This paper assesses individual and social environment determinants of obesity in the adult Mexican population based on socioeconomic position, rural residence, and areal deprivation. Using a nationally representative health and nutrition survey, this analysis considers individual and structural determinants of obesity from a socioeconomic position and health disparities conceptual framework using multilevel logistic regression models. We find that more than thirty percent of Mexican adults were obese in 2006 and that the odds of being obese were strongly associated with an individual's socioeconomic position, gender, place of residence, and the level of marginalization (areal deprivation) in the place of residence. Surprisingly, areas of the country where areal deprivation was highest had lower risks of individual obesity outcomes. We suggest that programs oriented towards addressing the health benefits of traditional food systems over high-energy dense refined foods and sugary beverages be promoted as part of a public health program aimed at curbing the rising obesity prevalence in Mexico. 1. Introduction Major improvements in health and economic well-being have occurred over the past several decades in Mexico. However health care expenditures and resources are lower, and major health indicators, such as life expectancy and infant mortality rates, are higher in Mexico compared to other OECD countries [1]. Additionally, obesity prevalence rates are high and increasing in Mexico [2–5], with approximately 30 percent of the adult population obese [6]; only the US has a higher adult obesity rate than Mexico of all OECD countries [1]. Other studies estimate obesity prevalence to be as high as 50 percent of the population [7], and almost 70 percent of the adult Mexican population is either obese or overweight [6, 8]. Similar obesity prevalence rates have been observed between poor rural and urban adults in Mexico [9]; however gender differences have been noted for overweight and obesity prevalence for Mexican adults indicating a female overweight/obesity disadvantage [6, 7, 10]. The rise in obesity prevalence presents new implications for the health care needs of the Mexican population and longer-term chronic health problems, like diabetes and hypertension [8, 11], for a low-income country with high levels of inequality in economic, social service, and health resources [1]. Differences in economic resources, social services, physical infrastructure, health care services, and food environments exist across regions of Mexico [12–14], with noticeable differences
References
[1]
OECD, 2009, OECD Health Data 2009: How Does Mexico Compare, http://www.oecd.org/dataoecd/46/9/38980018.pdf.
[2]
L. C. Fernald, X. Hou, and P. J. Gertler, “Oportunidades program participation and body mass index, blood pressure, and self-reported health in Mexican adults,” Preventing Chronic Disease, vol. 5, no. 3, p. A81, 2008.
[3]
R. M. Malina, M. E. Pe?a Reyes, S. K. Tan, P. H. Buschang, and B. B. Little, “Overweight and obesity in a rural amerindian population in Oaxaca, Southern Mexico, 1968–2000,” American Journal of Human Biology, vol. 19, no. 5, pp. 711–721, 2007.
[4]
L. Ruiz-Arregui, L. Castillo-Martínez, A. Orea-Tejeda, S. Mejía-Arango, and A. Miguel-Jaimes, “Prevalence of self-reported overweight-obesity and its association with socioeconomic and health factors among older Mexican adults,” Salud Publica de Mexico, vol. 49, supplment 4, pp. S482–S487, 2007.
[5]
K. V. Smith and N. Goldman, “Socioeconomic differences in health among older adults in Mexico,” Social Science and Medicine, vol. 65, no. 7, pp. 1372–1385, 2007.
[6]
J. A. Rivera, L. M. Irizarry, and T. Gonzalez-de Cossio, “Overview of the nutritional status of the Mexican population in the last two decades,” Salud Publica de Mexico, vol. 51, supplment 4, pp. S645–S656, 2009.
[7]
L. C. H. Fernald, “Socio-economic status and body mass index in low-income Mexican adults,” Social Science and Medicine, vol. 64, no. 10, pp. 2030–2042, 2007.
[8]
L. M. Gomez, B. Hernández-Prado, C. Morales Mdel, and T. Shamah-Levy, “Physical activity and overweight/obesity in adult Mexican population. The Mexican National Health and Nutrition Survey 2006,” Salud Publica de Mexico, vol. 51, supplment 4, pp. S621–S629, 2009.
[9]
L. C. Fernald, J. P. Gutierrez, L. M. Neufeld et al., “High prevalence of obesity among the poor in Mexico,” Journal of the American Medical Association, vol. 291, no. 21, pp. 2544–2545, 2004.
[10]
S. Barquera, L. Hernández-Barrera, I. Campos-Nonato et al., “Energy and nutrient consumption in adults: analysis of the Mexican National Health and Nutrition Survey 2006,” Salud pública de México, vol. 51, pp. S562–573, 2009.
[11]
G. Olaiz, J. Rivera, T. Shamah, et al., Encuesta Nacional de Salud y Nutrición 2006, Instituto Nacional de Salud Pública, Cuernavaca, México, 2006.
[12]
The World Bank, “Income generation and social protection for the poor,” in Income Generation and Social Protection for the Poor, The World Bank, Washington, DC, USA, 2005.
[13]
S. G. Sosa-Rubí, O. Galárraga, and R. López-Ridaura, “Diabetes treatment and control: the effect of public health insurance for the poor in Mexico,” Bulletin of the World Health Organization, vol. 87, no. 7, pp. 512–519, 2009.
