| dc.description.abstracteng | While underweight has always been a
challenge in developing countries, many poorer countries are today
increasingly affected by overweight and obesity. Leading causes for
this development are changes in food consumption and lifestyle
patterns. Consumption patterns change from traditional diets to
diets high in fats and sugar. Meat and dairy products are
increasingly consumed. In addition, the availability of processed
meals from newly emerging supermarkets and eating out also change
diets. Moreover, other parts of life undergo transition processes
with increasing income and urbanization. While work becomes more
sedentary, life gets more comfortable with appliances as helping
hands in households and increased motorized transportation. Leisure
time is spent to a greater extent with television, internet and
video games, even in poorer households. In the developed world,
these aspects have been part of the normal way of life for years.
This so-called nutrition transition progressively penetrates
developing countries today. Developments started in Latin America,
North Africa, the Middle East and Central Europe and recently even
arrived in Asia and Sub-Saharan Africa. Owing to these changes, the
nutritional status of the populations improves. Sufficient calorie
input is affordable for large parts of the population and energy
expenditure due to lower activity burdens is not so high anymore.
Accordingly, undernutrition is going down. However, there is an
almost immediate increase in overweight and obesity which limits
again productivity and leads to high cost non-communicable
diseases. Even worse, in most countries underweight did not
completely vanish but coexists now with the new challenge of
obesity. Furthermore, this dual burden of nutrition, evident in
most developing countries, can even be found at the household
level. Underweight children and overweight mothers is the most
prevalent paradoxical combination in developing countries. These
different nutritional outcomes challenge policy approaches even
more, since selection and targeting of strategies to address
overweight and obesity at the same time is complex. With Indonesia
as an example, this study sheds light on nutritional changes and
nutritional inequality at the household level over time. While
previous micro level studies on obesity have mostly used
cross-sectional data, we analyze trends and determinants with panel
data from Indonesian households. Our analysis among adults confirms
that Indonesia is in the process of a fast and profound nutrition
transition, with constantly rising obesity rates. The overweight
problem in Indonesia is especially pronounced among females. Unlike
often cited believes, rising obesity is not confined to urban and
relatively richer households, but is increasingly observed in rural
areas and low income segments. Panel regressions show that changes
in food consumption and physical activity levels are important
determinants of Body Mass Index (BMI) in Indonesia. Moreover, the
results suggest an additional increase in extent and severity in
the obesity pandemic in Indonesia, unless significant remedial
action is taken in the near future. In the second part of our
study, we incorporate for the first time a panel data approach into
research of intra-household inequality of nutrition. The
categorization of households shows that 20 percent of all
Indonesian households are dual burden households. While children
comprise a high share of the underweight household members, female
adults are often the ones with overweight. Trends over time
indicate that dual burden households are households in transition
that will develop to a large extent to overweight households in the
future. Still, high vulnerability of households falling back into
underweight also seems to prevail. Our second measure, the
intra-household Theil index, is newly introduced by us into this
research. This continuous measure is an exact measurement of
differences in nutritional outcome at the household level. We find
that the Theil index increases significantly over time and is also
high in overweight households. Similar to obesity, intra-household
nutritional inequality becomes a problem of the poor strata over
time. Furthermore, households with high inequality, measured by
both the categorization as well as the Theil index, tend to share
features of the nutrition transition and belong most probably to
the generation of households just involved in changing consumption
patterns and behavior. Panel regressions provide support for a
further increase of nutritional inequality since factors positively
associated with the Theil index in regression analysis will
increase in the future. Female decision-making supports a more
equal distribution and/or better adaption to personal needs,
lowering inequality. The results from our two empirical studies
bring up important policy implications. A crucial precondition is
that policymakers recognize obesity as a serious health and
development issue. For this, an important starting point is the use
of BMI cut-off values for Asian populations in national health and
nutrition statistics as the use of international cut-offs leads to
an underestimation of the obesity problem in Asia. Policy
approaches need to raise awareness for the obesity problem and its
costs in terms of lost health and life quality. To improve the
situation, broad-based education and information campaigns towards
more balanced diets and physical exercises should be considered,
also clearly explaining the health risks associated with excess
weight. They need to be accompanied by actions promoting the
different needs of children e.g., in micronutrients to reduce
intra-household inequality. Women should be in the center of
educational campaigns because of their high obesity levels as well
as for their crucial role in intra-household distribution.
Private–public partnerships may be important when it comes to
measures in the food industry to reduce the usage and consumption
of sugar, fat, and salt. Moreover, the improvement of the
healthcare system is important to increase the monitoring of
nutrition in individuals and detect reliably micronutrient
deficiencies that increase inequalities at household level. | de |