Change in the Body Mass Index Distribution for Women



Analysis of Surveys from 37 Low- and Middle-Income Countries

Razak F, Corsi DJ, SV Subramanian (2013)
 PLoS Med 10(1): e1001367. doi:10.1371/journal.pmed.1001367

Available online at: http://bit.ly/U1Dogn

“…..There are well-documented global increases in mean body mass index (BMI) and prevalence of overweight (BMI≥25.0 kg/m2) and obese (BMI≥30.0 kg/m2). Previous analyses, however, have failed to report whether this weight gain is shared equally across the population. We examined the change in BMI across all segments of the BMI distribution in a wide range of countries, and assessed whether the BMI distribution is changing between cross-sectional surveys conducted at different time points.

Methods and Findings

We used nationally representative surveys of women between 1991–2008, in 37 low- and middle-income countries from the Demographic Health Surveys
([DHS] n = 732,784). There were a total of 96 country-survey cycles, and the number of survey cycles per country varied between two (21/37) and five (1/37).
Using multilevel regression models, between countries and within countries over survey cycles, the change in mean BMI was used to predict the standard deviation of BMI, the prevalence of underweight, overweight, and obese. Changes in median BMI were used to predict the 5th and 95th percentile of the BMI distribution.

Quantile-quantile plots were used to examine the change in the BMI distribution between surveys conducted at different times within countries. At the population level, increasing mean BMI is related to increasing standard deviation of BMI, with the BMI at the 95th percentile rising at approximately 2.5 times the rate of the 5th percentile. Similarly, there is an approximately 60% excess increase in prevalence of overweight and 40% excess in obese, relative to the decline in prevalence of underweight.

Quantile-quantile plots demonstrate a consistent pattern of unequal weight gain across percentiles of the BMI distribution as mean BMI increases, with increased weight gain at high percentiles of the BMI distribution and little change at low percentiles. Major limitations of these results are that repeated population surveys cannot examine weight gain within an individual over time, most of the countries only had data from two surveys and the study sample only contains women in low- and middle-income countries, potentially limiting generalizability of findings.


Conclusions

Mean changes in BMI, or in single parameters such as percent overweight, do not capture the divergence in the degree of weight gain occurring between BMI at low and high percentiles. Population weight gain is occurring disproportionately among groups with already high baseline BMI levels. Studies that characterize population change should examine patterns of change across the entire distribution and not just

 

