Qual Life Res
DOI 10.1007/s11136-016-1403-6
The fatter are happier in Indonesia
Kitae Sohn1
Accepted: 25 August 2016
Ó Springer International Publishing Switzerland 2016
Abstract
Purpose Although obesity and happiness are known to be
negatively related in the developed world, little attention
has been paid to this relationship in the developing world.
We thus investigated the relationship in Indonesia and
attempted to explain the underlying rationale.
Methods We considered about 12,000 respondents aged
15? for each gender obtained from the Indonesian Family
Life Survey 2007 by relating a measure of happiness to
weight-related measures in ordered probit models.
Results The relationship between obesity and happiness
was positive in Indonesia, and this relationship was robust.
Our evidence suggests that the contrasting results for the
two worlds result from affordability of obesity. That is,
while even low socioeconomic status (SES) individuals in
the developed world can afford to be obese, only high SES
individuals in the developing world can do.
Conclusions Our findings imply that obesity prevention in
the developing world requires different measures than
those used in the developed world.
Keywords Obesity  Happiness  Developing country 
Socioeconomic status  Indonesia Family Life Survey 
Culture
Electronic supplementary material The online version of this
article (doi:10.1007/s11136-016-1403-6) contains supplementary
material, which is available to authorized users.
& Kitae Sohn
ksohn@konkuk.ac.kr
1
Department of Economics, Konkuk University, 120
Neungdong-ro, Gwangjin-gu, Seoul 05029, South Korea
Introduction
Although obesity is generally associated with the devel-
oped world, people in the developing world are no longer
safe from it [1, 2]. Obesity is of concern because it is
related to diverse chronic diseases such as cardiovascular
disease, Type 2 diabetes mellitus, hypertension, stroke,
dyslipidemia, osteoarthritis, and several types of cancer. As
a result, obese people (BMI C 30) incur medical costs
which are about 30 % higher than those incurred by people
with a BMI \ 25 [3]. Obesity is not merely a health issue.
Obesity is negatively related to labor market outcomes,
particularly among women [4]. As a result, obesity inevi-
tably influences socioeconomic aspects, such as income
and health inequalities, health insurance, disability benefits,
taxation, and negative externalities [5, 6].
When obesity is negatively related to health and eco-
nomic outcomes, it naturally influences various aspects of
life. Happiness is often used as a summary measure of life
evaluation, where happiness is defined as the degree to
which a person positively evaluates the overall quality of
his present life as a whole [7]. Happiness is appealing
because it is generally the ultimate goal in life, while
income, which is a typical measure of life evaluation in
economics, is a means to achieve happiness. In addition,
happiness, as part of quality of life, considers the totality
of life, whereas income concerns only one aspect of life.
By examining how obesity relates to happiness, one can
understand the pervasive effects of obesity on life. As
expected from the negative relationship of obesity to
health and economic outcomes, many studies have found
that in general, obesity is negatively related to happiness
(or life satisfaction) and positively to depression.
Research has demonstrated this relationship in the USA
[8–11], Britain [12], Switzerland [13], Germany [14–16],
123

