Body mass index, socio-economic status and socio-behavioral practices among Tz’utujil Maya women Jason M. Nagata a, *, Claudia R. Valeggia b , Frances K. Barg b,c , Kent D.W. Bream c a Health and Societies Program, Department of History and Sociology of Science, 249 South 36th Street, University of Pennsylvania, Philadelphia, PA 19104, United States b Department of Anthropology, 3260 South Street, University of Pennsylvania, Philadelphia, PA 19104, United States c Department of Family Medicine and Community Health, 2 Gates, 3600 Spruce Street, University of Pennsylvania, Philadelphia, PA 19104, United States 1. Introduction Obesity and overweight are rising problems in Latin America, especially as subsistence economies transition to market-based economies (Popkin, 2001). Although the prevalence of obesity and overweight has historically been higher in developed countries than in developing ones, several epidemiological studies have demonstrated that obesity and overweight prevalence in many developing countries has reached or exceeded levels in developed nations, particularly in Latin America (Filozof et al., 2001; Popkin, 2001; Pen ˜ a and Bacallao, 1997). In low income regions of Mexico, for instance, more than 50% of men and 60% of women are overweight or obese (Fernald et al., 2004). In Guatemala, the prevalence of obesity and overweight increased from 34.1% in 1995 to 44.9% in 2002 (Garnier et al., 2005). Obesity and overweight are major risk factors for several chronic conditions, including cardiovascular diseases, type II diabetes mellitus, sleep apnea and selected cancers (World Health Organization, 2000; Eckel and Krauss, 1998). In addition to obesity and overnutrition, child under- nutrition still plagues many Latin American countries. The prevalence of chronic child undernutrition in Guate- mala was 44% in 2000 (Marini and Gragnolati, 2003). The simultaneous combination of obesity and chronic child undernutrition, sometimes in the same household, Economics and Human Biology 7 (2009) 96–106 ARTICLE INFO Article history: Received 29 August 2008 Received in revised form 12 February 2009 Accepted 12 February 2009 Keywords: Body mass index Socio-economic status Socio-behavioral practices Marriage Obesity Malnutrition Guatemala Latin America ABSTRACT This study investigates the associations between body mass index (BMI), socio-economic status (SES) and related socio-behavioral practices including marriage and market visits in a population of adult Tz’utujil Maya women in Santiago Atitla ´ n, Guatemala, aged 18–82. Mixed qualitative and quantitative methods include cross-sectional anthropometric measurements and semi-structured interviews gathered in 2007, as well as participant observation and purposive interviews conducted in 2007–2008. The regional quota sample of 53 semi-structured interviews was designed to be representative of the cantones (municipal divisions) of Santiago Atitla ´ n. BMI was positively associated with years of schooling, income and literacy, all measures of SES. A statistical analysis of our data indicates that increased income, increased market visits and being married are significantly positively associated with BMI. Qualitative analysis based on the grounded theory method reveals relevant themes including a preoccupation with hunger and undernutrition rather than obesity, a preference for food quantity over dietary diversity, the economic and social influence of a husband, the effects of market distance and the increasing consumption of food from tiendas. These themes help to explain how SES, socio- behavioral practices and BMI are positively associated and can inform future public health interventions related to obesity and undernutrition. ß 2009 Elsevier B.V. All rights reserved. * Corresponding author. Tel.: +1 323 724 2808; fax: +1 323 724 2808. E-mail address: jasonmnagata@gmail.com (J.M. Nagata). Contents lists available at ScienceDirect Economics and Human Biology journal homepage: http://www.elsevier.com/locate/ehb 1570-677X/$ – see front matter ß 2009 Elsevier B.V. All rights reserved. doi:10.1016/j.ehb.2009.02.002