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BMC Public Health
Published in: BMC Public Health 1/2022

Open Access 01-12-2022 | Obesity | Research

Shifting educational gradients in body mass index trajectories of Indonesians: an age period cohort analysis

Author: Lilipramawanty Kewok Liwin

Published in: BMC Public Health | Issue 1/2022

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Abstract

Background

Globally, the number of obese adults has increased rapidly in many developing countries. The links between increased educational attainment and lower risks of overweight/obesity have been studied in a number of high-income contexts. However, educational attainment can have a different association with obesity at different levels of economic development and different stages of the nutritional transition, and these associations may vary by period and cohort. This study aims to provide evidence on the shifting of educational gradients in overweight/obesity in Indonesia, a low middle income country.

Methods

Using five waves of Indonesian Family Life Survey (IFLS), this study examines the Body Mass Index (BMI) trajectories of 14,810 individuals from 1993 to 2014. This study analyses how educational gradients in BMI have shifted over time and across cohorts using a hierarchical age-period-cohort (HAPC) model to account for the effects of age and the changes in historical periods (social and environmental contexts).

Results

In older generations, higher educational attainment is associated with higher BMI, but the gap between educational groups shrinks in more recently-born cohorts. The BMI of lower educational groups is catching up with that of the tertiary educated, leading to an increased risk of overweight/obesity among low educated individuals. Having tertiary education lowers the risk of weight gain (-0.04 point) among recently-born cohort of women, but it still increases the risk (+ 0.04 point) for men.

