Trade openness and the obesity epidemic: a cross-national study of 175 countries during 1975-2016

Purpose: This study assessed the longitudinal relationship between trade openness and obesity rate across 175 countries during 1975-2016. Methods: Two-way (country and year) fixed-effects regressions were performed to examine the openness index (i.e., sum of export and import over gross domestic product) in relation to country obesity rate, using data from World Health Organization and World Bank. Results: The openness index was found to be positively associated with country obesity prevalence-a 10% increase in the openness index was associated with an increase in obesity rate by 0.80% (95% confidence interval, 0.67%-0.94%). Across continents, the positive relationship between the openness index and obesity prevalence was strongest among Asian countries, followed by countries in North America and Africa. Across income levels, the positive relationship between the openness index and obesity prevalence was strongest among lower middle-income countries, followed by upper middle-income countries and low-income countries. In contrast, no relationship between the two was identified among high-income countries. Conclusions: Trade openness was positively associated with country obesity prevalence, and its influence concentrated among developing nations. Policy makers should closely monitor the evolution in obesity rate during trade liberalization and nutrition transition to minimize its negative impact on weight-related population health. (C) 2019 Elsevier Inc. All rights reserved.