Publication: Obesity and Food Away from Home: What Drives the Socioeconomic Gradient in Excess Body Weight ?
Loading...
Files in English
379 downloads
Published
2019-11
ISSN
Date
2019-12-06
Author(s)
Editor(s)
Abstract
Rising obesity rates are one of the most challenging public health issues in many emerging economies. The extent to which the nutritional composition of food consumed away from home is behind this rise, and the links with socioeconomic status, is not yet well understood. This paper explores this question by combining a representative restaurant survey that includes detailed information on the nutritional composition of the most widely consumed meals in Metropolitan Lima and a representative household survey with anthropometric measures of adult women. The findings indicate that the nutritional quality in restaurants located in the food environment of the households is significantly associated with higher rates of obesity and overweight. Up to 15 percent of the socioeconomic gradient in obesity is attributable to restaurant food quality, with sodium being the main driver. This highlights the importance of considering the food environment to inform public health policies, particularly for the poor.
Link to Data Set
Citation
“Strupat, Christoph; Farfan, Gabriela; Moritz, Laura; Negre, Mario; Vakis, Renos. 2019. Obesity and Food Away from Home: What Drives the Socioeconomic Gradient in Excess Body Weight ?. Policy Research Working Paper;No. 9066. © World Bank. http://hdl.handle.net/10986/32807 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Publication The Economic Value of Weather Forecasts: A Quantitative Systematic Literature Review(Washington, DC: World Bank, 2025-09-10)This study systematically reviews the literature that quantifies the economic benefits of weather observations and forecasts in four weather-dependent economic sectors: agriculture, energy, transport, and disaster-risk management. The review covers 175 peer-reviewed journal articles and 15 policy reports. Findings show that the literature is concentrated in high-income countries and most studies use theoretical models, followed by observational and then experimental research designs. Forecast horizons studied, meteorological variables and services, and monetization techniques vary markedly by sector. Estimated benefits even within specific subsectors span several orders of magnitude and broad uncertainty ranges. An econometric meta-analysis suggests that theoretical studies and studies in richer countries tend to report significantly larger values. Barriers that hinder value realization are identified on both the provider and user sides, with inadequate relevance, weak dissemination, and limited ability to act recurring across sectors. Policy reports rely heavily on back-of-the-envelope or recursive benefit-transfer estimates, rather than on the methods and results of the peer-reviewed literature, revealing a science-to-policy gap. These findings suggest substantial socioeconomic potential of hydrometeorological services around the world, but also knowledge gaps that require more valuation studies focusing on low- and middle-income countries, addressing provider- and user-side barriers and employing rigorous empirical valuation methods to complement and validate theoretical models.Publication Direct and Indirect Impacts of Transport Mobility on Access to Jobs: Evidence from South Africa(Washington, DC: World Bank, 2025-11-12)Access to jobs is essential for economic growth. In Africa, unemployment rates are notably high. This paper reexamines the relationship between transport mobility and labor market outcomes, with a particular focus on the direct and indirect effects of transport connectivity. As predicted by theory, wages are influenced by the level of commuting deterrence. Generally, higher earnings are associated with longer commute times and/or higher commuting costs. Local accessibility is also important, especially for individuals with time constraints. Both direct and indirect impacts are found to be significant in South Africa, where job accessibility has been challenging since the end of apartheid. For the direct impact, the wage elasticity associated with commuting costs is significant. Returns on commute are particularly high for women. Local accessibility to socioeconomic facilities, such as shops and health services, is also found to have a significant impact, consistent with the concept of mobility of care. To enhance employment, therefore, it is crucial to connect people not only to job locations but also to various socioeconomic points of interest, such as markets and hospitals, in an integrated manner. This integration will enable individuals to spend more time working and commuting longer distances.Publication The Macroeconomic Implications of Climate Change Impacts and Adaptation Options(Washington, DC: World Bank, 2025-05-29)Estimating the macroeconomic implications of climate change impacts and adaptation options is a topic of intense research. This paper presents a framework in the World Bank's macrostructural model to assess climate-related damages. This approach has been used in many Country Climate and Development Reports, a World Bank diagnostic that identifies priorities to ensure continued development in spite of climate change and climate policy objectives. The methodology captures a set of impact channels through which climate change affects the economy by (1) connecting a set of biophysical models to the macroeconomic model and (2) exploring a set of development and climate scenarios. The paper summarizes the results for five countries, highlighting the sources and magnitudes of their vulnerability --- with estimated gross domestic product losses in 2050 exceeding 10 percent of gross domestic product in some countries and scenarios, although only a small set of impact channels is included. The paper also presents estimates of the macroeconomic gains from sector-level adaptation interventions, considering their upfront costs and avoided climate impacts and finding significant net gross domestic product gains from adaptation opportunities identified in the Country Climate and Development Reports. Finally, the paper discusses the limits of current modeling approaches, and their complementarity with empirical approaches based on historical data series. The integrated modeling approach proposed in this paper can inform policymakers as they make proactive decisions on climate change adaptation and resilience.Publication From Policy to Practice: Lessons from the Implementation of the Refugee Work Rights Policy in Ethiopia(Washington, DC: World Bank, 2025-11-10)This paper examines the early implementation of Ethiopia’s refugee work rights policy, with a focus on the issuance of permits that enable refugees to engage in economic activities. Building on significant legal and institutional advances under the 2019 Refugee Proclamation and subsequent directives, the analysis explores how these reforms are being operationalized in practice. Using a mixed-methods approach, combining document review, administrative data analysis, and semi-structured interviews, the paper identifies both progress and remaining challenges. Permit issuance has increased since the adoption of detailed operational guidance in 2024, reflecting the Government of Ethiopia’s commitment to operationalizing its progressive legal framework and ensuring that refugees can exercise their right to work. However, take-up remains modest, with about 5.2 percent of the working-age population holding a permit. Preliminary evidence suggests that coordination gaps, limited subnational capacity, low awareness among refugees and employers, and disincentives to formalize in a largely informal labor market are contributing to the low take-up. The paper offers policy suggestions, grounded in the Ethiopian context and emerging evidence, to help translate legal commitments into improved labor market outcomes for refugees.Publication Monitoring Global Aid Flows: A Novel Approach Using Large Language Models(Washington, DC: World Bank, 2025-11-04)Effective monitoring of development aid is the foundation for assessing the alignment of flows with their intended development objectives. Existing reporting systems, such as the Organisation for Economic Co-operation and Development’s Creditor Reporting System, provide standardized classification of aid activities but have limitations when it comes to capturing new areas like climate change, digitalization, and other cross-cutting themes. This paper proposes a bottom-up, unsupervised machine learning framework that leverages textual descriptions of aid projects to generate highly granular activity clusters. Using the 2021 Creditor Reporting System data set of nearly 400,000 records, the model produces 841 clusters, which are then grouped into 80 subsectors. These clusters reveal 36 emerging aid areas not tracked in the current Creditor Reporting System taxonomy, allow unpacking of “multi-sectoral” and “sector not specified” classifications, and enable estimation of flows to new themes, including World Bank Global Challenge Programs, International Development Association–20 Special Themes, and Cross-Cutting Issues. Validation against both Creditor Reporting System benchmarks and International Development Association commitment data demonstrates robustness. This approach illustrates how machine learning and the new advances in large language models can enhance the monitoring of global aid flows and inform future improvements in aid classification and reporting. It offers a useful tool that can support more responsive and evidence-based decision-making, helping to better align resources with evolving development priorities.
