Education matters when it comes to fighting off obesity in low- and middle-income countries, a new study suggests.

Researchers from the University College London observed that women in wealthier households tended to have higher levels of obesity — a pattern they attribute to the purchase of energy-dense foods (which are increasingly introduced from the global food market). But these obesity levels appeared to lower when the women had a secondary or higher level of education. According to the study’s lead author, Dr. Amina Aitsi-Selmi, getting an education develops a habit of critical thinking that makes a huge difference when applied to health.

“The findings mean that women might be able to reduce their risk of obesity by paying closer attention to the decisions they make on a daily basis,” Aitsi-Selmi told Medical Daily. “There are a lot of pressures to consume calories — time, cost, convenience, taste — but by stopping and thinking for a moment about why I might want to buy something or whether I really need to eat it, they may make different decisions and ultimately be more in line with their true health goals.”

Dr. Aitsi-Selmi’s study is one of the first to approach a less-probed question: Can education improve a woman’s health, no matter what her level of income is?

Aitsi-Selmi’s team looked at the wealth, education, and obesity levels of more than 250,000 women in seven middle-to-low-income countries: India, Nigeria, Benin, Egypt, Jordan, Peru, and Colombia. Before the study, they divided the women into five groups based on their income — the lowest-income women were grouped together and so were the highest. The study thus isolates education from wealth as a factor for obesity: If wealth provokes obesity, education may counter it. The researchers found that within these groups, as the women’s levels of education increased, their risk of obesity decreased. For example, women with primary education had an average obesity risk of 39 percent; women with secondary education had an obesity risk of 25 percent; women with higher education had an obesity risk of only two percent.

“Our study suggests that investing in women’s education protects against this effect by empowering individuals to look after their health,” Aitsi-Selmi said. She emphasizes, however, that seeking out an education on one’s own does not mean governments should loosen up on strong public health systems. Investing in one’s own education “is not a substitute for the regulation of commercial activity such as the aggressive marketing that puts pressure on individuals to consume unhealthy products and take unnecessary risks with their health,” she added.

Obesity is fast overtaking malnutrition as a common problem in low- and middle-income countries, according to the Harvard School of Public Health. The World Health Organization reports that obesity is increasing in low-to-middle income countries, most especially in urban areas. More than 2.8 million people worldwide die each year due to issues associated with overweight and obesity. The Harvard School cites globalization — or the introduction of foreign foods to middle-income countries — as a major reason, describing the shift from traditional to Western diets as a “nutrition transition”. Researchers from the University of North Carolina called for the need for middle-income countries to address the dietary challenges of obesity in a paper published last year. They also attributed the issue partly to the growing popularity of the Western Diet, which is characterized by a high intake of carbs, sugars, fats, and animal-source foods and an especially popular trend in urban areas of these middle-income countries.

But according to both Aitsi-Selmi, the Harvard School of Public Health, and other researchers like Dr. Barry Popkin, there is no education to warn people in middle-income countries about the health risks of the incoming Western foods. "The central issue is the imbalance between new health risks in these rapidly developing countries (new food products, increased availability of calories, rising incomes and growing consumerism) without the public health systems and regulatory and taxation mechanism to counter these trends and raise consumer awareness," Aitsi-Selmi explained. She advises individuals in the meantime to take the initiative and educate themselves about healthy eating and physical activity, as well as take steps to develop healthy habits through conscious decision-making.

Source: Aitsi-Selmi A, Bell R, Shipley M, Marmot M. Education modifies the association of wealth with obesity in women in middle-income but not low-income countries: an interaction study using seven national datasets, 2005-2010. PLoS ONE.