Body Mass Index and Self-Perception of Overweight and Obesity in Rural, Urban and Rural-to-Urban Migrants: PERU MIGRANT Study

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Abstract

Objective This study aimed to compare self-reported weight and body mass index (BMI) in order to determine discrepancies between subjective and objective obesity-related markers, and possible explanatory factors of overweight and obesity underestimation, in urban, rural and migrant populations. Materials and Methods Data from the PERU MIGRANT study, a cross-sectional study, in low-income settings, of urban, migrant (rural-to-urban), and rural groups, including BMI, self-reported weight and socio-demographic indicators were analyzed. Percentage of concurrences between BMI and self-reported weight and Kappa coefficients for inter-rater agreement were calculated. Univariate and standardized descriptive analyses were performed to identify potential explanatory variables for weight underestimation in only overweight and obese individuals, using established BMI and waist circumference cut offs. Results 983 Participants–199 urban, 583 migrants and 201 rural–were analyzed. Based on BMI, overall prevalence of obesity was 20.1% (95% CI 17.6%–22.6%), and overweight was 38.3% (95% CI 35.2%–41.2%), with differences between study groups (p<0.001). Only 43% of the whole sample had matching self-reported weight and BMI status, whereas 54% underestimated and 3% overestimated their BMI category. Kappa coefficient, between BMI and self-reported weight, for the entire sample was 0.16, rural residents had the lowest coefficient (0.01) and the most underestimation, especially in the overweight category. In overweight and obese individuals, deprivation index (p = 0.016), age (p = 0.014) and waist circumference (p<0.001) were associated with weight underestimation. Discussion Overall, high levels of overweight, obesity, and underestimation of BMI status were found, with poor agreement between BMI and self-reported weight, showing the unawareness of weight status severity in this low-income setting.

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The nutrition transition: worldwide obesity dynamics and their determinants.

B Popkin, P Gordon-Larsen (2004)

This paper explores the major changes in diet and physical activity patterns around the world and focuses on shifts in obesity. Review of results focusing on large-scale surveys and nationally representative studies of diet, activity, and obesity among adults and children. Youth and adults from a range of countries around the world. The International Obesity Task Force guidelines for defining overweight and obesity are used for youth and the body mass index > or =25 kg/m(2) and 30 cutoffs are used, respectively, for adults. The nutrition transition patterns are examined from the time period termed the receding famine pattern to one dominated by nutrition-related noncommunicable diseases (NR-NCDs). The speed of dietary and activity pattern shifts is great, particularly in the developing world, resulting in major shifts in obesity on a worldwide basis. Data limitations force us to examine data on obesity trends in adults to provide a broader sense of changes in obesity over time, and then to examine the relatively fewer studies on youth. Specifically, this work provides a sense of change both in the United States, Europe, and the lower- and middle-income countries of Asia, Africa, the Middle East, and Latin America. The paper shows that changes are occurring at great speed and at earlier stages of the economic and social development of each country. The burden of obesity is shifting towards the poor.

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Body image and weight control in young adults: international comparisons in university students from 22 countries.

Anne M Haase, A Steptoe, J Wardle (2006)

Young women in the United States and Western Europe are notoriously concerned about weight but less is known about attitudes to weight in other regions of the world. This study explores the associations between body mass index (BMI), weight perceptions, and attempts to lose weight in male and female university students from 22 countries. Data were collected from 18,512 university students, using standardised methods, as part of the International Health Behaviour Survey. Measures included weight, height, perception of overweight, and weight loss status. BMI was calculated from weight and height, but was categorised into gender and country-standardised deciles rather than the conventional weight categories in response to the inaccuracy of self-reports. Perceived overweight and weight loss status were plotted against country-standardised BMI deciles. The 22 countries were grouped into five geopolitical/economic areas for regional analyses: North-Western Europe and the USA, Central and Eastern Europe, the Mediterranean, Pacific Asia, South America. Perceived overweight compared across the five regions. Perceived overweight increased systematically across BMI deciles in all countries. More women than men felt overweight at any decile. Women had low levels of perceived overweight in the lowest decile but rates rapidly increased to 50% by the 5th decile. Men, even in the highest deciles, were less aware that they are overweight and few of them were trying to lose weight. Women had a faster rise of weight loss attempts over the BMI deciles but nevertheless the proportion trying to lose in the highest decile did not exceed 75%. Perceived overweight profiles across BMI deciles were similar across all regions, suggesting that perceptions of overweight derive from local comparisons. The patterning for trying to lose weight was more diverse, with men and women from Asian countries showing higher levels of trying to lose weight at all deciles. This study shows the international consistency in perceptions of overweight in educated young men and women across diverse regions of the world. It confirms the patterning of women's overestimation of weight at lower BMI deciles and men's underestimation of weight at the higher deciles. Perceptions of overweight and attempts to lose weight were highest in the group of Asian countries where body weights are generally low, suggesting that local culture and norms could moderate attitudes to weight.

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Income-specific trends in obesity in Brazil: 1975-2003.

Barry M. Popkin, João C. Monteiro, Wolney Conde (2007)

We sought to update income-specific secular trends in obesity in Brazil to assess the hypothesis that the disease burden is shifting toward the poor. We compared overall and income-specific obesity prevalence rates estimated for Brazilian men and women from national surveys conducted in 1975, 1989, and 2003. We calculated age-adjusted prevalence ratios to assess time trends. In the first 14-year period examined (1975-1989), obesity rates among men and women increased by 92% and 63%, respectively, and increases were relatively higher among individuals in lower income groups. In the second 14-year period (1989-2003), there were further increases in obesity among men, and again increases were larger among the poor. In this second period, the obesity rate remained virtually stable in the overall female population, but it increased by 26% among women in the 2 lower income quintiles and decreased by 10% among women in the 3 higher income quintiles. The burden of obesity is shifting toward the poor and can no longer be considered a disease of the socioeconomic elite. Policymakers need to design policy and programs that reach all members of society, but especially the poor.