Effect of neighborhood exposures on changes in weight among women in Cebu, Philippines (1983-2002).

The authors aimed to identify the contributions of community factors to weight change in a cohort of women from Metropolitan Cebu, Philippines, between 1983 and 2002. The authors created a three-level random-intercept model to see whether mean body mass index (BMI; weight (kg)/height (m)(2)) varied by individual- and cluster-level variables and identified community characteristics associated with changes in BMI among 2,952 nonpregnant women. The average BMI among women living in places with four public amenities (telephones, electricity, mail delivery, and newspapers) was 0.16 kg/m(2) (95% confidence interval: 0.07, 0.26) higher than that of women living in places with fewer than three amenities. An increase in population density of 10,000 persons per km(2) was associated with a BMI increase of 0.09 kg/m(2) (95% confidence interval: 0.05, 0.13). A model with interactions revealed that the effect of population density increased significantly over time. These findings confirm earlier observations that in low-income countries, obesity starts among the wealthiest communities. Secondary and tertiary prevention policies designed to reduce obesity should be implemented in the most economically developed areas first. Primary prevention would be most needed in less developed areas, where the obesity epidemic is just beginning.