Body Mass Index Gap Research Articles

Trends in overall and abdominal obesity among Korean adults, 2007-2022: an Age-period-cohort analysis

Abstract Overall and abdominal obesity, often defined as having high body mass index (BMI) and waist circumference (WC), are associated with an increased risk of chronic disease. A comprehensive understanding of trends and contributing factors is necessary to reduce the disease burdens. This study investigated the nationwide trends and independent effects of age, period, and birth cohort on BMI and WC in Korean adults. We conducted hierarchical age-period-cohort (cross-classified random-effects models) analyses using measured BMI and WC data from 85,292 Korean adults (aged ≥19) in the Korea National Health and Nutrition Examination Survey 2007-2022. We also examined whether the age, period, and cohort effects varied by socioeconomic subgroups. In 2007-2022, the age-standardized mean BMI (23.6 to 24.2 kg/m2) and WC (81.7 to 83.5 cm) increased in the overall population. An upward trend was evident among men, while only a slight change was observed in women. The mean BMI was highest at age 47 (25.1 kg/m2) in men and age 60 (24.2 kg/m2) in women and it decreased at older ages. Controlling for age and period effects, mean BMI was lowest among the birth cohorts of 1960-1964 (24.15 kg/m2), with the highest mean BMI observed among the birth cohorts of 1919-1939 (24.97 kg/m2) and 1990-2003 (24.99 kg/m2). The mean WC was highest at age 55 (88.0 cm) in men and age 79 (83.4 cm) in women. Similar U-shaped birth cohort effect was observed with WC, with the lowest mean observed among the birth cohorts of 1960-1964 [82.92 (0.30)]. At most age, period, and birth cohorts, mean BMI and WC were consistently higher among adults at lower income and education. The overall period effect was consistently found in all socioeconomic subgroups, but the gap in BMI between income and education subgroups widened over time. Our findings suggest that BMI and WC slightly increased in overall Korean adults in 2007-2022, with some inequalities among age, sex, birth cohort, and socioeconomic subgroups. Key messages • The obesity indices increased from 2007 to 2022, but the cohort effect on BMI and WC showed a U-shaped pattern with the lowest mean among birth cohorts of 1960-1964. • The obesity prevalence is varied by socioeconomic status, suggesting that more intense interventions may be needed to target the susceptible groups.

Abstract 04: Intersectional Inequities in Obesity Among Multiracial Adults by Urbanicity: A Random Effects MAIHDA Analysis

Based on 2020 Census Bureau data, the percentage of people who reported multiple races changed more than all of the race alone groups, increasing from 2.9% of the population (9 million people) in 2010 to 10.2% of the population (33.8 million) in 2020. Yet, the majority of national health surveys aggregate all individuals who identify with multiple races into one heterogeneous group. We hypothesize this aggregation masks important differences in terms of health. Beyond the aggregation, there are multiple dimensions of race/ethnicity including racial self-identification (the race(s) one identifies with), racial category (the census category one selects), Hispanic ethnicity, and others that do not ideally overlap among multiracial adults. For multiracial adults, it is unknown how these multiple contexts of race and ethnicity intersect with one another. We evaluated the intersection of racial self-identification, racial category, and Hispanic ethnicity on body mass index (BMI) among multiracial adults as a second-level social identity strata. We then examined if these intersectional inequities in BMI were differently patterned in urban, suburban, and rural areas. We used multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) among multiracial adults in the US (n=42,632) with a three-year (2010-2012) pooled sample of the Behavioral Risk Factor Surveillance System (BRFSS). We observed intersectional effects on BMI inequities. Most of the effects of social identity on BMI were explained by the combination of racial self-identification, racial category, and Hispanic ethnicity among multiracial adults (85.3%). Those living in a rural area had considerably higher BMIs than those living in an urban or suburban area. This is especially true for individuals with racial self-identification of White-Black, White-Native Hawaiian/Pacific Islander (NHPI), Black-American Indian/Alaska Native (AIAN), Asian-NHPI, and White-Black-AIAN and those who chose the racial category of NHPI. For example, individuals who self-identified as White-Black had an average BMI 4.5 kg/m 2 (p<0.01) higher in rural areas compared to White-Blacks living in urban areas. The magnitude of this BMI gap across urban-rural environments varied considerably across social identity strata ranging from 35.3 kg/m 2 among Non-Hispanic White-Black-AIAN with no preference for one race to 22.5 kg/m 2 among Non-Hispanic White-Asian with no preference for one race. This study highlights aspects of the social construction of race and patterning across the urban-rural divide in evaluation of BMI/obesity. This study brings to light inequities within people who identify as multiracial and highlights sub-populations to focus future policy and intervention research on.

