The overweight and obesity transition from the wealthy to the poor in low- and middle-income countries: A survey of household data from 103 countries

Autoři: Tara Templin aff001;  Tiago Cravo Oliveira Hashiguchi aff002;  Blake Thomson aff003;  Joseph Dieleman aff004;  Eran Bendavid aff005
Působiště autorů: Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America aff001;  Organisation for Economic Co-operation and Development ELS/HD, Paris, France aff002;  Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom aff003;  Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America aff004;  Center for Population Health Sciences, Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America aff005
Vyšlo v časopise: The overweight and obesity transition from the wealthy to the poor in low- and middle-income countries: A survey of household data from 103 countries. PLoS Med 16(11): e32767. doi:10.1371/journal.pmed.1002968
Kategorie: Research Article



In high-income countries, obesity prevalence (body mass index greater than or equal to 30 kg/m2) is highest among the poor, while overweight (body mass index greater than or equal to 25 kg/m2) is prevalent across all wealth groups. In contrast, in low-income countries, the prevalence of overweight and obesity is higher among wealthier individuals than among poorer individuals. We characterize the transition of overweight and obesity from wealthier to poorer populations as countries develop, and project the burden of overweight and obesity among the poor for 103 countries.

Methods and findings

Our sample used 182 Demographic and Health Surveys and World Health Surveys (n = 2.24 million respondents) from 1995 to 2016. We created a standard wealth index using household assets common among all surveys and linked national wealth by country and year identifiers. We then estimated the changing probability of overweight and obesity across every wealth decile as countries’ per capita gross domestic product (GDP) rises using logistic and linear fixed-effect regression models. We found that obesity rates among the wealthiest decile were relatively stable with increasing national wealth, and the changing gradient was largely due to increasing obesity prevalence among poorer populations (3.5% [95% uncertainty interval: 0.0%–8.3%] to 14.3% [9.7%–19.0%]). Overweight prevalence among the richest (45.0% [35.6%–54.4%]) and the poorest (45.5% [35.9%–55.0%]) were roughly equal in high-income settings. At $8,000 GDP per capita, the adjusted probability of being obese was no longer highest in the richest decile, and the same was true of overweight at $10,000. Above $25,000, individuals in the richest decile were less likely than those in the poorest decile to be obese, and the same was true of overweight at $50,000. We then projected overweight and obesity rates by wealth decile to 2040 for all countries to quantify the expected rise in prevalence in the relatively poor. Our projections indicated that, if past trends continued, the number of people who are poor and overweight will increase in our study countries by a median 84.4% (range 3.54%–383.4%), most prominently in low-income countries. The main limitations of this study included the inclusion of cross-sectional, self-reported data, possible reverse causality of overweight and obesity on wealth, and the lack of physical activity and food price data.


Our findings indicate that as countries develop economically, overweight prevalence increased substantially among the poorest and stayed mostly unchanged among the wealthiest. The relative poor in upper- and lower-middle income countries may have the greatest burden, indicating important planning and targeting needs for national health programs.

Klíčová slova:

Body Mass Index – Economic analysis – Economic development – Food consumption – Health surveys – Obesity – Public and occupational health – Surveys


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