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Poverty Measurement in the Era of Food Away from Home(World Bank, Washington, DC, 2019-01)Food consumed outside the home in restaurants or other food establishments is a growing segment of consumption in many developing countries. However, the survey methods that are utilized to collect data on expenditures on food away from home are often simplistic and could potentially result in inaccurate reporting. This study addresses the potential inaccuracy of commonly used methods and tests potentially superior methods to inform best practices when collecting data on consumption of food away from home. A household survey experiment was implemented in Hanoi, Vietnam, to test these different methods. Using a food away from home consumption diary as a benchmark, the study finds that many of the alternative methods considered -- including asking about consumption in one line (the existing practice in Vietnam) or asking each individual about their food away from home -- lead to underreporting (33 and 22 percent underestimates, respectively). Surprisingly, using one respondent and helping them with recall with a simple worksheet as well as bounding (two-visits) results in food away from home estimates that are indistinguishable from those reported in the benchmark diary. This finding implies that there is a more cost-effective way to collect accurate data on food away from home than an intensive daily diary. Furthermore, it highlights the inaccuracy associated with collecting data on consumption of food away from home from a single question in a survey. Although limited analysis can be conducted on the implications for poverty, the study finds that the profiles of the poorest households differ across different methods of collecting information on food consumed away from home.Publication You Are What (and Where) You Eat(World Bank, Washington, DC, 2015-05)Consumption of food away from home is rapidly growing across the developing world. Surprisingly, the majority of household surveys around the world haven not kept up with its pace and still collect limited information on it. The implications for poverty and inequality measurement are far from clear, and the direction of the impact cannot be established a priori, since consumption of food away from home affects both food consumption and the poverty line. This paper exploits rich data on food away from home collected as part of the National Household Survey in Peru, shedding light to the extent to which welfare measures differ depending on whether they properly account for food away from home. Peru is a relevant context, with the average Peruvian household spending 28 percent of their food budget on food away from home by 2010. The analysis indicates that failure to account for the consumption of food away from home has important implications for poverty and inequality measures as well as the understanding of who the poor are. First, accounting for food away from home results in extreme poverty rates that are 18 percent higher and moderate poverty rates that are 16 percent lower. These results are also consistent, in fact more pronounced, with poverty gap and severity measures. Second, consumption inequality measured by the Gini coefficient decreases by 1.3 points when food away from home is included, a significant reduction. Finally, inclusion of food away from home results in a reclassification of households from poor to non-poor status and vice versa: 20 percent of the poor are different when the analysis includes consumption of food away from home. This effect is large enough that a standard poverty profile analysis results in significant differences between the poverty classification based on whether food away from home is included or not. The differences cover many dimensions, including demographics, education, and labor market characteristics. Taken together, the results indicate that a serious rethinking of how to deal with the consumption of food away from home in measuring well-being is urgently needed to properly estimate and understand poverty around the world.Publication You Are What (and Where) You Eat(Elsevier, 2017-10)Consumption of food away from home is rapidly growing across the developing world, and will continue to do so as GDP per person grows and food systems evolve. Surprisingly, the majority of household surveys have not kept up with its pace and still collect limited information on it. The implications for poverty and inequality measurement are far from clear, and the direction of the impact cannot be established a priori. This paper exploits rich data on food away from home collected as part of the National Household Survey in Peru, to shed light on the extent to which welfare measures differ depending on whether food away from home is accounted for or not. Peru is a relevant context, with the average Peruvian household spending over a quarter of their food budget on food away from home since 2010. The analysis indicates that failure to account for this consumption has important implications for poverty and inequality measures as well as the understanding of who the poor are. First, accounting for food away from home results in extreme poverty rates that are 18 percent higher and moderate poverty rates that are 16 percent lower. These results are also consistent, in fact more pronounced, with poverty gap and severity measures. Second, consumption inequality measured by the Gini coefficient decreases by 1.3 