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A Socioeconomic Analysis of Obesity and Intra-Household Nutritional Inequality in Indonesia

dc.contributor.advisorQaim, Matin Prof.
dc.contributor.authorRoemling, Corneliade
dc.titleA Socioeconomic Analysis of Obesity and Intra-Household Nutritional Inequality in Indonesiade
dc.title.translatedEine sozioökonomische Analyse von Fettleibigkeit und ernährungsbezogener Ungleichheit innerhalb von Haushalten in Indonesiende
dc.contributor.refereeQaim, Matin Prof.
dc.subject.dnb330 Wirtschaftde
dc.subject.gokLMG 290de
dc.description.abstractengWhile 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
dc.contributor.coRefereeKlasen, Stephan Prof.
dc.contributor.thirdRefereeWollni, Meike Prof.
dc.subject.topicAgricultural Sciencesde
dc.subject.engNutrition transitionde
dc.subject.engBody mass indexde
dc.subject.engFood consumptionde
dc.subject.engPhysical activityde
dc.subject.engDual burdende
dc.subject.engIntra-household inequalityde
dc.subject.engPanel datade
dc.affiliation.instituteFakultät für Agrarwissenschaftende

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