and Finland [17]. All studies involved developed
countries.1
In contrast, two well-known facts suggest that the rela-
tionship between obesity and happiness is likely to be
positive in the developing world. First, obesity and
socioeconomic status (SES) are positively related in the
developing world [18–20]. Second, SES and happiness are
positively related there [21–24]. These two facts suggest
that affordability of obesity differs between the two worlds.
In the developed world, even low SES individuals can
afford to be obese if they so desire. In fact, obesity is more
prevalent among low, rather than high, SES individuals
[25]. In contrast, in the developing world, it is not evident
whether low SES individuals can afford to be obese even if
they wanted to. In this case, obesity can be a costly signal
of high status, as only high SES people can afford [26].
Following this conjecture, we aimed to determine how
obesity was related to happiness in Indonesia, a large
populous developing country. Furthermore, unlike other
studies, we examined men and women separately because
there is no a priori reason to assume that the relationship is
the same for both genders.
Methods
Source of data
The main dataset was the Indonesian Family Life Survey
(IFLS), an ongoing longitudinal survey. Data collection for
the first IFLS survey (IFLS1) began in 1993, involving
over 22,000 individuals from 7224 households in 13 pro-
vinces. The IFLS selected 13 provinces to maximize rep-
resentation of the population (83 %), capture the cultural
and socioeconomic diversity within Indonesia, and be cost-
effective. A total of 321 enumeration areas were randomly
selected from the 13 provinces. Within a selected enu-
meration area, households were randomly selected. Four
follow-ups were conducted in 1997 (IFLS2), 1998
(IFLS2?), 2000 (IFLS3), and 2007 (IFLS4). Respondent
attrition was not a serious issue: the re-contact rate of the
original dynasties was 93.6 % in IFLS4. Although the
survey is longitudinal, we only analyzed IFLS4 because it
was the only survey to include a variable of happiness and
other variables of interest, not included in the other follow-
ups.
1
The World Bank uses gross national income per capita to classify
economies into four income categories. In this study, developed
countries correspond to the upper-middle- or high-income economies,
and developing countries to the lower-middle- or low-income
economies.
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Qual Life Res
Main variables
Happiness was measured by the response to the following
question: ‘‘Taken all things together how would you say
things are these days—would you say you were very
happy, pretty happy, or not too happy?’’ This question is
identical to that of the US General Social Survey and is
nearly identical to that of the Euro-barometer Survey Ser-
ies. Note that the IFLS question referred to three possible
responses (very happy, pretty happy, and not too happy) in
itself, but respondents chose one of four possible responses
(very happy, happy, unhappy, and very unhappy). We
combined the categories of unhappy and very unhappy
because only 0.29 % of men and 0.33 % of women in our
sample said that they were very unhappy (Table 1). We
assigned a value of 1 to very unhappy and unhappy, 2 to
happy, and 3 to very happy. The variable of happiness in
IFLS4 appears to be valid because factors that are known to
be associated with happiness in other countries have been
also associated with happiness in IFLS4 to similar degrees
[21–23, 27].
Weight was measured by trained nurses using Seca
Model 770 scales. Various measures are available to
classify obesity, but BMI is widely used in the social sci-
ences for its simplicity and availability [28]. Following the
World Health Organization’s suggestion [29], we used the
following BMI cut-off points for Asians: underweight
defined as BMI \ 18.5, normal weight as
18.5 B BMI \ 23, overweight as 23 B BMI \ 25, and
obesity as BMI C 25. We used BMI in not linear but
dummy form to detect any nonlinear relationship between
BMI and happiness. BMI in IFLS4 was accurate because
specially trained nurses measured height and weight,
thereby reducing measurement error and bias in self-re-
ported height and weight. We considered a range of
covariates (listed in ‘‘Statistical analysis’’ section) and
presented the descriptive statistics of these variables in
Table 1. Appendix B describes all covariates, and for more
information, an interested reader may consult the user’s
manual available at http://www.rand.org/labor/FLS/IFLS.
html. Appendix C explains why we used BMI and the
obesity cut-off point.
Inclusion and exclusion criteria
In IFLS4, 29,055 respondents aged 15? provided valid
answers to the happiness question. We only included
respondents who received a secular, rather than Islamic,
education to ensure greater sample homogeneity. We fur-
ther excluded a small number of respondents whose highest
education level was difficult to compare with others’ (adult
education and open university) and another small number
of respondents with missing and unreasonable values (to
Qual Life Res

Table 1 Descriptive statistics

Gender Men Women
% or Mean (SD) % or Mean (SD)

