Abstract
Low-and middle-income countries (LMICs) are experiencing a nutritional transition in which the burden of obesity tends to shift towards the lower-socioeconomic status (SES) group. We propose a system dynamics (SD) model for assessing the nutritional stage dynamics of the Colombian urban population by age and SES projected to 2030. This SD model captures the ageing population according to body mass index (BMI) categories and SES. In this model, the transference rates (TRs) between BMI categories by age and SES are estimated using a heuristic based on data obtained from national surveys. The simulation results show that the Colombian population, particularly those aged 20 to 39 years with a lower SES, is moving towards the overweight and obese categories. The TRs for overweight and obese categories in the lower SES group (the mean TR from not overweight to overweight = 0.0215 (per year) and mean TR from overweight to obese = 0.0098 (per year)) are increasing more rapidly than the those in the middle (the mean TR from not overweight to overweight = 0.0162 (per year) and mean TR from overweight to obese = 0.0065 (per year)) and higher SES groups (the mean TR from not overweight to overweight = 0.0166 and mean TR from overweight to obese = 0.0054 (per year)). Additionally, from 2005 to 2010, individuals aged 20 to 39 years had the highest TRs towards the overweight and obese categories (from 0.026 to 0.036 per year and from 0.0064 to 0.012 per year, respectively). The TRs also indicated that children aged 0 to 14 years are moving from the obese to overweight and from the overweight to not overweight categories. These TRs show that the Colombian population is experiencing an SES-related nutritional transition that is affecting the lower SES population. The proposed model could be implemented to assess the nutritional transitions experienced in other LMICs.
Highlights
Obesity is a major public health problem worldwide [1,2]
The retention rates of individuals by body mass index (BMI) category and age group i (α1,i, α2,i, and α3,i), which correspond to the fractions of individuals who remain in the same BMI category between 2005 and 2010, were closed to 1
Notable are the transference rates (TRs) from not overweight to overweight and from overweight to obese for individuals aged 20 to 39 years in the lowest socio-economic status (SES) group, which are increasing more rapidly than the corresponding TRs for the other age and SES groups. These findings provide evidence that Colombian adults are experiencing a nutritional transition that is highly dependent on the SES, which suggest that policy interventions should be differentiated
Summary
Obesity is a major public health problem worldwide [1,2]. according to a recent policy report in 2010, a high body mass index (BMI) was the sixth leading risk factor for premature death and disability [3]. The global mortality trends projected by the World Health Organization (WHO) predict that an increase in the total death rate by 2030 primarily due to non-communicable diseases (NCDs), cancers and cardiovascular diseases and predominantly in low- and middle-income countries (LMICs) [4]. LMICs are currently experiencing a nutritional transition in which the burden of obesity is shifting towards those with a lower socio-economic status (SES) [5,6,7]. In contrast to pre-1989 studies, which positively linked obesity with a high SES in LMICs but with a low SES in high-income countries (HICs) [8], recent research suggests that obesity in LMICs is not solely a disease of higher SES groups. Obesity, in women, tends to transition towards the lower-SES population as a country’s gross national product (GNP) increases [5,6]
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