Elsevier

Preventive Medicine

Volume 37, Issue 5, November 2003, Pages 396-405
Preventive Medicine

Regular article
Social class, family, and life-style factors associated with overweight and obesity among adults in Peruvian cities

https://doi.org/10.1016/S0091-7435(03)00159-2Get rights and content

Abstract

Background

Overweight and obesity have reached epidemic proportions in Latin America.

Objective

The purpose of this study was to explore social and behavioral factors associated with obesity in Peruvian cities.

Design

Between 1998 and 2000 health examination surveys were conducted among adults in 1176 families identified in six cities. Stratified by social class, multistaged random sampling was used. Using body mass index (weight (kg)/height (m)2), men and women were classified into normal weight (BMI <25), overweight (BMI 25–29), or obese (BMI ≥30); abdominal circumference (≥94 cm in men and ≥84 cm in women) further identified morbidity risk. Several demographic, social, and behavioral variables were collected following standardized procedures.

Results

Adjusting for age, 37% of women were categorized as normal weight, 40% overweight, and 23% obese; corresponding figures for men were 40, 44, and 16%. More developed cities, e.g., Lima, Arequipa, and Ica, had the largest prevalence of overweight and obesity for both men and women. Adjusted logistic models showed that BMI ≥25 was positively correlated with age; whereas, education was negatively associated, only among women. Other significant associated factors of overweight included city of residence, television viewing ≥4 h daily in women, and underestimation of body weight status.

Conclusions

The study showed elevated rates of overweight across the income level spectrum. Factors such as urban development stage, income, education, and gender posed differential relationships with the risk of overweight and must be considered in designing future public health interventions. Underestimation of body weight status and sedentary behavior may also constitute specific areas of intervention.

Introduction

Latin America is in the middle of an epidemic of obesity that transcends socioeconomic boundaries and affects the highest socioeconomic levels as well as the most disadvantaged [1], [2]. This is of great concern, since overweight and obesity have been associated with increased morbidity and mortality from various chronic diseases, including coronary heart disease, diabetes, and several cancers [3]. These new emerging problems challenge existing public health institutions, which are primarily devoted and equipped to deal with infectious diseases and undernutrition.

Overweight (BMI 25–29 kg/m2) and obesity (BMI ≥30 kg/m2) have increased in prevalence in urban populations and have been documented in over one-third of Latin American women of childbearing age [2]. In Perú the prevalence of BMI ≥25 in women, increased from 31% in 1992 to 44.8% in 1996, and is mostly concentrated in urban populations [4]. Also, Peruvian preschool children have experienced a nearly 50% increase in obesity rates, from 3.7% in 1985 to 7% in 1996 [4].

Though genetics may explain about 30% of the observed obesity [5], [6], changes in lifestyles and in the environment over the last half-century are more likely to explain the recent epidemic manifestation of obesity. In fact, environmental factors are capable of derailing biological mechanisms responsible for keeping body weight stable over the long term [3]. In Latin America, the obesity epidemic has been associated with economic growth, rapid urbanization, and subsequent lifestyle changes, among them increased consumption of fat, sugar, and refined grains and reductions in daily physical activity [1], [7]. Much of this explanation, however, is based on ecological data and limits the understanding of social and individual factors involved in the development of obesity.

The increase in overweight and obesity has been extensively documented in industrialized societies, showing over the last quarter of a century a transition from a positive to a negative association between income and obesity [8], [9], [10]. A similar phenomenon is now emerging in developing countries [7] and in some Latin American middle income countries, where greater levels of obesity among the poor are observed, especially in urban areas [11], [12]. Conversely, less developed societies and rural environments tend to display a more positive association between overweight and social status [2].

Conceptually, environmental and behavioral factors associated with obesity can be arranged in upstream, intermediate, and proximal variables. Intermediate variables are thought to provide a link between upstream factors as income and education, and proximal obesity-related behaviors as diet and physical activity. Some of those intermediate variables are health knowledge, leisure time availability, and the cultural valuation of fatness [7]. For example, level of knowledge regarding the health implications of obesity has been described as an important influence on lifestyle profiles [3], [11]. Higher levels of health knowledge may be negatively associated with obesity, as individuals opt for healthier diets and lifestyle behaviors. Higher social class may also provide more leisure time available for recreation and greater availability of a safe and appropriate environment for engaging in a routine physical activity or exercise [13]. Similarly, sedentary behavior, such as TV viewing, has been shown to be positively associated with later development of obesity, among children [14] and adults [15].

The cultural valuation of fatness or weight status is also hypothesized as a determinant of overweight, operating through cultural mechanisms that either value or stigmatize obesity in a given social group [16], [17]. Individuals in lower SES strata may perceive that heavier body figures are healthier and protective against financial and economic downturns [18], [19], thus influencing behaviors associated with diet and physical activity.

To investigate the associations and relative importance of the above outlined factors in connection with overweight and obesity, this study used survey data gathered by the Office of Epidemiology of the Ministry of Health of Perú from December 1998 to February 2000.

Section snippets

Study population and sampling

From east to west the geography of Perú spans the Jungle, the Andes, and a narrow desert strip that runs along the coastline. Most urban development has taken place along the coast over the last 25 years, now concentrating two-thirds of the Peruvian population. The study focused on an urban population and was conducted in six cities selected by the Office of Epidemiology, representing the most important urban developments in the three major geographical regions of Perú. Random population

Results

The nonresponse rate was about 7% in all cities but Santa Luzmila, Lima (20%), where the study started. This higher rate might be explained by a limited presurvey motivational campaign in the community as compared to the other cities. Most of the surveyed households (90%) were composed of nuclear families, i.e., both parents and their children, and their characteristics are shown in Table 1. The age and years of education for women and men, the number of rooms in the house, and the frequency of

Social factors and study site

The fact that more than half of the study population was overweight or obese is of concern in view of the increased morbidity and premature mortality that accompanies those conditions. Peruvian urban women had elevated rates of obesity as compared to other countries [2] and higher rates than men [25], [26], [27], [28]. Interestingly enough, the overall rates of overweight and obesity in this study are very similar to those obtained by a more recent national representative survey of urban Perú.

Acknowledgements

Support for this study has been provided in part by Office of Epidemiology, MOH of Peru, and the Pan American Health Organization. The authors are indebted to Dr. Percy Minaya, past-Director of the Oficina General de Epidemiologia (OGE) MOH; Dr. Roberto del Aguila, Director de Vigilancia y Evaluacion Epidemiologica, OGE; and Ms. Marie Andre Diouf, The Pan American Health Organization representative in Peru, who made possible the Non-Communicable Risk Factors surveys. We also extend our

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