Overweight and obesity in urban Africa: A problem of the rich or the poor?

BACKGROUND: Obesity is a well recognized risk factor for various chronic diseases such as cardiovascular diseases, hypertension, and type 2 diabetes mellitus. The aim of this study was to shed light on the patterns of overweight and obesity in sub-Saharan Africa, with special interest in differences between the urban poor and the urban non-poor. The specific goals were to describe trends in overweight and obesity among urban women; and examine how these trends vary by education and household wealth. METHODS: The paper used Demographic and Health Surveys data from seven African countries where two surveys had been carried out with an interval of at least 10 years between them. Among the countries studied, the earliest survey took place in 1992 and the latest in 2005. The dependent variable was body mass index coded as: Not overweight/obese; Overweight; Obese. The key covariates were time lapse between the two surveys; woman's education; and household wealth. Control variables included working status, age, marital status, parity, and country. Multivariate ordered logistic regression in the context of the partial proportional odds model was used. RESULTS: Descriptive results showed that the prevalence of urban overweight/obesity increased by nearly 35% during the period covered. The increase was higher among the poorest (+50%) than among the richest (+7%). Importantly, there was an increase of 45-50% among the non-educated and primary-educated women, compared to a drop of 10% among women with secondary education or higher. In the multivariate analysis, the odds ratio of the variable time lapse was 1.05 (p < 0.01), indicating that the prevalence of overweight/obesity increased by about 5% per year on average in the countries in the study. While the rate of change in urban overweight/obesity did not significantly differ between the poor and the rich, it was substantially higher among the non-educated women than among their educated counterparts. CONCLUSION: Overweight and obesity are on the rise in Africa and might take epidemic proportions in the near future. Like several other public health challenges, overweight and obesity should be tackled and prevented early as envisioned in the WHO Global strategy on diet, physical activity and health.