A synergistic impact of body mass index and gamma gap on heart failure and mortality rate among older patients with coronary artery disease: a prospective study with 10-year follow-up

PurposeThis prospective study with 10-year follow-up aimed to analyze potential impact of body mass index (BMI) and gamma gap on heart failure and mortality rate in older patients with coronary artery disease (CAD).MethodsThere were 987 consecutive older patients with CAD included and divided into four groups according to BMI and gamma gap levels.ResultsMedian age was 86 years. The highest proportion of heart failure (46.2%) and the highest mortality rate (84.4%) was observed in patients with low BMI and high gamma gap, whereas the lowest proportion of heart failure (18.9%) and the lowest mortality rate (62.9%) was observed in those with high BMI and low gamma gap. After full adjustment in multivariate Logistic regression analysis, heart failure was most common in patients with low BMI and high gamma gap compared with those with high BMI and low gamma gap (hazard ratio [HR]: 2.82, 95% confidence interval [CI]: 1.79–4.48, P < 0.05). Meanwhile, multivariate Cox regression analysis showed that mortality rate was the highest in those with low BMI and high gamma gap compared with patients with high BMI and low gamma gap (HR: 1.65, 95% CI: 1.32–2.07, P < 0.05).ConclusionThe combination of low BMI and high gamma gap could further promote heart failure and increase mortality rate in older patients with CAD. Future studies should explore the underlying mechanisms linking low BMI, high gamma gap, and mortality rate, as well as the potential benefits of nutritional and immunological interventions to improve health prognosis in older patients with CAD.

Early-life stress and current stress predict BMI and height growth trajectories in puberty.

In cross-sectional analyses, early institutional care is associated with shorter stature but not obesity during puberty in children adopted into US families. We examined whether shorter stature and leaner body composition in youth adopted internationally from institutions would continue as puberty progressed. We also examined whether current psychosocial stress would moderate the association between early institutional deprivation and growth during adolescence. Using an accelerated longitudinal design and linear mixed-effects models, we examined the height and body mass index (BMI) of 132 previously institutionalized (PI) and 176 nonadopted (NA) youth. We examined youth aged 7-15 at the beginning of the study three times across 2 years. Nurses assessed anthropometrics and pubertal status. Current psychosocial stress was measured using the Youth Life Stress Interview. Our results indicated that PI youth remained shorter and leaner across three assessments than NA youth. However, age-and-sex-adjusted BMI increased faster in PI youth. Psychosocial stress during puberty predicted greater age-and-sex-adjusted BMI, but this effect did not differ by group. The gap in BMI but not height appears to close between PI and NA youth. Higher psychosocial stress was associated with higher BMI during puberty.

Contribution of sociodemographic determinants in explaining the nutritional gap between the richest-poorest women of Bangladesh: A decomposition approach.

