Food Availability and Changes in Weight among Women in Metropolitan Cebu, Philippines (1983-2002)

1. Center for a Livable Future “Insights Along the Path to Sustainability” 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 Arantxa Colchero, PhDNational Institute of Public Health, Mexico

2. 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

3. 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)

4. Mean BMI for each barangay

5. 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)

6. 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

7. Food supply in Metro Cebu • 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 preparation • Raw • Steamed • Grilled • Sautee • Fried/deep fried

9. 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)

10. Public markets dispersed in urban and rural areas Fig 1 Supermarkets clustered in urban areas Fig 2

11. Food supply and weight in the CLHNS Linear regression for Body Mass Index in 2002 Controlling for age, activity level at occupation, income, education, calories consumed, children under 5, parity, breastfeeding, owing a car, owing a TV. Observations: 624 Rsquared: 0.205

12. 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

13. Center for a Livable Future “Insights Along the Path to Sustainability” 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 Arantxa Colchero, PhDNational Institute of Public Health, Mexico