The Effects of education on obesity in China: heterogeneity and mechanisms
Creators: name: Li, Yaoyue
Publisher: name: Macquarie University
Year: 2024
Subjects: classificationCode: 420606
subject: Social determinants of health

description: The obesity epidemic is posing a major challenge in many parts of the world, placing enormous burdens on the population’s health and socioeconomic systems. Alongside socioeconomic development, tremendous changes in diet and physical activity environments have been recognised as drivers of obesity at the population level, but significant disparities in obesity have been long observed across education groups in different settings, implying an underlying socioeconomic cause of obesity; however, the effect of education on obesity remains an ongoing area of research. Using national-representative longitudinal data and employing multiple econometric strategies with the address of causality, this thesis investigates the effects of education on obesity in adults and the intergenerational effects of education on obesity in children and middle-aged and older parents in the context of China; it also examines heterogeneity in the effects of education and explores the underlying mechanisms. The findings promote the understanding of the education–obesity relationship and provide insights into obesity prevention and health promotion.
This thesis consists of four interconnected studies. The first two concern the effects of education on obesity in Chinese adults. Using data from the 1991–2015 China Health and Nutrition Survey (CHNS) and employing multilevel mixed-effects models with instrumental variables, the first study finds that education has an overall positive effect on obesity for males and a negative effect for females, and it also indicates prominent heterogeneity in the effects of education: The obesogenic role of education is more pronounced among rural populations and becomes attenuated with urbanisation and across successive birth cohorts. These results imply an underlying moderating effect of the socioeconomic environment.
The second study uses data from the 2004–2015 CHNS to conduct the mediation analysis, further illustrating how, through multiple pathways of lifestyle, education affects obesity in Chinese adults. It reveals that education indirectly decreases the risk of obesity by reducing dietary imbalance but increases the risk by lowering labour intensity and encouraging sedentary activities. Furthermore, socioeconomic environments moderate the mediating effects: Urban environments and urbanisation strengthen the protective role of education against obesity through the mediation of dietary behaviours.
The third study examines the intergenerational effects of education on obesity in children and the intergenerational effects of caregiving. Using data from the 2010–2020 China Family Panel Studies (CFPS) and adjusting for endogeneity, the study finds that maternal education plays a protective role against childhood overweight, while the effects of paternal and grandparental education are much less evident. By contrast, grandparental care for children significantly increases their risk of being overweight in children, and the positive effect remains constant across different levels of parental and grandparental education. In addition, the intergenerational effects on childhood overweight are attenuated with the child’s age. The mechanism analysis reveals the opposite effects of maternal education and grandparental care on the child’s obesity-related behaviours.
The fourth study addresses the intergenerational effects of education on obesity in middle-aged and older parents. Employing data from the 2011–2015 China Health and Retirement Longitudinal Study (CHARLS) and applying treatment effect models, the study indicates a positive effect of adult children’s education on abdominal obesity in fathers but an insignificant effect in mothers. The promoting role of the daughter’s education in the father’s abdominal obesity is more pronounced compared to the son’s education. Furthermore, the positive effect of adult children’s education is more evident in less-educated fathers, rural parents, and parents in earlier birth cohorts, implying that children’s education can serve as a supplement for parents with fewer resource endowments. The mediation analysis suggests that a rise in adult children’s education potentially elevates the risk of abdominal obesity through increased food intake and reduced physical activity, and the obesity-promoting mechanisms are more prominent among rural parents.
The thesis concludes that the effects of education on obesity display salient gender patterns over the life course but are heterogeneous across generations, and socioeconomic environments moderate these effects. The findings expand current knowledge and contribute to the literature by addressing the causal effect of education on obesity, highlighting its heterogeneity and mechanisms, and providing insights into public policies aiming to tackle obesity.