Social determinants of overweight and obesity in Paraguayan adults using quantile regression

  • Ho Cheol Lee
    Yonsei Global Health Center, Yonsei University, Wonju, Korea, Republic of.
  • Ji Eon Kim
    Yonsei Global Health Center, Yonsei University, Wonju, Korea, Republic of.
  • Adriana Amarilla
    Pan American Health Organization (PAHO), Asuncion, Paraguay.
  • Yanghee Kang
    Yonsei Global Health Center, Yonsei University, Wonju, Korea, Republic of.
  • Boram Sim
    Health Insurance Review and Assessment Service (HIRA), Wonju, Korea, Republic of.
  • Eun Woo Nam
    Department of Health Administration, College of Health Science, Yonsei University, Wonjum , Korea, Republic of.


Background: The World Health Organization (WHO) defines the double burden of malnutrition as the new face of malnutrition. This is a serious problem in Latin American countries, especially Paraguay, which has a high obesity rate. This study aimed to gather data to inform a national strategy for confronting the double-burden challenge in Paraguay by 1) identifying whether the body mass index (BMI) of study subjects differed significantly according to social determinants, and 2) assessing the factors affecting BMI and the extent of their impact according to BMI quantile levels.

Design and Methods. Data were collected using a questionnaire adapted from the WHO World Health Survey. We collected 2,200 responses from September 16 to October 7, 2018. After excluding the questionnaires with missing data, we analyzed 1,994 respondents aged 17 years and older living in Limpio, Paraguay. The analyses included t-test and chi-squared test to identify significant differences and 10th quantile regression to assess associations.

Results. Analyses showed significant differences in participants’ BMI levels based on age and diagnoses of diabetes or hypertension. In quantile regression analyses, age was significantly associated with BMI quantiles at all but one level. Educational attainment was significantly associated with the 10%–40% and 60%–70% quantiles of BMI.

Conclusions. Age, education level, diabetes, and hypertension were significant predictors of obesity. Obesity programs that focus on people aged more than 60 years are required. In addition, targeted nutritional education may be a useful intervention.


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