Happiness
Very happy 6.1 % 6.8 %
Happy 85.0 % 85.4 %
Unhappy 8.7 % 7.5 %
Very unhappy 0.29 % 0.33 %
Height (cm) 162.1 (6.5) 150.8 (5.8)
Weight (kg) 57.1 (10.7) 52.5 (10.4)
BMI (kg/m2) 21.7(3.6) 23.0 (4.2)
Underweight (BMI \ 18.5) 16.9 % 12.4 %
Normally weighted (18.5 B BMI \ 23) 53.2 % 42.8 %
Overweight (23 B BMI \ 25) 13.3 % 15.5 %
Obese (BMI C 25) 16.6 % 29.3 %
Demographic variable
Age 37.2 (15.4) 36.8 (15.3)
Years of schooling 8.5 (4.3) 7.7 (4.6)
Single, separated, divorced, or widowed 29.0 % 30.1 %
Married 71.1 % 69.9 %
Non-Javanese 58.0 % 59.0 %
Javanese 42.0 % 41.0 %
Non-Islamic 11.3 % 11.1 %
Islamic 88.7 % 88.9 %
Not working 15.5 % 42.5 %
Working 84.5 % 57.5 %
Rural residence 45.8 % 45.2 %
Urban residence 54.2 % 54.8 %
Province fixed effects (not listed but controlled for)
Socioeconomic status variable
Consumption of eggs per week (days) 3.0 (2.1) 2.9 (2.1)
Consumption of fish per week (days) 3.6 (2.4) 3.5 (2.5)
Consumption of meat per week (days) 1.8 (1.8) 1.6 (1.8)
Consumption of dairy products per week (days) 1.4 (2.3) 1.4 (2.4)
Ln(Wealth) 17.11 (2.00) 17.09 (2.06)
Subjective wealth level 1 5.5 % 4.8 %
Subjective wealth level 2 24.4 % 23.7 %
Subjective wealth level 3 53.4 % 53.0 %
Subjective wealth level 4 15.5 % 17.2 %
Subjective wealth level 5 1.1 % 1.0 %
Subjective wealth level 6 0.18 % 0.22 %
Objective health variable
Grip strength (kg) 36.44 (9.81) 22.97 (7.93)
Lung capacity (L) 3.84 (0.94) 2.61 (0.66)
Hemoglobin level (g/dL) 14.63 (1.65) 12.60 (1.46)
No hypertension 73.9 % 74.9 %
Hypertension 26.1 % 25.1 %
# Words recalled 8.9 (3.7) 8.5 (3.9)
Subjective health variable
# Depression symptoms 3.1 (1.6) 3.2 (1.7)
# Acute diseases 2.1 (2.0) 2.3 (2.1)
Very healthy 11.3 % 9.6 %

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 Qual Life Res

Table 1 continued
Gender Men Women
% or Mean (SD) % or Mean (SD)

Somewhat healthy 76.5 % 74.9 %

Somewhat unhealthy 12.0 % 15.2 %
Unhealthy 0.26 % 0.32 %
Did not have a general check-up in the past 5 years 85.2 % 86.2 %
Have a general check-up in the past 5 years 14.8 % 13.8 %
Did not visit a doctor in the past 4 weeks 89.7 % 80.8 %
Visited a doctor in the past 4 weeks 10.3 % 19.2 %
Do not have health benefits or insurance 72.3 % 74.6 %
Have health benefits or insurance 27.7 % 25.4 %
Na 11,926 12,910
a
Sample sizes slightly varied depending on covariates

