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Location, location, location: Why affluence isn’t the sole driver of obesity in China

By Cheryl Marie Tay+

16-May-2017
Last updated on 23-May-2017 at 16:15 GMT2017-05-23T16:15:49Z

Obesity levels have risen alongside growing affluence in China, but location is an overlooked factor. ©iStock
Obesity levels have risen alongside growing affluence in China, but location is an overlooked factor. ©iStock

Increasing affluence and rising obesity have appeared to go hand in hand in China, but new research reveals how geographic location may also play a significant role. 

A new study involving 98,058 mainland Chinese adults aged 18 and above has found that geographic variation affects both affluence and obesity in the country.

The study was nationally representative, using data from the National Center for Chronic and Non-communicable Disease Control and Prevention, which accounted for 161 randomly selected counties from all seven geographical regions in China. It also used education levels as an indicator of socioeconomic circumstances.

Until recently, higher BMI among the affluent in developing countries like China was often attributed to the availability of energy-rich “Western-style” fast food, refined carbohydrates, processed meats, and sugary drinks, which were widely thought to be affordable only to the well-to-do.

This line of thinking was perpetuated by major fast food retailers opening outlets in regions where more affluent consumers resided.

However, China’s geographically uneven economic development does little to justify the theory that affluence and obesity go hand in hand, according to researchers.

Multilevel approach

According to the study, "Location plays a key tole in determining associations between socioeconomic circumstances and BMI".

When measured against each other, it was observed that an individual’s education level and BMI were typically directly proportional. The average BMI of someone with no educational qualifications was 23.8, while that of someone with university education was 24. But when geographic variation was factored in, this pattern changed drastically.

The study found that in the least educated counties, the BMI of those with no educational qualifications was lower than those who had a university education. However, in the most educated counties, the reverse was true.

At the same time, the study acknowledged that “the area-level indicator of the mean years of education is likely to be highly correlated with an indicator of urbanisation”, and that “major change spanning the last two decades has seen the rise of a middle class that may have more economic capital”, but whose formal qualifications might be lacking.

The study’s authors concluded: “Our study has demonstrated that multilevel models are essential for enhancing understanding on the patterning of BMI by socioeconomic circumstances in China. People's qualifications matter, but their importance for BMI is shaped by the context of the local surroundings. A multilevel approach is crucial to engage with this complex health challenge.”

 

Source: Health and Place

http://doi.org/10.1016/j.healthplace.2017.02.012

“Lifting the lid on geographic complexity in the relationship between body mass index and education in China”

Authors: Maigeng Zhou, Xiaoqi Feng, Jiang Yong, Yichong Li, Mei Zhang, Andrew Page, Thomas Astell-Burt, Wenhua Zhao

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