A doctor walks into the heart of darkness


Oct 14, 2012 – Javed Anand, in Asian Age
First, if you’ve not seen it already, go find the recent issue of a national weekly which has “The Silent Killers of Chhattisgarh” as its cover story. It’s not the story that I’m talking about but the picture on the cover for it has many stories to tell.
Stay with the picture for a bit. A young mother, an adivasi woman with a child in her lap, faces the camera. As for the child, except for the bloated belly, you see more bones than flesh. You can easily count the ribs. The child in apparent anguish is bawling. But you get the feeling you may not hear any sound even if this was a video shoot.
If a single picture of a victim of acute undernourishment could be disturbing enough, what are we to do with facts no less disturbing? According to the National Nutrition Monitoring Bureau, we learn from Dilip D’Souza’s The Curious Case of Binayak Sen, more than 60 per cent of scheduled tribes in India have a body mass index (BMI) of less than 18.5. The World Health Organisation (WHO) puts this statistic in perspective: if more than 40 per cent of the population of a community has a BMI of less than 18.5, the community can be considered to be in a condition of famine. In other words, famine and starvation are an everyday reality for the scheduled tribes of our “socialist republic”.
Let’s go back to the picture, give it another look and consider if it’s telling us something about ourselves. Then ask ourselves the question: Should we be proud of India the “Emerging Superpower”, or should we be ashamed of being Indians?
Perhaps years ago Dr Binayak Sen — product of one of the highly prestigious Christian Medical College, Vellore — asked himself some such question and found an answer: Those who are not a part of the solution are a part of the problem. The answer took him and his colleague, Dr Saibal Jana, in 1983 to the Dalli Rajhara mining belt in Madhya Pradesh, now Chhattisgarh, to offer their services to a medical centre set up by workers for workers, Shaheed Hospital.
From the perspective of today’s Mr and Ms Middle Class especially, Dr Sen is an obvious “loser”. As it happens, the ’60s generation of which he is a part produced many losers such as him. Something called “social concern” took the good doctor away from the glitter of the metropolis to the heart of darkness. He was lucky having acquired a professional expertise which was badly needed where he went.
Once there, he should have stuck to the trodden path: prescribing pills and injections, recommending tests after tests, hospitalisation… But his alma mater had taught him to reach out to the person(s) behind the patient, to think of preventive healthcare.
Thus Dr Sen and his colleagues discovered that at the root of the ailments of the patients who came to him was chronic hunger. What pills, what injections can you prescribe for treating “stable famine” malady? Healthcare, he realised, was a human rights issue. Experience was driving Dr Sen towards “dangerous territory”. He began entertaining dangerous thoughts such as “structural violence” against the poor and the hungry, even suggesting that, “this situation fits the definition of genocide: not by guns or machetes or gas chambers, but by creating conditions for communities” (Dilip D’Souza’s words), “in which the survival of (these communities) is at risk” (Dr Sen’s words).
To compound matters, Dr Sen gravitated towards the People’s Union for Civil Liberties (PUCL) and ended up being elected general secretary of its Chhattisgarh unit. On request, Dr Sen in his dual capacity as a doctor and as PUCL general secretary visits an ailing Maoist leader, Narayan Sanyal, in the Raipur Central Jail, with written permission from the jail authorities.
Ah ha! So this up-to-no-good doctor with dangerous thoughts is mixed up with Maoists? Not just Maoists, the ISI as well! Proof: An email from his impounded computer shows a message addressed to the ISI. The well-known Indian Social Institute (ISI) Delhi! So the dangerous doctor is arrested and charged with sedition: waging war against the Indian state.
Read D’Souza’s book with an open mind and you cannot but conclude that in place of hard evidence all that you find in the voluminous chargesheet against Dr Sen are insinuations and innuendos, apart from falsehoods and mindlessness. Many years ago the Supreme Court was constrained to remark that policemen are like “criminals in uniform”. The remark is most apt for the Chhattisgarh police in the context of Dr Sen’s case. What’s more scandalous, however, is the December 2010 verdict of the trial court that held Dr Sen and two co-accused guilty of sedition (among other charges) and sentenced to life imprisonment. Allow D’Souza to take you through parts of the judgment, hold your breath and decide for yourself.
A January 2011 appeal against the conviction is currently pending before the Chhattisgarh high court. Over-ruling a nay from the high court, the Supreme Court has granted bail to Dr Sen. It’s difficult to see how the trial court’s verdict can stand the scrutiny of the high court and the Supreme Court.
Meanwhile, it is hopefully a matter of some consolation to Dr Sen, his colleagues and family — and us — that their trials and tribulations have charged the demand for the expulsion of the long-outdated sedition charge embedded into the Indian Penal Code by our colonial masters.

 

Despair can lead people to disastrous path: Dr Binayak Sen


BANGALORE – Speaking at the 6th Henry Volken Memorial lecture at Indian Social Institute in Bangalore Dr.Binayak Sen said that the weak has to develop internal strength to do politics otherwise the wide spread despair can lead people to disastrous path.

He said that democracy is about governance by consent and it cannot be reduced to series of election. He further said that for this very purpose social mobilization has to be constant and running theme of democracy.

Citing the recent hunger death of tea workers in Bengal Dr.Sen said that these starvation death and tragic death like these need to be contextualized and must not be seen in isolation.

Referring to Prime Minister’s latest remark on Malnutrition as National Shame he asked that if Child Malnutrition is shame then what to say about Adult Malnutrition which is equally rampant and about which we never talk.

Dr.Sen also argued in his lecture that Famine is not about shortage of grain, citing the case of Bengal Famine of 1943 he said that there was not shortage of food grains and all those boats carrying the grains were savaged by direct orders from British Raj

He said that Body mass index is very low in this country and 37 % has BMI less than 18.5 and if 40 % of population has low BMI then it is referred as state of famine and we are near to it.

‘National grain consumption has seen a fall of 110 kg in from 880 kg to 770 kg’, he added. ‘This famine is getting worse’. ‘The incident of hunger death of those tea workers at Dhekla pal is just the tip of iceberg’ He said.

Referring to various resistance movements in the country he said that ‘resistance is only way for these community’. ‘The struggle against POSCO in Odisha is an admirable one’ he added

He criticized the public policy practices in the country and urged that this must be directed towards well being of its citizen which is possible through equity.

Source- Newzfirst

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