Final Report Summary - BODYWEIGHTDYNAMICS (Determinants and dynamics of the obesity epidemic)
Project Objectives
This project aimed to increase our understanding of the determinants and dynamics of the obesity epidemic. Such increased understanding is important for many, including policy makers, because obesity is known to significantly increase the spread of non-communicable diseases such as cardiovascular disease, diabetes, hypertension, musculoskeletal disorders and various cancers. Currently almost a third of people living in the European Union are overweight and more than one in ten is now clinically obese. Obesity therefore has a significant inlfuence on the development of health care costs.
The overall objective of the project was to perform a comprehensive investigation of the recent rise in overweight and obesity in the People’s Republic of China. In particular, micro-data from the China Health and Nutrition Survey waves 1991-2009 were used. The China Health and Nutrition Survey is maintained and delivered by the Carolina Population Center at the University of North Carolina at Chapel Hill and the National Institute of Nutrition and Food Safety at the Chinese Center for Disease Control and Prevention. For further information, see: http://www.cpc.unc.edu/projects/china.
Data from this database were used to:
(1) identify dynamic patterns in the socio-economic gradient of overweight,
(2) estimate the relative importance of increased caloric intake as opposed to reduced caloric expenditure in explaining the continuous rise in overweight and
(3) identify the impact of formal maternal employment on the propensity of overweight among Chinese youth.
The findings aim to inform the scientific community and policy makers, respectively.
China is an interesting case to investigate the development of obesity for several reasons: First, for the last three decades, China’s economy grew at an unprecedented annual rate of about 10%. At the same time this development was rather unequally distributed over the country. Coastal regions were the main beneficiaries of economic growth were in major cities living standards and lifestyles are, as by now, comparable to their western counterparts. Second, following the patterns of the United States and various European countries, China has experienced tremendous increases of overweight levels - especially in urban areas (see Popkin et al. (2006) who estimates the future health cost of the overweight epidemic -and direct consequences thereof- to reach 9% of China’s GDP by 2025). The nutrition transition in China is currently progressing at a fast pace with already more than 20% of the Chinese being overweight and another 3% being obese nowadays - translating into more than 200 million Chinese being affected by the epidemic in absolute terms.
Note, however, that the share of overweight in China is still below that of countries like the US, UK or Germany (all above 60%).
Clearly, such insights from China are not only valuable to policy makers from developing countries, but are also very relevant for more developed societies. One key question to be asked here is: can we expect the problem of rising body-weight levels to be self-limiting, i.e. after trickling down from high to low socio-economic ranks, can we ultimately expect a reversal of the phenomenon? Extrapolating from the current situation in most developed societies one could argue that, with growing awareness and a trend towards more healthy foods (especially among lower socio-economic ranks) an overall decrease in overweight can be imagined.
Description of work performed since the beginning of the project
During the initial phases of the project much time was devoted to a comprehensive review of the existing literatures on (1) the determinants of obesity at the individual level, (2) the impact of obesity on biological and non-biological outcomes, (3) existing policy approaches to tackle obesity in populations and (4) econometric methods suited for the analyses of interest. Existing results from this review formed the point of departure for the proposed research articles.
The analyses of interest used data from the China Health and Nutrition Survey. Although the data is delivered in a longitudinal format, a significant amount of time was needed to prepare the data (i.e. merge different data-sets, check the quality of the data, clean inconsistencies, develop sample selection criteria for the different sub-projects). Unfortunately, the data quality turned out to be worse than expected.
Most of the proposed analyses have been carried out by the end of the project funding period. The results were disseminated among interested researchers and presented in internal and external seminar. Comments and feedback received were included in various revisions of the analyses which helped to improve the quality of the research
Expected final results of the project and related potential impact and use
In particular, three research articles were produced based on the findings. One article was successfully published as:
Tafreschi, Darjusch, 2015. "The income body weight gradients in the developing economy of China," Economics & Human Biology, Elsevier, vol. 16(C), 115-134.
Two other articles (co-authored by Tom Van Ourti (Erasmus University Rotterdam)) were not published in peer-reviewed scientific journals by the end of the project period. However, the findings were presented and discussed at various conferences and seminars. Based on the received feedback the authors are confident that the findings will be published in high quality journals in the future.
Strong links between the health economics group where the fellow performed the project and the global community of health economists, Dutch government ministries and agencies and international organizations such as the WHO, World Bank and Unicef will be used to further disseminate the project's results and leverage their adoption in those institutions.