Conclusion

Changes in access to education and the ongoing nutritional transition in Indonesia are leading to a shifting of educational gradients in overweight/obesity over time. The rising trends in BMI among low-educated and younger individuals are of substantial concern for Indonesian public health due to their implications for the risk of communicable and non-communicable diseases in the future.
Appendix
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Literature
1.
Aune D, Sen A, Prasad M, Norat T, Janszky I, Tonstad S, Romundstad P, Vatten LJ. BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ. 2016;353:i2156.CrossRef
2.
Mongraw-Chaffin ML, Peters SAE, Huxley RR, Woodward M. The sex-specific association between BMI and coronary heart disease: a systematic review and meta-analysis of 95 cohorts with 1·2 million participants. Lancet Diabetes Endocrinol. 2015;3(6):437–49.CrossRef
3.
Abdullah A, Peeters A, de Courten M, Stoelwinder J. The magnitude of association between overweight and obesity and the risk of diabetes: A meta-analysis of prospective cohort studies. Diabetes Res Clin Pract. 2010;89(3):309–19.CrossRef
4.
Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis. BMC Public Health. 2009;9(1):88–88.CrossRef
5.
Tremmel M, Gerdtham U-G, Nilsson P, Saha S. Economic Burden of Obesity: A Systematic Literature Review. Int J Environ Res Public Health. 2017;14(4):435.CrossRef
6.
Goettler A, Grosse A, Sonntag D. Productivity loss due to overweight and obesity: a systematic review of indirect costs. BMJ Open. 2017;7(10):e014632.CrossRef
7.
Di Cesare M, Bentham J, Stevens GA, Zhou B, Danaei G, Lu Y, Bixby H, Cowan MJ, Riley LM, Hajifathalian K, et al. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet (British edition). 2016;387(10026):1377–96.
8.
Lobstein T, Brinsden H: Obesity: missing the 2025 global targets. Trends, Costs and Country Reports. In. London: World Obesity Federation; 2020.
9.
Ailshire JA, House JS. The Unequal Burden of Weight Gain: An Intersectional Approach to Understanding Social Disparities in BMI Trajectories from 1986 to 2001/2002. Soc Forces. 2012;90(2):397–423.CrossRef
10.
Ford ES, Mokdad AH, Giles WH, Galuska DA, Serdula MK. Geographic Variation in the Prevalence of Obesity, Diabetes, and Obesity-Related Behaviors. Obesity (Silver Spring, Md). 2005;13(1):118–22.
11.
Devaux M, Sassi F. Social inequalities in obesity and overweight in 11 OECD countries. Eur J Public Health. 2013;23(3):464–9.CrossRef
12.
El-Sayed AM, Scarborough P, Galea S. Unevenly distributed: A systematic review of the health literature about socioeconomic inequalities in adult obesity in the United Kingdom. BMC Public Health. 2012;12(1):18–18.CrossRef
13.
Board on Health P, Disease P, Institute of M, Committee on Assuring the Health of the Public in the 21st C: Understanding Population Health and Its Determinants. In., edn.: National Academies Press; 2002: 46–95.
14.
Soobader M, Cubbin C, Gee GC, Rosenbaum A, Laurenson J. Levels of analysis for the study of environmental health disparities. Environ Res. 2006;102(2):172–80.CrossRef
15.
Ljungdahl S, Bremberg SG. Might extended education decrease inequalities in health? - A meta-analysis. Eur J Pub Health. 2015;25(4):587–92.CrossRef
16.
Hamad R, Elser H, Tran DC, Rehkopf DH, Goodman SN. How and why studies disagree about the effects of education on health: A systematic review and meta-analysis of studies of compulsory schooling laws. Soc Sci Med. 1982;2018(212):168–78.
17.
Cohen AK, Rai M, Rehkopf DH, Abrams B. Educational attainment and obesity: a systematic review: Educational attainment and obesity. Obes Rev. 2013;14(12):989–1005.CrossRef
18.
Sassi F, Devaux M, Borgonovi F, Church J, Cecchini M. Exploring the Relationship Between Education and Obesity. OECD J Econ Studies. 2011;2011(1):1–40.
19.
Bollyky TJ, Templin T, Cohen M, Dieleman JL. Lower-income countries that face the most rapid shift in noncommunicable disease burden are also the least prepared. Health Aff. 2017;36(11):1866–75.CrossRef
20.
Baker DP, Smith WC, Muñoz IG, Jeon H, Fu T, Leon J, Salinas D, Horvatek R. The Population Education Transition Curve: Education Gradients Across Population Exposure to New Health Risks. Demography. 2017;54(5):1873–95.CrossRef
21.
Benaabdelaali W, Hanchane S, Kamal A: Educational Inequality in the World, 1950–2010: Estimates from a New Dataset. In. Volume 20, edn.: Emerald Group Publishing Limited; 2012: 337–366.
22.
Lynch SM. Cohort and life-course patterns in the relationship between education and health: A hierarchical approach. Demography. 2003;40(2):309–31.CrossRef
23.
Jeon H, Salinas D, Baker DP. Non-linear education gradient across the nutrition transition: mothers’ overweight and the population education transition. Public Health Nutr. 2015;18(17):3172–82.CrossRef
24.
Benson R, von Hippel PT, Lynch JL. Does more education cause lower BMI, or do lower-BMI individuals become more educated? Evidence from the National Longitudinal Survey of Youth 1979. Soc Sci Med. 1982;2018(211):370–7.
25.
