Abstract
BackgroundSocial inequalities in obesity have been observed not only by gender but also between ethnic groups. Evidence on combined dimensions of inequality in health, and specifically including indigenous populations, is however scarce, and presents a particularly daunting challenge for successful prevention and control of obesity in Bolivia, as well as worldwide.ObjectiveThe aims of this study were i) to examine intersectional inequalities in obesity and ii) to identify the factors underlying the observed intersectional inequalities.MethodsAn intersectional approach study was employed, using the information collected in a cross-sectional community-based survey. The sample consisted of youth and adults with permanent residence in Cochabamba department (N = 5758), selected through a multistage sampling technique. An adapted version of the WHO-STEPS survey was used to collect information about Abdominal obesity and risk factors associated. Four intersectional positions were constructed from gender (woman vs. men) and ethnic group (indigenous vs. mestizo). Joint and excess intersectional disparities in obesity were estimated as absolute prevalence differences between binary groups, using binomial regression models. The Oaxaca-Blinder decomposition was applied to estimate the contributions of explanatory factors underlying the observed intersectional disparities, using Oaxaca command in Stata software v15.1.ResultsThe prevalence of abdominal obesity had a higher prevalence in mestizos (men 35.01% and women 30.71%) as compared to indigenous (men 25.38% and women 27.75%). The joint disparity was estimated at 7.26 percentage points higher prevalence in the doubly advantaged mestizo men than in the doubly disadvantaged indigenous women. The gender referent disparity showed that mestizo-women had a higher prevalence than indigenous-women. The ethnic referent disparity showed that mestizo-men had a higher prevalence than indigenous men. The behavioural risk factors were the most important to explain the observed inequalities, while differences in socioeconomic and demographic factors played a less important role.ConclusionOur study illustrates that abdominal obesity is not distributed according to expected patterns of structural disadvantage in the intersectional space of ethnicity and gender in Bolivia. In the Cochabamba case, a high social advantage was related to higher rates of abdominal obesity, as well as the behavioural risk factors associated with them.
Highlights
Social inequalities in obesity have been observed by gender and between ethnic groups
This applies to many Latin American countries, which over the last decade have experienced a remarkable increase in obesity, presumably associated to changes in lifestyle and demographics as nations transition from low-income to middle-income countries [1,2,3]
Despite that the dually disadvantaged group of indigenous women displayed lower obesity than the dually advantaged mestizo men; our findings showed that they still had higher obesity prevalence than we might expect from the fact that they were women on the one hand, and of ethnic disadvantage on the other, both facets of social disadvantage by themselves being protective against obesity
Summary
Social inequalities in obesity have been observed by gender and between ethnic groups. The increase in obesity has affected women more than men in Bolivia and in other Latin American countries [1, 4, 7, 8, 10]. These gender inequalities have been attributed to biological [11, 12], behavioral and social conditions, such as higher level of physical activity among men [7, 13], unemployment among women [14, 15], and the influence of gender roles in the choice of occupation [16, 17]. Obesity seems to be affecting more mestizo (people of mix European and Amerindian descendants) than indigenous [18,19,20,21]
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