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