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BACKGROUND/OBJECTIVE: Mexico has one of the highest rates of obesity and overweight worldwide, affecting 75% of the population. The country has experienced a dietary and food retail transition involving increased availability of high-calorie-dense foods and beverages. This study aimed to assess the relationship between the retail food environment and body mass index (BMI) in Mexico. SUBJECTS/METHODS: Geographical and food outlet data were obtained from official statistics; anthropometric measurements and socioeconomic characteristics of adult participants (N = 22,219) came from the nationally representative 2012 National Health and Nutrition Survey (ENSANUT). Densities (store count/census tract area (CTA)) of convenience stores, restaurants, fast-food restaurants, supermarkets and fruit and vegetable stores were calculated. The association of retail food environment variables, sociodemographic data and BMI was tested using multilevel linear regression models. RESULTS: Convenience store density was high (mean (SD) = 50.0 (36.9)/CTA) compared with other food outlets in Mexico. A unit increase in density of convenience stores was associated with a 0.003 kg/m2 (95% CI: 0.0006, 0.005, p = 0.011) increase in BMI, equivalent to 0.34 kg extra weight for an adult 1.60 m tall for every additional 10% store density increase (number of convenience stores per CTA (km2)). Metropolitan areas showed the highest density of food outlet concentration and the highest associations with BMI (ß = 0.01, 95% CI: 0.004-0.01, p < 0.001). A 10% store density increase in these areas would represent a 1 kg increase in weight for an adult 1.60 m tall. CONCLUSIONS: Convenience store density was associated with higher mean BMI in Mexican adults. An excessive convenience store availability, that offers unhealthy food options, coupled with low access to healthy food resources or stores retailing healthy food, including fruits and vegetables, may increase the risk of higher BMI. This is the first study to assess the association of the retail food environment and BMI at a national level in Mexico.

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OBJECTIVE: The present study investigates whether the reversal of the social gradient in obesity, defined as a cross-over to higher obesity prevalence among groups with lower education level, has occurred among men and women in urban and rural areas of Mexico. DESIGN: Cross-sectional series of nationally representative surveys (1988, 1999, 2006, 2012 and 2016). The association between education and obesity was investigated over the period 1988-2016. Effect modification of the education-obesity association by household wealth was tested. SETTING: Mexico. SUBJECTS: Women (n 54 816) and men (n 20 589) aged 20-49 years. RESULTS: In both urban and rural areas, the association between education and obesity in women varied by level of household wealth in the earlier surveys (1988, 1999 and 2006; interaction P<0·001). In urban areas in 1988, one level lower education was associated (prevalence ratio; 95 % CI) with 45 % higher obesity prevalence among the richest women (1·45; 1·24, 1·69), whereas among the poorest the same education difference was protective (0·84; 0·72, 0·99). In the latest surveys (2012, 2016), higher education was protective across all wealth groups. Among men, education level was not associated with obesity in urban areas; there was a direct association in rural areas. Wealth did not modify the association between education and obesity. CONCLUSION: The reversal of the educational gradient in obesity among women occurred once a threshold level of household wealth was reached. Among men, there was no evidence of a reversal of the gradient. Policies must not lose sight of the populations most vulnerable to the obesogenic environment.

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BACKGROUND: Obesity is one of the leading causes of global morbidity and mortality. Trends in educational inequalities in obesity prevalence among Mexican women have not been analysed systematically to date. METHODS: Data came from four nationally representative surveys (1988, 1999, 2006, and 2012) of a total of 51 220 non-pregnant women aged 20 to 49. Weight and height were measured during home visits. Education level (higher education, high school, secondary, primary or less) was self-reported. We analysed trends in relative and absolute educational inequalities in obesity prevalence separately for urban and rural areas. RESULTS: Nationally, age-standardised obesity prevalence increased from 9.3% to 33.7% over 25 years to 2012. Obesity prevalence was inversely associated with education level in urban areas at all survey waves. In rural areas, obesity prevalence increased markedly but there was no gradient with education level at any survey. The relative index of inequality in urban areas declined over the period (2.87 (95%CI: 1.94, 4.25) in 1988, 1.55 (95%CI: 1.33, 1.80) in 2012, trend p<0.001). Obesity increased 5.92 fold (95%CI: 4.03, 8.70) among urban women with higher education in the period 1988-2012 compared to 3.23 fold (95%CI: 2.88, 3.63) for urban women with primary or no education. The slope index of inequality increased in urban areas from 1988 to 2012. Over 0.5 M cases would be avoided if the obesity prevalence of women with primary or less education was the same as for women with higher education. CONCLUSIONS: The expected inverse association between education and obesity was observed in urban areas of Mexico. The declining trend in relative educational inequalities in obesity was due to a greater increase in obesity prevalence among higher educated women. In rural areas there was no social gradient in the association between education level and obesity across the four surveys.

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BACKGROUND: Colombia is a lower-middle income country that faces the challenge of addressing health inequalities. This effort includes the task of developing measures of socioeconomic position (SEP) to describe and analyse disparities in health and health related outcomes. This study explores the use of a multidimensional approach to SEP, in which socioeconomic inequalities in contraceptive use are investigated along multiple dimensions of SEP. We tested the hypothesis that provision of Public capital compensated for low levels of Human capital. METHODS: This study used the 2005 Colombian Demographic and Health Survey (DHS) dataset. The outcome measures were 'current non-use' and 'never use' of contraception. Inequalities in contraceptive behaviour along four measures of SEP were compared: the Household wealth index (HWI), Physical capital (housing, consumer durables), Public capital (publicly provided services) and Human capital (level of education). Principal component analysis was applied to construct the HWI, Physical capital and Public capital measures. Logistic regression models were used to estimate relative indices of inequality (RII) for each measure of SEP with both outcomes. RESULTS: Socio-economic inequalities among rural women tended to be larger than those among urban women, for all measures of SEP and for both outcomes. In models mutually adjusted for Physical, Public and Human capital and age, Physical capital identified stronger gradients in contraceptive behaviour in urban and rural areas (Current use of contraception by Physical capital in urban areas RII 2.37 95% CI (1.99-2.83) and rural areas RII 3.70 (2.57-5.33)). The impact of women's level of education on contraceptive behaviour was relatively weak in households with high Public capital compared to households with low Public capital (Current use of contraception in rural areas, interaction p = < 0.001). Reduced educational inequalities attributable to Public capital were partly explained by differences in household wealth but not at all by health insurance cover. CONCLUSIONS: A multidimensional approach provides a framework for disentangling socioeconomic inequalities in contraceptive behaviour. We provide evidence that material circumstances indexed by Physical capital are important socioeconomic determinants while higher provision of Public capital may compensate for low levels of Human capital with respect to modern contraceptive behaviour.