This project aimed to increase our understanding of the determinants and dynamics of the obesity epidemic. Such increased understanding is important for many, including policy makers, because obesity is known to significantly increase the spread of non-communicable diseases such as cardiovascular disease, diabetes, hypertension, musculoskeletal disorders and various cancers. Currently almost a third of people living in the European Union are overweight and more than one in ten is now clinically obese. Obesity therefore has a significant inlfuence on the development of health care costs.
The overall objective of the project was to perform a comprehensive investigation of the recent rise in overweight and obesity in the People’s Republic of China. In particular, micro-data from the China Health and Nutrition Survey waves 1991-2009 were used. The China Health and Nutrition Survey is maintained and delivered by the Carolina Population Center at the University of North Carolina at Chapel Hill and the National Institute of Nutrition and Food Safety at the Chinese Center for Disease Control and Prevention. For further information, see: http://www.cpc.unc.edu/projects/china.
Data from this database were used to:
(1) identify dynamic patterns in the socio-economic gradient of overweight,
(2) estimate the relative importance of increased caloric intake as opposed to reduced caloric expenditure in explaining the continuous rise in overweight and
(3) identify the impact of formal maternal employment on the propensity of overweight among Chinese youth.
The findings aim to inform the scientific community and policy makers, respectively.
China is an interesting case to investigate the development of obesity for several reasons: First, for the last three decades, China’s economy grew at an unprecedented annual rate of about 10%. At the same time this development was rather unequally distributed over the country. Coastal regions were the main beneficiaries of economic growth were in major cities living standards and lifestyles are, as by now, comparable to their western counterparts. Second, following the patterns of the United States and various European countries, China has experienced tremendous increases of overweight levels - especially in urban areas (see Popkin et al. (2006) who estimates the future health cost of the overweight epidemic -and direct consequences thereof- to reach 9% of China’s GDP by 2025). The nutrition transition in China is currently progressing at a fast pace with already more than 20% of the Chinese being overweight and another 3% being obese nowadays - translating into more than 200 million Chinese being affected by the epidemic in absolute terms.
Note, however, that the share of overweight in China is still below that of countries like the US, UK or Germany (all above 60%).
Clearly, such insights from China are not only valuable to policy makers from developing countries, but are also very relevant for more developed societies. One key question to be asked here is: can we expect the problem of rising body-weight levels to be self-limiting, i.e. after trickling down from high to low socio-economic ranks, can we ultimately expect a reversal of the phenomenon? Extrapolating from the current situation in most developed societies one could argue that, with growing awareness and a trend towards more healthy foods (especially among lower socio-economic ranks) an overall decrease in overweight can be imagined.
Description of work performed since the beginning of the project
During the initial phases of the project much time was devoted to a comprehensive review of the existing literatures on (1) the determinants of obesity at the individual level, (2) the impact of obesity on biological and non-biological outcomes, (3) existing policy approaches to tackle obesity in populations and (4) econometric methods suited for the analyses of interest. Existing results from this review formed the point of departure for the proposed research articles.
The analyses of interest used data from the China Health and Nutrition Survey. Although the data is delivered in a longitudinal format, a significant amount of time was needed to prepare the data (i.e. merge different data-sets, check the quality of the data, clean inconsistencies, develop sample selection criteria for the different sub-projects). Unfortunately, the data quality turned out to be worse than expected.
Most of the proposed analyses have been carried out by the end of the project funding period. The results were disseminated among interested researchers and presented in internal and external seminar. Comments and feedback received were included in various revisions of the analyses which helped to improve the quality of the research
Expected final results of the project and related potential impact and use
In particular, three research articles were produced based on the findings. One article was successfully published as:
Tafreschi, Darjusch, 2015. "The income body weight gradients in the developing economy of China," Economics & Human Biology, Elsevier, vol. 16(C), 115-134.
Two other articles (co-authored by Tom Van Ourti (Erasmus University Rotterdam)) were not published in peer-reviewed scientific journals by the end of the project period. However, the findings were presented and discussed at various conferences and seminars. Based on the received feedback the authors are confident that the findings will be published in high quality journals in the future.
Strong links between the health economics group where the fellow performed the project and the global community of health economists, Dutch government ministries and agencies and international organizations such as the WHO, World Bank and Unicef will be used to further disseminate the project's results and leverage their adoption in those institutions.