The study, published in the International Journal of Behavioral Nutrition and Physical Activity, followed 978 residents of São Paulo between 2014 and 2024. Researchers collected information during three assessment periods: 2014–2015, 2020–2021, and 2023–2024. The investigation was led by researchers associated with the University of São Paulo, including Andreia Alexandra Machado Miranda of the Center for Epidemiological Research in Nutrition and Health and Alex Antonio Florindo of the School of Arts, Sciences, and Humanities.

Rather than examining social characteristics separately, the researchers used an intersectional approach. This method considers how multiple aspects of identity and social position—such as sex, race or skin color, and educational attainment—combine to influence people’s opportunities and experiences. To quantify these overlapping disadvantages, the team applied a Multiple Jeopardy Index, with scores ranging from zero, representing the least vulnerable group, to four, representing the most vulnerable.

The contrast between the most and least advantaged groups became more pronounced during the study. At the beginning, 51% of highly educated white men reported engaging in physical activity during leisure time, compared with 29% of Black, Brown, Asian, or Indigenous women with lower levels of education. By the third assessment, participation had increased to 65% among the more advantaged group and 39% among the most vulnerable. Although both groups became more active, the difference between them widened from 22 to 26 percentage points.

The researchers argue that the pattern reflects structural barriers rather than a simple difference in interest. Women often perform a disproportionate share of unpaid domestic and caregiving work, leaving less time for sports or exercise. They may also earn lower wages and have fewer resources for gym memberships, organized sports, or transportation to recreational facilities. In many neighborhoods, particularly on the outskirts of São Paulo, poorly lit streets, limited green space, inadequate infrastructure, and concerns about personal safety further restrict access to outdoor activity.

“These inequalities persisted and the gap between groups widened over ten years,” Miranda said. “Leisure-time physical activity remains a privilege of the most socially advantaged groups.” The researchers emphasize that public health strategies focused only on individual behavior are unlikely to close this gap. Their analysis is based on an ecological model of physical activity, which recognizes that behavior is influenced by social support, family circumstances, the built environment, transportation systems, and government policy as well as personal preference.

The study also examined walking as a form of transportation, particularly walking associated with commuting. In contrast to leisure-time exercise, transport-related physical activity showed no statistically significant relationship with the social vulnerability index. Overall, the proportion of participants who walked for transportation rose from 61.8% in the first assessment to 71.6% in the third. This form of activity was most common among young Black or mixed-race men with a high school education.

The difference may reflect the role of necessity in everyday mobility. Walking to work or to public transport is often determined by household income, access to vehicles, public transit routes, and the location of employment rather than by a deliberate decision to exercise. Neighborhood design can also influence whether walking is practical and safe. Because commuting is built into daily routines, the researchers suggest that policies improving sidewalks, public transit connections, street lighting, and pedestrian safety could increase physical activity without requiring people to find additional leisure time.

The findings have significance beyond São Paulo. The World Health Organization recommends that adults complete 150 to 300 minutes of moderate-intensity physical activity or 75 to 150 minutes of vigorous-intensity activity each week. Yet an estimated 1.8 billion adults—nearly one-third of the global adult population—failed to meet those recommendations in 2022. Physical inactivity is associated with higher risks of cardiovascular disease, stroke, diabetes, unhealthy weight gain, and other chronic conditions, while sedentary lifestyles are linked to approximately five million deaths each year.

Brazil faces the same challenge. Data from the Ministry of Health’s 2024 VIGITEL surveillance system indicate that 42.3% of adults achieved at least 150 minutes of moderate physical activity per week. The proportion was 47.7% among men and 37.9% among women. Brazil aims to raise the national figure to 50.7% by 2030, but the São Paulo study indicates that progress will depend on addressing unequal access to opportunities for movement. The researchers point to measures such as expanding safe public spaces, improving infrastructure in vulnerable districts, supporting active transportation, and investing in cycling networks. Previous research by Florindo’s group found that having a bike lane within 500 meters of a residence significantly increased the likelihood that residents would cycle. The new study concludes that health promotion will be most effective when urban planning and social policy are designed to prioritize people facing the greatest barriers to physical activity.