list only a few, outside the following ranges,
120 cm B height B 200 cm, 30 kg B weight B 150 kg,
10 B BMI B 40, 70 mm Hg B systolic blood pres-
sure B 300 mm Hg, and 50 mm Hg B diastolic blood
pressure B 200 mm Hg). The final sample size was about
12,000 observations for each gender.
Statistical analysis
Since the measure of happiness was ordinal, we used an
ordered probit model. This model facilitates comparisons
between our results and those in the literature. We esti-
mated the following model:
yi ¼ b0 Underwti þ b1 Overwti þ b2 Obesei þ xi b3 þ ei ; and
ei jUnderwti ; Overweighti ; Obesei ; xi  Normalð0; 1Þ
ð1Þ
where yi is the latent variable of individual i’s happiness.
Underwt refers to being underweight, Overwt to being
overweight, and Obese to being obese; the normal-weight
group is the reference group. x is a vector of covariates,
including demographic variables (Demo), SES variables
(SES), objective health indicators (Obj.Health), and sub-
jective health indicators (Subj.Health). We considered
these sets of covariates because they are known to be
closely related to happiness in general [30] and in
Indonesia [21–23, 31], and because, as revealed below,
they played an important role in explaining the positive
relationship between obesity and happiness. e refers to a
random error, and the b to the coefficients to estimate; b2
was the coefficient of interest. We applied sampling
weights to all estimations to make them nationally repre-
sentative. We also clustered standard errors at the county
level to account for possible correlation within a county.
Because an ordered probit is a nonlinear model and the b
are difficult to interpret, we presented the mean marginal
effects for the response of very happy.
After estimating the relationship between obesity and
happiness, we attempted to understand the relationship by
using the following specification:
wi ¼ c1 Underwti þ c2 Obesei þ Demoi c3 þ ei ð2Þ
where wi refers to the goodness of individual i’s life, the c
to coefficients to estimate, and e to an error term. wi
includes each element of SES, Obj.Health, and Sub-
j.Health, one at a time. For continuous and dichotomous
dependent variables, we used OLS; for multi-level (more
than 2) discrete dependent variables, we used an ordered
probit model and reported the mean marginal effects for the
response of very happy. Note that all dependent variables
in this specification were covariates in specification (1).
Thus, by estimating specification (2), we do not argue that
these factors explained the remaining portion of the rela-
tionship between obesity and happiness. The remaining
portion was likely to be driven by unobservable factors,
and by definition, we could not control for them. The
purpose of specification (2) was to suggest that obese
people enjoyed better lives than non-obese people in terms
of SES and health, and consequently, they were happier.
This argument implies that unobservable factors responsi-
ble for the remaining portion were those positively related
to a good life. Each dependent variable is not a perfect
indicator of SES or health, but collectively, they can draw a
reasonable picture of one’s life.
Results
Descriptive results
Table 1 presents descriptive statistics. Because the number
of variables was large, we briefly explained only some
variables. Most Indonesians were happy, which reduced
variation in our dependent variable. This feature reinforces

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Qual Life Res
our argument that the statistically significant positive
relationship was not a false positive. Indonesians were
short (on average, 162 cm for men and 151 cm for women)
and light (on average, 57 kg for men and 53 kg for
women). Men and women exhibited a large difference in
height, but not as much in weight. The mean BMI was thus
greater in women than in men. Underweight and obese
individuals coexisted in Indonesia: 16.9 % of men and
12.4 % of women were underweight, while 16.6 % of men
and 29.3 % of women were obese.
Figure 1 provides an intuitive understanding of the rela-
tionship between BMI and happiness by gender. BMI is
categorized in 1 kg/m2, and the circles represent BMI-hap-
piness cells. The diameter of each circle is proportional to the
cell size. The added lines are fitted regression lines, weighted
by cell sizes. The average level of happiness was almost the
same for both genders, but the slope of the relationship was
steeper for men than for women, suggesting that happiness
was more closely related to BMI in men than in women. This
finding anticipates our baseline results.
Baseline results
Table 2 lists the marginal effect of obesity on happiness,
and each column heading indicates the set of covariates
added to those in the previous column. Panel A lists the
results for men, and Panel B for women. We incrementally
added sets of covariates to assess the degree to which each
set affected the association between obesity and happiness,
while omitting their coefficients to save space. We also
omitted the coefficients on being underweight and
Fig. 1 Relation between BMI
and happiness. Notes: BMI is
categorized in 1 kg/m2, and the
circles represent BMI-happiness
cells. The diameter of each
circle is proportional to the cell
size. The added lines are fitted
regression lines weighted by
cell sizes
overweight because they were not statistically significant in
almost all estimations. Therefore, in a statistical sense, the
reference group consisted of normal-weight persons;
however, the reference group essentially consisted of
underweight, normal-weight, and overweight persons. We
collectively referred to these three groups as the non-obese
group. For illustration purposes, Table A-1 in Appendix A
presents the results with the full set of covariates (i.e.,
Columns 5 and 10 of Table 2).
When we added only a constant (Column 1), relative to
normal-weight men, obese men are 3.25 % points (or
53.7 % relative to the mean) more likely to say very happy.
When we introduced Demo (Column 2), b2 decreased by
43 %. When we added SES, b2 further decreased by 30 %
(Column 3); objective wealth and subjective wealth
explained most of the reduction. Although these two
variables did not represent all SES variables, we doubt that
adding more SES variables would reduce b2 discernably
because we already controlled for a critical SES variable,
i.e., subjective wealth [32]. Furthermore, when we added
SES variables related to the consumption of protein-rich
foods, b2 only slightly decreased.
When we added Obj.Health, b2 decreased by 7 %
(Column 4), and adding Subj.Health caused b2 to decrease
by 13 % (Column 5). As a result, b2 in Column 5 was much
smaller than in Column 1. However, the size of b2 in
Column 5 was not small: relative to normal-weight men,
obese men were still 1.00 % points (or 17 % relative to the
mean) more likely to say very happy. This positive rela-
tionship between obesity and happiness stands in stark
contrast to the negative relationship in the developed
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 Qual Life Res

