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American Journal of Epidemiology Advance Access published online on December 24, 2007
American Journal of Epidemiology, doi:10.1093/aje/kwm340
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American Journal of Epidemiology © The Author 2007. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Original Contribution

Effect of Neighborhood Exposures on Changes in Weight among Women in Cebu, Philippines (1983–2002)

M. Arantxa Colchero1,2 and David Bishai2

1 Department of Health Economics and Evaluation, National Institute of Public Health, Cuernavaca, Mexico
2 Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

Correspondence to Dr. Arantxa Colchero, Room 217, National Institute of Public Health, Av. Universidad No. 655, Col. Sta. Maria Ahuacatitlán, CP 62508 Cuernavaca, Morelos, Mexico (e-mail: acolcher{at}jhsph.edu).

Received for publication May 23, 2007. Accepted for publication October 24, 2007.

The authors aimed to identify the contributions of community factors to weight change in a cohort of women from Metropolitan Cebu, Philippines, between 1983 and 2002. The authors created a three-level random-intercept model to see whether mean body mass index (BMI; weight (kg)/height (m)2) varied by individual- and cluster-level variables and identified community characteristics associated with changes in BMI among 2,952 nonpregnant women. The average BMI among women living in places with four public amenities (telephones, electricity, mail delivery, and newspapers) was 0.16 kg/m2 (95% confidence interval: 0.07, 0.26) higher than that of women living in places with fewer than three amenities. An increase in population density of 10,000 persons per km2 was associated with a BMI increase of 0.09 kg/m2 (95% confidence interval: 0.05, 0.13). A model with interactions revealed that the effect of population density increased significantly over time. These findings confirm earlier observations that in low-income countries, obesity starts among the wealthiest communities. Secondary and tertiary prevention policies designed to reduce obesity should be implemented in the most economically developed areas first. Primary prevention would be most needed in less developed areas, where the obesity epidemic is just beginning.

body mass index; body weight changes; developing countries; multilevel model; obesity; occupations; overweight; residence characteristics

Abbreviations: BMI, body mass index; CI, confidence interval


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