Subject of Research: Social inequalities in leisure-time and transport-related physical activity in São Paulo, Brazil.

Article Title: Social inequalities in leisure-time and transport-related physical activity through the lens of intersectionality: 10-year longitudinal study in Brazil

News Publication Date: 5 May 2026

Web References: https://doi.org/10.1186/s12966-026-01900-5; https://www.agencia.fapesp.br/en

References: International Journal of Behavioral Nutrition and Physical Activity, DOI: 10.1186/s12966-026-01900-5.

Image Credits: Cecília Bastos/USP Imagens

Keywords: physical activity, exercise inequality, public health, intersectionality, São Paulo, Brazil, sedentary lifestyle, active transportation, urban planning, health equity

Center for Emerging and Infectious Diseases

The Center for Emerging and Infectious Diseases (CEID) will contribute to the ongoing advancement of diagnostic testing, enabling rapid and accurate identification of infectious agents. The center’s researchers will engage with local and global communities to better understand disease transmission patterns, devise evidence-based strategies for prevention and control, and enhance public health preparedness. The epidemiological work that will take place within CEID will allow public health agencies to make informed decisions, particularly in times of urgent need, and allocate resources effectively.

“The mission of the Center for Emerging and Infectious Diseases is to develop, evaluate and implement effective countermeasures against existing and emerging infectious disease threats,” said Marcus Zervos, M.D., co-director of the center. “Along with co-directors Teena Chopra, M.D., MPH, and Paul Kilgore, M.D., CEID will conduct basic, clinical and applied research to accelerate development and introduction of vaccines and related interventions to control emerging and re-emerging infectious diseases affecting populations in Detroit, Michigan, the United States and around the world. This center will be a unique resource within the Wayne State University and Detroit communities and beyond that will enable rapid implementation of research teams to prepare clinical vaccine trials in outpatient, inpatient and community settings.”

CEID’s programs will provide credible, evidence-based information to guide informed decision-making for participation in clinical trials as well as utilization of proven tools that enhance preparedness and protect communities from diseases of epidemic and pandemic potential.

“It is our goal to be an important resource for many to understand emerging and infectious diseases that have increased mortality and morbidity impact,” said Zervos. “In particular, communities such as Detroit often have less direct access to information, and the center will play a critical role in providing our citizens with critical communications that can ultimately impact the health of themselves as well as their friends and family.”

“CEID’s state-of-the-art microbiology laboratory has capabilities for rapid detection of emerging and re-emerging infectious diseases,” said Chopra. “This will provide quality and timely care to Detroit residents.”

Hossein Salimnia, Ph.D., serves as the microbiology director of the lab and Chopra is the medical director.

Ben L. Silberstein Institute for Brain Health

The Ben L. Silberstein Institute for Brain Health (IBH) will advance the understanding of the brain’s structure, chemistry and function as it relates to both disease and the promotion of health and well-being. It will accelerate and promote team interactional science through biomedical imaging platforms, neurogenetics, addiction and pain biology, post-traumatic stress disorder and trauma neurobiology, gerontology nanotechnology, neurodevelopment, targeting and reducing health care disparities, and innovative and novel diagnostic and treatment development.

“The Ben L. Silberstein Institute for Brain Health will bring together transdisciplinary, cross-campus neuroscience researchers, as well as combine undergraduate, graduate and post-doctoral neuroscience education to focus on health equity and challenges related to brain and behavioral health in urban environments, particularly in Southeast Michigan and Detroit,” said David Rosenberg, co-director of IBH. “It is our goal to make a significant impact on promoting brain health by targeting and accelerating diagnostic and therapeutic advances for real-world childhood and adult-onset brain disorders impacting our community and beyond.”

