Closer analysis of obesity prevalence and trend data from around the world reveals a number of interesting patterns and features. These include an increase in population mean BMI with socioeconomic transition, a tendency for urban populations to have higher rates of obesity than rural populations, a tendency for peak rates of obesity to be reached at an earlier age in the less developed and newly industrialized countries, and a tendency for women to have higher rates of obesity than men. These and others are considered in some detail below.
In developed countries there is usually an inverse association between level of education and rates of obesity that is more pronounced among women. In the MONICA survey, a lower educational level was associated with higher BMI in almost all female populations (both surveys) and in about half of male populations. Between the two surveys, there was a strengthening of this inverse association and the differences in relative body weight by education increased. This suggests that socioeconomic inequality in health consequences associated with obesity may actually be widening in many countries (10). One analysis has shown that reproductive history, unhealthy dietary habits, and psychosocial stress may account for a large part of the association between low SES and obesity among middle-aged women (11).
There is some evidence to suggest that there are racial differences between BMI and SES in developed countries. Although women in the USA with low incomes or low education are more likely to be obese than those of higher SES overall, this association was not found in a large survey of Mexican American, Cuban American, and Puerto Rican adults (12). Similar findings have been reported for young girls where a lower prevalence of obesity was seen at higher levels of SES in white girls, but no clear relationship was detected in black girls (13), who tend to have much higher overall rates of obesity.
Developing and Transition Societies
New evidence from India illustrates the positive association between SES and obesity in developing countries. Nearly a third of males, and more than half of females, belonging to the 'upper middle class' in urban areas are currently overweight (BMI > 25). This is in stark contrast to the prevalence of overweight among slum dwellers (see Table 1.7) (14).
In Latin American and a number of Caribbean countries, a recent assessment of maternal and child obesity from national surveys since 1982 also found a tendency for higher obesity rates in poorly educated women throughout the region, except in Haiti and Guatemala where the reverse was true.
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