Associations between Multiple Indicators of Socioeconomic Status and Obesity in Young Adult Filipinos Vary by Gender, Urbanicity, and Indicator Used

More research is needed on the socio-environmental determinants of obesity in lower- and middle-income countries. We used generalized estimating equations to evaluate the cross-sectional effect of urban residence and multiple individual-level indicators of socioeconomic status (SES) on the odds of overweight or central adiposity in a birth cohort of young adult (mean age 21.5 y) Filipino males (n = 987) and females (n = 819) enrolled in the Cebu Longitudinal Health and Nutrition Survey. Overweight was defined as BMI ≥25 kg/m2 and central adiposity was defined as a waist circumference >85 cm for males or >80 cm for females. Community-level urbanicity was measured on a continuous scale. Multiple indicators of SES included assets, income, education, and marital status. In the final multivariable models, assets and being married were positively related to overweight and central adiposity in males (P < 0.05), but being married was the only predictor of these outcomes in females. However, once the modifying effects of urban residence were accounted for, assets were positively related to overweight and central adiposity among the most rural women, but not in more urban women. Our results are consistent with a growing body of literature that suggests the relationship between SES and obesity is positive in lower-income contexts and inverse in higher-income contexts, particularly in females. The pattern of relationships we observed suggests that as the Philippines continues to develop economically, the public health impact of obesity will increase similarly to what has been observed in countries further along in their economic transition