Obesity matters but is not perceived: A cross-sectional study on cardiovascular disease risk factors among a population-based probability sample in rural Zambia

Abstract

BackgroundSub-Saharan Africa, including Zambia, has experienced an increase in overweight and obesity due to rapid lifestyle changes associated with recent economic growth. We explored the prevalence and correlates of overweight and obesity in rural Zambia. We also investigated the role of self-perception of body weight in weight control given the local socio-cultural context.MethodsIn this cross-sectional study, we recruited 690 residents of the Mumbwa district aged 25–64 years through a multistage, clustered, household random sampling. We administered a questionnaire and collected anthropometric and bio-behavioral data from May to July 2016. Factors associated with body mass index (BMI) ≥25 kg/m2 and underestimation of body weight were assessed using multiple logistic regression.ResultsOf the weighted sample of 689 participants (335 men and 354 women), 185 (26.8%) had BMI ≥25 kg/m2. In multivariate analyses, female gender, age 45–64 years, tertiary education, higher fruit and vegetable intake, high blood pressure, abnormal blood lipid profile, and Hemoglobin A1c ≥5.7% were significantly associated with BMI ≥25 kg/m2. Among participants with BMI ≥25 kg/m2, 14.2% and 58.2% perceived themselves as being underweight and normal weight, respectively. Age 45–64 years was the only factor significantly associated with body weight underestimation. Preference for obesity was reported by 17.5% and 3.6% of respondents with BMI <25 kg/m2 and BMI≥25 kg/m2, respectively; “looks attractive” and “fear of being perceived as HIV-positive” were the main reasons.ConclusionIn rural Zambia, overweight and obesity are prevalent and significantly associated with alterations in blood pressure, blood lipid profile, and glucose metabolism. However, most subjects with BMI ≥25 kg/m2 underestimated their body weight; some preferred obesity, in part due to cultural factors and HIV-related stigma. A health promotion program that addresses such perceptions and body weight underestimation should be urgently introduced in Zambia.

Association Between Food Insecurity and Key Metabolic Risk Factors for Diet-Sensitive Non-Communicable Diseases in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

“…A large proportion of the studies (n = 10 studies) was conducted in urban settings, [24][25][26][27][28][29][30][31][32][33] and four studies were conducted in rural settings only. [34][35][36][37] One study was conducted in a periurban 38 and one study in a semi-rural setting. 39 The remaining six studies recruited participants from both rural and urban settings.…”

“…[40][41][42][43][44][45] Overall, the studies selected for inclusion (n = 22 studies) involved a total of 26 609 participants, 12 453 (46.8%) participants were males, and one study recruited only women of reproductive age living in informal settlements in Accra, Ghana 29 . The distribution of the rest of the studies by countries was as follows: 4 from Ethiopia, 25,27,40,41 ; 1 Nigeria, 24 ; 1 Madagascar, 26 ; 3 Ghana, 29,38,39 ; 1 Zambia, 37 ; 2 Tanzania, 28,35 ; 1 Malawi, 34 ; 1 Cameroon, 33 ; 2 Sudan, 30,31 ; 1 Burkina Faso, 42 ; 1 Kenya, 32 ; 1 Botswana, 45 and 3 studies from South Africa 36,43,44 . Figure 2 shows the study distribution from the four regions of sub-Saharan Africa, with only 1 study from Central Africa 33 and…”

“…In this group of studies, a subset (n = 3 studies) involved designs where researchers measured food insecurity at the household level using the food insecurity access scale criterion. 32,37,40 Another subset (n = 9 studies) measured food insecurity at an individual level using the Minimum Adequate Diet criterion, 24,25,27,31,33,36,37,42,43 the Minimum Dietary Diversity criterion (n = 5 studies), 28,29,38,39,45 and the last subset (n = 4 studies) used more than one tool to gauge food insecurity. 30,37,44,45 While studies on children ≤ 5 years used the Minimum Meal Frequency criterion, 30 the Weight-for-height criterion, 34 and the Quetelet index 26 to ascertain food insecurity.…”

“…Moreover, these findings somewhat reflect a gender-specific effect of metabolic risk factors discussed among African-American women precipitating diet-sensitive NCDs. [55][56][57] In several sub-Saharan African countries 37,58,59 , as well as in the African-American population 15,57 , the higher prevalence of metabolic risk factors in women compared to men has also been identified. However, prevalence estimates from non-African American and other developed nations do not show a clear trend for gender variance in the prevalence of metabolic risk factors 53,57,60 .…”

“…Sex differences in health-seeking behaviour, cultural values, positive social perceptions surrounding body weight may be attributed to the apparent gender disparities observed in the prevalence of metabolic risk factors, particularly in the context of sub-Saharan Africa 37,61 . An overweight status/ obesity is socially tolerated or even desired in African cultures, and this might be another explanation of the observed gender-variance.…”