Increasing Obesity in Treated Female HIV Patients from Sub-Saharan Africa: Potential Causes and Possible Targets for Intervention

Abstract

Objectives: To investigate changing nutritional demographics of treated HIV-1-infected patients and explore causes of obesity, particularly in women of African origin.Methods: We prospectively reviewed nutritional demographics of clinic attenders at an urban European HIV clinic during four one-month periods at three-yearly intervals (2001, 2004, 2007, and 2010) and in two consecutive whole-year reviews (2010–2011 and 2011–2012). Risk-factors for obesity were assessed by multiple linear regression. A sub-study of 50 HIV-positive African female patients investigated body-size/shape perception using numerical, verbal, and pictorial cues.Results: We found a dramatic rise in the prevalence of obesity (BMI > 30 kg/m2), from 8.5 (2001) to 28% (2011–2012) for all clinic attenders, of whom 86% were on antiretroviral treatment. Women of African origin were most affected, 49% being obese, with a further 32% overweight (BMI 25–30 kg/m2) in 2012. Clinical factors strongly associated with obesity included female gender, black African ethnicity, non-smoking, age, and CD4 count (all P < 0.001); greater duration of cART did not predict obesity. Individual weight-time trends mostly showed slow long-term progressive weight gain. Investigating body-weight perception, we found that weight and adiposity were underestimated by obese subjects, who showed a greater disparity between perceived and actual adiposity (P < 0.001). Obese subjects targeted more obese target “ideal” body shapes (P < 0.01), but were less satisfied with their body shape overall (P = 0.02).Conclusion: Seropositive African women on antiretroviral treatment are at heightened risk of obesity. Although multifactorial, body-weight perception represents a potential target for intervention.

Cardiometabolic risk among hiv-positive Ugandan adults: prevalence, predictors and effect of long-term antiretroviral therapy

“…The prevalence of abdominal obesity in our study is comparable to the 30% observed in a Southwestern Ugandan ART cohort [26] but was lower than that reported in the background GPC population-56% [10]. High prevalence of obesity among women than men has also been previously established by studies in SSA (24-26) and Europe [29]. The observed risk of obesity from PI-based ART corroborates results from a US based observational study [30] and is possibly attributed to ART associated metabolic aberrations and fat mal-distribution.…”

Evaluation of nutrition care to adult patients on HAART attending primary healthcare facilities in Mpumalanga

“…Although weight loss and underweight are independently associated with increased risk of disability and death, 18 this study suggests that many patients, especially females, who are clinically stable and on lifelong HAART, are at greater risk of overweight and obesity than severe malnutrition. This is consistent with other studies that found obesity to be more prevalent than wasting in patients on lifelong HAART 16,19,20 and non-white females to be at greater risk. 19,20 Previous South African studies 15,16 have reported weight gain following the initiation of ART, particularly in African females, and possible reasons proposed for this include the stigma of weight loss, thinness being associated with HIV and/or TB infection and poor health, cultural norms regarding what is considered to be ideal body size, and the belief that 'bigger is better' .…”

“…This is consistent with other studies that found obesity to be more prevalent than wasting in patients on lifelong HAART 16,19,20 and non-white females to be at greater risk. 19,20 Previous South African studies 15,16 have reported weight gain following the initiation of ART, particularly in African females, and possible reasons proposed for this include the stigma of weight loss, thinness being associated with HIV and/or TB infection and poor health, cultural norms regarding what is considered to be ideal body size, and the belief that 'bigger is better' . 15,21 This perception is also consistent with other studies, 15 where the desire has been reported for HIV-positive individuals to achieve and maintain what is considered to be a 'healthy' overweight body size.…”

HIV‐positive Malawian women with young children prefer overweight body sizes and link underweight body size with inability to exclusively breastfeed

“…Although most women chose figures that were within one BMI category of their actual figures (e.g., overweight women indicated normal weight figures), these slightly inaccurate self‐perceptions could have important health implications because overweight status is associated with increased risk for noncommunicable diseases (World Health Organization, ). Similar research studies across sub‐Saharan Africa have found that women tend to perceive their figures as smaller than their actual body sizes (Devanathan et al, ; Matoti‐Mvalo & Puoane, ; McCormick et al, ; Muhihi et al, ; Njecko, Meyer, Ashu, & Gobte, ; Puoane et al, ). Although our results matched these findings for overweight women, who tended to underestimate their current sizes, we conversely found that underweight women tended to overestimate their current sizes.…”