points when food away from home is included – a significant reduction. Finally, the inclusion of food away from home results in a reclassification of households across poor/non-poor status – 20 percent of the poor are different, resulting in small but significant differences in the profile of the poor in dimensions such as demographics, education, and labor market characteristics. Taken together, the results indicate that a serious rethinking of how to deal with the consumption of food away from home in measuring well-being is urgently needed to properly estimate and understand poverty around the world.Publication Poor Expectations(World Bank, Washington, DC, 2021-03)Do teachers’ stereotypes of social class bias their assessment of students? This study uses a lab-in-the-field experiment among primary school teachers to test whether they are biased against poor students. Teachers assessed a student in a video of an oral exam after watching one of two versions of an introductory video that portrayed the child’s home and playground. When the student in the exam video exhibited inconsistent performance, showing varying levels of scholastic aptitude and focus during the exam, teachers were far more likely to judge his scholastic aptitude as below grade-level if they had watched the introductory video portraying a poor background than if they had watched the introductory video portraying a middle-class background. The social class background portrayed in the introductory video did not affect teachers’ behavioral assessments of the student. When the student in the exam video was consistently high achieving, showing high levels of scholastic aptitude and focus throughout the exam, teachers who watched the introductory video depicting a poor background were more likely to assess the student as above grade-level than teachers who watched the video conveying a middle-class background. In this case, however, they had a more negative assessment of the child’s behavior when they thought he came from a poor background, deeming him to be less motivated and less emotionally mature than when the introductory video depicted a middle-class background. These findings suggest that stereotypes influence how teachers assess the scholastic aptitude and behavior of their students.Publication Determining the Caloric Content of Food Consumed away from Home(World Bank, Washington, DC, 2022-04)Food purchased and consumed away from home is a growing share of household expenditure in developing countries. Therefore, measuring the monetary value and estimating the caloric equivalent of these meals are increasingly important for the accurate calculation of a cost-of-basic-needs poverty line. The standard approach uses the per-calorie cost of the food consumed at home to estimate the caloric equivalent of food purchased and consumed away from home, but it does not include an allowance for the overhead or profit of the food seller. This paper retains the assumption of equal composition in the food baskets consumed inside and outside the home and uses data from a consumption experiment in the Marshall Islands to estimate a “multiplier” to increase the per-calorie cost to allow for these expenses. The methodology generates reasonable estimates of meal-specific and overall multipliers. Although the impact of their application is minimal in this case, it may be larger in contexts with higher shares of food purchased and consumed away from home in total consumption.
Users also downloaded
Showing related downloaded files
Publication Rwanda Diagnostic Review of Consumer Protection and Financial Literacy(World Bank, Washington, DC, 2013-11)Although the Parliament of Rwanda has passed an impressive array of financial sector laws since 2008, the laws relevant to financial consumer protection are very limited and in some cases overlapping. Consumer protection in Rwandan banking, microfinance, and insurance sectors is fragmented because of insufficiently defined roles and responsibilities among institutions and unclear enforcement capacity. While there are some strong provisions in some areas such as electronic money transfer, electronic transmission, credit information, and market conduct regulation in the insurance industry, many other areas are lagging. Rwandan authorities recognize that a sound financial consumer protection framework is fundamental to improving usage and quality of financial services, access to them, and overall deepening of the financial sector. This World Bank diagnostic review was requested by the National Bank of Rwanda (BNR) in November 2012. Modules on banking and microfinance sectors were developed based on publicly available information and data during the World Bank mission in Rwanda, and the review of the insurance sector was conducted through a desk review using the data obtained from BNR data requests and questionnaires, and the analysis is therefore constrained by it. Volume I of the review summarizes its key findings and recommendations, and volume II provides a detailed assessment against the World Bank’s good practices on financial consumer protection.Publication Accessing Economic and Political Impacts of Hydrological Variability on Treaties : Case Studies on the Zambezi and Mekong Basins(2012-03-01)International river basins will likely face higher hydrologic variability due to climate change. Increased floods and droughts would have economic and political consequences. Riparians of transboundary basins governed by water treaties could