Malnutrition among women disproportionately exists across socioeconomic classes of Bangladesh. According to our knowledge, studies which attempted to identify determinants and their contributions to explain BMI-based nutritional gap between the poorest and the richest categories of Wealth Index are still scarce. To identify the nutritional gap of women between the richest-poorest classes in Bangladesh, and to determine how much of this gap are attributed to differences in predictors and differences in coefficients. Reproductive-aged (15-49 years) women of Bangladesh. We utilized the latest round (2017-2018) data of the Bangladesh Demographic and Health Survey (BDHS). Body mass index (BMI) has been used to measure the nutritional status of women. The kernel density was used to visualize the nutritional gap. The Oaxaca-Blinder (OB) decomposition method was used to ascertain influential determinants and their contributions to the existing gap between the richest-poorest classes of women. We analyzed the data of 18,682 reproductive-aged women. There was a significant mean BMI gap of 4.1 unit (95% CI: 3.90-4.35) between the poorest-richest (25.6 vs 21.5) women. The overall prevalence of underweight, overweight and obese were 11.8%, 33.8% and 15.4%, respectively. The richest women were less underweight (7.5%) but more overweight (23.7%) and obese (42.2%). In contrast, the poorest women were more underweight (32.0%) but less overweight (13.9%) and obese (7.0%). According to results of OB decomposition method, all predictors combinedly can explain 1.62 units (95% CI: 1.31-1.93) of the total mean BMI gap (equivalent to 40%). Some of the major predictors were women years of education (0.45 units, 95% CI: 0.27-0.64), spouse years of education (0.16 units, 95% CI: -0.02-0.34), current working status (0.17 units, 95% CI: 0.10-0.34), access to Television (0.50 units, 95% CI: 0.28-0.72), and place of residence (0.37 units, 95% CI: 0.22-0.72). The unexplained part of the poorest-richest gap was 2.51 units (95% CI: 2.13-2.89), which means that this particular gap will remain unchanged even though the mean difference of the predictors was diminished. A large part of the nutritional gap (approximately 60%) between the poorest and richest classes of women are found to be unchanged by the predictors of the study. Therefore, further predictors should be identified to minimize such gap. Moreover, policy makers and relevant stakeholders should implement feasible strategies to minimize the existing differences in the major predictors.

Parental Education or Household Income? Which Socioeconomic Status Indicator Can Better Reduce Body Mass Index Disparities among Latino Children?

We compared the effects of parental education and household income on children's body mass index (BMI) in Hispanic White (HW) and non-Hispanic White (NHW) families. In this cross-sectional study, we borrowed data from the Adolescent Brain Cognitive Development (ABCD) study and analyzed data of 5100 children between the ages of 9 and 10. The independent variables were parental education and household income. The primary outcome was BMI value. Ethnicity was the moderating variable. Confounders were age, sex, and family structure. Three mixed-effects regression models were used for data analysis. Overall, higher parental education and household income were associated with lower BMI levels in children. While an interaction was found between ethnicity and parental education, no interaction was noted between ethnicity and household income regarding BMI. The interaction indicated weaker protective effects of high parental education on BMI in HW children than NHW children. Household income showed similar protective effects on children's BMI in HW and NHW families. Parental education but not household income loses some of its protective effects on childhood BMI among HW families compared to NHW families. Distal social determinants of health may be more vulnerable to the MDRs (minorities' diminished returns) than proximal ones. As a result, closing the income gap may be a good strategy towards closing the childhood BMI gap between highly educated HW and NHW families. Policies that raise the minimum wage and those that help HW families save money (e.g., earned income tax policies) maybe more promising strategies to eliminate the ethnic gap in BMI than increasing the education level of ethnic minority families.

EXAMINING CUMULATIVE INEQUALITY IN THE ASSOCIATION BETWEEN CHILDHOOD SES AND BMI FROM MIDLIFE TO OLD AGE

Socioeconomic status (SES) is among the strongest determinants of body mass index (BMI). For older populations, selection bias is a large barrier to assessing cumulative disadvantages. We investigated the extent to which childhood SES affects BMI from midlife to old age and gender differences in the association. Data come from Midlife in the U.S. We used latent growth models to estimate BMI trajectory over a period of 20 years and examined results under different missing data patterns. Compared to individuals from higher childhood SES, those from lower childhood SES have higher BMI in midlife and experience a faster increase in BMI between midlife and old age. The observed associations remain significant even after controlling for midlife SES. After addressing nonrandom selection, the gap in BMI between high and low childhood SES widens from midlife to old age for women. The findings provide new evidence of cumulative inequality among older adults.

Examining Cumulative Inequality in the Association Between Childhood Socioeconomic Status and Body Mass Index From Midlife to Old Age.

Socioeconomic status (SES) is among the strongest determinants of body mass index (BMI), particularly for women. For older populations, selection bias due to attrition is a large barrier to assessing the accumulation of inequality. Under multiple missing data mechanisms, we investigated the extent to which childhood and midlife SES affects BMI from midlife to old age and gender differences in the association. Data come from a longitudinal national study of 2,345 U.S. adults aged 40-54 at baseline. We used latent growth models to estimate BMI trajectory over a period of 20 years. We examined results under different missing data patterns and applied methods that account for nonrandom-selection bias. Compared with individuals who had higher childhood SES, individuals who had lower childhood SES have higher BMI in midlife and experience a faster increase in BMI between midlife and old age. The observed associations remain significant even after controlling for midlife SES. After addressing nonrandom selection, the gap in BMI between high and low childhood SES widens from midlife to old age for women. The findings provide new evidence of cumulative inequality among older adults, documenting increasing BMI inequality from midlife to old age, particularly for women from low-SES families.

