title: Ideal Body Size as a Mediator for the Gender-Specific Association Between Socioeconomic Status and Body Mass Index: Evidence From an Upper-Middle-Income Country in the African Region.
abstract: BACKGROUND
  While obesity continues to rise globally, the associations between body size, gender, and socioeconomic status (SES) seem to vary in different populations, and little is known on the contribution of perceived ideal body size in the social disparity of obesity in African countries.
  
  
  OBJECTIVE
  We examined the gender and socioeconomic patterns of body mass index (BMI) and perceived ideal body size in the Seychelles, a middle-income small island state in the African region. We also assessed the potential role of perceived ideal body size as a mediator for the gender-specific association between SES and BMI.
  
  
  METHODS
  A population-based survey of 1,240 adults aged 25 to 64 years conducted in December 2013. Participants' BMI was calculated based on measured weight and height; ideal body size was assessed using a nine-silhouette instrument. Three SES indicators were considered: income, education, and occupation.
  
  
  RESULTS
  BMI and perceived ideal body size were both higher among men of higher versus lower SES (p< .001) but lower among women of higher versus lower SES (p< .001), irrespective of the SES indicator used. Multivariate analysis showed a strong and direct association between perceived ideal body size and BMI in both men and women (p< .001) and was consistent with a potential mediating role of perceived ideal body size in the gender-specific associations between SES and BMI.
  
  
  CONCLUSIONS
  Our study emphasizes the importance of gender and socioeconomic differences in BMI and ideal body size and suggests that public health interventions that promote perception of healthy weight could help mitigate SES-related disparities in BMI.
authors.affiliation: Lausanne University Hospital, Lausanne, Switzerland University of Lausanne, Lausanne, Switzerland maryam.yepes@unil.ch.
authors.forename: Maryam
authors.initials: M
authors.lastname: Yepes
authors.affiliation: University of Lausanne, Lausanne, Switzerland.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Maurer
authors.affiliation: Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Silvia
authors.initials: S
authors.lastname: Stringhini
authors.affiliation: NCD Section, Ministry of Health, Victoria, Republic of Seychelles.
authors.forename: Barathi
authors.initials: B
authors.lastname: Viswanathan
authors.affiliation: NCD Section, Ministry of Health, Victoria, Republic of Seychelles.
authors.forename: Jude
authors.initials: J
authors.lastname: Gedeon
authors.affiliation: Lausanne University Hospital, Lausanne, Switzerland NCD Section, Ministry of Health, Victoria, Republic of Seychelles.
authors.forename: Pascal
authors.initials: P
authors.lastname: Bovet
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D012737:Sex Factors; D012750:Seychelles / Q000453:epidemiology; D012923:Social Class
keywords: Africa; body mass index; obesity; perceived ideal body size; silhouette; socioeconomic status