Associations between macrolevel economic factors and weight distributions in low- and middle-income countries: a multilevel analysis of 200,000 adults in 40 countries

Abstract

Objectives: 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.

FIGURE 1—

Ecological associations between mean BMI among men and macrolevel characteristics (a) per capita GDP, (b) percentage of urban residents, (c) FDI as a percentage of GDP, and (d) mean tariff: 40 low- and middle-income countries included in the World Health Survey, 2002–2003. Note. BMI = body mass index; CI = confidence interval; FDI = foreign direct investment; GDP = gross domestic product. Results are derived from bivariate random-effects meta-regression models weighted by the inverse of the standard error of the mean BMI for men in each country. The sample size was n = 90 167.

FIGURE 2—

Ecological associations between mean BMI among women and macrolevel characteristics (a) per capita GDP, (b) percentage of urban residents, (c) FDI as a percentage of GDP, and (d) mean tariff: 40 low- and middle-income countries included in the World Health Survey, 2002–2003. Note. BMI = body mass index; CI = confidence interval; FDI = foreign direct investment; GDP = gross domestic product. Results are derived from bivariate random-effects meta-regression models weighted by the inverse of the standard error of the mean BMI for women in each country. The sample size was n = 110 628.