Table 2 Marginal effect of

Covariates 1 2 3 4 5
obesity on happiness by gender:
Constant ?Demo ?SES ?Obj.Health ?Subj.Health
baseline results
Panel A: men
BMI C 25 (/10) 0.325 0.185 0.129 0.120 0.105
(0.043)*** (0.041)*** (0.038)*** (0.040)*** (0.041)**
N 11,926 11,924 11,924 11,387 11,387
Pseudo R2 0.005 0.048 0.075 0.074 0.091
6 7 8 9 10
Panel B: Women
BMI C 25 (/10) 0.083 0.114 0.078 0.057 0.051
(0.036)** (0.037)*** (0.037)** (0.039) (0.038)
N 12,909 12,909 12,909 12,608 12,608
Pseudo R2 0.001 0.042 0.065 0.068 0.080
The reference group was individuals with 18.5 B BMI \ 23. We omitted the coefficients on BMI \ 18.5
and 23 B BMI \ 25. We applied cross-section person weights with attrition correction. Standard errors
clustered at the county level are in parentheses
* p value \0.10; ** p value \0.05; *** p value \0.01

world. Furthermore, the reduction in b2 owing to the
introduction of covariates implies that compared to non-
obese men, obese men enjoyed higher SES and better
health and consequently were happier. We elaborated this
implication in the next subsection. The decreasing rate of
the reduction in b2 and the large number of covariates
suggest that adding more observable variables would not
markedly reduce b2.
Different results were found in women (Panel B). When
we added only a constant (Column 6), obese women were
happier than normal-weight women by 0.83 % points
(12.2 % relative to the mean). When we added Demo
(Column 7), b2 increased, but the inclusion of SES reduced
b2 (Column 8). When we added Obj.Health, b2 was no
longer statistically significant, not even weakly (Column
9). This result remained the same when we added Sub-
j.Health (Column 10). Hence, the relationship between
obesity and happiness for women was also positive, but
unlike men, it was largely explained by Demo, SES, and
Obj.Health.
Because we entered Subj.Health after Obj.Health, it is
unclear which set of covariates was responsible for the
statistical non-significance of b2. Hence, after controlling
for Demo and SES, we added Obj.Health and Subj.Health
one at a time (Table A-2 in Appendix A). Obj.Health
reduced b2 more than Subj.Health (to 0.56 % points vs.
0.68 % points), but even when we added Subj.Health, b2
became weakly statistically significant. Thus, the choice of
sets of health covariates was not critical. We thus argue
that in women, health explained the positive relationship
between obesity and health, although demographic and
SES factors also contributed to the explanation.
Obesity and a good life
In Appendix D, we reinforced our evidence that obesity
was positively related to happiness among Indonesians and
argued that this relationship was not explained by the two
following accounts applicable to the developed world: the
low willpower of the obese and the norm of obesity. So,
what makes the obese in Indonesia happier? The previous
subsection provided the reason for women, but some por-
tion of the positive relationship for men remain to be
explained. In the previous subsection, we suggested that
unobservable factors made Indonesian men both obese and
happier. The positive relationship between obesity and SES
in the developing world suggests that the obese in
Indonesia enjoy better lives than the non-obese. This sub-
section presents evidence consistent with this. This evi-
dence is of importance because it implies that only high-
ability people can afford to be obese.
Table 3 considers SES indicators in specification (2).
Columns 1–3 show that relative to normal-weight men,
obese men ate eggs for 0.21 more days (the coefficient
should be divided by 10 for this and others), fish for 0.17
more days, and meat for 0.35 more days per week.
Although these numbers appear small, they were not small
relative to the means: 7.4, 5.1, and 20.5 %, respectively.
The size was the largest for meat, which is a relatively
expensive commodity in Indonesia. There was, however,
little difference between obese and non-obese men
regarding the consumption of dairy products (Column 4).
In addition to the consumption of protein-rich foods, obese
men were wealthier than non-obese men, in terms of both
objective or subjective wealth. Relative to normal-weight

