food availability and changes in weight among women in metropolitan cebu, philippines (1983-2002)
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Center for a Livable Future “Insights Along the Path to Sustainability”. Food Availability and Changes in Weight among Women in Metropolitan Cebu, Philippines (1983-2002). Johns Hopkins Bloomberg School of Public Health Baltimore, MD, April 8th, 2008. - PowerPoint PPT PresentationTRANSCRIPT
Food Availability and Changes in
Weight among Women in
Metropolitan Cebu, Philippines
(1983-2002)
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD, April 8th, 2008
Center for a Livable Future“Insights Along the Path to Sustainability”
Arantxa Colchero, PhDNational Institute of Public Health, Mexico
Objectives of the study
• To estimate the effect of neighborhood
exposures on changes in weight
among women in the CLHNS between
1983 and 2002
• To study the type of food sold by food
stores and street vendors in Cebu for
a selected sample of CLHNS localities
The Philippines
• GPD per capita: US$1,300
• Population over 85 million
• Total fertility rate 3.1
• Life expectancy at birth: 71 years
• Country entering the nutrition transition
• Cebu Longitudinal Health and Nutrition Surveys
– Cohort of women in Metro Cebu
– 3,327 pregnant women from 33 randomly selected barangays
– 7 surveys (1983-2002)
Mean BMI for each barangay
QuickTime™ and aTIFF (PackBits) decompressorare needed to see this picture.
Effect of neighborhood exposures
• Multilevel model: three random
intercept model– Variation at the cluster level (barangay)
– Variation at the individual level (women)
• Variables at the barangay level– Population density (persons/km2)
– Public amenities (electricity, mail delivery, telephone and newspaper)
Results multilevel model
• BMI among women living in places with four public amenities was 0.16 kg/m2 (95% CI: 0.07,0.26) higher
• Increase in population density of 10,000 persons/km2 was associated with a BMI increase of 0.09 kg/m2 (95% CI:0.05,0.13)
• Effect of population density increased significantly with time
Food supply in Metro Cebu
Establishment Fresh Food Cooked Food
Large corporations 20 supermarkets Fast food chains
Medium/small family business
239 sari-sari stores12 public markets
59 carenderias 61 ambulants
Questionnaire fresh food
• Fruits and vegetables
• Checklist for different types of grains, milk, bread, cereals, oils, fish, meat, soda
• Prices (rice, noodles, eggs, oil, soft drink)
•Prices (low fat vs regular options)
Questionnaire cooked food
• Checklist items offered
• Mode of preparationRawSteamedGrilledSauteeFried/deep fried
Description of the food supply in Cebu
• Sari-sari stores – Snacks/chips/noodles/candies, more variety in urban barangays
• Public markets– Wide variety: fruits/vegetables/meat/poultry/fish
• Supermarkets– Wide variety of items/brands, prices low fat options higher than
regular
• Carenderias/ambulants– Rice/vegetables/fish/pork/noodles
– Higher proportion of fried/deep fried options in urban barangays
• Jollibee fast food chain– Price hamburger: $45FP (daily minimum wage: $185-$250)
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
Fig 1
Public markets dispersed in urban and rural areas
Supermarketsclustered in urban areas
Fig 2
Food supply and weight in the CLHNS
Variable Coefficie
nt
95% CI
At least one supermarket in
the barangay o next
barangay
0.93 0.01-1.86
At least on fried/deep fried
option on average in the
barangay
0.86 -0.10-1.83Controlling for age, activity level at occupation, income, education, calories consumed, children under 5, parity, breastfeeding, owing a car, owing a TV.
Observations: 624Rsquared: 0.205
Linear regression for Body Mass Index in 2002
Conclusions
• Significant differences in the food
supply between urban and rural
barangays
• More studies should be conducted in
countries entering the nutrition
transition to understand the
contribution of changes in the food
supply on obesity
Food Availability and Changes in
Weight among Women in
Metropolitan Cebu, Philippines
(1983-2002)
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD, April 8th, 2008
Center for a Livable Future“Insights Along the Path to Sustainability”
Arantxa Colchero, PhDNational Institute of Public Health, Mexico