[14]
M. Acosta-Mendez, L. Mariscal-Servitje, and C. Santos-Burgoa, “The present and future of Mexican health promotion,” Promotion & Education, vol. 14, no. 4, pp. 224–227, 2007.
[15]
J. B. Anderson and J. Gerber, Fifty Years of Change on the U.S.-Mexico Border: Growth, Development and Quality of Life, University of Texas Press, Austin, Tex, USA, 2007.
[16]
S. Barquera, C. Hotz, and J. Rivera, “Food consumption, food expenditure, anthropometric status and nutrition-related diseases in Mexico,” in The Double Burden of Malnutrition: Case Studies from Six Developing Countries, Food and Agriculture Organization of the United Nations, Ed., pp. 161–203, Food and Agriculture Organization of the United Nations, Rome, Italy, 2006.
[17]
J. A. Rivera, S. Barquera, F. Campirano, I. Campos, M. Safdie, and V. Tovar, “Epidemiological and nutritional transition in Mexico: rapid increase of non-communicable chronic diseases and obesity,” Public Health Nutrition A, vol. 5, no. 1, pp. 113–122, 2002.
[18]
J. A. Rivera, S. Barquera, T. González-Cossío, G. Olaiz, and J. Sepúlveda, “Nutrition transition in Mexico and in other Latin American countries,” Nutrition Reviews, vol. 62, no. 7, pp. S149–S157, 2004.
[19]
A. M. Buttenheim, R. Wong, N. Goldman, and A. R. Pebley, “Does social status predict adult smoking and obesity? Results from the 2000 Mexican national health survey,” Global Public Health, vol. 5, no. 4, pp. 413–426, 2010.
[20]
B. Galobardes, M. Shaw, D. A. Lawlor, G. D. Smith, and J. Lynch , “Indicators of socioeconomic position,” in Methods in Social Epidemiology, J. M. Oakes and J. S. Kaufman, Eds., pp. 47–85, Jossey-Bass, San Francisco, Calif, USA, 2006.
[21]
The World Bank, Poverty in Mexico: An Assessment of Trends, Conditions, and Government Strategy, The World Bank, Washigton, DC, USA, 2004.
[22]
A. M. Valle, “Social class, marginality and self-assessed health: a cross-sectional analysis of the health gradient in Mexico,” International Journal for Equity in Health, vol. 8, article 3, 2009.
[23]
S. F. Reardon, “conceptual framework for measuring segregation and its association with population outcomes,” in Methods in Social Epidemiology, J. M. Oakes and J. S. Kaufman, Eds., pp. 169–192, Jossey-Bass, San Francisco, Calif, USA, 2006.
[24]
B. M. Popkin and P. Gordon-Larsen, “The nutrition transition: worldwide obesity dynamics and their determinants,” International Journal of Obesity, vol. 28, supplement 3, pp. S2–S9, 2004.
[25]
D. Williams, “Patterns and causes of disparities in health,” in Policy Challenges in Modern Health Care, D. Mechanic, L. B. Rogut, and D. C. Colby, Eds., pp. 115–134, Rutgers University Press, New Brunswick, NJ, USA, 2005.
[26]
I. B. Grafova, V. A. Freedman, R. Kumar, and J. Rogowski, “Neighborhoods and obesity in later life,” American Journal of Public Health, vol. 98, no. 11, pp. 2065–2071, 2008.
[27]
P. Verger, B. Saliba, V. Guagliardo, A. D. Bouhnik, and S. Eichenbaum-Voline, “Individual social characteristics, municipal environment and the prevalence of weight problems in early childhood: a multilevel analysis,” Revue d'Epidemiologie et de Sante Publique, vol. 55, no. 5, pp. 347–356, 2007.
[28]
T. King, A. M. Kavanagh, D. Jolley, G. Turrell, and D. Crawford, “Weight and place: a multilevel cross-sectional survey of area-level social disadvantage and overweight/obesity in Australia,” International Journal of Obesity, vol. 30, no. 2, pp. 281–287, 2006.
[29]
J. P. Habicht, “Standardization of quantitative epidemiological methods in the field,” Boletin de la Oficina Sanitaria Panamericana, vol. 76, no. 5, pp. 375–384, 1974.
[30]
L. F. Lopez-Calva, L. Rodriguez-Chamussy, and M. Szekely, “Poverty maps and public policy in Mexico,” in More than a Pretty Picture: Using Policy Maps to Design Better Policies and Interventions, T. Bedi, A. Coudouel, and K. Simler, Eds., pp. 188–207, The World Bank, Washington, DC, USA, 2007.
[31]
S. Pe?a, “Recent developments in urban marginality along Mexico's northern border,” Habitat International, vol. 29, no. 2, pp. 285–301, 2005.
[32]
D. Bates, M. Maechler, and B. Bolker, lme4: linear mixed-effects models using S4 classes. 2011.
[33]
R Development Core Team, R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing, Vienna, Austria, 2012.
[34]
A. C. Carle, “Fitting multilevel models in complex survey data with design weights: recommendations,” BMC Medical Research Methodology, vol. 9, no. 1, article 49, 2009.
