title: A cross sectional survey on social, cultural and economic determinants of obesity in a low middle income setting.
abstract: BACKGROUND
  Obesity is an increasing problem in South Asian countries and Sri Lanka is no exception. The socioeconomic determinants of obesity in Sri Lanka, and in neighbouring countries are inadequately described. Aim was to describe social, cultural and economic determinants of obesity in a representative sample from Kalutara District in Sri Lanka.
  
  
  METHODS
  This was a cross sectional descriptive study conducted among adults aged 35-64 years. A representative sample was selected using stratified random cluster sampling method from urban, rural and plantation sectors of Kalutara District. Data were collected using a pre-tested questionnaire. A body mass index of 23.01 kg/m(2)-27.50 kg/m(2) was considered as overweight and ≥27.51 kg/m(2) as obese. Waist circumference (WC) of ≥ 90 cm and ≥80 cm was regarded as high for men and women respectively. Significance of prevalence of obesity categories across different socio-economic strata was determined by chi square test for trend.
  
  
  RESULTS
  Of 1234 adults who were screened, age and sex adjusted prevalence of overweight, obesity and abdominal obesity (high WC) were 33.2% (male 27.3%/female 38.7%), 14.3% (male 9.2%/female 19.2%) and 33.6% (male 17.7%/female 49.0%) respectively. The Muslims had the highest prevalence of all three obesity categories. Sector, education, social status quintiles and area level deprivation categories show a non linear social gradient while income shows a linear social gradient in all obesity categories, mean BMI and mean WC. The differences observed for mean BMI and mean WC between the lowest and highest socioeconomic groups were statistically significant.
  
  
  CONCLUSIONS
  There is a social gradient in all three obesity categories with higher prevalence observed in the more educated, urban, high income and high social status segments of society. The higher socioeconomic groups are still at a higher risk of all types of obesity despite other public health indicators such as maternal and infant mortality displaying an established social gradient.
authors.affiliation: Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka. pubududesilva@ymail.com.
authors.forename: Ambepitiyawaduge Pubudu
authors.initials: AP
authors.lastname: De Silva
authors.affiliation: Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka. padmaldes@gmail.com.
authors.forename: Sudirikku Hennadige Padmal
authors.initials: SH
authors.lastname: De Silva
authors.affiliation: Centre for Tropical Medicine, University of Oxford, Oxford, UK. rashan@nicslk.com.
authors.forename: Rashan
authors.initials: R
authors.lastname: Haniffa
authors.affiliation: Department of Para Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala University, Ratmalana, Sri Lanka. isurujith@gmail.com.
authors.forename: Isurujith Kongala
authors.initials: IK
authors.lastname: Liyanage
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka. sarojoffice@yahoo.com.
authors.forename: Kosala Saroj Amarasiri
authors.initials: KS
authors.lastname: Jayasinghe
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka. pkatulanda@yahoo.com.
authors.forename: Prasad
authors.initials: P
authors.lastname: Katulanda
authors.affiliation: Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka. mandika59@hotmail.com.
authors.forename: Chandrika Neelakanthi
authors.initials: CN
authors.lastname: Wijeratne
authors.affiliation: Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka. sumedhaw@gmail.com.
authors.forename: Sumedha
authors.initials: S
authors.lastname: Wijeratne
authors.affiliation: Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka. lalinirajapaksa@gmail.com.
authors.forename: Lalini Chandika
authors.initials: LC
authors.lastname: Rajapakse
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000191:economics / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D011203:Poverty / Q000191:economics* / Q000523:psychology / Q000706:statistics & numerical data; D012737:Sex Factors; D012923:Social Class; D012959:Socioeconomic Factors; D013188:Sri Lanka / Q000453:epidemiology