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. 2014 Jun 11;9(6):e99327.
doi: 10.1371/journal.pone.0099327. eCollection 2014.

National economic development and disparities in body mass index: a cross-sectional study of data from 38 countries

Melissa Neuman  1 , Ichiro Kawachi  1 , Steven Gortmaker  1 , Sv Subramanian  1
Affiliations

National economic development and disparities in body mass index: a cross-sectional study of data from 38 countries

Melissa Neuman et al. PLoS One. .

Abstract

Background: Increases in body mass index (BMI) and the prevalence of overweight in low- and middle income countries (LMICs) are often ascribed to changes in global trade patterns or increases in national income. These changes are likely to affect populations within LMICs differently based on their place of residence or socioeconomic status (SES).

Objective: Using nationally representative survey data from 38 countries and national economic indicators from the World Bank and other international organizations, we estimated ecological and multilevel models to assess the association between national levels of gross domestic product (GDP), foreign direct investment (FDI), and mean tariffs and BMI.

Design: We used linear regression to estimate the ecological association between average annual change in economic indicators and BMI, and multilevel linear or ordered multinomial models to estimate associations between national economic indicators and individual BMI or over- and underweight. We also included cross-level interaction terms to highlight differences in the association of BMI with national economic indicators by type of residence or socioeconomic status (SES).

Results: There was a positive but non-significant association of GDP and mean BMI. This positive association of GDP and BMI was greater among rural residents and the poor. There were no significant ecological associations between measures of trade openness and mean BMI, but FDI was positively associated with BMI among the poorest respondents and in rural areas and tariff levels were negatively associated with BMI among poor and rural respondents.

Conclusion: Measures of national income and trade openness have different associations with the BMI across populations within developing countries. These divergent findings underscore the complexity of the effects of development on health and the importance of considering how the health effects of "globalizing" economic and cultural trends are modified by individual-level wealth and residence.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Per capita GDP and predicted BMI by type of residence.
Figure 2
Figure 2. Per capita GDP and predicted BMI by wealth group.
Figure 3
Figure 3. FDI and predicted BMI by type of residence.
Figure 4
Figure 4. FDI and predicted BMI by wealth group.
Figure 5
Figure 5. Average tariff rate and predicted BMI by type of residence.
Figure 6
Figure 6. Average tariff rate and predicted BMI by wealth group.
See this image and copyright information in PMC

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