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Qual Life Res

Table 3 Relationship between

Dep. var. 1 2 3 4 5 6
obesity and socioeconomic
Egg Fish Meat Dairy Ln(Wealth) Subj. Wealth
status for men
BMI \ 18.5 (/10) -0.799 -1.016 -0.731 0.861 -0.764 -0.012
(0.466)* (0.448)** (0.434)* (0.513) (0.623) (0.012)
18.5 B BMI \ 23 Reference Reference Reference Reference Reference Reference
23 B BMI \ 25 (/10) 0.193 0.313 1.327 -0.135 1.937 0.038
(0.514) (0.741) (0.485)*** (0.795) (0.596)*** (0.018)**
BMI C 25 (/10) 2.119 1.681 3.501 0.192 5.169 0.051
(0.402)*** (0.676)** (0.491)*** (0.617) (0.583)*** (0.014)***
Mean dep. var. 2.86 3.32 1.71 1.35 17.12 0.014
2
Pseudo or adj. R 0.082 0.169 0.139 0.086 0.113 0.042
The sample size was 11,924. We controlled for all demographic variables. We applied cross-section person
weights with attrition correction. Standard errors clustered at the county level are in parentheses
* p value \0.10; ** p value \0.05; *** p value \0.01

men, obese men were 68 % (=exp(0.5169) - 1) wealthier
and 0.51 % points (41 % relative to the mean) more likely
to feel that they were the richest. Not surprisingly, under-
weight men ate fish (possibly eggs and meat as well) fewer
days per week than normal-weight men.
Health indicators also suggest that life is better for obese
than non-obese men. Table 4 shows objective health indi-
cators and Table 5 subjective health indicators. c2 was
generally positive and statistically significant. Columns
1–3 of Table 4 show that relative to normal-weight men,
obese men had 2.4 kg greater grip strength, 0.20 L greater
lung capacity, and 0.54 g/dL greater hemoglobin levels.
Relative to the mean, each was 6.5, 5.1, and 3.7 %. Rela-
tive to normal-weight men, obese men were 23 % points
more likely to be hypertensive (Column 4) but recalled 0.4
more words; relative to the mean, each was 89 and 4.8 %.
Conversely, relative to normal-weight men, underweight
men had weaker grip strength, smaller lung capacity, and
smaller hemoglobin levels.
Regarding subjective health indicators, obese men and
normal-weight men did not exhibit a statistically significant
difference for the number of symptoms of depression and the
number of acute diseases although c2 displayed the expected
sign (Columns 1 and 2). Relative to normal-weight men,
however, obese men were 1.8 % points more likely to report
that they were very healthy (Column 3), 5.0 % points more
likely to have had a general check-up in the past five years
(Column 4), 2.2 % points more likely to have visited a doctor
over the past four weeks (Column 5), and 3.7 % points more
likely to have health benefits or health insurance (Column 6).
Relative to the mean, each was 16, 34, 22, and 13 %. Rela-
tive to normal-weight men, underweight men suffered more
acute diseases, reported to be less healthy, and were less
likely to undergo a general check-up.

