Essays on obesity in low- and middle-income countries
- This dissertation investigates the trends and causes of obesity in low- and middle-income countries. The first chapter (with Tiago Cravo Oliveira Hashiguchi, Blake Thomson, Joseph Dieleman, and Eran Bendavid) investigates the phenomenon that obesity prevalence is highest among wealthier population strata in poorer countries, but the burden of obesity shifts to poorer population strata as national wealth increases. While the flipped wealth gradients of obesity in poor and rich countries are documented, no research shows how this shift happens or where it occurs along the range of economic development. We collated 182 Demographic and Health Surveys and World Health Surveys [n = 2.24 million respondents] from 103 countries with information on respondent height, weight, personal wealth, and country wealth. We estimated the relationship of personal wealth with overweight and obesity, and examined how that relationship varies with country wealth. The transition is driven by increasing obesity among the poor without appreciable decreasing obesity among the wealthy. At a gross domestic product (GDP) per capita of $8,000, the prevalence of obesity is no longer the highest among those in the top wealth decile ($10,000 for overweight), and at $30,000, obesity prevalence among those in the poorest decile is higher than among the wealthiest ($50,000 for overweight). We estimate that 70.2% (64.1%--76.4%) of countries will begin or have undergone this shift by 2040, and the number of people who are both obese and poor (in the lowest quintile) in our study countries will increase by 17.3 million people (15.3--19.6). The second chapter studies the effect of Progresa, a major conditional cash transfer (CCT) program that affected 25\% of the Mexican population, on obesity among program-eligible and ineligible populations. CCTs are often targeted at poor populations to reduce hunger and under-nutrition, but may have the unintended consequence of increasing obesity for certain individuals. I leverage Progresa, a randomized CCT rollout in Mexico in 1998, to explore the causal effect of the program on obesity and the mechanisms underlying obesity changes. I investigate three mechanisms: health information, labor supply, and caloric consumption. I find that the program decreased obesity in women and increased obesity in men relative to control villages in 2003; this sex-specific effect spilled over into households ineligible for the program. Women in treatment villages report greater medical advice adherence, suggesting health promoting behaviors outside the health facility may play a role in lower obesity. Men in treatment villages report greater soda consumption, suggesting that nutritional quantity and quality may underpin relative obesity increases. Importantly, the program decreased obesity in women to a greater extent than most policies targeted at reducing obesity. The third chapter (with Jay Bhattacharya, Grant Miller, and Enrique Seira) investigates the contribution of food price reductions to the rapid rise of obesity in Mexico. In wealthy and poor countries alike, obesity and related cardiometabolic disease prevalence is rising. Although this rise is unambiguously bad for population health, some of the underlying causes may not be socially or economically undesirable. In this paper, we study the relationship between declining real food prices and obesity in Mexico (which experienced the most rapid increase in bodyweight in the world between 1990 and 2010), focusing on the implementation of the North American Free Trade Agreement (NAFTA). We find that NAFTA tariff reductions decreased food prices by 15-30%, increased consumption of unhealthy foods -- and that overall food price reductions in Mexico explain about 21% of the observed obesity increase, 39% of the observed hypertension increase, and 20% of type-2 diabetes incidence over this period. Our findings suggest that public policy may be unable to directly address some (socially and economically desirable) root causes of obesity, and should instead focus on cushioning their population health impact.
|Type of resource
|electronic resource; remote; computer; online resource
|1 online resource.
|Templin, Tara Nicole
|Stanford University, Department of Health Policy
|Statement of responsibility
|Submitted to the Department of Health Policy.
|Thesis Ph.D. Stanford University 2022.
- © 2022 by Tara Nicole Templin
- This work is licensed under a Creative Commons Attribution 3.0 Unported license (CC BY).
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