Is overweight still a problem of rich in sub-Saharan Africa? Insights based on female-oriented demographic and health surveys
Is overweight still a problem of rich in sub-Saharan Africa? Insights based on female-oriented demographic and health surveys
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DOI：
10.1016/j.wdp.2021.100388
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发表时间：
2022-03-01
影响因子：
1.9
通讯作者：
Levasseur, Pierre
中科院分区：
文献类型：
--
作者：
Daran, Bertille;Levasseur, Pierre
对于大多数人来说，撒哈拉以南非洲 (SSA) 就是饥饿和挨饿的代名词。然而，超重和肥胖目前也是该地区的一个主要公共卫生问题，有时甚至超过体重不足的患病率。尽管SSA的平均体重指数（BMI）显着增加，但现有文献仍然认为家庭社会经济地位（SES）与个人BMI之间存在正相关关系，表明超重是财富的象征，而瘦则与贫困有关。本文旨在通过研究 SSA 中 SES 和 BMI 之间关系的潜在非线性和异质性来更新这种传统且可能过时的看法。首先，我们汇集了 1990 年至 2019 年期间代表大量 SSA 国家的几项横断面女性成人人口和健康调查。其次，我们实施了普通最小二乘 (OLS) 和工具变量 (IV) 回归。一旦控制了一组全面的观察到的特征，OLS 估计表明 SES 指标与女性 BMI 之间存在非线性关联，呈倒 U 形。控制反向因果关系和未观察到的异质性的 IV 校正揭示了类似的趋势，证实了中等财富和教育水平中超重的比例过高。此外，这项研究还确定了撒哈拉以南非洲地区肥胖负担的社会转变：从 20 世纪 90 年代末开始，肥胖负担从正向曲线转变，包括目前被归类为中低收入国家。总而言之，本文为展示 SSA 中持续的营养转型以及新兴中产阶级在肥胖流行病上升中的作用的文献做出了贡献。这一结果对公共卫生政策具有重要意义。
To most people, sub-Saharan Africa (SSA) is synonymous with hunger and starvation. However, overweight and obesity are currently also a major public health concern in this region, sometimes even more than the prevalence of underweight. Despite the significant increase in the average body mass index (BMI) in SSA, the existing literature still considers a positive association between household socioeconomic status (SES) and individual BMI, suggesting that excess weight is a symbol of wealth while thinness is linked to poverty. This article aims to update this traditional and probably outdated perception by investigating potential nonlinearities and heterogeneity in the relationship between SES and BMI in SSA. First, we pool several cross-sectional female adultoriented demographic and health surveys that are representative of a large number of SSA countries from 1990 to 2019. Second, we implement both ordinary least-squares (OLS) and instrumental variables (IV) regressions. Once a comprehensive set of observed characteristics was controlled for, OLS estimates suggest a nonlinear association between SES indicators and female BMI, taking a U-inverted shape. IV corrections controlling for reverse causality and unobserved heterogeneity reveal similar trends, confirming the overrepresentation of excess weight in intermediate levels of wealth and education. Furthermore, this study dates the social shift of the obesity burden in SSA: changing from positive to curvilinear from the end of the 1990s, including for countries currently classified as lower middle income. To conclude, this article contributes to the literature demonstrating the ongoing nutrition transition in SSA and the role of an emergent middle class in the rise of the obesity epidemic. This result has important implications for public health policies.