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3–6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

Cytochrome P450 2C19 polymorphisms and valproic acid-induced weight gain.

Cytochrome P450 (CYP) 2C19 plays a role in the biotransformation of clinically relevant drugs as well as endogenous compounds, including sex hormones, which are known to be modulators of food intake and energy balance in humans. We attempted to investigate the influence of CYP2C19 polymorphisms on valproic acid (VPA)-induced weight gain. This retrospective longitudinal study included 85 VPA-treated and 93 carbamazepine (CBZ)-treated (as a reference) young patients with epilepsy. The body mass index (BMI) gap between the patient's BMI and the cutoff value for being overweight was calculated in each patient during the follow-up period. The longitudinal associations of the CYP2C19 genotype with the BMI gap and risk for becoming overweight during VPA or CBZ therapy were examined retrospectively using the generalized estimating equations approach and the Kaplan-Meier method. During the follow-up period, the values of the BMI gap were significantly greater (P = 0.002 or P = 0.005) and the cumulative incidence of becoming overweight tended to be higher (P = 0.032) in the VPA-treated female patients with one or two loss-of-function CYP2C19 alleles than in the females without the loss-of-function CYP2C19 alleles. No associations were observed among the VPA-treated male patients and CBZ-treated male and female patients (P > 0.05). This is the first report to show a relationship between the CYP2C19 polymorphism and VPA-induced weight gain in female patients with epilepsy. Further investigations are needed to verify these findings.

Ethnic disparities in adolescent body mass index in the United States: The role of parental socioeconomic status and economic contextual factors

This paper examined the importance of household and economic contextual factors as determinants of ethnic disparities in adolescent body mass index (BMI). Individual-level data from the National Longitudinal Survey of Youth 1997 for the years 1997 through 2000 were combined with economic contextual data on food prices, outlet density and median household income. The Oaxaca–Blinder decomposition method was used to examine the factors that could help explain ethnic disparities in BMI. Ethnic differences in household demographic, parental socioeconomic status (SES), and economic contextual factors explained the majority of the male black–white (63%), male Hispanic–white (78%) and female Hispanic–white (62%) BMI gaps but less than one-half of the female black–white BMI gap (44%). We found that adding the economic contextual factors increased the explained portion of the ethnic BMI gap for both female and male adolescents: the economic contextual factors explained 28% and 38% of the black–white and Hispanic–white BMI gaps for males and 13% and 8% of the black–white and Hispanic–white BMI gaps for females, respectively. Parental SES was more important in explaining the Hispanic–white BMI gap than the black–white BMI gap for both genders, whereas neighborhood economic contextual factors were more important in explaining the male BMI gap than the female BMI gap for both black–white and Hispanic–white ethnic disparities. A significantly large portion of the ethnic BMI gap, however, remained unexplained between black and white female adolescents.

Weight misperceptions and racial and ethnic disparities in adolescent female body mass index.

This paper investigated weight misperceptions as determinants of racial/ethnic disparities in body mass index (BMI) among adolescent females using data from the National Survey of Youth 1997. Compared to their white counterparts, higher proportions of black and Hispanic adolescent females underperceived their weight status; that is, they misperceived themselves to have lower weight status compared to their clinically defined weight status. Compared to their black counterparts, higher proportions of white and Hispanic adolescent females misperceived themselves to be heavier than their clinical weight status. Oaxaca-Blinder decomposition analysis showed that accounting for weight misperceptions, in addition to individual and contextual factors, increased the total explained portion of the black-white female BMI gap from 44.7% to 54.3% but only slightly increased the total explained portion of the Hispanic-white gap from 62.8% to 63.1%. Weight misperceptions explained 13.0% of the black-white female BMI gap and 3.3% of the Hispanic-white female BMI gap. The regression estimates showed that weight underperceptions were important determinants of adolescent female BMI, particularly among black and Hispanic adolescents. Education regarding identification and interpretation of weight status may play an important role to help reduce the incidence and racial disparity of female adolescent obesity.

