Food Availability and Changes in Weight Among Women in Metropolitan Cebu, Philippines (1983-2002)
Arantxa Colchero, PhD, MS Powerpoint Slides Overweight and obesity is rapidly increasing in developing countries even in regions suffering from malnutrition and high infant mortality rates. Urbanization and economic development are driving major lifestyle transformations in dietary habits and physical activity that may be linked to this rapid increase in overweight and obesity in low- and middle-income countries. Studies of the effects of environmental exposures on obesity in developing countries are limited due to unavailability of data at the neighborhood or community level and scarce longitudinal studies of trends in weight. The objective of the project was to explore the effect of community factors on obesity among women in the Cebu Longitudinal Health and Nutrition Surveys (CLHNS). We first estimated the effect of population density and services available at the neighborhood level on changes in weight in this cohort. We also studied the contribution of the food supply on obesity by collecting data on the type of food offered by medium/large corporations and small family businesses in the localities where the CLHNS was conducted. We found that places with higher economic development, as reflected by public amenities and population density, had the greatest gains in weight. We identified significant differences in the food supply between urban and rural Barangays that may have contributed to the dramatic increase in obesity among women participating in the CLHNS. We found that neighborhoods with more options of fried and deep fried food items had the highest mean weight in the CLHNS. Identifying community exposures associated with obesity helps in targeting high-risk groups for intervention. Our findings confirm earlier observations that in low-income countries obesity starts among the wealthiest communities. Secondary and tertiary prevention policies designed to reduce obesity should be implemented in the most economically developed areas first. However, primary prevention of obesity in adult women would be most needed in less developed areas, where the obesity epidemic is just beginning. Showing the contribution of the environment on changes in weight, our research emphasizes the importance of addressing obesity at the community level. Public health interventions to reduce obesity should integrate innovative changes in the environment. Presenter’s Biography Arantxa Colchero is a health economist. She has a PhD from the Department of International Health at the Johns Hopkins Bloomberg School of Public Health and a master of science degree in health economics from the National Institute of Public Health (INSP). She is currently working as a researcher at the Center for Research on Surveys and Evaluation at the Health Economics Division. Her doctoral dissertation is an econometric analysis of the effect of income, occupation and neighborhood exposures on changes in weight among women participating in the Cebu Longitudinal Health and Nutrition Surveys. She also studied the effect of weight on wages among this cohort of women using econometric techniques to control for selection bias. She designed and implemented a survey to study the food supply in Cebu Philippines. She is currently working on an economic evaluation of early childhood development programs in Mexico with the World Bank. She is also conducting different analyses of obesity in a cohort of women and adolescent beneficiaries of the Mexican anti-poverty program called Oportunidades. | 
