The economics of obesity in developing countries: The case of Cebu, Philippines

This study presents an analysis of the economic and social determinants of obesity among women enrolled in the Cebu Longitudinal Health and Nutrition Surveys (CLHNS). The study also describes the effect of height and weight on hourly earnings in the same population. The CLHNS is a cohort of women who gave birth in 1983 in Metropolitan Cebu, Philippines. A single stage cluster design was used to select 33 clusters to locate all pregnant women in Cebu that were followed for twenty years at different points in time between 1983 and 2002.; The Philippines, located in Southeast Asia, is a lower middle-income country with a Gross National Income per capita of US{dollar}1,300, a population over 85 million and a life expectancy at birth of 71 years. The prevalence of overweight and obesity, defined as a body mass index (BMI) higher than 25, reached 28% among women in 2005 nation wide. More dramatic changes occurred among the cohort of women enrolled in the CLHSN where overweight and obesity increased from less than 7% in 1983 to 43% in 2002.; We assessed the effects of changes in income and occupational activities on changes in BMI among 2,952 non-pregnant women in the CLHNS between 1983 and 2002. Panel methods were used to account for unobserved heterogeneity that results from taking repeated measures over time. On average, BMI among women whose previous occupations were classified as low activities was 0.29 kg/m2 (standard error [SE] 0.11) larger compared to women occupied in heavy activities. BMI among women previously engaged in medium activities was on average 0.12 kg/m2 (SE 0.05) larger compared to women in heavy activities. A one-unit increase in past log household income was associated with small increase in BMI of 0.006 kg/m2 (SE 0.02) but the effect was not significant. The trend of increasing body mass was higher in the late 1980s than during the 1990s. These period effects were stronger for the women who were younger at baseline and for women with low and medium activity levels.; We specified a three level random intercept model to account for variations at the individual and cluster level and identified variables at the community level associated with changes in BMI among 2,919 non-pregnant women in the CLHNS between 1983 and 2002. Women gained weight at different rates depending on the cluster where they lived. On average, BMI among women living in places with all services (telephone, electricity, mail and newspaper) was 0.16 kg/m 2 (SE 0.04) larger compared to those living in places with less than three services. An increase of 10,000 individuals per km2 was associated with an increase in BMI of 0.09 kg/m2 (SE 0.02). The effect of population density on changes in BMI significantly increased with time.; We estimated the effect of past BMI categories and height on log hourly earnings, in 2002 Filipino pesos, among 2,696 women working on a per time basis, per piece or self-employed in the CLHNS between 1983 and 2002. Panel methods were used to account for unobserved heterogeneity and Heckman's models to correct for selection bias. Log hourly earnings among women of normal weight (BMI between 18.5 and 25) was 0.11 (SE 0.04) larger than among underweight women (BMI less than 18.5). Log hourly earnings among overweight women (BMI between 25 and 30) was 0.16 (SE 0.06) larger that among underweight women. The difference in real earnings between underweight and obese (BMI>30) was lower but not significant. One additional centimeter was associated with an increase in log hourly earnings of 0.008 (SE 0.003) independent of BMI category.