In many middle and low income countries, obesity levels rise along with income. But a new study says the better educated women are -- the better their chances of avoiding obesity.
Dr. Amina Aitsi-Selmi is the lead author of the University College London study. She wanted to know if trends in high-income countries could be found elsewhere.
“We know that in high income countries education and income tend to go together -- and that those who are most educated and have the highest income tend to be thinnest and the opposite being true,” she said.
The study looked at the middle-income countries of Egypt, Jordan and Colombia – and the low-income countries of Nigeria, India and Benin. These are countries where income levels are on the rise. As a result, women are buying higher calorie foods. Researchers call them energy-dense foods. Simply put, they can pack on the pounds because they’re often laden with sugar, salt and fat. These can be processed foods or so-called fast foods.
Aitsi-Selmi said, “The study shows that although higher income or higher wealth seems to be correlated with a greater risk of obesity in women in middle income countries – and low income countries as well – in middle income countries something strange happened in that education seemed to start protecting against this effect. So that women with higher education weren’t affected by this wealth effect that made other women more obese.”
There may be a few explanations for this.
“It could be that more educated women just have that different body shape preferences. They’re more in contact with Western images of beauty, which promote thinness. It could also be that they have better health understanding – different time preferences – so they kind of invest in future health,” she said.
But the link between education, wealth and health appears a bit different in low income countries. It may have to do with past economic conditions when many types of high-calorie foods were scarce. The desire for those foods now may outweigh the protective education-effect seen in middle and high income countries.
“The greater scarcity means that obesity is just not an issue in that kind of environment. Any advantage you might have, socio-economically, where there is higher education or higher wealth, might be used to be able to access a greater quantity of food. And the market isn’t as complex as a middle income county where you have lots of products – and there are lots of decisions to be made. And that’s where education may start to kick in as something that helps consumers to make decisions,” she said.
Also, low income countries may not have public health systems in place to deal with growing obesity levels. Obesity has been linked to such non-communicable diseases as cancer, diabetes and cardiovascular disease.
Dr. Aitsi-Selmi said more study is needed on the “interplay between education and the wider environment.”
She said, “Interventions could target either the education side of things to encourage women’s education or health knowledge. I mean we need to look in more detail in the pathways that link education to obesity. Or it could be to do with the general environment and the kind of information that is in the environment. And that, in some ways, puts those who don’t have education at a disadvantage because the signals coming from the environment might promote unhealthy behaviors like over consumption.”
That environmental information may include multi-media advertisements, which tell consumers fast food is delicious, cheap and easy to get. They often lack details on the food’s nutritional value.
Education, she said, can be a good defense against unhealthy food choices.
“Yeah, I think that’s fair to say. If you understand the risks that are around you and how your decisions affect your health, then you’ll probably make different decisions.”
Aitsi-Selmi is a Wellcome Trust Fellow at University College London. The study appears in PLOS ONE.
Dr. Amina Aitsi-Selmi is the lead author of the University College London study. She wanted to know if trends in high-income countries could be found elsewhere.
“We know that in high income countries education and income tend to go together -- and that those who are most educated and have the highest income tend to be thinnest and the opposite being true,” she said.
The study looked at the middle-income countries of Egypt, Jordan and Colombia – and the low-income countries of Nigeria, India and Benin. These are countries where income levels are on the rise. As a result, women are buying higher calorie foods. Researchers call them energy-dense foods. Simply put, they can pack on the pounds because they’re often laden with sugar, salt and fat. These can be processed foods or so-called fast foods.
Aitsi-Selmi said, “The study shows that although higher income or higher wealth seems to be correlated with a greater risk of obesity in women in middle income countries – and low income countries as well – in middle income countries something strange happened in that education seemed to start protecting against this effect. So that women with higher education weren’t affected by this wealth effect that made other women more obese.”
There may be a few explanations for this.
“It could be that more educated women just have that different body shape preferences. They’re more in contact with Western images of beauty, which promote thinness. It could also be that they have better health understanding – different time preferences – so they kind of invest in future health,” she said.
But the link between education, wealth and health appears a bit different in low income countries. It may have to do with past economic conditions when many types of high-calorie foods were scarce. The desire for those foods now may outweigh the protective education-effect seen in middle and high income countries.
“The greater scarcity means that obesity is just not an issue in that kind of environment. Any advantage you might have, socio-economically, where there is higher education or higher wealth, might be used to be able to access a greater quantity of food. And the market isn’t as complex as a middle income county where you have lots of products – and there are lots of decisions to be made. And that’s where education may start to kick in as something that helps consumers to make decisions,” she said.
Also, low income countries may not have public health systems in place to deal with growing obesity levels. Obesity has been linked to such non-communicable diseases as cancer, diabetes and cardiovascular disease.
Dr. Aitsi-Selmi said more study is needed on the “interplay between education and the wider environment.”
She said, “Interventions could target either the education side of things to encourage women’s education or health knowledge. I mean we need to look in more detail in the pathways that link education to obesity. Or it could be to do with the general environment and the kind of information that is in the environment. And that, in some ways, puts those who don’t have education at a disadvantage because the signals coming from the environment might promote unhealthy behaviors like over consumption.”
That environmental information may include multi-media advertisements, which tell consumers fast food is delicious, cheap and easy to get. They often lack details on the food’s nutritional value.
Education, she said, can be a good defense against unhealthy food choices.
“Yeah, I think that’s fair to say. If you understand the risks that are around you and how your decisions affect your health, then you’ll probably make different decisions.”
Aitsi-Selmi is a Wellcome Trust Fellow at University College London. The study appears in PLOS ONE.
