Martha J. Bailey and Jason M. Lindo
Changes in childbearing affect almost every aspect of human existence. Over the last fifty years, American women have experienced dramatic changes in the ease and convenience of timing and limiting childbearing, ranging from the introduction of the birth control pill and the legalization of abortion to more recent availability of long-acting reversible contraceptives (LARCs). This chapter chronicles these changes, provides descriptive evidence regarding trends in the use of contraception and abortion, and reviews the literature linking them to changes in childbearing and women’s economic outcomes. It concludes by discussing the recent surge in LARC use, which seems to be one of the most pressing areas in need of further research.
Asher Rosinger and Ricardo Godoy
Weight and height are critical indicators of short- and long-term human nutrition and health. This chapter reviews secular trends of weight, height, and body mass index (BMI) from studies that relied on primary data of living adults in small-scale, native populations in rural areas of developing nations. Most studies reviewed found trends of increases in weight and BMI over an average study period of 20 years. Women gained an average of 8.8 kg and 3.1 kg/m2, and men gained an average of 5.1 kg and 2.1 kg/m2 over this time span. Additionally, 10 of 13 native populations reviewed had a recent overweight and obesity prevalence of at least 10 percentage points lower than the national averages for men and women combined. In contrast to weight, 12 out of 21 studies found no change (n = 8) or a decline (n = 4) in secular trends of height.
Alexander Moradi and Kalle Hirvonen
African adult populations are remarkably tall for the low income levels that prevail at the country level. The average African woman is about 158.5 cm tall, whereas the low gross domestic product per capita would lead us to expect a mean height more similar to the shortest populations in the world, about 4 cm shorter. This is the case in spite of the fact that indicators of socioeconomic status and height are positively correlated within each country. The chapter also shows that the physical stature of African children fit well into the global income–height relationship. Hence, we conclude that the anomaly in the income–height nexus at country level appears to originate between childhood and adulthood. We present evidence for considerable catch-up growth involving entire populations. We discuss possible reasons for this catch-up growth including genetics, and, above all, better nutrition and health conditions during adolescence.
Halvor Mehlum and Karl Moene
This article explores the tendency for poverty and conflict, as well as for prosperity and peace, to reinforce one another, examining two specific factors. One is the type of rents that adversaries may contest, as rents can differ in terms of the vulnerability of their value to conflict; more vulnerable rents tend to induce more peace, whereas less vulnerable rents have the opposite effect. The second factor concerns the relationship between the elites and the entrepreneurs in their respective groups—specifically, the extent to which the elites care about their entrepreneurs. While these two factors can predispose countries to either virtuous or vicious circles, multiple equilibria are also possible.
John Cawley and Barrett Kirwan
This chapter investigates the extent to which agricultural policies contribute to childhood obesity. It starts by exploring the policies that directly affect production, such as agricultural subsidies (i.e., price supports, production subsidies, and farmland subsidies), acreage controls, tariffs on imported commodities, and agricultural extension research. The chapter then evaluates the policies aimed at stimulating the demand for food, such as commodity-distribution programs and commodity-promotion programs, and proposes the reforms that would better align agricultural policy with health policy regarding childhood obesity. Agricultural subsidies fall into three main categories: price supports, production subsidies, and farmland subsidies. The United States imposes tariff-rate quotas on imports of certain agricultural commodities. Banning the use of checkoff funds to develop and market fast food could decrease the prevalence of being overweight by 1.4 percent among those aged 3–11 years and by 1.1 percent among those aged 12–18 years.
Robert D. Plotnick
Susan Griffin and Karl Claxton
Cost-effectiveness analysis (CEA) is intended to help collective purchasers of health care to determine which interventions to prioritize, by ranking them according to the cost of each unit of “health benefit” they produce. The primary focus of this article is on the social decision-making approach where the decision-maker's objective is assumed to be the maximization of health gains subject to a given budget constraint. This article begins with the rationale for presenting a full characterization and analysis of uncertainty within any CEA. An overview of methods that can be used to conduct a CEA that accounts for uncertainty is provided, including the means to present and interpret the results. The benefits and limitations of the methods for analyzing uncertainty are considered in the context of providing information to decision-makers. The article concludes by discussing the additional questions that arise when the need for further research to support those decisions is considered.
Lee A. Craig
Since the late 18th century the long-run trend in economic growth—conventionally measured by real gross domestic product, income, and wages—has been positive in the United States and throughout Europe. However, in the 19th century, many Western countries, including the United States, experienced stagnation and even cyclical downturns in the biological standard of living—as measured by, for example, the expectation of life and adult stature—thus creating the “antebellum puzzle,” so named because the downturn began in the decades before the US Civil War. This puzzle suggests that industrialization and modern economic growth were accompanied by an increase in inequality and a decrease in the consumption of net nutrients.
Amanda L. Thompson and Penny Gordon-Larsen
This chapter first offers a description of anthropological approaches to the study of obesity, and then provides several theoretical models used to study obesity, with key examples of each type of model. Some of the essential methodologies used to model obesity, and a few examples of topical areas and current trends in the anthropology of obesity, are discussed. Changes in energy balance, both improvements in energy availability and reductions in energy expenditure over the course of human history, are central to the development of obesity. The link between formula feeding and early excess weight gain has been observed in several settings and ethnic groups, including African Americans, and may contribute behaviorally to the intergenerational transmission of obesity. With modernization, relatively recent changes in diet and physical activity behaviors (and thus energy balance) have shaped current trends in body size, resulting in obesity as a critical, global issue.