experience non-compliance and inter-state tensions if flow falls below levels presumed in a treaty. Flow information is essential to cope with these challenges through water storage, allocation, and use. This paper demonstrates a simple yet robust method, which measures gauge station runoff with wetness values derived from satellite data (1988-2010), for expanding sub-basin stream flow information to the entire river basin where natural flow information is limited. It demonstrates the approach with flow level data that provide estimates of monthly runoff in near real time in two international river basins: Zambezi and Mekong. The paper includes an economic framework incorporating information on existing institutions to assess potential economic and political impacts and to inform policy on conflict and cooperation between riparians. The authors conclude that satellite data modeled with gauge station runoff reduce the uncertainty inherent in negotiating an international water agreement under increased hydrological variability, and thus can assist policy makers to devise more efficient institutional apparatus.Publication Improving Access to Medicines in Developing Countries : Application of New Institutional Economics to the Analysis of Manufacturing and Distribution Issues(World Bank, Washington, DC, 2005-03)This paper examines alternative frameworks for empirical analysis of supply side activities, namely, the manufacture and distribution of medicine, through the application of New Institutional Economics (NIE) concepts. Attention is focused particularly upon the potential utility of ideas from agency theory, transaction cost analysis and contemporary ideas from strategy theory. The major purpose of this paper is to use these theoretical frameworks to provide insight for policy makers, when faced with specific situations, whether in an international agency, or a private company, or in defining a national strategy. The analysis attempts to show the importance of distinctions between ideas of 'make' or 'buy', between 'national self sufficiency' and 'international purchasing' strategies, the limitations of contractual agreements under market governance and the crucial linkages between strategy formulation, strategy implementation and the necessary capabilities to achieve successful performance in practice. The current international situation on the investment, location and capacity of pharmaceutical manufacturing is reviewed and likely future scenarios suggested. Correspondingly current patterns of trade in medicines and their likely development within the context of the WTO and bilateral trade agreements are discussed. Against this background the promise and the pitfalls for new forms of public-private partnerships, which may offer attractive alternatives to conventional structures are evaluated. The implications of alternative future strategic options for national governments in setting the balance between health and industrial policies are examined and in particular the extent to which a national manufacturing capability should be developed or sustained. Similarly the scope for improving low cost distribution systems for medicines, based upon a mix of public and private sector channels, is assessed. We conclude with suggestions for further development of a transaction-based framework.Publication Strategic Planning for Poverty Reduction in Vietnam : Progress and Challenges for Meeting the Localized Millennium Development Goals(World Bank, Washington, DC, 2003-01)This paper discusses the progress that Vietnam has made toward meeting a core set of development goals that the government recently adopted as part of its Comprehensive Poverty Reduction and Growth Strategy (CPRGS). These goals are strongly related to the Millennium Development Goals (MDGs), but are adapted and expanded to reflect Vietnam's national challenges and the government's ambitious development plans. For each Vietnam Development Goal, the authors describe recent trends in relation to the trajectories implied by the MDGs, outline the intermediate targets identified by the government, and discuss the challenges involved in meeting these. Relative to other countries of similar per capita expenditures, Vietnam has made rapid progress in a number of key areas. Poverty has halved over the 1990s, enrollment rates in primary education have risen to 91 percent (although there is a quality problem), indicators of gender equity have been strengthened, child mortality has been reduced, maternal health has improved, and real progress has been made in combating malaria and other communicable diseases. In contrast, Vietnam scores worse than other comparable countries in the areas of child malnutrition, access to clean water, and combating HIV/AIDS. A number of important crosscutting issues emerge from this analysis that need to be addressed. One such challenge is improving equity, both in terms of ensuring that the benefits of growth are distributed evenly across the population and in terms of access to public services. This will involve addressing the affordability of education and curative health care for poor households. Improvements in public expenditure planning are needed to align resources better to stated desired outcomes and to link nationally-defined targets to subnational planning and budgeting processes. There is also a need to address capacity and data gaps which will be crucial for effective monitoring.Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.