Explaining Gender-Specific Racial Differences in Obesity Using Biased Self-Reports of Food Intake

Policymakers have an interest in identifying the differences in behavior patterns - namely, habitual caloric intake and physical activity levels - that contribute to demographic variation in body mass index (BMI) and obesity risk. While disparities in mean BMI and obesity rates between whites (non-Hispanic) and African-Americans (non-Hispanic) are well-documented, the behavioral differences that underlie these gaps have not been carefully identified. Moreover, the female-specificity of the black-white obesity gap has received relatively little attention. In the National Health and Nutrition Examination Surveys (NHANES) data, we initially observe a very weak relationship between self-reported measures of caloric intake and physical activity and either BMI or obesity risk, and these behaviors appear to explain only a small fraction of the black-white BMI gap (or obesity gap) among women. These unadjusted estimates echo previous findings from large survey datasets such as the NHANES. Using an innovative method to mitigate the widely recognized problem of measurement error in self-reported behaviors - proxying for measurement errors using the ratio of reported caloric intake to estimated true caloric needs - we obtain much stronger relationships between behaviors and BMI (or obesity risk). Behaviors can in fact account for a significant share of the BMI gap (and the obesity gap) between black women and white women and are consistent with the presence of much smaller gaps between black men and white men. The analysis also shows that the effects smoking has on BMI and obesity risk are small-to-negligible when measurement error is properly controlled.

Decomposing body mass index gaps between Mediterranean countries: A counterfactual quantile regression analysis

Wide cross-country variation in obesity rates has been reported between European Union member states. Although the existing cross-country differences have not been analyzed in depth, they contain important information on health production determinants. In this paper we apply a methodology for conducting standardized cross-country comparisons of body mass index (BMI). We draw on estimations of the marginal density function of BMI for Italy and Spain in 2003, two countries with similar GDP and socio-economic conditions. We produce different counterfactual distribution estimates using covariates (health production inputs) specified in a quantile regression. Our findings suggest that Spain-to-Italy BMI gaps among females are largely explained by cross-country variation in the returns to each covariate, especially for younger women. We find that adverse underlying determinants do not explain the gap observed in particular between younger Spanish females and their Italian counterfactuals; behavioural differences appear to be the key. We tentatively conclude that Spanish policy on obesity should target mainly younger females.

Recent growth of children in the two Koreas: A meta-analysis

Height differences between the two Koreas were injected into the U.S. presidential debate. The purpose of this article is to report briefly the height, weight, and body mass index (BMI) differences between North and South Korean children by using previous sources and new data. This study employs South Korean data published by the Korean Research Institute for Standards and Science in 1997 and by the Korean Agency for Technology and Standards in 2004, comparing them to North Korean data stemming from the 1997 and 2002 nutritional surveys conducted by the United Nations. Furthermore, this article makes use of anthropometric measurements of North Korean refugee children immigrating to South Korea from 2000 to 2007. In 1997, South Korean preschool children were found on average to be 6–7 cm (2–3 in.) taller and about 3 kg (6.6 pounds) heavier than their Northern counterparts; in 2002, the average gap was about 8 cm (3 in.) and 3 kg (6.6 pounds), and the BMI gap was about 1. North Korean boys and girls escaping to South Korea were also found to be on average about 3–4 cm (1–1.6 in.) shorter and 1 kg (2.2 pounds) lighter than their Southern peers.

Diabetes Treatments and Moral Hazard

Abstract In the face of rising rates of diabetes, many states have passed laws requiring health insurance plans to cover medical treatments for the disease. Although supporters of the mandates expect them to improve the health of diabetics, the mandates have the potential to generate a moral hazard to the extent that medical treatments might displace individual behavioral improvements. Another possibility is that the mandates do little to improve insurance coverage for most individuals, as previous research on benefit mandates has suggested that mandates often duplicate what plans already cover. To examine the effects of these mandates, we employ a triple‐differences methodology comparing the change in the gap in body mass index (BMI) between diabetics and nondiabetics in mandate and nonmandate states. We find that mandates do generate a moral hazard problem, with diabetics exhibiting higher BMIs after the adoption of these mandates.