Associations between macrolevel economic factors and weight distributions in low- and middle-income countries: a multilevel analysis of 200,000 adults in 40 countries.
OBJECTIVE
We examined associations between macrolevel economic factors hypothesized to drive changes in distributions of weight and body mass index (BMI) in a representative sample of 200,796 men and women from 40 low- and middle-income countries.


METHODS
We used meta-regressions to describe ecological associations between macrolevel factors and mean BMIs across countries. Multilevel regression was used to assess the relation between macrolevel economic characteristics and individual odds of underweight and overweight relative to normal weight.


RESULTS
In multilevel analyses adjusting for individual-level characteristics, a 1-standard-deviation increase in trade liberalization was associated with 13% (95% confidence interval [CI] = 0.76, 0.99), 17% (95% CI = 0.71, 0.96), 13% (95% CI = 0.76, 1.00), and 14% (95% CI = 0.75, 0.99) lower odds of underweight relative to normal weight among rural men, rural women, urban men, and urban women, respectively. Economic development was consistently associated with higher odds of overweight relative to normal weight. Among rural men, a 1-standard-deviation increase in foreign direct investment was associated with 17% (95% CI = 1.02, 1.35) higher odds of overweight relative to normal weight.


CONCLUSIONS
Macrolevel economic factors may be implicated in global shifts in epidemiological patterns of weight.
Arijit Nandi and Jody Heymann are with the Institute for Health and Social Policy and the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec. Elizabeth Sweet is with the Center on Social Disparities and Health, Institute for Policy Research, Northwestern University, Evanston, IL. Ichiro Kawachi is with the Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA. Sandro Galea is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY.
Arijit
A
Nandi
Elizabeth
E
Sweet
Ichiro
I
Kawachi
Jody
J
Heymann
Sandro
S
Galea
D015992:Body Mass Index; D001835:Body Weight; D003431:Cross-Cultural Comparison; D003906:Developing Countries / Q000706:statistics & numerical data*; D057217:Economic Development / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors