Central obesity and normal-weight central obesity among adults attending healthcare facilities in Buffalo City Metropolitan Municipality, South Africa: a cross-sectional study

Abstract

BackgroundCentral obesity (CO) confers a significant threat on the cardio-metabolic health of individuals, independently of overall obesity. Disparities in the measures of fat distribution lead to misclassification of individuals who are at risk of cardio-metabolic diseases. This study sought to determine the prevalence and correlates of central obesity and normal-weight central obesity among adults attending selected healthcare facilities in Buffalo City Metropolitan Municipality (BCMM), South Africa, assess their health risk and examine the association between central obesity and cardio-metabolic diseases among adults with normal weight, measured by body mass index (BMI).MethodsA cross-sectional survey of 998 adults was carried out at the three largest outpatient clinics in BCMM. Overall and central obesity were assessed using BMI, waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHTR). The WHO STEPwise questionnaire was used for data collection. Blood pressure and blood glucose were measured. Normal-weight central obesity was defined as CO among individuals with normal weight, as assessed by BMI. Health risk levels were assessed using the National Institute for Health and Clinical Excellence (NICE) BMI-WC composite index. Bivariate and multivariate analyses were used to determine the prevalence of CO, normal-weight central obesity and the predictors of CO.ResultsThe mean age of participants was 42.6 (± 16.5) years. The prevalence of CO was 67.0, 58.0 and 71.0% by WC, WHR and WHTR, respectively. The prevalence of normal-weight central obesity was 26.9, 36.9 and 29.5% by WC, WHR and WHTR, respectively. About 41% of the participants had a very high health risk, 13% had increased risk or high risk and 33% had no health risk. Central obesity was significantly associated with hypertension but not associated with diabetes among those with normal weight (by BMI). Female sex, age over 30 years, marriage, secondary or tertiary level of education, non-smoking status, diabetes and hypertension significantly predicted central obesity among the study participants.ConclusionThe prevalence of central obesity among the study participants is high, irrespective of the defining criteria. One in three adults of normal weight had central obesity. Body mass index should therefore not be used alone for clinical assessment by healthcare workers in the study setting.

Magnitude and predictors of normal-weight central obesity– the AWI-Gen study findings

“…In the current sample, general obesity was over 5 times higher in women (32.2%) compared to men (5.6%). These findings are considerably higher than the national figures in Kenya which found obesity was 3 times higher in women than in men [24] but comparatively similar to observations in South Africa on the prevalence and correlates of central obesity and normal-weight central obesity among adults [25]. A growing body of literature demonstrates the increasing burden of general obesity in diverse settings in Kenya and across Africa [1,[26][27][28] but there is scant evidence highlighting the burden of normal-weight central obesity in the region [25].…”

“…There is increasing evidence showing that normalweight central obesity is associated with higher risk of allcause cardiovascular disease and cancer mortality. Central obesity has gained recognition as an independent risk factor for cardio-metabolic diseases and a better predictor of cardiovascular risk than overall obesity [25,32]. Independent of BMI, or even among individuals with normal weight (BMI, <25.0), those with central obesity remain predisposed to increased risk of mortality because of excessive abdominal fat accumulation [12][13][14]32,33].…”

“…Independent of BMI, or even among individuals with normal weight (BMI, <25.0), those with central obesity remain predisposed to increased risk of mortality because of excessive abdominal fat accumulation [12][13][14]32,33]. Recent obesity management guidelines are aware of this available evidence and are recommending measuring central obesity among people who are overweight (class I obesity) [25,32].…”

A Cross-Sectional Survey of the Prevalence and Determinants of Overweight and Obesity Among Primary Healthcare Professional Nurses In Eastern Cape, South Africa

“…Owolabi et al (2015) in their study conducted among adults in the same province as the current study, with an almost similar mean age reported a lower prevalence (46%) compared to the prevalence found among nurses in this setting. Though this study and that of Owolabi et al (2017) was conducted in the same setting, the slight age difference in the study participants as well as the gender distribution could be the reasons for the observed difference. Also, Owolabi et al's (2017) study was conducted among the general adult population not specifically nurses.…”

“…Though this study and that of Owolabi et al (2017) was conducted in the same setting, the slight age difference in the study participants as well as the gender distribution could be the reasons for the observed difference. Also, Owolabi et al's (2017) study was conducted among the general adult population not specifically nurses. Even so, this is worrying and points at the fact that nurses, who are supposed to be health promotion models and are knowledgeable about the health implications of overweight and obesity appears to be more obese than the general population.…”