Table 4 Relationship between obesity and objective health indicators for men
Dep. var. 1 2 3 4 5
Grip strength (kg) Lung capacity (L) Hemoglobin (g/dL) Hypertension # of words recalled

BMI \ 18.5 (/10) -27.99 -3.276 -3.498 -0.788 -0.656

(2.05)*** (0.309)*** (0.487)*** (0.105)*** (0.917)
18.5 B BMI \ 23 Reference Reference Reference Reference Reference
23 B BMI \ 25 (/10) 14.71 1.241 3.419 1.321 3.260
(1.99)*** (0.267)*** (0.468)*** (0.093)*** (1.068)***
BMI C 25 (/10) 23.81 1.956 5.401 2.316 4.306
(2.30)*** (0.235)*** (0.419)*** (0.129)*** (0.785)***
Mean dep. var. 35.40 3.747 14.52 0.284 8.61
N 11,873 11,530 11,809 11,924 11,924
Pseudo or adj. R2 0.391 0.302 0.147 0.164 0.370
We controlled for all demographic variables. We applied cross-section person weights with attrition correction. Standard errors clustered at the
county level are in parentheses
* p value \0.10; ** p value \0.05; *** p value \0.01

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 Qual Life Res

Table 5 Relationship between obesity and subjective health indicators for men
Dep. var. 1 2 3 4 5 6
Depression Symptoms Acute Diseases Healthy General Check-Up Visit Doctor Insurance

BMI \ 18.5 (/10) 0.508 1.854 -0.146 -0.226 0.149 0.148

(0.321) (0.521)*** (0.064)** (0.081)*** (0.091) (0.148)
18.5 B BMI \ 23 Reference Reference Reference Reference Reference Reference
23 B BMI \ 25 (/10) -0.552 0.609 0.100 0.138 0.145 0.253
(0.448) (0.618) (0.055)* (0.098) (0.108) (0.122)**
BMI C 25 (/10) -0.486 -0.461 0.176 0.503 0.222 0.366
(0.444) (0.593) (0.064)*** (0.112)*** (0.091)** (0.135)***
Mean dep. var. 3.06 2.01 0.117 0.137 0.106 0.271
Pseudo or adj. R2 0.048 0.045 0.043 0.067 0.017 0.074
The sample size was 11,924. We controlled for all demographic variables. We applied cross-section person weights with attrition correction.
Standard errors clustered at the county level are in parentheses
* p value \0.10; ** p value \0.05; *** p value \0.01

Tables 3, 4, and 5 demonstrate that obesity was posi-
tively related to SES and health. Therefore, life looked
promising for obese men, while the opposite was true for
underweight men. Even if one wanted to be overcome by
the temptation of overeating, not all people could afford it.
Recall that only 16.6 % of men were obese even with a
BMI of 25 (instead of 30). If obesity represents SES, not
many people are in a position to be overcome by the
temptation. Weak willpower in the face of the temptation is
a luxury in Indonesia.
For each dependent variable, c2 was sometimes small
relative to the mean. However, when the relationships for
all dependent variables are considered together, the total
sum should be substantial. All dependent variables suggest
that unobservable aspects of life were likely to be much
better for obese than non-obese men. It seems that obesity
in Indonesia is a luxury good that only high SES people can
purchase. These facts suggest that obesity is a costly signal
of high status; it is costly in the sense that obese people
spend more money on food and suffer more from chronic
diseases. Otherwise, high SES people, who can afford both
slimness and fatness, would be slim.
Discussion
This study is not the first to find a positive relationship
between obesity and happiness in Indonesia. Sohn already
reported it [21, 22], but he paid scanty attention to it
because his aim was to identify factors that were strongly
associated with happiness [21] or to understand why the
taller were happier [22]. Consequently, he did not check
the robustness of the relationship between BMI and hap-
piness, which we did above. He also did not present
comparisons with developed countries or possible mecha-
nisms, which we did below.
The positive relationship in Indonesia suggests that
explanations for the negative relationship between obesity
and happiness in the developed world do not apply to
Indonesia. Our evidence suggests that the positive rela-
tionship can be explained by improved SES and health
enjoyed by the obese. These findings have important
implications for the rationality of obesity and public poli-
cies for obesity prevention in the developing world. As the
higher prevalence of hypertension among the obese shows
(Table 4), obesity does pose a health threat in Indonesia
[33]. Therefore, obesity prevention is highly desirable. The
positive relationship between obesity and happiness in
Indonesia, however, suggests that obesity prevention in the
developing world would be more challenging than antici-
pated. Since this study has not established causality, we do
not argue that a reduction in obesity would automatically
result in less happiness. Granted, one point is clear: the
obese in Indonesia are content with their lives and happier
than the non-obese. In this situation, it would be difficult to
encourage them to lose weight, particularly if obesity is a
costly signal of high status. Although our data did not
provide direct evidence of this, anthropologists have long
understood this aspect of obesity in traditional societies and
developing countries [34, 35: Chaps. 9–10]. According to
them, when food shortages are common, slim people are to
be pitied, whereas fat people are to be admired. Fatness is a
symbol of health, prestige, and prosperity, and people want
to be fat to survive hunger in a risky world. Although we
did not locate an anthropological study discussing this
mechanism specifically in the Indonesian context, it is
likely that this mechanism applies to Indonesia, given the
widespread malnutrition in children, the relatively late
menarche of adolescent girls, and the short stature of adults
(two symptoms of malnutrition in childhood) [22, 36–46].
As demonstrated by the social stigma attached to obesity in
the developed world, however, these symbolic and survival

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values of fatness can be reversed once food is no longer
scarce. When low SES people can afford to be obese in the
developed world, high SES people purchase slimness
through costly manners, such as restrained eating, investing
in exercise, and purchasing expensive nutritious food.
This logic suggests that as long as food is scarce (that is,
low SES people are underweight), high SES people are
unlikely to lose weight on their own. Fatness is admired,
and thinness in low SES people is a constant reminder of
the immediate possibility of hunger and starvation. Relat-
edly, there appears to be little social pressure on them to
lose weight. This situation is in stark contrast to the
developed world, where thinness is admired, the diet
industry flourishes, and social campaigns constantly pro-
mote obesity prevention. When willpower is low and social
pressure is weak, obesity does not disappear easily.
Therefore, obesity prevention alone would be ineffec-
tive in the developing world as long as low SES people
remain underweight. Clearly, we need different approaches
than those used in the developed world. For example, the
emphasis on reducing the risk of chronic diseases in the
future would not be an effective strategy for people who
face immediate food shortages. Similarly, ‘‘sin’’ taxes on
fat and sugar and a reduction in meat consumption may
help obese people lose weight, but harm malnourished
people. Furthermore, the promotion of exercise among
people, many of whom are malnourished, is not an
attractive strategy. In environments such as these, curtail-
ing malnutrition in low SES people by addressing food
scarcities could prevent high SES people from becoming
obese. This strategy is appealing because it can also
address the dual burden of the disease. At the same time,
we should consider the possibility that once food is easily
affordable, low SES people become obese while high SES
people become slim. Future research needs to develop
obesity prevention programs that are effective and sus-
tainable in the developing world.
Despite our contributions to the literature, we
acknowledge some limitations. First, the relationship
between obesity and happiness in this study was based on
correlation rather than causality. If plausible instrumental
variables (IVs) had been available, we could have esti-
mated the causal effects of obesity on happiness. Some
previous attempts notwithstanding, we could not find
plausible IVs. Future research may find plausible IVs and
place the relationship on firmer ground. However, since our
main arguments were not based on causality, the lack of
causality should not undermine the value of this study.
Second, although we provided some evidence that obesity
acts as a costly signal, the evidence was circumstantial.
Future research may use clever experiments to obtain
definitive evidence.
Acknowledgments I am grateful to the three anonymous reviewers
for helpful comments and suggestions.
Compliance with ethical standards
Conflict of interest All authors have no conflict of interest.
Ethical standard Ethics approval was granted from the Institutional
Review Board at Rand Corporation (USA) and from the Ethics
Committee at Universitas Indonesia (Indonesia) for the first wave and
the Ethics Committee at Universitas Gadjah Mada (Indonesia) for the
next three waves.
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