IBH aims to be a leader in translational neurosciences and inspire the next generation of students and researchers to improve the health and care of individuals affected by psychiatric or neurological disorders or injuries in the nervous system. The institute will identify mechanisms promoting brain health as well as enhancing the understanding of disease mechanisms as it can related to enhanced diagnosis and treatment, ultimately aiding many with real-world childhood and adult-onset brain disorders.

“IBH will work with strategic partners and faculty across campus to improve lives through important research and community outreach that will provide diagnosis and new treatments for many psychiatric and brain disorders,” said Rosenberg. “By building a large collaborative team, we are now better able to facilitate the important work that needs to be done to help the lives of so many impacted by brain health issues.”

“Wayne State University is committed to improving the lives of our community and beyond, and through the Center for Emerging and Infectious Diseases and the Ben L. Silberstein Institute for Brain Health, we are now well positioned to be a leader in Detroit for advancing research, technology development and education in these critical health areas,” said Stemmler. “Collaboration is a critical component of research, and these two institutes will be excellent examples of how bringing disciplines from across campus together can lead to groundbreaking discoveries that will improve lives.”

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About Wayne State University

Wayne State University is one of the nation’s pre-eminent public research universities in an urban setting. Through its multidisciplinary approach to research and education, and its ongoing collaboration with government, industry and other institutions, the university seeks to enhance economic growth and improve the quality of life in the city of Detroit, state of Michigan and throughout the world. For more information about research at Wayne State University, visit research.wayne.edu.

Contact info
Julie O’Connor
Director, Research Communications
Phone: 313-577-8845
Email: julie.oconnor@wayne.edu

Obesity and related health issues have long been interpreted through a relatively linear lens—higher socioeconomic status often correlates with better health outcomes in developed countries, while low SES is linked to higher obesity rates in vulnerable populations. However, the dynamics can invert or shift in countries experiencing rapid economic transitions, especially in urbanizing contexts like the Philippines. The CLHNS study spearheaded by Voloshchuk and colleagues seeks to unpack these complicated associations by looking beyond average BMI values and instead examining how SES influences BMI across its entire distribution and how these effects differ between men and women.

What sets this research apart is its use of rigorous statistical methods that analyze the role of SES variables not just on mean BMI but on various quantiles of the BMI distribution. This approach recognizes that individuals at different points on the BMI spectrum—ranging from underweight to severely obese—may experience quite distinct influences from socioeconomic factors. Particularly in a region where traditional diets and lifestyles are rapidly giving way to urban nutritional patterns characterized by processed food consumption and sedentary behavior, understanding these nuanced effects is critical.

The researchers drew data from a longitudinal cohort based in Cebu, a city emblematic of the Philippines’ urban transformation. This rich dataset allowed them to capture the ongoing nutrition transition, characterized by shifts from predominately undernutrition and infectious disease burden to increasing prevalence of overweight and obesity alongside chronic non-communicable diseases. The investigation focused on young adults, a segment of the population particularly vulnerable to lifestyle-related weight changes as economic and social mobility unfolds.

Importantly, the study uncovered that the relationship between SES and BMI is far from uniform. For men, higher socioeconomic status was linked with increased BMI predominantly at the higher end of the BMI distribution. This suggests that wealthier men in urban Cebu may be more susceptible to obesity, potentially due to greater access to energy-dense foods and sedentary occupations, mirroring trends seen in many middle-income countries undergoing development transitions. Conversely, women exhibited a different pattern wherein SES appeared to influence BMI more consistently across the spectrum but with varying intensities, indicating differentiated mechanisms at play, possibly involving cultural norms, reproductive health, and differences in metabolism or social pressures around body image.

Such sex-specific disparities highlight the critical need for tailored public health strategies. Interventions that do not account for these differences risk oversimplification and ineffectiveness. For instance, policies designed to curb obesity by focusing solely on low-income groups might overlook affluent men’s increased obesity risk or the heterogeneous patterns among women. This evidence points toward a more precision-health approach customized by sex and socioeconomic strata, leveraging detailed population-level insights for maximum impact.

