The Paradox of Female Obesity in Low and Lower-Middle Income Countries

Setting: Obesity, once considered an epidemic of the developed world, is now becoming an even more prominent problem than underweight in low and lower-middle income countries (LLMICs). Ample literature has shown that as the income of a country increases, the burden of obesity shifts from the rich to the poor. Many studies have explored the effects of various social determinants of health on obesity, but few have studied the association between obesity and education. Additionally, while some data exists on the association in men, there have been limited comprehensive studies focusing on the relationship in the female population of LLMICs. Objective: Globally, adult females have a higher prevalence of obesity and the obesity shift occurs more quickly for women than for men. We aim to address this disparity and explore the association of education and obesity in women. Design: In this cross-sectional study, we used a multi-national and multi-year database from the publicly available Demographic and Health Surveys program with data from 34 LLMICs. Results: Our age-adjusted analysis shows that women in LLMICs with higher education have a significantly greater prevalence of obesity than women with no education. We analyzed this phenomenon by individual nations, continents, and income classifications. Educated women living in low income countries are 5.12 times more likely to be obese than uneducated women (APR, 95% CI=4.75, 5.32) and 3.48 times (APR, 95% CI=3.37, 3.60) more likely in lower-middle income countries. Conclusion: These findings highlight a need for more studies and policy attention focusing on female education levels to understand, predict, and prevent obesity in LLMICs.