[35]
M. Monteverde, K. Noronha, A. Palloni, and B. Novak, “Obesity and excess mortality among the elderly in the United States and Mexico,” Demography, vol. 47, no. 1, pp. 79–96, 2010.
[36]
M. Pena and J. Bacallao, “Obesity among the poor: an emerging problem in Latin America and the Caribbean,” in Obesity and Poverty: A New Public Health Challenge, M. Pena and J. Bacallao, Eds., pp. 3–10, Pan American Health Organization, Washington, DC, USA, 2000.
[37]
S. Barquera, L. Hernandez-Barrera, M. L. Tolentino et al., “Energy intake from beverages is increasing among Mexican adolescents and adults,” Journal of Nutrition, vol. 138, no. 12, pp. 2454–2461, 2008.
[38]
A. Jimenez-Aguilar, M. Flores, and T. Shamah-Levy, “Sugar-sweetened beverages consumption and BMI in Mexican adolescents. Mexican National Health and Nutrition Survey 2006,” Salud Publica de Mexico, vol. 51, supplement 4, pp. S604–S612, 2009.
[39]
N. Moise, E. Cifuentes, E. Orozco, and W. Willett, “Limiting the consumption of sugar sweetened beverages in Mexico's obesogenic environment: a qualitative policy review and stakeholder analysis,” Journal of Public Health Policy, vol. 32, no. 4, pp. 458–475, 2011.
[40]
J. A. Rivera, O. Mu?oz-Hernández, M. Rosas-Peralta, C. A. Aguilar-Salinas, B. M. Popkin, and W. C. Willett, “Drink consumption for a healthy life: recommendations for the general population in Mexico,” Gaceta médica de México, vol. 144, no. 5, pp. 369–388, 2008.
[41]
L. E. Bautista, J. P. Casas, V. M. Herrera et al., “The Latin American Consortium of Studies in Obesity (LASO),” Obesity Reviews, vol. 10, no. 3, pp. 364–370, 2009.
[42]
L. M. Neufeld, S. Hernández-Cordero, L. C. Fernald, and U. Ramakrishnan, “Overweight and obesity doubled over a 6-year period in young women living in poverty in Mexico,” Obesity, vol. 16, no. 3, pp. 714–717, 2008.
[43]
N. Almeida-Filho, I. Lessa, L. Magalh?es et al., “Social inequality and depressive disorders in Bahia, Brazil: Interactions of gender, ethnicity, and social class,” Social Science and Medicine, vol. 59, no. 7, pp. 1339–1353, 2004.
[44]
M. Bronfman, “Infant mortality and crisis in Mexico,” International Journal of Health Services, vol. 22, no. 1, pp. 157–167, 1992.
[45]
R. Lozano, B. Zurita, F. Franco, T. Ramirez, P. Hernandez, and J. L. Torres, “Mexico: marginality, need and resource allocation at the county level,” in Challenging Inequities in Health: From Ethics to Action, T. Evans, M. Whitehead, F. Diderichsen, A. Bhuiya, and M. Wirth, Eds., pp. 276–295, Oxford University Press, Oxford, UK, 2001.
[46]
E. Bastida and G. A. Soydemir, “Obesity and employment as predictors of diabetes in Mexican Americans: findings from a longitudinal study,” Applied Economics, vol. 41, no. 20, pp. 2533–2540, 2009.
[47]
A. Bersamin, K. D. Hanni, and M. A. Winkleby, “Predictors of trying to lose weight among overweight and obese Mexican-Americans: a signal detection analysis,” Public Health Nutrition, vol. 12, no. 1, pp. 64–73, 2009.
[48]
S. E. Colby, S. Morrison, and L. Haldeman, “What changes when we move? A transnational exploration of dietary acculturation,” Ecology of Food and Nutrition, vol. 48, no. 4, pp. 327–343, 2009.
[49]
U. Colón-Ramos, F. E. Thompson, A. L. Yaroch et al., “Differences in fruit and vegetable intake among hispanic subgroups in California: results from the 2005 California Health Interview Survey,” Journal of the American Dietetic Association, vol. 109, no. 11, pp. 1878–1885, 2009.
[50]
N. Kaushal, “Adversities of acculturation? Prevalence of obesity among immigrants,” Health Economics, vol. 18, no. 3, pp. 291–303, 2009.
[51]
R. Pérez-Escamilla and P. Putnik, “The role of acculturation in nutrition, lifestyle, and incidence of type 2 diabetes among Latinos,” Journal of Nutrition, vol. 137, no. 4, pp. 860–870, 2007.
[52]
P. J. Salsberry and P. B. Reagan, “Comparing the influence of childhood and adult economic status on midlife obesity in Mexican American, white, and African American women: populations at risk across the lifespan: population studies,” Public Health Nursing, vol. 26, no. 1, pp. 14–22, 2009.
[53]
J. A. Skelton, S. R. Cook, P. Auinger, J. D. Klein, and S. E. Barlow, “Prevalence and trends of severe obesity among US children and adolescents,” Academic Pediatrics, vol. 9, no. 5, pp. 322–329, 2009.