Moreover, the study throws light on how the urban environment in emerging economies acts as a double-edged sword. On one hand, urbanization can drive upward mobility, improved education, and better healthcare access, which traditionally improve nutritional outcomes. On the other, it concurrently fosters obesogenic environments filled with fast food outlets, reduced physical activity opportunities, and social determinants that compound unhealthy weight gain, especially among certain socioeconomic groups. This duality makes the associations between SES and BMI highly context-dependent and dynamic.

The methodological rigor of this research extends beyond traditional regression analyses by employing quantile regression techniques, which allow the assessment of SES effects at distinct points along the BMI distribution rather than an average effect. This differentiation uncovers critical heterogeneity that average-based models mask. It acknowledges that the determinants pushing someone from normal weight to overweight may differ substantially from those transforming mild obesity into severe obesity, thereby tailoring preventive and clinical strategies accordingly.

Furthermore, by integrating sex as a fundamental effect modifier, the study expands our understanding of the biological, social, and cultural factors influencing body composition. This gender-centric lens aligns with growing calls in global health to dismantle one-size-fits-all models, especially in nutrition science, where hormonal status, reproductive roles, and gendered behaviors intersect with socioeconomic contexts to mediate health outcomes.

The findings are timely against the backdrop of rising global obesity rates, particularly in low- and middle-income countries experiencing rapid urbanization and market globalization. The Philippines mirrors these broader trends, with malnutrition manifesting as a ‘double burden’—persisting undernutrition in some groups amidst burgeoning obesity in others. By highlighting divergent SES-BMI pathways by sex and BMI levels, the CLHNS study offers nuanced evidence for policymakers grappling with this complex public health problem.

This research also invites further inquiry into the underlying mechanisms mediating SES influences on BMI, such as dietary patterns, physical activity, psychosocial stress, and access to health education. Understanding how these elements vary by sex and socioeconomic strata can inform more sophisticated interventions that address root causes rather than just symptoms of the nutrition transition.

Another implication from this study is the importance of continuous, context-specific longitudinal surveillance to capture evolving nutrition realities amidst socioeconomic and urban shifts. Cross-sectional snapshots, while informative, cannot unravel the temporal dynamics and causality embedded within these transitions, underscoring the value of cohort studies like CLHNS.

For practitioners and researchers, these findings advocate incorporating nuanced statistical approaches and accounting for intersectional factors—sex, SES, and BMI quantiles—to illuminate hidden disparities and inform equity-driven public health actions. The study stands as a model for leveraging big data and advanced analytical tools to refine our grasp of complex biomedical and social interactions shaping population health.

In conclusion, the intricate relationship between socioeconomic status and BMI among young adults in an urbanizing Philippine context reveals crucial sex-specific and distribution-specific patterns that challenge simple narratives about obesity. As the global burden of obesity continues to grow, especially in transitional economies, this type of insightful, data-driven inquiry points toward more targeted, effective strategies that recognize diversity within populations rather than rely on generalized frameworks. The Cebu Longitudinal Health and Nutrition Survey continues to be an invaluable resource shedding light on the evolving interplay of social determinants and nutrition, guiding both local and global health policies toward a healthier future.

Subject of Research: Association of socioeconomic status with body mass index (BMI) among young adults in an urbanizing setting, analyzed across the BMI distribution and by sex.

Article Title: Association of socioeconomic status with BMI differs by sex and position on BMI distribution among participants in the Cebu Longitudinal Health and Nutrition Survey (CLHNS).

Article References:
Voloshchuk, R.S., Lee, N.R., Carba, D.B. et al. Association of socioeconomic status with BMI differs by sex and position on BMI distribution among participants in the Cebu Longitudinal Health and Nutrition Survey (CLHNS). Int J Obes (2025). https://doi.org/10.1038/s41366-025-01826-1

Image Credits: AI Generated

DOI: https://doi.org/10.1038/s41366-025-01826-1