Clarke P, O’Malley PM, Johnston LD, Schulenberg JE. Social disparities in BMI trajectories across adulthood by gender, race/ethnicity and lifetime socio-economic position: 1986–2004. Int J Epidemiol. 2009;38(2):499–509.
26.
Sturm R, An R. Obesity and economic environments. CA Cancer J Clin. 2014;64(5):337–50.CrossRef
27.
Hruby A, Hu FB. The Epidemiology of Obesity: A Big Picture. Pharmacoecon. 2015;33(7):673–89.CrossRef
28.
Swinburn B, Egger G, Raza F. Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. Prev Med. 1999;29(6):563–70.CrossRef
29.
Kanter R, Caballero B. Global gender disparities in obesity: A review. Advances in nutrition (Bethesda, Md). 2012;3(4):491–8.CrossRef
30.
Singer JD, Willett JB. Applied longitudinal data analysis: modeling change and event occurrence. New York;Oxford: Oxford University Press; 2003.CrossRef
31.
Siegel JS, Olshansky SJ. The demography and epidemiology of human health and aging. New York;Dordrecht: Springer; 2012.CrossRef
32.
Bell A, Jones K: Age, Period and Cohort Processes in Longitudinal and Life Course Analysis: A Multilevel Perspective. In: A Life Course Perspective on Health Trajectories and Transitions [Internet]. edn. Edited by Burton-Jeangros C CS, Sacker A, et al.: Cham (CH): Springer; 2015.
33.
Zanden JLv, Marks D: An economic history of Indonesia 1800–2010, vol. 109., 1 edn. Milton Park, Abingdon, Oxon;New York, NY;: Routledge; 2011.
34.
National Institute of Health Research and Development (BALITBANGKES): Laporan Nasional Riskesdas 2018. In. Edited by Indonesia MoHR. Jakarta: Lembaga Penerbit BALITBANGKES; 2019.
35.
National Institute of Health Research and Development (BALITBANGKES): Laporan Nasional Riskesdas 2010. In. Edited by Indonesia MoHR. Jakarta: Lembaga Penerbit BALITBANGKES; 2010.
36.
Rachmi CN, Li M, Alison Baur L. Overweight and obesity in Indonesia: prevalence and risk factors—a literature review. Public Health. 2017;147:20–9.CrossRef
37.
Oddo VM, Maehara M, Rah JH. Overweight in Indonesia: an observational study of trends and risk factors among adults and children. BMJ Open. 2019;9(9): e031198.CrossRef
38.
Roemling C, Qaim M. Obesity trends and determinants in Indonesia. Appetite. 2012;58(3):1005–13.CrossRef
39.
Sudharsanan N: A Global Perspective On Aging And Inequality. Dissertation. University of Pennsylvania; 2017.
40.
Vaezghasemi M, Razak F, Ng N, Subramanian SV. Inter-individual inequality in BMI: An analysis of Indonesian Family Life Surveys (1993–2007). SSM-Population Health. 2016;2:876–88.
41.
Idzalika R, Lo Bue MC. Educational Opportunities in Indonesia: Are Factors Outside Individual Responsibility Persistent Over Time? J Dev Studies. 2020;56(8):1473–88.CrossRef
42.
Jones GW, Pratomo D. Education in Indonesia: trends, differentials, and implications for development. In: Contemporary Demographic Transformations in China, India and Indonesia. edn. Switzerland: Springer; 2016. p. 195–214.
43.
44.
Barba C, Cavalli-Sforza T, Cutter J, Darnton-Hill I, Deurenberg P, Deurenberg-Yap M, Gill T, James P, Ko G, Miu AH, et al. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. The Lancet (British edition). 2004;363(9403):157–63.
45.
Curran PJ, Obeidat K, Losardo D. Twelve frequently asked questions about growth curve modeling. J Cogn Dev. 2010;11(2):121–36.CrossRef
46.
McNeish D, Matta T. Differentiating between mixed-effects and latent-curve approaches to growth modeling. Behav Res Methods. 2018;50(4):1398–414.CrossRef
47.
Bell A. Age, Period and Cohort Effects: Statistical Analysis and the Identification Problem. New York: Routledge; 2020.
48.
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel J-P, Rolland Y, Schneider SM: Sarcopenia: European consensus on definition and diagnosisReport of the European Working Group on Sarcopenia in Older PeopleA. J. Cruz-Gentoft et al. Age and ageing 2010, 39(4):412-423
49.
Baker P, Friel S. Processed foods and the nutrition transition: evidence from Asia: Processed foods and nutrition transition in Asia. Obes Rev. 2014;15(7):564–77.CrossRef
50.
Tzotzas T, Vlahavas G, Papadopoulou SK, Kapantais E, Kaklamanou D, Hassapidou M. Marital status and educational level associated to obesity in Greek adults: Data from the National Epidemiological Survey. BMC Public Health. 2010;10(1):732–732.CrossRef
51.
Baum F, Narayan R, Sanders D, Patel V, Quizhpe A. Social vaccines to resist and change unhealthy social and economic structures: a useful metaphor for health promotion. Health Promot Int. 2009;24(4):428–33.CrossRef
52.
Nomaan M, Nayantara S. Employment and growth in Indonesia (1990–2015). In: Employment. Geneva, Switzerland: International Labour Office; 2018.
53.
Kinge JM, Strand BH, Vollset SE, Skirbekk V. Educational inequalities in obesity and gross domestic product: evidence from 70 countries. J Epidemiol Comm Health (1979). 2015;69(12):1141–6.CrossRef
Metadata
Title
Shifting educational gradients in body mass index trajectories of Indonesians: an age period cohort analysis
Author
Lilipramawanty Kewok Liwin
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2022
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-022-13379-3

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