of SES with obesity (body mass index, ≥25) across 3 age groups by sex, after controlling for marital status, age, and urbanization.ResultsObesity increased with age and was more prevalent among males than females (22.7% vs 9.9%); more females were underweight (21.8% vs 6.2%). Annual income was 2000 to 3000 US dollars for most participants. High SES, defined by education, income, household assets, and housing type, associated strongly with obesity—positively for males and inversely for females—especially for participants younger than 40 years. The OR for obesity associated with income was as high as 1.54 for males and as low as 0.68 for females (P for trend <0.001).ConclusionsOur national Thai cohort has passed a tipping point and assumed a pattern seen in developed countries, ie, an inverse association between SES and obesity in females. We expect the overall population of Thailand to follow this pattern, as education spreads and incomes rise. A public health problem of underweight females could emerge. Recognition of these patterns is important for programs combating obesity. Many middle income countries are undergoing similar transitions.
Highlights
Worldwide, obesity has shown contrasting socioeconomic associations in 144 studies reported from 1933 to 1988
Jeffery proposed that the obesity risk for those with low socioeconomic status (SES) in developed countries reflects both economic discrimination and economic deprivation: obese persons are restricted in social advancement and the poor resort to cheap high-calorie foods and spend less on recreational exercise.[4]
This study investigates the relationship between SES and obesity in Thailand
Summary
Obesity has shown contrasting socioeconomic associations in 144 studies reported from 1933 to 1988. SES and Obesity in Thailand an income threshold at which obesity in developing countries “tips” from a direct to an inverse relationship with SES has been suggested, and evidence indicates that this threshold may be lower for women. This tipping point may due, in part, to the fact that opportunities for occupational exercise decline at a certain level of economic development, which may initially affect poor urban women when average incomes reach approximately US$2500 per capita.[5] It could reflect the differential effects of education for men and women, as women convert health and nutritional knowledge into behavioral change earlier than their male counterparts. We report the differential effects of increasing SES on males and females in different age groups, noting any evidence of an income tipping point for the SES–obesity relationship
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