Long-run height series for several southern European countries stagnate or decline from the early 18th to the mid-19th century. Read jointly with estimates of gross domestic product (GDP) per capita and real wages, this evidence indicates that Mediterranean households were forced to work increasing annual hours in an effort to protect an already meager living standard. After the mid-19th century, conditions improved in all countries, but with different timing. Also different was the phasing of anthropometric and economic improvements, reflecting distributional and public health influences on living conditions. Today’s southern Europeans are typically shorter than their northern neighbors, which is only partly explicable in terms of measured health and wealth in the region. New evidence indicates that genetic differences may also play a role.
William Encinosa, Dongyi (Tony) Du, and Didem Bernard
This chapter describes the startlingly good outcomes associated with bariatric surgery, such as rapid improvement or even resolution of high blood pressure and Type II diabetes in almost all patients, and decreased mortality relative to a control group that is morbidly obese but did not get surgery. There are two main types of prescription drugs approved by the U.S. Food and Drug Administration for treating obesity: appetite suppressants and lipase inhibitors. There is significant weight loss under bariatric surgery, which results in much more weight loss and reduction in co-morbidities (e.g., diabetes) and mortality than bariatric medications. The potential move to endoscopically placed gastric devices is based on research which shows that many of the benefits of gastric bypass, such as immediate mitigation of diabetes, is due to a change in gut peptide release, not a reduction in food intake.
William A. Darity Jr., Mary Lopez, Olugbenga Ajilore, and Leslie Wallace
Kevin S. O’Neil and Marta Tienda
Yonatan Ben-Shalom, Robert Moffitt, and John Karl Scholz
Julie S. Downs and George Loewenstein
This chapter describes different phenomena identified by behavioral economists that can shed light on the problem of obesity. It discusses the limitations of the information-based approach to combating obesity and outlines empirical research suggesting that the benefits of information provision for the population at large are minimal at best. Next, the chapter considers the research examining two categories of alternative approaches to policies aimed at obesity, both of them inspired by ideas from behavioral economists: (1) environmental “nudges” to tip the balance of small decisions against weight-gaining behaviors; and (2) ways of “supercharging” incentive programs for weight loss. There are many decision phenomena that encourage overeating or, perhaps more importantly, stand in the way of attempts to cut back by those prone to overeat. Attempts to “nudge” consumers to make healthier food choices have shown some potential. Ideas from behavioral economics can be used to improve the effectivity of economic incentives.
Lashanda R. Jones-Corneille, Rebecca M. Stack, and Thomas A. Wadden
This chapter discusses the behavioral treatment of obesity, including its short- and long-term results and approaches to improve long-term weight management, and also explores obesity outcomes and treatment recommendations for ethnic-minority populations. Lifestyle modification includes three principal components: diet, physical activity, and behavior therapy. Three components of behavioral treatment, namely self-monitoring, cognitive restructuring, and stimulus control, are covered. Additionally, the chapter briefly reports the use of more structured or restrictive diets that have been used to induce larger initial weight losses. Long-term patient–provider contact can be obtained in several ways, including on-site visits, telephone, Internet, and e-mail contact. It is shown that behavioral treatment is effective in inducing weight loss and improving health-related complications of obesity.
Rebecca M. Puhl
This chapter describes the evidence that men find obese women unattractive, specifically reviewing the evidence of weight bias in multiple settings and its negative impact on quality of life for those affected. It is shown that both overweight men and women are susceptible to weight discrimination in the workplace. Severely obese individuals report more relationship strain and less support from family members compared to thinner peers, and other research illustrates a positive link between body mass index and loneliness, even after controlling for age, gender, annual income, employment, and marital status. The consequences of weight bias include adverse outcomes for emotional functioning, social well-being, physical health, and even public health efforts to address obesity. Despite ample documentation of weight bias in the literature, the amount of research testing strategies to reduce weight bias pales in comparison.
Elizabeth Frankenberg, Jessica Ho, and Duncan Thomas
With populations aging and the epidemic of obesity spreading across the globe, global health risks are shifting toward noncommunicable diseases. Innovative biomarker data from recently conducted population-representative surveys in lower, middle, and higher income countries are used to describe how four key biological health risks—hypertension, cholesterol, glucose, and inflammation—vary with economic development and, within each country, with age, gender, and education. As obesity rises in lower income countries, the burden of noncommunicable diseases will rise in roughly predictable ways, and the costs to society are potentially very large. Investigations that explain cross-country differences in these relationships will have a major impact on advancing the understanding of the complex interplay among biology, health, and development.
Richard H. Steckel
Beginning with Bismarck’s Germany in the late 19th century, nations gave increasing attention to measures of well-being while traveling the path to welfare states of the 20th century. Following the ascent of the germ theory of disease, governments could play a large and cost-effective role in serving public health and national competitiveness. The Great Depression energized the creation of a second important policy tool, national income accounts. This chapter discusses the evolution and application of biological measures of well-being, with comparisons to per capita gross domestic product from vital registration and life tables to morbidity and to anthropometric measures such as stature, weight, and skeletal remains. Recently, surveys of happiness have entered scholarly debate.